1. Emotional
Health and
Foster Care
Adolescents
A Research Proposal by
Eandra Hall, Sarah
Parks, and Karen
Wortham

2. Abstract
Why foster care?
In 2008, more than 9,000 South Carolina children spent time in foster care.
Children who spend at least one year in foster care will, on average, spend 4 years in care
and live in 4 different homes before receiving a permanent placement or emancipating.
Why adolescents?
According to the CDC, 15-17 years old is a key developmental milestone.
1. Emotional Changes
2. Social Changes
3. Thinking/Learning

3. Introduction and Literature Review
Children and adolescents in foster care have a number of emotional and mental
health problems including:
Prenatal risk factors
Psychopathological disorders
Emotional trauma
Emotional behavioral problems

4. Prenatal Risk Factors
Foster children are at risk for a series of prenatal exposures to dangerous
substances
Seven out of ten children are removed because of parents addicted to dangerous
substances
Foster children are more likely to be raised by single mothers
Foster children are more likely to be prenatally exposed to addictive substances
such as alcohol, nicotine, of psychoactive drugs.
These exposures often lead to developmental disorders

5. Psychopathology and Foster Care
Psychopathologies are common among those in foster care. Most common are:
Post-traumatic stress disorder- 42%
24% have atypical cortisol release patterns
Reactive attachment disorder- 37%
Substance abuse
Eating disorders- one of two patterns emerge:
Self-injurious pica
Excessive eating and maintenance

6. Emotional Trauma and Foster Care
There are 5 types of trauma:
1. Emotional abuse
2. Physical abuse
3. Sexual abuse
4. Neglect
5. Domestic violence
Often, those in foster care have experienced these types: 70.7% had experienced 2
or more kinds of trauma, while 11.7% had experienced all types of trauma.

7. Protective Factors
Higher levels of contact with biological parents were associated with lower
depression levels
Kinship care is not linked with better emotional health
Adolescents need a sense of familial belonging have a healthy emotional life and
to provide stability while they learn to balance dependence and autonomy
Stable, non-parental mentors have been shown to benefit youth in the foster care
system

8. The Gap in Current Knowledge
Assessment of adolescents is needed for three reasons:
Few studies have been conducted on the emotional stability of adolescents in
the foster care system
More exploratory research is needed on the adolescent population
More information is needed about how to improve the current system

9. Theoretical Framework
The Social Cognitive Theory (SCT) is useful for this theory because of three things:
1. Reciprocal determination
2. Ability to tie behavior to environmental and personal factors
3. Behavior is the best way to understand emotional health in foster care
adolescents.

10. Research Hypothesis
“The foster care system in South Carolina has a negative effect on the emotional health of
teenagers placed under its care.”
Purpose of this study
Evaluate the impact the foster care system on adolescents in South Carolina and
examine room for improvements in emotional care of adolescents.

11. Materials and Methods
A Mixed Methods Study is the best way to ensure a well-rounded, complete
assessment of the emotional well-being of adolescents within the foster care
system.
Focus Group Studies-Qualitative
Beck Youth Inventory-Quantitative

12. Focus Group Structure
Three Focus groups composed of:
8-10 participants
Male and Female
Ages 13-18
Variety of cities across the state
Equal Representation of all Foster Care living situations
1. Emergency Foster Care
2. Respite Foster Care
3. Short Term/Long Term Foster Care
4. Kinship Care

13. Focus Group Questions
1. What is your name?
2. When did you enter the foster system?
3. Were you initially placed near biological siblings and/or parents?
4. How many placements have you had during your time in the system?
5. How would you describe your emotional state?
6. What types of experiences have impacted your emotional state for the better?
7. What types of experiences have impacted your emotional state for the worse?
8. Who do you turn to for emotional support?
9. What activities or practices would help improve your confidence and sense of belonging?
10. How would you describe the foster care system’s approach towards maintaining or improving the emotional well being of the
adolescents it cares for?

14. Beck Youth Inventory
This inventory is composed of 20 statements designed to assess the range of negative
emotions typically experienced during adolescence, and results can be compared to a
normative range gathered by two population sample and a clinical sample. Emotions include:
1. Depression
2. Anxiety
3. Anger
4. Disruptive Behavior
5. Self-Concept
These 20 statements are measured on a four item scale: Never, Sometimes, Often, and Always.

15. Limitations and Scope
Because this study will sample from all types of foster care, it will give a
generalized view of the SC foster care system and its effect on adolescent
emotional health
Small study sample due to focus groups
Reliance on self-report means that the study is open to error

16. Justification and Conclusion
The research that will be performed will help to educate those who are affected directly and indirectly by
the foster care system.
What will come of the Research
Why children in foster care behave the way they do
Why stability is extremely important for the mental and emotional development of a child
New studies that are being brought forth about how to make living in the foster care system
better
Pass a law that could enable children to have a session weekly with a counselor
Why does this research deserve funding?
Teenage years come with peer pressure, bullying, etc. but when one of 13-18 years of age and
is living in foster care that can cause a great deal of stress on a young person

17. References
Ahrens, K., DuBois, D., Garrison, M., Spencer, R., Richardson, L., & Lozano, P. (2011). Qualitative exploration of relationships with important non-
parental adults in the lives of youth in foster care. Children and Youth Services Review, 33(6), 1012-1023.
Bandura, A. (2012). Social cognitive theory. In Handbook of theories of social psychology (pp. 349-372). Los Angeles: SAGE.
Children Waiting for Adoption. (2015). Retrieved November 27, 2015, from https://dss.sc.gov/content/customers/adoptions/data.aspx
Committee on early childhood, adoption and dependent care. (2000). Developmental issues for young children in foster care. Pediatrics, 106(5),
1145-1150.
Community‐University Partnership for the Study of Children, Youth, and Families (2011). Review of the Beck Youth Inventories – For Children and
Adolescents 2nd Edition (BYIII). Edmonton, Alberta, Canada.
Cunningham, M., & Diversi, M. (2013). Aging out: Youths’ perspectives on foster care and the transition to independence. Qualitative Social Work,
12(5), 587-602.
Deighton, Dr. J., & Wolpert, Dr M. (Eds.). (n.d.). Mental Health Outcome Measures for Children and Young People (Vol. CAMHS Evidence Based
Practice Unit, p. 6). University College London.
Fechter-Leggett, M., O’Brien, K. (2010). The effects of kinship care on adult mental health outcomes of alumni of foster care. Children and Youth
Services Review, 32(2), 206-213.
Greeson, J., Briggs, E., Kisiel, C., Layne, C., Ake, G., Ko, S., Gerrity, E., Steinberg, A., Howard, M., Pynoos, R., & Fairbank, J. (2011). Complex
trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child
Welfare, 90(6), 91-108.

18. References (Continued)Kools, S., & Kennedy, C. (2003). Foster child health and development: Implications for primary care. Pediatric Nursing, 29(1).
Lawrence, C., Carlson, E., & Egeland, B. (2006). The impact of foster care on development. Development and Psychopathology, 18, 57-76.
McWey, L., Acock, A., & Porter, B. (2010). The impact of continued contact with biological parents upon the mental health of children in foster care.
Children and Youth Services Review, 32(10), 1338-1345.
Oswald, S., Heil, K., & Goldbeck, L. (2009). History of maltreatment and mental health problems in foster children: A review of the literature. Journal
of Pediatric Psychology, 35(5), 462-472.
South Carolina Department of Social Services. (2014). Foster care services. Retrieved December 3, 2015, from
https://dss.sc.gov/content/customers/protection/fcs/index.aspx
Teenagers (15-17 years of age). (2015, November 6). Retrieved December 7, 2015, from
http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence2.html
Thompson, R., & Auslander, W. (2011). Substance use and mental health problems as predictors for HIV sexual risk behaviors among adolescents in
foster care. Health Social Work, 36(1), 33-43.
Troutman, B., Ryan, S., & Cardi, M. (n.d.). The effects of foster care placement on young children’s mental health. Retrieved December 3, 2015, from
http://www.medicine.uiowa.edu/icmh/archives/reports/Foster_Care.pdf
Types of Foster Care. (2015). Retrieved December 7, 2015, from http://www.adoptionandfostering.hscni.net/fostering/types-of-foster-care
U.S. Department of Health and Social Services. (2015). The AFCARS report. Retrieved December 3, 2015, from
http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport22.pdf