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TITLE: Failure and Success in Foster Care Programs. AUTHOR: Judith Reifsteck ([email protected]) PUBLICATION: North American Journal of Psychology; Vol. 7 Issue 2, p313, 14p, 1 chart DATE: 2005

The purpose of the current study was to classify types of services provided for youth in one sample (N=208) of children in foster care. A comparison review of average Child and Adolescent Functional Assessment Scale (CAFAS) scores on these youth in pre and post intervention groups showed an 14% reduction in average score of impairment of functional status in the post intervention group. CAFAS scores for each class of service were presented. A review of utilization trends and omissions in service suggests that even though some youth and their families benefit slightly from prevention efforts, 82% of the cases in the post intervention group of this sample still have clinically significant elevations in CAFAS scores following provision of services. Considering the persistence of elevated CAFAS scores, it appears that satisfactory services for youth referred for child abuse and neglect are not readily apparent for all children in need. For decades, the number of children in foster care has steadily increased (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001). These children have remained in the foster care system for longer periods of time (Clark et al., 1994), and the long term outcome of the care they received is not systematically monitored or reported (Galaway, Nutter, & Hudson, 1995; Reddy & Pfeiffer, 1997). Some of these children carry the effects of child abuse and trauma, while others are diagnosed with a variety of physical, emotional, behavioral and mental handicaps. Local service agencies are required to adapt, alter and expand the types of services available in the community while budgets and other resources are shrinking. The need for research to guide policy and service planning for child welfare systems of care is evident. Between 1970 and 2000, reports of child abuse and neglect increased from approximately 60,000 to 2.4 million (U.S. Department of Health and Human Services, 2000). Estimates of the percentage of children in the foster care system who are in severe to critical need of mental health services range from 40% to 62% (Boyd, 1992). At the same time, it is estimated that the number of available foster homes for endangered children has decreased. In recent years, the number of youth in foster care nationally has remained steady at approximately 550,000 (Shealy, 1994). In one year (1999), 183,000 children had been in foster care for more than three years while 99,618 of the youth were between the ages of 16 and 21. Approximately 20,000

youth age out (emancipate) from state foster care systems each year (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001). In addition, the percentage of children needing foster placement has increased by 48%, whereas the number of foster homes available has decreased by 27% (Terpstra, & McFadden, 1993). Classification of Types of Services To meet these needs, in recent years, approaches to preserving the family's ability to care for their children have included therapeutic foster care, in home family services, individualized case management, and independent living skills training programs. As early as 1960, several residential treatment programs for children began developing therapeutic foster homes to supplement or serve as an alternative to long term residential care (Galaway, Nutter, & Hudson, 1995; Bryant, & Snodgrass, 1992). In such a program, training support services, enhanced payments and treatment team status is extended to foster parents. The findings of multiple research studies in the U.S., England, and Canada suggest that youth who experience serious emotional and behavior problems are served well in therapeutic foster care. Therapeutic foster care programs are less costly than the institutional and group home alternatives to which they have been compared (Chamberlain, 1990). In Home Family Service is an intensive parent and child intervention which offers therapy, education, referral, and case coordination in the client's home. These services occur more frequently than traditional outpatient counseling, and seek to remove barriers to treatment (i.e. cost, transportation, denial of need). In Home Family Service can be used in response to indicators of less severe child or parent impairment for the purpose of preventing further dysfunction and maintaining family placements (Swenson, Randall & Henggeler, 2000). According to several studies, the percentage of youth and their families who receive only one modality of service after entering foster care is very low (Chamberlain, 1991). Because of this reality, individualized case management is believed to be an effective method for maintaining the mission of family reunification and permanency planning. This is accomplished through the use of one case manager who is responsible for seeing to it that the child receives individualized services as needed. The child receives all of the supports available in the home, school, and community setting. This wrapping of services around children, based on their individual needs and those of their families, is correlated with improved outcomes, higher utilization, and lower costs (Clark et al., 1994).

Legislative Guidelines At the social and political systems level, child welfare advocacy, and legislation to advance it, has transformed our procedures for the care of children and adolescents in state custody. Over the past several decades, foster care has been utilized as a solution to the plight of children in need. The majority of professionals working in the child welfare system are hard working idealists who are attempting to meet the federal mandates (i.e. permanency planning, preventing child endangerment, and reducing unnecessary out of home placements) our lawmakers design to further the protection and long term welfare of our children. This federal legislation includes The Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272), The Family Preservation and Family Support Act of 1993 (P.L. 66), The Social Security Amendment of 1994 (P.L. 432), The Adoption and Safe Families Act of 1997 (P.L. 89), and The Foster Care Independence Act of 1999 (P.L. 106-169). In 1992, The Comprehensive Services Act for at Risk Youth and Families was passed. This legislation provided guidelines, authorization and reporting procedures for the use of public funds in cases of mandated and non-mandated (preventative) foster care. The CSA established a state and local interagency service planning process for at risk or disabled youth in the mental health, social services, school, and juvenile justice systems. All of these federal and state laws are designed to increase the likelihood of achieving permanent placements for affected youth and to recommend the least restrictive setting safely possible for the individuals who are receiving services (Dollard, Evans, Lubrecht, & Schaeffer, 1994). However, research and evaluation on foster care outcomes must be cast against the backdrop of ongoing changes in state and federal regulations and policies regarding children in the custody of the state (Schwartz, 1991). Recently, lawsuits seeking a much fuller range of services, as well as a reduction in lengths of stay for children in out-of-home placements, have successfully captured the attention of state policymakers and many child welfare administrators. In some localities, caseloads for foster care caseworkers have decreased approximately 30% on average after funds were appropriated to increase the number of adoption caseworkers and attorneys available to process termination of parental rights. Changes such as these in the legal context of foster care service provision can lead to improvements in outcomes over time (Lambiase, & Cumes, 1987).

Despite these attempts to reduce risks of child abuse, neglect and abandonment, the need for child protective services is steadily on the rise or maintaining at high levels in most areas of the U.S.. In rural areas where there is lower population density, the problem of endangered youth is complicated by the absence of sufficient and satisfactory inpatient psychiatric or residential services for children and adolescents. The Need for Study In order to manage costs and risks responsibly in foster care programs and facilities, data analysis must be used to ensure responsible service utilization. To provide child protection consistent with public law, community service providers must conduct research to answer questions about foster care. METHOD For the current study, the total sample of foster care cases reviewed was 208 cases. In this sample, descriptive and summary statistics were compiled to ascertain the proportion of cases receiving regular foster care, therapeutic foster care, psychiatric hospitalization, residential treatment or in home family services. Additionally, a sub sample of ten cases of children and families receiving services under the Comprehensive Services Act were reviewed to document utilization patterns, trends and outcomes of care. The ten cases were randomly selected from the larger group of 208 cases for the three year period from July 1999 until August 2002. An analysis of CAFAS (The Child and Adolescent Functional Assessment Scale) or PECFAS (The Pre School Child and Family Assessment Scale) scores was performed. The CAFAS is a standardized mental health assessment tool which is sensitive to improvements and declines in the child or family's functional status. The psychometric properties of the CAFAS have been established to be robust and consistent. Over 15 states routinely train employees on the proper use and interpretation of this assessment tool (Hodges, & Wong, 1996). A CAFAS score of 30 or above generally indicates severe impairment of functioning. The method used in this evaluation is to investigate the mean CAFAS scores at initiation of services and post intervention. For the purposes of the current study, the pre intervention score is the initial CAFAS score for a group of children receiving services during the period July 1999 through August 2002. The post-intervention score is the CAFAS score

following intervention for 3, 6, 9 months or longer. Some percentage of these post-intervention CAFAS scores were CAFAS scores on discharge for the group of children receiving services July 1999 through August 2002. For the purposes of this report, "none or other," as a classification of services refers to regular foster care and other supportive services. The mean CAFAS scores for each classification of service (therapeutic foster care, in home family services, residential treatment and regular foster care/other supportive services) were also reported. An individual record review was conducted for ten randomly selected cases to audit the service planning process and check for utilization fidelity and errors. The analysis of pre and post intervention average CAFAS scores is documented in order to determine what percentage of children and their families score above 30 on the CAFAS, even after receiving services. RESULTS In 96% of the 208 foster care cases in the pre-intervention group of the sample, the CAFAS score was 30 or above, indicating severe impairment of functioning. In 82% of the post-intervention group of the sample, the CAFAS score was 30 or above, indicating severe impairment of functioning. The proportion of cases receiving each classification of service is as follows: Residential Treatment Center = 60 (29%), Therapeutic Foster Care AND Residential Treatment AND Psychiatric Hospitalization = 26 (12%), Therapeutic Foster Care = 41 (20%), Foster Care = 41 (20%), In Home Family Services = 40 (19%). The average CAFAS score for each classification of services is as follows: Residential Treatment Center = 71, Therapeutic Foster Care AND Residential Treatment AND Psychiatric Hospitalization = 78, Therapeutic Foster Care = 49, Foster Care = 60, In Home Family Services = 69. There were 86 (out of a total 208) children receiving psychiatric hospitalization, residential treatment or group home placement at a facility which was 45-200 miles away from their community. These 86 children suggest an immediate need for more localized services. An analysis of the costs of services for the 10 subjects in case studies indicates that the average cost of service for the entire time the child was in publicly funded foster care was $115,220 per child. This sub sample consisted of 5 females and 5 males. Their average age at initiation of services was 10.4 years. The average length of stay in services supervised by the state was 5.6 years, with the longest number of years in services being 12 years, and the shortest being 1 year (see

Table 1). Ethnicity was 50% Caucasian American, 30% African American and 20% Bi Racial. The children in this sample had an average number of placements of 7.2; the highest number of placements was 12, the lowest was 2. One child had no out of home placements. A brief description of the 10 children in the sub-sample case review is provided next (see Table 1). It should be noted that the services which were provided for these children, in several cases, mitigated life-threatening harm and endangerment for the children involved. The treatment providers in the cases reviewed for this study are believed to be thorough and highly effective in the services they provide. The following analysis is presented as an attempt to improve service delivery and build upon what is already excellent coordination of the highest quality of care, for the lowest possible cost. Several unique strengths were also apparent from this review of outcomes, and they are noted in the discussion section of this evaluation. Ten Sample Cases "Callie" Callie was 12 years old when she entered foster care because there was no suitable parental caregiver available due to poverty, father's abandonment, and severe parental substance abuse. She is still in state care at her 11th residential placement and she is currently 16 years old. She has been described as "crying at the drop of a hat" and although she successfully earned her behavioral privileges in the residential settings she was sent to, there was no foster home available for her to begin a permanent residence once she was ready for discharge. As the months and years in residential care progressed, Callie became more aggressive, threatening to injure herself and occasionally fighting physically with her peers. Recently she was told by a care worker that she would be placed in the state psychiatric hospital when she turns 17 if she cannot control her behavior. "Dominick" Dominick was 8 years old when he came under the supervision of the state because a relative filed charges against him for assault and battery. He is one of 2 children in this sample who were adopted when they were under 2 years of age. Dominick is currently 12 years old and has had 7 out-of-home placements since entering foster care. In one 12 month period in 2001, he was admitted to the state psychiatric facility for children 3 different times for court ordered evaluation. In the beginning of his time in foster care, he was diagnosed as oppositional defiant disorder and attention deficit hyperactivity disorder, but in recent months he has shown signs of a psychotic disorder as well. His adoptive parents are confused and ambivalent about

their desire for continued contact with Dominick. "Maryanne" Maryanne is a 16 year old who has been receiving individual counseling, in home family therapy, psychological evaluations and the supervision of the Department of Social Services off and on since she was 6 years old. When she was 13 years old, an anonymous report was made to DSS regarding her welfare. The current referral is the second time she and her siblings have received the help of social services. Ten years ago, Maryanne and her sister were victims of sexual molestation; the perpetrator was a family acquaintance and the abuse occurred in her mother's home. Maryanne has been in the custody of her mother, father, and paternal grandparents over the last 10 years. More recently, the child protective worker and the in-home family clinician have reported on Maryanne's school absences, physical violence, and multiple episodes of alcohol and other substance abuse. Although she is currently in her biological father's home, her functional status is severely impaired and her best interests would be served in a more restrictive, highly supervised setting. "Rachel" Rachel is a child who at age 13 was referred to Child Protective Services because she complained of inappropriate sexual touching and indicated her father had abused her. This report was judged to be unfounded, but Rachel continued to be seriously withdrawn and unresponsive in the classroom. The history of psychological care and services received from the state indicate multiple psychological evaluations and recommendations for repeating a grade in school two different times. When Rachel was 9 years old, special education services denied her placement in a special education class, despite her full scale IQ score of 70. "Michael" Michael is currently 14 years old and he has been residing in a residential facility in Richmond for the last year and a half. He has made an excellent adjustment to this facility which appears to be a permanent placement for him due to multiple severe handicaps and the family's inability to provide for his needs. Michael's mother was diagnosed with mental retardation due to febrile seizures as a child. This fact of his history was noted in one psychological evaluation, but omitted from a second evaluation. His family did not get the opportunity to visit Michael as often as they wished due to the long distance trip to his school. "Elizabeth" Elizabeth was first seen for psychological services when she was age 2. She continued to be seen by a doctor until she was 8 years old. Records indicate she was given medication for "emotional outbursts." Elizabeth's biological mother could not care for her and may have physically abused her during her first 2 years. Elizabeth was

adopted by her grandparents, whom she believed to be her adoptive parents, not her grandparents. She continued to be depressed and she was hospitalized two times at age 11 for severe depression. After these hospitalizations, the family received support and counseling from in home family workers for 18 months. When she was 16, Elizabeth went to a residential treatment facility 90 miles away from home because her grandmother was not able to manage her emotional problems and impulses to kill herself. A complete psychological evaluation while Elizabeth was getting care at the residential treatment facility recommended a 12 month stay. She was actually discharged after 7 months against medical advice. After she was brought home, the record indicates a severe decline in her emotional stability at home and at school. In home family services were discontinued when she was 17 years old. Despite several doctors and counselors recommendations that Elizabeth and her adoptive mother receive continued support for unresolved grief, depression, and trauma, it appears that her care was terminated. "Stephen" Stephen was trust placed in custody of the state at age 10. His only available parent was his mother who was an active addict, physically abusive to Stephen and frequently incarcerated. In the first three years of foster care, Stephen had 3 different in-home placements in treatment foster homes. But by the age of 13, there was no home available and his temper and occasional aggressive outbursts necessitated residential care. From the age of 12 until age 18 when services stopped, Stephen was moved 10 times from group home to residential treatment center to foster home to psychiatric hospital and back to the residential treatment center. Two months before his 18th birthday in 2001, a note in his record states that he is set for discharge and uses threats of runaway to obtain regular visitation with his disturbed mother. "Chris" Chris was 15 years old when he was referred for foster care prevention services. He had been charged with domestic disturbance and assault for physical threats and fighting with a relative in his immediate family. He had been suspended from school for truancy and carrying a weapon. The family, received in home family services and Chris was placed in an alternative educational setting. Chris' case was closed after 6 months of intensive in home therapy which consisted of 7-10 hours weekly for 24 weeks. Progress notes from the therapist indicate considerable improvement at the time the case was abruptly closed, however the relative again was filing charges against Chris and the in home family case worker (not the original therapist) filed a court order against the parent for not cooperating with service recommendations. "Joseph" In May of 1991, when Joseph was 6 years old, he was referred to

a specialized children's evaluation center by his mother. She reports that in March of 1990 he had an accident and hit his head. He has severe behavioral problems and cognitive deficits including not remembering the alphabet and not remembering how to count. He has staring episodes and he is highly resistant to discipline. He would frequently run away from school. His family included the maternal grandparents, mother, brother, and sister. When his mother was around, Joseph was disorganized, he would act out, and he refused to cooperate. According to a child developmental evaluation, Joseph's mother's approach is very passive; she does not give him structure or consequences. The recommendation from the doctors at age 6 was to reevaluate Joseph regularly at the neuropsychological clinic and have him return every 3 months. Because of frequent temper tantrums, nightmares, and head banging, Joseph requires multiple medications and was cycled through the following residential placements: Therapeutic foster home, regular foster home, psychiatric hospital, regular foster home, psychiatric hospital, psychiatric hospital, long term residential facility, psychiatric hospital, psychiatric hospital, long term residential facility, psychiatric hospital, long term residential facility where he is currently living. He turned 18 in March of 2003 and Joseph's family visited him frequently when he was residing at a treatment center close to his home. He will require specialized services his entire life due to multiple disabilities. "Jessica" Jessica was in the foster care system from age 12 to age 18 years. Services began when she was hospitalized for self injury at age 12. She spent one month in a psychiatric hospital and was placed back in her parents' home. After the Department of Social Services worker witnessed serious abuse from the father, Jessica was readmitted to a different psychiatric hospital for another month. Parental fights were terminated without protest at that time. She was then placed in 2 different foster homes, but these placements failed. Jessica was placed in a residential treatment facility two hours away from home for 9 months. Next, she went to live with relatives out of state for 5 months and then returned to Virginia. For the next 3 years she lived at three different group home/residential facilities until she turned 18 when she filed for emancipation and made the choice to no longer receive services from the Department of Social Services. Rationale for Program Evaluation Methods Used A qualitative research approach such as case history analyses represents an unconventional evaluation paradigm. It is included in the present study for the purpose of effectively examining unseen interactional

effects. One example of such effects is the evidence found in the current analysis which suggests a gap between foster care program goals, implementation and evaluation. This problem may compromise long term success for foster care alumni. If experts fail to use data driven conclusions coming from paradigms of evaluation such as these, we will face opposition from those we don't include in our evaluation strategies (for instance foster children themselves). We will also face evidence which proves we are wrong, irrelevant or unqualified at safeguarding foster children while they are in state care. A theoretical basis is found in the psychological research literature that offers a strategy for evaluating social programs such as state funded foster care. These research studies recommend that child welfare professionals provide social services to endangered youth, their parents and their foster families. These services include shelter, safety, basic needs, parental care/attachment, supervision and skills development. But the evidence we have from evaluating such services is minimal. There are evaluation instruments that we can use to measure desired outcomes for foster children and their families and environments. The assessment tool known as the CAFAS (The Child and Adolescent Functional Assessment Scale) is scientific and effective in measuring outcomes that are consistent with the stated goals of most foster care programs and foster care ancillary services. The CAFAS is a widely researched and well studied assessment tool used for the evaluation of foster children and their environments in several states (Quist, & Matshazi, 2000). The psychometric properties of this assessment tool are strong and scientifically acceptable (Hodges & Wong, 1996). If researchers don't attend to these aspects of best practice models for evaluating social programs, they miss an opportunity to improve services and reduce costs. Without evaluation strategies, experts and practitioners cannot know how many program participants were helped, how many were harmed, and how many still require services. In the case of foster care programs, this mistake may be costly and irresponsible. It may even lead to the ultimate effect of accelerating the very cycle of abuse the original interventions were designed to change. Similarly, research on program evaluation shows that some interventions for endangered youth may have negative effects overall (McCord, 1999). After a great expenditure of public resources, psychologists are sometimes faced with evidence that a social program has the unintended consequences of failing to help the young people they serve. In some cases, program planners and evaluators have arrived at the end of an intervention strategy with overtly negative effects on the participants.

Findings Based on examination of CAFAS scores, the results of the current analysis demonstrate there is no measurable, positive effect by distinctive treatment approach for the sample studied. There is a consistent trend towards a high percentage of the cases receiving most of the services available in the array of services currently offered. Considering that 85% of the cases reviewed have clinically significant CAFAS scores AFTER receiving services, the application of multiple service modalities is appropriate in most cases. Individualized case management is the most effective approach with this very difficult and challenging population. When it comes to severe and persistent cases of individual and family disturbance, it is accurate to say that "it takes what it takes" to responsibly and effectively treat emotional, social, behavioral and psychiatric disturbance. The key question is what types of services in the array of services available should be added or expanded to manage costs responsibly while improving long term outcomes for foster care youth and their families. DISCUSSION AND RECOMMENDATIONS In order to serve the increased numbers of foster children and the multiple problems of their troubled families, foster care program researchers and developers have suggested a long list of strategies. These recommendations include intensive family preservation and reunification strategies, professionalized care such as therapeutic foster care, a return to orphanages, and intensive individualized case management by family specialists (Clark et al., 1994). Despite advocacy efforts for family preservation and permanency planning, the child welfare field has been in some confusion as to what really works (Swenson, Randall, & Henggeler, 2000). A significant proportion of foster youth have had a difficult time making the transition to self sufficiency (Nixon & Garin-Jones, 2000). They report that the transition to independence was rapid and unplanned and that they felt "dumped" by the system. But other foster care programs advocate a long term, developmental, strengths based approach to service planning. Staff, parents and youth can use these programs to ensure long term success for foster alumni (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001). Outreach programs seek to teach independent living skills including learning how to locate appropriate housing, employment assistance, financial assistance, financial planning, transportation and how to practice personal self respect. Additional recommendations include the following:

1. Extend length of stay for in home family services as needed to avoid premature discharge from services in the middle of an intervention. 2. Establish additional residential services locally but only in close coordination with the existing facilities currently serving foster children and teens. 3. Provide foster care services which guarantee permanency of setting if the child or teen has been placed in multiple (i.e. three or more) settings. This may mean keeping a child or teen in an institutional or group home setting for the purpose of maintaining permanency. Planners should consult with a Foster Care Alumni Group regarding the permanency challenge. 4. Planners should institute long term follow up through mail and telephone survey with foster youth who have. "aged out" of the social service system. This outreach should include the offer of clarification, defined as "open communication about the abuse or neglect which led to removal from the home and the parent acknowledging responsibility for the maltreatment and removal of the child from the home." (Swenson, Randall, & Henggeler, 2000) 5. Foster care planners should provide transitional care by implementing living skills programs for individuals 18-23 years old, delivered through local community service system. 6. The providers of services to children in foster care should acknowledge service errors found in Department of Social Services records regarding placement of foster care youth. The administrators should establish quality control and risk management procedures at the local D.S.S. consistent with ethical procedures and for the purposes of avoiding future litigation. 7. Planners should institute Foster Care Adult Alumni Association using the historical foster children alumni model currently in place at group homes across the United States. In summary, the findings of this study of families served in one sample of foster care youth suggests that the children and families we serve are very challenging. They have many difficulties. We serve them well. But our resources are not expanding or even remaining the same in the pursuit of improving foster care outcomes. Our resources for supporting and helping foster children are shrinking. We need to protect and strengthen our resources and programs for the care of foster youth in state custody. We need to use evidence and scientifically valid evaluation procedures to guide the development of these services. And we need to add services for the emancipated foster alumni to support their transition into responsible adulthood.

TABLE 1 Total Costs And Number of Placements Per Child N = 10 Legend for Chart: A - Subject Name B - Years in Care C - Age at initiation of services D - Number of placements E - Costs A Callie Michael Elizabeth Chris Maryanne Joseph Stephen Dominick Jessica Rachel 1 3 12 8 4 5 6 B 5 6 6 C 12 yrs 8 yrs 11 yrs 15 yrs D 11 12 3 2 (kinship) 6 (kinship) 12 10 7 9 0 E $95,800 $419,118 46,388 9,610 20,051 $207,765 $73,710 $119,120 $156,202 4,400

6 yrs(*) 6 yrs 10 yrs 8 yrs 12 yrs 9 yrs

(*) 6 years at first referral; 13 at second referral REFERENCES ??? Barker, P., Buffe, C. & Zaretsky (1978). Providing a family alternative for the disturbed child. Child Welfare, 57, 373-379. ??? Boyd, L.A. (1992). A study of the mental health and substance abuse service needs of Florida's foster children. University of South Florida, Florida Mental Health Institute, Department of Child and Family Studies. ??? Bryant, B. & Snodgrass, R. (1992). Foster family care applications

with special populations: People Places, Inc. Community Alternatives: International Journal of Family Care, 4, 1-25. ??? Canale, J. (2000). Promoting altruism in troubled youth: Considerations and suggestions. North American Journal of Psychology, 1, 95-102. ??? Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care, 2, 19-36. ??? Chapin, J. (2003). Unrealistic optimism and school violence prevention programs. North American Journal of Psychology, 5, 193-202. ??? Chamberlain, P. & Reid, J. (1991). Using a specialized foster care community treatment model for children and adolescents leaving the state mental hospital. Journal of Community Psychology, 19, 266-276. ??? Clark, H., Prange, M., Lee, B., Boyd, A., McDonald, B. & Stewart, E. (1994). Improving adjustment outcomes for foster children with emotional and behavioral disorders: Early findings from a controlled study on individualized services. Journal of Emotional and Behavioral Disorders, 2, 207-218. ??? Cook-Fong, S. (2000). The adult well being of individuals reared in family foster care placements. Child & Youth Care Forum, 29, 7-25. ??? Courtney, M., Piliavin, I., Grogan-Kaylor, A. & Nesmith, A. (2001). Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare, 80, 685-717. ??? Curtis, P., Dale, G., & Kendall, J. (1999). The Foster Care Crisis. Lincoln, Nebraska: University of Nebraska Press. ??? Dollard, N., Evans, M.E., Lubrecht, J., & Schaeffer, D. (1994). The use of flexible service dollars in rural community based programs for children with serious emotional disturbance and their families. Journal of Emotional and Behavioral Disorders, 2, 117-125. ??? Galaway, B., Nutter, R., & Hudson, J. (1995). Relationship between discharge outcomes for treatment foster care clients and program characteristics. Journal of Emotional and Behavioral Disorders, 3, 46-54. ??? Hodges, K., & Wong, M.M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent

Functional Assessment Scale. Journal of Child and Family Studies, 5, 445-467. ??? Lambiase, E.A., & Cumes, J. W. (1987). Child custody decisions: How legal and mental health professionals view the concept of "best interests of the child." South African Journal of Psychology, 17, 127-130. ??? McCord, J. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54, 755-764. ??? Mech, E. & Fung, C. (1999). Placement restrictiveness and educational achievement among foster youth. Research on Social Work Practice, 9, 213-228. ??? Nixon, R. & Garin-Jones, M. (2000). Improving transitions to adulthood for youth served by the foster care system. Annapolis Junction, MD: Child Welfare League of America. ??? Pelton, L. (1987). Not for poverty alone: Foster care population trends in the twentieth century. Journal of Sociology & Social Welfare, 14, 37-62. ??? Quist, R. & Matshazi, D. (2000). The child and adolescent functional assessment scale (CAFAS): A dynamic predictor of juvenile recidivism. Adolescence, 35, 181-192. ??? Reddy, L. & Pfeiffer, S. (1997). Effectiveness of treatment foster care with children and adolescents: A review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 581-588. ??? Schwartz, I. M. (1991). Out of home placement of children: Selected issues and prospects for the future. Behavioral Sciences and the Law, 9, 189-199. ??? Shealy, C. (1995). From Boys Town to Oliver Twist: Separating fact from fiction in welfare reform and out of home placement of children and youth. American Psychologist, 50, 565-580. ??? Swenson, C., Randall, J., & Henggeler, S. (2000). The outcomes and costs of an interagency partnership to serve maltreated children in state custody. Children's Services: Social Policy, Research, and Practice, 3, 191-209. ??? Terpstra, J. & McFadden, E. J. (1993). Looking backward, looking forward: New directions in foster care. Community Alternatives:

International Journal of Family Care, 5, 115-134. ??? U.S. Department of Health & Human Services, (2000). The U.S. Advisory Board of Child Abuse and Neglect: Critical first steps in response to a national emergency. Washington, D.C.: U.S. Government Printing Office. ~~~~~~~~ By Judith Reifsteck, James Madison University Correspondence should be sent to: Dr. Judith Reifsteck, Psychology Dept., James Madison University, Harrisonburg, VA. 22807. _____ Copyright of North American Journal of Psychology is the property of North American Journal of Psychology and its content may not be copied or e-mailed to multiple sites or posted to a listserv without the copyright holder`s express written permission. However, users may print, download, or e-mail articles for individual use. Source: North American Journal of Psychology, 2005, Vol. 7 Issue 2, p313, 14p Item: 17385644 _____

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