Lived Mental Health Experiences of African American Adolescents in Foster Care

Ella M. Scott PhD, RN, CNS-BC

Assistant Professor

Kent State University, College of Nursing

Kent, Ohio

August 6, 2008

Andrew

Outline

Purpose/Problem Statement Methods/Sample Analysis/Results Recommendations

Purpose of Research

To explore the lived mental health (MH) experiences of African American adolescents in foster care (FC)

Gain knowledge and understanding of the MH experiences of AAA in FC

Problem Statement

Crisis in MH in US w/children/adol >problem in FC

( National Action Agenda /Children’s Mental Health, 2001)

>MH problem AA children in FC

Problem Statement

Foster Care – Welfare service for children who must live

apart from their parents for a period of time for various reasons (Child Welfare League of America, 2004)

– >500,000 children in foster care (Sedlak & Boadhurst, 1996)

Disproportional AA children in FC– 15% of U.S. child population– 49% of foster care population

(Child Welfare League of America, 2003

Overview of Literature

Adolescence– Vulnerability

inappropriate behavior (e.g. drug use), insecurity, emotional crises, mental health disorders, and other problems (Egan, 1997).

– Identitytime for searching, determining identity

(ethnicity)defining oneself as person (Papalia et al., 2004)

– 30% children in FC adolescents 11-15 yr(Child Welfare League of

America, 2003)

Overview of Literature

Children/AA – System of child welfare in U.S. maintained hx of racial

discrimination for AA children/White dominance/control (Billingsley & Giovannoni, 1972).

Misguided view– Black children can/should function separated from

Black families– Permeated most concepts on child welfare (Billingsley &

Giovannoni, 1972).

Overview of Literature

Child welfare services institutionalized in U.S. – Surrogate parental care is focus of care of children

separated from parents – Services to promote welfare of children living w/own

families sparsely developed/minute portion of child welfare efforts (Billingsley & Giovannoni, 1972).

By 1900 orphanages and foster homes became independent of organizations that had worked directly with families and children in their homes.

Overview of Literature

Bureaucratization and professionalization of social work infused means of caring for children (Billingsley & Giovannoni, 1972).

Child welfare services priority remains placing children away from their parents.

Bureaucratization is organized system of agencies w/specialized functions/elaborate governing rules.

Bureaucracies funded based on functions they performed. Services organized by functions, but functions not necessarily promote

best interests of children and families. The result was that child welfare services and services to children in

their own homes became separate endeavors. Black children or children of color have generally not fared well under

policies and practices that stem from bureaucratic arrangements (Billingsley & Giovannoni, 1972).

Overview of Literature

Results to AA children1. insufficient or no services for Black children2. inequality of services3. inadequate efforts to change system

(Billingsley & Giovannoni, 1972).

Majority of reports to child protective services involves cases of neglect (USDHHS Children of Color, 2003)

Methods

Study Design Phenomenological approach: geared to qualities of

humans (Giorgi, 2005)

– Descriptions of raw everyday lived-through experiences

– Philosophy: How do we know or what constitutes the nature of a phenomenon (Ray, 1994; Annells,1996)

Hermeneutic approach– Implies understanding – Means uncovering a phenomenon’s concealed

meanings (Omery, 1983)

Methods

Setting Midwestern state, population 400,000 25% <18yrs Only 8% AA 33% of FC placements AA children/adoles

Sample Target AAA, 15-17 yrs Of Color/Black, Mixed black Nine (n=9)

Methods

Procedure Recruitment

– Children Services of Child Welfare Data Collection

– Face-to-face interviews – Audiotaped– 172 pages of transcribed data

Methods

Summary of participants’ characteristics – 1 to 7 siblings. – Multi-placements - mean 6.8. – Highest number of placements -12, next highest 10. – Lowest number of placements - 3. Number of years in FC 4 to 14

years. – 4 of participants stated they were in FC because drug use by their

mothers. – 2 participants did not know why they were in FC. – 2 male participants experienced the deaths of their mothers.

One of the 2 participants was 5 when placed in FC shortly after his mother’s death.

The other participant was 11 when his mother died, in FC for 8 years.

Methods

Summary of participants’ characteristics – All but 1 had diagnosed mental disorder e.g. separation

anxiety disorder, ADHD, oppositional defiant disorder, obsessive-compulsive personality disorder, depression, PTSD.

– All w/diagnosed condition treated w/medication/therapy. – One female sexual/abuse/witness abuse of siblings. – All separated from siblings . – Data reported by adolescents, not chart review. – Identifying data eliminated/names replaced by

pseudonyms to protect confidentiality/privacy.

Methods

Analysis

Giorgi’s 4 Step1. Listen to interview tape, read transcript, get sense of

overall substance of data2. Identify units for meaning of the experience 3. Develop description of major themes 4. Determine whole meaning of experience

(Giorgi, 1985)

Results

3 Themes Emerged from Data

1. Antecedents r/t separation from biological families to FC

2. Consequences r/t separation from biological families to FC

3. Adverse perceptions of MH diagnoses & tx

Recommendations

More research needed to:– Create policies/practices < MH problems for adols– Explore better ways of preventing situations that may result in separations

from birth families – Focus on MH problems r/t separating from families– Identify better interventions/support for adolescents when separation occurs– Determine alternate means of dealing w/child abuse and neglect– Eliminate poverty

Recommendations

Immediate – Allow children/adolescents separated from their

families to have regular contact w/their birth families especially siblings (Minnesota Model)

– Communicate better w/children/adols r/t reasons for separations

– Provide anger management

Questions??

Rare