Mental Health of Foster Care Alumni
Literature Review
Tyresa Johnson
9/16/2013
Mental Health of Foster Care Alumni
Topic Problem Statement
The topic I will be exploring is the mental health outcomes for African American foster care
alumni. I will be furthering my research on this topic using the explanatory research along with
the quantitative method. By looking at others’ research on the mental health outcomes for
African American foster care alumni, I can see whether my results fall in line with their results.
Also, reading others’ research on this topic will give me an overall basis of what to look for and
what other factors can contribute to mental health issues with this population.
While doing my research, I realized that my topic has just recently been researched.
There are not many studies done on this topic so far, which really heightened my interest. Since I
have started research, my project has not changed much.
Introduction
There is little information on the mental health problems that occur in the adulthood of those
who grew up in foster care. Particularly, the mental health outcomes for African American men
and women are worse than their white counterparts (Scott, McCoy, Munson, Snowden, &
McMillen , 2011). African American children account for twenty-seven percent of the foster care
population in the United States (Childrensrights.gov, 2011). My hypothesis is: If an African
American adult was in foster care as a child, they will be at a higher risk for mental illness than
those who were not placed in foster care. I believe that this topic is very important not only for
African Americans but for any race that has been placed in foster care. Often, mental health is
overlooked, especially for children that have been placed in foster care. I find this topic
interesting because as I was doing research, I realized that research on this topic has not been
done in depth until around 2008. Identifying the problem is the first step to making transitioning
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from foster care in to the real world more successful.
Article Review
There have been numerous child welfare reforms throughout the years, including reforms
to foster care. Despite these reforms, research shows that foster care alumni still experience
negative developmental outcomes than those who do not experience foster care (Garcia, Pecora,
Aisenberg, & Harachi, 2012). The study that has really helped shape my research project has
been the one done by Peter Pecora, Catherine Roller White, Lovie Jackson and Tamera Wiggins,
because it is an overview of recent studies. This article discusses the limitation and other factors
that can also play a role in the outcomes of foster care alumni. In this overview, one of the
studies they looked at was the Northwest Alumni Study. In this study the targeted population was
foster care alumni between the ages of 20 and 33 years old. They assessed the lifetime
prevalence rate of mental health in these individuals. They assessed the participants for nine
mental health disorders. The participants with a lifetime prevalence of mental disorders
exceeded the general population on all nine disorders tested (Pecora, White, Jackson, & Wiggins,
2009). Thirty percent of the alumni had posttraumatic stress disorder, which was comparable to
the PTSD rate in Vietnam War vets at 30.9 percent (Pecora, White, Jackson, & Wiggins, 2009).
In comparison, the researchers looked at the Casey National Foster Care Alumni Study, which
looked at the 12 month rate of PTSD among foster care alumni. In this study they found that the
12 month rate of PTSD among foster care alumni was five times greater than the general
population.
The studies that were mentioned in this article help me because it gives me statistics on
what mental illness foster care alumni face. It also gives me comparison from the general
population. This article also gives me the major limitations that I will face in doing this study.
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The next study that I looked at was done by Garcia, Pecora, Aisenberg, & Harachi. They
looked at the predictors of developmental outcomes in racially diverse foster care alumni. It is
extremely important to my study to look at other races and not just African Americans because I
need something to compare my results to. Also, the role of race is a huge factor. African
American/ minority children generally stay in foster care longer than Caucasian children (Aubry,
2011). In the study done by Garcia, Pecora, Aisenberg, & Harachi it was found that those who
were foster care alumni reported on average 65 placements before being adopted or ageing out
(Pecora, Aisenberg, & Harachi 2012). In this study participants were asked a multitude of
questions such as: was their experience in foster care negative or positive? How accessible were
mental health service before being released out of foster care? And other questions (Pecora,
Aisenberg, & Harachi, 2012).The questions that they asked in their study will help me formulate
my questions when I do my survey. The results of this study were that if the participants had a
more positive experience in foster care and felt prepared when they left, the chances of them
having a mental illness as an adult greatly decreased (Pecora, Aisenberg, & Harachi, 2012).
Next, I looked at studies that had background information. One study looked at the
effects of enhanced foster care on long term mental health for foster care alumni. They looked at
the difference between two private foster care programs and two public foster care program
(Kessler et al , 2008).The researchers interviewed a representative sample of 479 foster care
alumni 1-13 years after leaving foster care and assessed their mental and physical health (Kessler
et al, 2008). Their findings were that the higher quality foster care services that were offered, the
better the long-term mental and physical health of the people that were interview (Kessler et al,
2008). The study also found that although the participants that were placed in a private foster
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care had fewer mental disorders, they had significantly more respiratory disorders than those in
public foster care (Kessler et al, 2008).
Next, I looked at a study that examined the cultural mistrust of mental health
professionals in transitioning black males from foster care. In this study, the researchers looked
at African American males who were transitioning from foster care and their mistrust for mental
health professionals from a cultural stand point. To carry out the study the researchers used 406
older youth from Missouri Children’s Division (MCD) 23 percent of them were African
American (Scott, McCoy, Munson, Snowden, & McMillen, 2011). This study was a longitudinal
study and continued from a previous study on the same topic (Scott, McCoy, Munson, Snowden,
& McMillen, 2011). Twenty-Seven percent of the children were already receiving mental health
services according to the self-report (Scott, McCoy, Munson, Snowden, & McMillen, 2011).
Thirty-six percent of the participants had reported not having any mental health treatment or
services at all. The Diagnostic Interview Schedule (DIS) was used to assess the participant’s
psychiatric history (Scott, McCoy, Munson, Snowden, & McMillen, 2011). It was found that 45
percent of the African American participants that reported having no mental illness or mental
health services fit the DSM-IV diagnostic criteria for having long term or past-year psychiatric
disorders. The study concluded that a positive experience in foster care did not improve African
American male’s trust of mental health professionals (Scott, McCoy, Munson, Snowden, &
McMillen, 2011). Many of the males reported that they felt if they were to seek help, it would be
used against them somehow.
After reading the above article, it led me to another article that discussed infusing culture
into evidence-based mental health services for African American foster care youth (Briggs &
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McBeth, 2010). This article reviews the negative effects of insufficient and culturally sensitive
interventions for African Americans in foster care youth (Briggs & McBeth, 2010).
Next I looked at an article that compared outcomes of children in kinship care versus
those who were not in kinship care. This study was done in Europe in 2005 (Holtan, Ronning,
Handegard, & Sourander, 2005). The researchers noticed that children who were in kinship care
had less behavioral and developmental challenges than those who were placed with nonrelatives. No studies of this sort had been done in European countries at the time. The researchers
studied 214 children in kinship and non-kinship care between the ages of 4-13 (Holtan, Ronning,
Handegard, & Sourander, 2005). They administrated the Child Behavioral Check list to the foster
care parents to collect demographic and placement information. The researchers concluded that
51.8% of the non-kinship care children scored above the borderline on the CBCL total problem
score (Holtan, Ronning, Handegard, & Sourander, 2005). The kinship group had fewer
placements, was usually placed in their community, and had more contact with their biological
parents (Holtan, Ronning, Handegard, & Sourander, 2005). Overall, negatives outcomes were
associated with the male gender and location of foster care home outside of birth community
(Holtan, Ronning, Handegard, & Sourander, 2005). Positive outcomes were significant in being
placed in own community, which related to kinship care (Holtan, Ronning, Handegard, &
Sourander, 2005).
This study concluded that kinship care plays a major positive role in the outcomes of
foster care children (Holtan, Ronning, Handegard, & Sourander, 2005). This will help me in my
study recognize one of the variables that can cause a more positive outcome for foster care
Alumni.
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It is found that stressful life events play a major long term effect on children that have
been placed in foster care (Glover, & Glenwick, 2009). Foster care children face TWICE as
many stressor/traumas than non-foster care children (Glover, & Glenwick, 2009). In my research
I am hoping to find ways to reduce these traumas so when the children become adults they are
less likely to have mental illnesses.
After reviewing all this information, I thought it would be a good idea to look at the cost
of mental health services for foster care children. The researchers in this study assessed the
service used and the associated cost of those services (Minnis, Everett, Pelosi, Dunn, & Knapp,
2006). The researchers used a postal survey of 182 children in central Scotland (Minnis, Everett,
Pelosi, Dunn, & Knapp, 2006). In the results of this study, 90% of the children had been abused
before and 60% had signs of mental illness and/or behavioral issues compared to 251 other
children who had not been on foster care (Minnis, Everett, Pelosi, Dunn, & Knapp, 2006).
Conclusion
Rather these sources are used as actual material or just as background information; all of
them have helped me in my research process. The most important study that will lead my
research is a study done by Peter Pecora, Catherine Roller White, Lovie Jackson and Tamera
Wiggins. In their study, they reviewed previous research on the mental health status of current
and former recipients of foster care. They found that you cannot come to a complete conclusion
on the effects of child maltreatment on child, adolescent, and adult mental health because of the
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many limitations such as “lack of statistical controls, lack of comparison group, and scarce use of
complex multivariate models” (Pecora, White, Jackson,& Wiggins, 2009). There are also
numerous and diverse effects that being placed in foster care can have on and adult as they get
older. Many of the participants faced “mental health issues, risk-taking behavior social
disadvantages and physical health disorders” (Pecora, White, Jackson, & Wiggins, 2009). It was
also found that the worse the stress, the more likely that they would be diagnosed with a DSMIIIR disorder (personality disorder) as an adult (Pecora, White, Jackson, & Wiggins, 2009).
This review of recent studies is the most helpful for me. It gives me a baseline of what
the major limitations that I will have. It also gives me information on how pre-foster care
situations can have a major effect on the participant’s mental health as an adult.
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Reference
Aubry,L. (2011). Race a major factor in foster care disparities. Los Angeles Sentinel. Retrieved
from:http://www.lasentinel.net/index.php?option=com_content&view=article&id=1735:r
ace-a-major-factor-in-foster-care-disparities&catid=95&Itemid=185
Briggs, H., & McBeath, B. (2010). Infusing culture into practice: developing and implementing
evidence-based mental health services for African American foster youth. Child Welfare,
89:1, 31-60.
Childrensrights.gov (2011). Facts about disparities in foster care. Retrieved from:
http://www.childrensrights.org/issues-resources/foster-care/facts-about-disparities-infoster-care/
Clausen, J. M., Landsverk, J., Ganger, W., Chadwick, D., & Litrownik, A. (1998). mental health
problems of children in foster care. Journal of Child & Family Studies, 7:3, 283-296.
Garcia, A., Pecora, P., Aisenberg, E. Harachi, T. (2012). Institutional predictors of
developmental outcomes among racially diverse foster care alumni. Journal of
Orthopsychiatry. 82:4. doi:10.1111/j.1939-0025.2012.01181.x
Glover, R., & Glenwick, D. (2009). Stressful life events experienced by clinically
referred foster care and nonfoster care children. Journal of Early Childhood & Infant
Psychology, (5), 127-140.
Holtan, A., Ronning, J., Handegard, B., & Sourander, A. (2005). A comparison of mental health
problems in kinship and nonkinship foster care. European Child & Adolescent
Psychiatry, 14:4, 200-207.
Jackson, L., O’Brien, K., Pecora, P. (2011). Posttraumatic stress disorder in foster care alumni:
the role of race, gender, foster care context. Journal of Child Welfare. 90:5.
Kessler, R. C., Pecora, P. J., Williams, J., Hiripi, E., O'Brien, K., English, D., & Sampson, N. A.
(2008). Effects of enhanced foster care on the long-term physical and mental health of
foster care alumni. Archives of General Psychiatry, 65:6, 625.
Minnis, H., Everett, K., Pelosi, A., Dunn, J., & Knapp, M. (2006). Children in foster care: mental
health, service use and costs. European Child & Adolescent Psychiatry, 15:2, 63-70.
O’Brien, K. (2006). Mental health outcomes of the northwest foster care alumni study. Retrieved
from: http://www.sprc.org/library_resources/items/mental-health-outcomes-northwestfoster-care-alumni-study
Pecora, P. J., White, C., Jackson, L. J., & Wiggins, T. (2009). Mental health of current and
former recipients of foster care: a review of recent studies in the USA. Child & Family
Social Work, 14:2, 132-146. doi:10.1111/j.1365-2206.2009.00618.x
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Scott, L. D., McCoy, H., Munson, M. R., Snowden, L. R., & McMillen, J. (2011). Cultural
mistrust of mental health professionals among black males transitioning from foster care.
Journal of Child and Family Studies, 20:5, 605-613.
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neglected children: new findings from a 30-year follow-up. American Journal of Public
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Zlotnick, C., Tarn, T. W., & Soman, L. A. (2012). Life course outcomes on mental and physical
health: The impact of foster care on adulthood. American Journal of Public Health,
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