Impacting the Positive Mental Health of Nonkinship Foster Children: The Perceptions of Primary Caregivers

PURPOSE: This study used a qualitative approach to answer the question: What are the experiences of primary caregivers of non-kinship foster children in supporting the positive mental health of children in their care?

Occupational therapists, as professionals that address mental health of various populations, should be informed about the challenges faced by primary caregivers of foster children. Mental health is the most significant unmet health need of foster children¹. Foster children often enter adulthood with unresolved trauma, which leads to negative consequences such as re-victimization, homelessness, or incarceration². Using the Positive Mental Health Surveillance Indicator³ as a guide, this study looked at certain aspects that contribute to positive mental health. Specifically, the primary caregivers were asked to describe their experiences with trying to support the psychological and social well-being of their foster children.

DESIGN: Interpretive Phenomenological Analysis was the specific study design used. Through purposeful snowball sampling, primary caregivers of non-kinship foster children meeting the following inclusion criteria were recruited: 21 years or older; have fostered at least two children between the ages of 6-18 years old, with one currently residing in the home for greater than 90 days; residing in the state that the research was conducted.

METHODS: 15 foster parents were interviewed using a semi-structured interview guide. All interviews were audio recorded and transcribed verbatim. In order to improve verify the analysis and improve trustworthiness of the findings, a reflective research journal was kept by the researcher, the participants provided a written reflection about the topic prior to the interview, and member checking was completed. Data analysis was systematic throughout the process using the specific guidelines of the phenomenological approach including phenomenological reduction, imaginative variation, interpretation, horizonalization, clustering, and elimination.

RESULTS: Final thematic analysis is still underway. However, preliminary analysis has been completed. Participants reported significant struggles to support the development of foster children’s psychological well-being more than social well-being, although both are typical barriers to the positive mental health of the foster children in their care. They encounter challenges in meeting the children’s mental health needs due to the complex trauma experienced prior to entering the foster home and the difficulty obtaining adequate resources for the children in their care. The barriers of navigating the Child Protective Services/ and Department of Human Resources to obtain needed services effectively was also a consistent theme. Many parents reported that “the system is broken” with workers being overwhelmed and ineffective for various reasons. Having a foster parent support system and other allies such as the school and church were consistently mentioned as facilitators in supporting the foster parents’ efforts at improving the psychological and social well-being of the children.

CONCLUSION: Although this study is limited in scope, the information gained can be used to raise awareness of the unique needs of this population. This is important to practitioners who work with foster children and their foster parents in the clinic, but also to raise awareness about the need for strategies to reduce the potential for poor outcomes of foster children including poverty, homelessness, and incarceration, all of which place a burden on society and can be improved by occupational therapy initiatives.

References

1. American Academy of Pediatrics (2016). Healthy Foster Care America: Mental and behavioral health. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Mental-and-Behavioral-Health.aspx.

2. Havlicek, J. R., Garcia, A. R., & Smith, D. C. (2013). Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions. Children and youth services review, 35(1), 194-203. doi: 10.1016/j.childyouth.2012.10.003

3. Orpana, H., Vachon, J., Dykxhoorn, J., McRae, L., & Jayaraman, G. (2016). Monitoring positive mental health and its determinants in Canada: The development of the positive mental health surveillance indicator framework. Chronic Diseases and Injuries in Canada, 36(1).