Lasting strains from foster-care childhoods

Half of all 'alums' of the turbulent foster-care system have mental health problems, a broad new study finds.

For the first time, researchers are beginning to understand the pivotal mechanisms that help children in foster care thrive after they've undergone the double trauma of being abused by a loved parent and then forcibly removed from home.

The key has turned out to be "foster care alumni" - the adults who as children survived a system that is often overwhelmed, underfunded, and lacking enough caring homes to take in an estimated 800,000 US children each year.

A look at the lives and early experiences of these alumni provides a view that is at once stunning and disturbing, but ultimately hopeful because their stories provide the tools needed to ensure that more foster children flourish as adults.

While about 20 percent of foster care alumni are doing well, graduating from school and succeeding in their professional lives, more than half, 54 percent, have what doctors diagnose as mental health problems, from depression to anxiety. Indeed, research has found that more than 25 percent of foster-care alums experience post-traumatic stress disorder. That's twice as high as the percentage of veterans who faced combat.

"This is a wake-up call: The foster care, mental health, and educational systems are not building strong enough bridges to the future," says Peter Pecora, senior director of research services with the Casey Family Programs, a leading foster-care foundations. "These systems have to work differently. We have to spend the funds we have available to us in more targeted ways."

The Casey Family Programs worked in conjunction with Harvard Medical School to identify factors that helped determine whether a child who enters the system at, say, age 5, as Adam Cornell did, will end up in trouble, possibly homeless or in jail, or as a successful prosecutor, as Mr. Cornell did. The factors turned out to be fairly simple, seemingly common-sense remedies, such as reducing the number of foster homes that kids cycle in and out of.

The average foster child changes homes almost every year. Cornell had more than half a dozen placements - more if you include the three times he was returned to his mother before being removed permanently and adopted at age 14. He calls it being "bounced around," an experience that did not add to his success. But he did have something else that researchers have found is vital if foster kids are to succeed: meaningful relationships with caring adults.

"At every crossroads in my life, there was somebody - a foster parent, a teacher, or a friend - who believed I could thrive and helped me do that," says Cornell, now a prosecutor in Snohomish County in Washington State. "A kid needs somebody who can dream for them when they can't dream for themselves."

Schooling is another challenge for foster kids. While the Casey study found that foster-care alums have high school graduation rates that are slightly higher than the general population, the majority of them earned graduate equivalency diplomas (GEDs). That's in part because they get bumped from school to school so often. Sixty-five percent had eight or more school changes during their time in foster care; 30 percent had 10 or more school changes. That's changing schools about every 16 months, so many opted for the GED. That concerned the researchers, in part because studies show that people with GEDs are less likely to attend college and generally earn less than people who graduate from high schools.

"Sometimes they come in to these new schools two to three years behind," says Professor Pecora. "If we increase access to educational supports, we can increase educational success."

Other key reforms the report recommends are increasing access to mental-health services and targeting the current resources better, as well as improving the supports that foster kids receive as they approach age 18, the year they "age out" of the system. While a federal law called the Chafee Act requires all foster children to have written transition plans, their effectiveness varies across the states, as does the level of support offered. Many foster children who "age out" still find themselves alone in the world without the tools to succeed. In fact, it's estimated that more than 1 in 5 will end up homeless at some time.

In Florida, for instance, foster children generally need to be enrolled in continuing education if they're to be eligible for a stipend after they reach age 18. Howard Talenfeld, a lawyer and foster-child advocate, says that leaves too many without the support they need. He's currently representing a young man who is approaching age 18 and has been in foster care since he was 9. The juvenile courts have so far turned down his requests for an independent-living stipend. So it now appears that the young man will end up returning to the mother he was taken from nine years ago.

"The tragedy is, if the system can't do better after nine years than to send him back to the place that they took him from, you have to ask yourself, 'What did we accomplish, and why didn't we do a better job?' " says Mr. Talenfeld, president of Florida's Children First in Fort Lauderdale.

Other researchers agree that much more needs to be done to help improve the supports around kids in foster care, but they caution that the process of taking a child out of a home is inherently complicated and fraught with difficulties often unique to each case.

"It's easy to look for quick solutions like, 'Why are we taking the kid out of the home seven times?' " says Audrey Smolkin, director of research and evaluation at the Center for Adoption Research at the University of Massachusetts Medical School in Shrewsbury. "When you get down to real kids and real families, it's not so simple."

But some of the alums of the system do believe that what's needed is simple - just to believe in these children and to start by treating them as if they will succeed.

"It's very important to make note that youth are in care not because of themselves, but because of something that happened to them," says Dixie Horn, who entered foster care at age 14 and is now a sophomore in college. "They are very capable of being wonderful and productive members of society."

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