TERMINATION OF LONG-TERM MENTAL HEALTH TREATMENT WITH FOSTER YOUTH

Kimberlin Borca, Foster Care Research GroupUniversity of San FranciscoApril 29, 2012

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

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

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).

Types of Mental Health Licenses and Degrees Earned

MA or MS (38%)

Ph.D., Psy.D., Ed.D., D.M.H. (62%)

Psychologists 55%

MFT26%

LCSW10%

Other 5%

Registered Psychological As-sistant

3%

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

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

Results: Patients

•Females (51%) and Males (49%)

•Primarily School Aged

10 years at start of treatment (SD=5.53)

African Amer-ican 60%

Caucasian29%

Hispanic 8%

Asian/Pacific Islander 3%

Patient Ethnicity

Neglect Emotional Abuse Parents Inability to Caretake

Physical Abuse Sexual Abuse

64%

38%35%

26%

13%

Reasons for Entry into Foster Care

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%)

Collaborative Work in the Last Year of Treatment

Fost

er P

aren

ts

DHS So

cial W

orke

rs

Teac

hers

Biolo

gica

l Par

ents

Other

Sch

ool P

erso

nnel

Attorn

eys

Other

The

rapi

sts

Other

Soc

ial A

genc

y St

aff

Psyc

hiat

rists

Non-P

sych

iatri

st P

hysic

ians

Tuto

rs

51%

41% 38%

20% 18%14% 13% 13% 11%

6% 4%

Major Obstacles in the Last Year of Treatment

Transportation Issues

Resistance by Patient

Lack of Support from Foster

Parents

Lack of Support from DHS

Change in Foster Home Placement

Change in School

52%

39%

30%

13%11%

7%

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.”

Patient Re-location

22%

Unexpected Pa-tient Drop-Out

20%

Lack of Support from Fam-ily or Social Services

14%

Patient Resistance to Treatment

16%

Caretaker Ter-mination of Tx

11%

Treatment Goals Reached

17%

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.