Hi All,
I'm finally going to take a few minutes to post a short summary of my research (dissertation) with you and share some exciting news! I am honored to report that my manuscript titled Adverse childhood experiences and psychosocial well-being of adult women formerly in foster care as children has been accepted for publication with The Permanente Journal. The editor, Dr. Janisse, shared that it is scheduled for publication in the August print issue, but may be moved up to May.
Briefly, my study examined the relationship between adverse childhood experiences (ACEs) and psychosocial well-being of adult women formerly in foster care during childhood. I collected anonymous data using a web-based survey. I obtained data from both female and male adult participants, but had very few completely filled out questionnaires from adult males (n=10); thus, male participants were dropped from the study. My final sample included 101 women between the ages of 18-71 years with a mean age of 36 years. My sample represented child welfare systems from 37 different states.
The General Health Questionnaire (GHQ-12) was used to measure present mental health (level of psychiatric distress) and the Sense of Coherence questionnaire (SOC-13) to measure overall mental health. The ACE questionnaire was used to measure 10 different types of abuse occurring before the age of 18 years old. In addition to collecting total ACE sums, ACEs reported before and during foster care were also collected. Other variables such as the age of foster care entry, the number of years in care, the type of placement, the number of foster care placements and the number of school changes while in foster care were examined.
The mean age of foster care entry reported was 8 years old; 33% of respondents reported being less than 5 years old. Respondents reported being in foster care for 7 years on average. The average number of foster care placements reported was 6 with an average of 4 school changes. Most respondents who reported living in a foster care home (58%) lived with an unknown (non-kinship) family (77%).
The results of my study found an association between the number of ACEs reported and the degree of mental health problems. Over 56% of women were identified as experiencing psychological distress noted in low SOC sums (lesser sense of cohesion and perceived control in one's life) and high GHQ sums (less favorable psychosocial well-being). The most prevalent diagnoses reported were depression (43%) and posttraumatic stress disorder (29%).
Ninety-seven percent of respondents reported at least 1 ACE; 70% reported at least 5 or more ACEs while 33% reported 8 or more ACEs. The number of foster care placements was the only foster care variable that was statistically correlated with other variables. Specifically, greater number of foster care placements reported was associated with a greater number of reported ACEs noted in a simple linear regression model, (b = 0.453, SE = 0.10), t(1,89) = 4.602, p < 0.001. Two foster care placements were associated with an increase in ACEs by nearly 1 point.
SOC sums (M=54.26, SD=15.35) were significantly inversely correlated with both GHQ (M=14.83, SD=5.88) and ACE (M=5.68, SD=2.90) sums. SOC sums in this study were dramatically lower (worse) than previous studies and both GHQ and ACE sums were dramatically higher (worse) in comparison.
More ACEs were reported before foster care (M=4.18, SD=3.19) than during foster care (M=3.09, SD=2.58), p < 0.01. Basically, the data suggests that children entering foster care are an already fragile population.
When comparing the difference between the types of abuse reported before and during foster care, notable differences were found. Abuses associated with physical neglect (ACE 5, not enough to eat, had to wear dirty clothes, or no one to protect or care for you) and living in a dysfunctional household (ACEs 6-10, parental loss, maternal abuse, and household member associated with substance abuse or prison) were more prevalent prior to foster care. Psychological and physical types of abuses (ACEs 1-4, sworn at, put down, pushed, slapped, sexually abused, and not feeling loved, important, or looked after) were reported before foster care as the most prevalent types of abuses and remained as prevalent during foster care.
To further examine the differences in different domains of abuse such as psychological and physical abuse (ACEs 1-4), physical neglect (ACE 5) and living in a dysfunctional household, an independent-samples Z-test was done. Results indicated that entering the foster care system significantly reduced physical neglect by 16% (46% to 30%) and abuses associated with living in a dysfunctional family by 19% (64% to 45%), z = -3.92, p < 0.001. And as previously mentioned, emotional and physical abuses reported remained as prevalent before (74%) and during (79%) foster care.
In conclusion, several child welfare policy and practice recommendations were suggested such as developing social health policies and practices that address the social problems afflicting many families and that also protect and strengthen the family unit (familial ties). Social services that ameliorate social problems at a population level may have a greater impact on a larger scale as opposed to interventions that target the individual/family unit. Such social services may reduce the number of ACEs and the number of children entering the foster care services. While we cannot ignore family risk factors for abuse, the unique developmental needs of children in foster care must not be overshadowed by the process of child protection. A few other policy and practice implications were addressed in this article with much more detail.
Finally, I was so excited that my manuscript would be published in a medical journal. I was asked an important question from one of my reviewers about the relevancy of my work in a medical journal. Without prolonging my short summary of my research, my goals and efforts toward advocating for this vulnerable population includes positively influencing the child welfare system towards a developmentally sensitive social intervention (foster care). It seems that for this to truly occur, a multidisciplinary approach is needed where those from the medical system, for example, can partner with others to increase a greater awareness of how adversity "gets under our skin" (biologically) and becomes a part of who we are as adults.
I meant to keep this short and worked hard at not including more. Please feel free to ask any questions. It may take me a bit to get back to you as I just started an adjunct teaching position as a clinical instructor (exciting) and still working my way through a new role as a legal nurse consultant working with the State of Washington's Office of Public Defense where I advocate for children and families in an effort to protect and promote developmental health outcomes of children in foster care. Since finishing the UW nursing science PhD program, I have had many exciting opportunities (nothing permanent yet) and look forward to seeing how things unfold in the future.
Gratefully,
Delilah Bruskas, PhD, RN
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