Service support and quality of life for youth in foster care

Studies have consistently shown that children and youth in out-of-home care have substantially more health problems and greater health care needs than children and youth in general populations. Therefore, researchers and national decision makers agree that youth in foster care need extra service support. Hence, the question is whether youth in foster care receive services according to need and how the families experience the quality of the help received. Furthermore, we need more knowledge about positive outcomes for youth in foster care. The overall aim of the current thesis was to examine service use among foster families, foster parents’ experiences of quality of care, quality of life (QoL) among youth in foster care, and whether different characteristics were related to these outcomes. To reach this aim we utilized data from the prospective follow up study “Young in foster care” concerning foster families in Norway. Carers of children in foster care aged 6-12 years (n = 236) and child welfare caseworkers (n = 220) answered survey questionnaires in 2011/2012 (T1). Carers reported on the child's mental health, and caseworkers reported on pre-placement maltreatment and service contact. The follow-up study (T2) was conducted in 2016/2017 when the youths were aged 11-18 years. Youths (n = 303) and carers (n = 330) completed questionnaires regarding mental health and service use. In addition, youths reported their QoL, and foster parents reported their service experiences and perceived outcomes following contact with their main service provider. The foster families had a high service use, with 31.2% of carers reporting contact with child and adolescent mental health services and 61.2% with primary health care services during the last two years (Paper I). Furthermore, a substantial number of families reported contact with several service providers, and there was a positive association between youth mental health problems and service use. However, less than half of the youth with indications of mental health problems had received services from child and adolescent mental health services. Moreover, youth in kinship care had a lower use of the primary health care services compared to youth in nonkinship care, even when controlling for mental health problems. Foster parents reported overall positive service experiences, especially regarding the clinician’s communication and professional skills (Paper II). However, they were less satisfied with the information provided about the youth in their care and with the cooperation between services. Half of the foster parents reported improvements in the youth’s condition and functioning following the service contact. Foster parents that had younger youths, reported more frequent service contact and no waiting time had more positive experiences of the service contact. The youths in our sample had lower QoL across all dimensions compared to Swedish youth in the general population (Paper III). Their highest QoL scores were on the dimension of parent relations and autonomy, while their lowest scores were on the physical wellbeing dimension. Male gender and younger age were associated with higher QoL across all dimensions. Moreover, youth in kinship care and youth with more prosocial behavior five years earlier had higher QoL on some dimensions. In sum, foster families had a high service use and the service contact was dependent on mental health problems. However, less than half of the youths with indications of mental health problems had contact with the child and adolescent mental health services during the last two years, which highlight the need for standardized assessments of youth in foster care to identify those with a need for specialized services. Overall, foster parents had positive experiences of their main service provider. Still, our findings indicate areas for service improvements, such as enhancing routines for sharing information and collaboration between services, securing frequent enough service contact and short waiting time, and evaluating measures provided to ensure that they are experienced as beneficial by the youth and their families. Lastly, the youths in foster care had lower QoL than youth in the general population, indicating that the help received has not fully counteracted the effect of the youth's previous experiences. At the same time, most youth seemed to have established supportive relationships with their foster parents, which is an important premise for having a positive development in foster care.Doktorgradsavhandlin