2 research outputs found
Relationally focused specialized foster care : Relational experiences and changes in mental health and adaptive functioning
Background: Foster care is a relatively common arrangement when parents are unable to meet the needs of their children. Specialized foster care is sometimes applied in cases when problems are more serious and complex. More knowledge is needed about the effects of such specialized foster care. Aims: To explore trajectories of change associated with specialized foster care in a treatment model with a relational and mentalization-based orientation, and to develop the understanding of foster childrenâs and their foster parentsâ experiences of their relationship living in a treatment foster family. Methods: Children and young people between the ages of 5 and 20 years who received treatment within a specialized foster care model, Treatment By Foster care (TBF), participated in this study. Longitudinal data collected in a naturalistic setting were analyzed quantitatively. In Studies 1 and 2, the number of participants at baseline varied for different instruments between 76 â 105. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure how psychiatric symptoms change from the perspectives of the foster children, the foster parents, and teachers. The Adaptive Behavior Assessment System â second edition (ABAS-II) was used to measure adaptive functioning from the foster parentsâ perspective. Self-ratings by the children and young people of their emotional and social problems were measured with the Beck Youth Inventories of Emotional and Social Impairment (BYI). Data about experiences of the relationship between child and foster parent were collected through repeated individual short interviews/speeches with both children and their foster parents according to Five Minute Speech Sample (FMSS) (n = 14). Interviews/speeches were analyzed using Thematic Analysis (TA). Results: The ratings of foster parents and foster children differed. The analyses showed a significant reduction in psychiatric symptoms, emotional and social problems according to the self-ratings by the children and young people. According to foster parents and teachers, psychiatric symptoms did not decrease. The baseline ratings of adaptive functioning by foster parents showed that adaptive functioning was considerably below peers from the Swedish non-clinical norm group. Adaptive functioning did improve but not enough to approach or catch up with peers. Analysis of the interviews/speeches generated three main themes containing seven subthemes. Main themes were: No 'real' family, A co-created relationship, and Time. Participants related to a norm for what a 'real' family is and seemed to presuppose that the biological family is the 'real' family. A co-created relationship related to No 'real' family as an answer or a solution. The challenges in the foster family constellation could be overcome by a mutual ambition to build a relationship and by liking each other. Time appeared as a common theme and both as an opportunity and a threat to the relationship. Despite the fact that no interview question concerned the duration of the relationship, the participants described their relationship based on how long they had known each other. Conclusions: According to the foster childrenâs and young peopleâs self-ratings, their mental health improved, and their social problems decreased. It is likely that the TBF-model contributed to this improved psychological well-being, although causal relationships could not be established without any comparison group. However, the model did not seem to contribute to the foster parents experiencing improvement in the foster childrenâs psychological well-being or adaptive functioning. Based on the results of this thesis, it may be effective to place children and young people in specialized foster care with a relational and mentalization-oriented focus, but the results are not clear-cut. Practice and policies should take greater account of the time aspect in foster care, and work with the aim of increasing clarity and security, and thereby enabling a more stable upbringing for some of societyâs most vulnerable children. Also, this may make foster parents want to continue their mission. More studies are needed to gain knowledge about how specialized foster care should be applied. Future studies also need to focus on creating knowledge about which aspects of the treatment are decisive.Familjehemsplacering Ă€r en förhĂ„llandevis vanlig Ă„tgĂ€rd nĂ€r förĂ€ldrar inte kan tillgodose sina barns behov. Specialiserad, mycket förstĂ€rkt, familjehemsvĂ„rd anvĂ€nds ibland i de fall dĂ„ problemen Ă€r mer allvarliga och komplexa. Det behövs mer kunskap om effekterna av sĂ„dana insatser. Syftet med denna avhandling har varit att utforska förĂ€ndringsbanor förknippade med mycket förstĂ€rkt familjehemsvĂ„rd i en relationsinriktad och mentaliseringsbaserad behandlingsmodell, och att utveckla förstĂ„elsen för familjehemsplacerade barns och deras familjehemförĂ€ldrars upplevelser av sin relation i en behandlingsfamilj. Barn och unga i Ă„ldrarna mellan 5 till 20 Ă„r som fĂ„tt behandling inom en mycket förstĂ€rkt familjehemsmodell, Treatment By Foster care (TBF), deltog i denna studie. Longitudinella data som samlats in i en naturalistisk miljö analyserades kvantitativt. I studierna 1 och 2 varierade antalet deltagare vid baseline för olika instrument mellan 76 â 105. Achenbach System of Empirically Based Assessment (ASEBA) anvĂ€ndes för att mĂ€ta hur psykiatriska symtom förĂ€ndras ur de familjehemsplacerade barnens, familjehemsförĂ€ldrarnas och lĂ€rarnas perspektiv. Adaptive Behaviour Assessment System â second edition (ABAS-II) anvĂ€ndes för att mĂ€ta adaptiva fĂ€rdigheter ur familjehemsförĂ€ldrarnas perspektiv. Barnen och ungdomarna skattade sina emotionella och sociala problem med Beck Youth Inventories of Emotional and Social Impairment (BYI). Data om upplevelser av relationen mellan familjehemsplacerade barn och familjehemsförĂ€ldrar samlades in genom upprepade individuella korta intervjuer/tal med bĂ„de barn och deras familjehemsförĂ€ldrar enligt Five Minute Speech Sample (FMSS) (n = 14). Intervjuer/tal analyserades med tematisk analys (TA). Resultaten visade att barnens och familjehemsförĂ€ldrarnas skattningar skilde sig Ă„t. Analyserna visade en signifikant minskning av psykiatriska symtom, kĂ€nslomĂ€ssiga och sociala problem enligt barnens och ungdomarnas sjĂ€lvskattningar. Enligt familjehemsförĂ€ldrar och lĂ€rare minskade inte de psykiatriska symtomen. Skattningar vid baseline av adaptiva fĂ€rdigheter visade att de skattade adaptiva fĂ€rdigheter betydligt lĂ€gre Ă€n för jĂ€mnĂ„riga frĂ„n den svenska icke-kliniska normgruppen. Adaptiva fĂ€rdigheter förbĂ€ttrades men inte tillrĂ€ckligt för att nĂ€rma sig eller komma ikapp jĂ€mnĂ„riga. Analysen av intervjuerna/talen genererade tre huvudteman innehĂ„llande sju underteman. Huvudteman var: Ingen 'riktig' familj, En samskapad relation och Tid. Deltagarna relaterade till en norm för vad en 'riktig' familj Ă€r och verkade förutsĂ€tta att den biologiska familjen Ă€r den 'riktiga' familjen. En samskapad relation relaterade som ett svar eller en lösning till Ingen 'riktig' familj. Utmaningarna i familjehemskonstellationen kunde övervinnas genom en ömsesidig ambition att bygga en relation och genom att man tycker om varandra. Tid framstod som ett Ă„terkommande tema och bĂ„de som en möjlighet och ett hot mot relationen. Trots att ingen intervjufrĂ„ga gĂ€llde relationens varaktighet beskrev deltagarna sin relation utifrĂ„n hur lĂ€nge de kĂ€nt varandra. Sammanfattningsvis förbĂ€ttrades barnens och ungdomarnas psykiska hĂ€lsa och deras sociala problem minskade enligt deras sjĂ€lvskattningar. Det Ă€r troligt att TBF-modellen bidrog till deras förbĂ€ttrade psykologiska vĂ€lbefinnande, Ă€ven om orsakssamband inte kunde faststĂ€llas utan nĂ„gon jĂ€mförelsegrupp. Modellen verkade inte bidra till att familjehemsförĂ€ldrarna upplevde att barnen förbĂ€ttrades vad gĂ€ller psykiskt vĂ€lbefinnande eller adaptiva fĂ€rdigheter. UtifrĂ„n resultaten av denna avhandling kan det vara verkningsfullt att placera barn och ungdomar i mycket förstĂ€rkt familjehemsvĂ„rd med en relations- och mentaliseringsbaserad inriktning, men resultaten Ă€r inte entydiga. Praxis och policier bör ta större hĂ€nsyn till tidsaspekten vid familjehemsplaceringar och arbeta för att öka tydlighet och trygghet, och dĂ€rigenom möjliggöra en stabilare uppvĂ€xt för nĂ„gra av samhĂ€llets mest utsatta barn. Detta kan ocksĂ„ fĂ„ familjehemsförĂ€ldrar att vilja fortsĂ€tta sitt uppdrag. Fler studier behövs för att fĂ„ kunskap om hur insatser och behandling i familjehemsvĂ„rd bör tillĂ€mpas. Framtida studier behöver ocksĂ„ fokusera pĂ„ att skapa kunskap om vilka aspekter av behandlingen som Ă€r avgörande
Effects of Mentalization-based Interventions on Mental Health of Youths in Foster Care
Knowledge about the development of mental health in young people in foster care is limited. This naturalistic study examined the effects of a relational and mentalization-focused treatment in foster families in Sweden on the placed young peopleâs mental health. The Achenbach System of Empirically Based Assessment (ASEBA) was used to measure change in psychiatric symptoms. Self-ratings showed significant improvements and medium to strong effects after 24 months in both boys and girls. No significant changes were found in the foster parentsâ ratings or in the school staffâs ratings. Foster parentsâ ratings suggested that girlsâ behavioral problems decreased, but not the boysâ. Based on these findings, we want to emphasize the importance of evaluating treatment effects using self-ratings by the young people in addition to parentsâ and parent substitutesâ ratings