Termination of Long-Term Mental Health Treatment with Foster Youth

1. Termination of Long-Term Mental Health Treatment with Foster Youth Kimberlin Borca, Foster Care Research Group University of San Francisco April 29, 2012

2. Background • Children who have a history of abuse and neglect can suffer several psychological and social difficulties • Youth who are placed into the foster care system experience a multitude of stressors that increase the risk for various mental health problems • Research has indicated that psychotherapy is a useful approach for treating foster youth • Our previous work has demonstrated that long-term, relationship-based psychotherapy reduces the severity of mental health symptoms in foster youth • The nature of treatment termination with foster youth has not yet been examined

3. Current Study: Termination of Treatment • A Home Within is a national organization that provides pro-bono, long-term, psychotherapy to current and former children “for as long as it takes.” • Foster Care Research Group collects data regarding treatment and patient progress from therapists • 55 finished completed cases across California were examined to determine the nature of treatment termination

4. Methods: Participants • Participants • N= 55 AHW Therapists who had provided pro-bono psychotherapy to a current or former foster child • Sex: • Female (72%) and Male (27%) • Age: • M = 49 years (SD = 9.96 years) • Ethnicity: • 90% Caucasian • Experience Post Licensure: • M = 9 years (SD = 6.27 years).

5. Types of Mental Health Licenses and Degrees Earned MA or MS (38%) Ph.D., Psy.D., Ed.D., D.M.H. (62%)

6. Methods: Measures • Initial Telephone Questionnaire for Therapists • Therapist and Patient Demographics • Patient Mental Health Status • Exit Telephone Questionnaire for Therapists • Patient Demographics • Patient Mental Health Status • Treatment Parameters • Nature of Therapeutic Intervention

7. Methods: Procedure • A Home Within provided therapist name and contact information to the Foster Care Research Group when a patient was matched to a therapist • Therapists who agreed to participate were scheduled for an initial telephone interview • Telephone Consent was obtained and an initial telephone interview was administered at the beginning of treatment • An exit telephone interview was conducted at the termination of treatment

8. Results: Patients Females (51%) and Males (49%) Primarily School Aged 10 years at start of treatment (SD=5.53)

10. Last Year of Treatment: A Snapshot • Parameters of Treatment • Mean length of treatment: 3 Years (SD = 2.97) • Patients were seen on a weekly (66%) or biweekly (18%) basis • Other forms of treatment occurring simultaneously • Individual Psychological Therapy (7%) • Family Therapy (16%) • Group Therapy (11%) • Medication Therapy(11%) • Educational Treatments(5%)

11. Collaborative Work in the Last Year of Treatment

12. Major Obstacles in the Last Year of Treatment

13. Reasons For Treatment Termination “My patient’s family moved to a city 100 miles away.” “Patient relapsed into substance abuse.” “We were scheduled for a session but my patient never showed up.” “My patient was ready to move on from therapy.”

14. Conclusion • Treatment end often comes prematurely as a result of several obstacles in the patient’s life • Premature treatment conclusion may be linked to major obstacles over the last year of treatment • Importance of interventions across all aspects of the foster child’s life • Limitations of the study include a small sample size, potential bias from therapist informants, and lack of a comparison group • Future studies should explore the long-term efficacy of treatment by studying foster youth after treatment termination.