This month in our quarterly column, Publications of Interest (POI), we are bringing you a selection of articles which explore dissociation among youth in out of home care/foster care. Youth in foster care or exiting foster care commonly report an extensive history of early abuse and neglect, re-abuse within foster care, and repeated cycles of exiting and re-entering foster care. There is limited research investigating dissociation among foster care youth, but we have collated a selection of articles here, for your interest. As usual we have tried to find some articles that are Open Access or are available to members through our Journal of Trauma & Dissociation. We hope you enjoy catching up on some professional reading. If you have any ideas for topics you would like to see in POI, please let us know.
Anderson, K., Hillman, S., Zhong, W. & Cross, R. (2023). Exploring looked-after adolescents’ reports of their dissociative experiences. European Journal of Trauma & Dissociation, 7(3). https://doi.org/10.1016/j.ejtd.2023.100334
Objective: In this study, the relationship between levels of dissociation, several pre-placement factors and other background variables was explored to facilitate understanding of the high prevalence of dissociation in adolescents living in care.
Methods: A sample of adolescents(n=68) between the ages of 11 and 17 in care at Five Rivers Child Care(FRCC)participated in the study. The Adolescent Dissociative Experiences Scale(ADES), a self-administered dissociation questionnaire was compared with an established carer-report measure of dissociation, the Child Dissociative Checklist(CDC), the Strengths and Difficulties Questionnaire(SDQ)and the Trauma and Adverse Life experiences Assessment(TALE) to explore the relationship between dissociation and other emotional, behavioural, and trauma-related difficulties in a looked-after population.
Results: The exploration of demographic variables revealed that dissociation was more likely to be present in females than males, with the age placed in care also influencing levels of dissociation. Measures related to pre-placement risk factors were not shown to be related to dissociative experiences. As expected, regression models were not significant in explaining variance in ADES scores with minimal effects from background, pre-placement risk and psychopathology variables. Finally, a discrepancy was observed between participant self-related dissociation and carer, or residential worker observational scores of the adolescents’ dissociation.
Conclusion: The study findings corroborate previous research confirming high levels of dissociation among adolescents in a specific care population, with the ADES questionnaire demonstrating the ability to measure dissociation. Utilising the ADES can offer an opportunity to understand the presentation of dissociation in looked-after children, and for clinicians, may provide a deeper comprehension when formulating a more sophisticated support or treatment plan.
Engler, A. D., Sarpong, K. O., Van Horne, B. S., Greeley, C. S., & Keefe, R. J. (2022). A Systematic Review of Mental Health Disorders of Children in Foster Care. Trauma, Violence, & Abuse, 23(1), 255–264. https://doi.org/10.1177/1524838020941197
Objectives: This article summarizes the rate of mental health disorders of foster children, the specific types of disorders faced by this population, and how factors such as type of abuse or placement variables can affect mental health outcomes.
Method: A search in PsycInfo Ovid, EMBASE Elsevier, and Cochrane Library Wiley resulted in 5,042 manuscripts that were independently reviewed by two authors, yielding 25 articles.
Inclusion criteria: Published in or after 2000, written in English, and having a population sample of foster children (ages 0–18) in Western countries including the United States, Norway, Australia, and Canada.
Results: Foster children have higher rates of mental health disorders than those of the general population. The most common diagnoses include oppositional defiant disorder/conduct disorder, major depressive disorder, post-traumatic stress disorder, and reactive attachment disorder. Variables such as type of maltreatment and type of placement predicted mental health outcomes.
Conclusions and implications of key findings: Children in foster care experience more mental health disorders, as a response to either the circumstances that led to being removed from their homes or the experience of being placed in foster care. These results demonstrate the necessity for providers to consider mental health issues when caring for children in foster care and to perform appropriate screenings and assessments. With adequate trauma-informed training, providers can quickly become comfortable and competent in identifying mental health needs of children in foster care who have experienced trauma.
Kisiel, C.L., Torgersen, E. & McClelland, G. (2020) Understanding dissociation in relation to child trauma, mental health needs, and intensity of services in child welfare: A possible missing link, Journal of Family Trauma, Child Custody & Child Development, 17:3, 189-218, DOI: 10.1080/26904586.2020.1816867
While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N = 27,737) and in residential treatment (N = 5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.
Tarren-Sweeney M. (2018). The Mental Health of Adolescents Residing in Court-Ordered Foster Care: Findings from a Population Survey. Child psychiatry and human development, 49(3), 443–451. https://doi.org/10.1007/s10578-017-0763-7
The mental health of a representative sample of 230 adolescents residing in foster care in New South Wales, Australia, was estimated in a state-wide epidemiological survey from carer-report responses on the Child Behavior Checklist (CBCL) and the Assessment Checklist for Adolescents (ACA). Rates of CBCL total problems, externalizing and internalizing scores above the borderline range cut-points were 49, 44 and 29% respectively, representing a relative risk of 3.8, 3.7 and 2.7 respectively in comparison to Australian children at large. These rates are 10–14% lower than that previously estimated for pre-adolescent Australian children in foster care. Whereas older age is associated with poorer mental health among pre-adolescent children in foster care, the present study findings suggest that this effect does not extend into adolescence. Around half of adolescents residing in foster care have mental health difficulties requiring referral to treatment services, including attachment- and trauma-related difficulties that are uncommon among clinic referred children at large.
Hulette, A. C., Freyd, J. J., & Fisher, P. A. (2011). Dissociation in middle childhood among foster children with early maltreatment experiences. Child abuse & neglect, 35(2), 123–126. https://doi.org/10.1016/j.chiabu.2010.10.002
Objective: This study examined levels of dissociation in school-aged foster children who had been maltreated before age 5.
Method: Data were collected from 118 children (age in years: M = 9.34, SD = 1.02) and their caregivers. Chi-Square and ANOVA were used to compare foster children (n = 67) to community comparison children (n = 51). Regression analyses examined predictors of dissociation for the foster children.
Results: The foster children showed significantly higher levels of dissociation than the control children. Within the foster care group, number of placement transitions, female gender, and maltreatment subtype significantly predicted dissociation.
Conclusions: The foster children were more dissociative than the control children. The finding that children who had experienced all types of abuse and who had experienced physical abuse with emotional maltreatment and neglect showed the highest levels of dissociation is consistent with findings from previous research.
Practice implications: The findings from this study suggest that maltreated girls and children with specific maltreatment profiles are at increased risk for dissociation. Further, as number of foster placements appears to contribute to dissociation, child welfare professionals should consider this factor during placement transitions.