Lived Mental Health Experiences of African American Adolescents in Foster Care

1. 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

2. Andrew

3. Outline • Purpose/Problem Statement • Methods/Sample • Analysis/Results • Recommendations

4. 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

5. 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

6. 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

7. Overview of Literature • Adolescence • Vulnerability • inappropriate behavior (e.g. drug use), insecurity, emotional crises, mental health disorders, and other problems (Egan, 1997). • Identity • time 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)

8. 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).

9. 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.

10. 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).

11. Overview of Literature • Results to AA children • insufficient or no services for Black children • inequality of services • inadequate efforts to change system (Billingsley & Giovannoni, 1972). • Majority of reports to child protective services involves cases of neglect (USDHHS Children of Color, 2003)

12. 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)

13. 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)

14. Methods Procedure • Recruitment • Children Services of Child Welfare • Data Collection • Face-to-face interviews • Audiotaped • 172 pages of transcribed data

15. 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.

16. 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.

17. Methods Analysis Giorgi’s 4 Step • Listen to interview tape, read transcript, get sense of overall substance of data • Identify units for meaning of the experience • Develop description of major themes • Determine whole meaning of experience (Giorgi, 1985)

18. Results 3 Themes Emerged from Data • Antecedents r/t separation from biological families to FC • Consequences r/t separation from biological families to FC • Adverse perceptions of MH diagnoses & tx

19. 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

20. 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

21. Questions?? Rare