Respond to your colleague Provide at least two additional treatment strategies that could be used with this client and at least one additional cultural influence that you think should be considered. Explain your responses.
Introduction
The United States Department of Health and Human services, reported that about 408,425 children and adolescents were in foster care in 2010 (Sadock, Sadock & Ruiz, 2014). Many children in foster care are said to have experienced multiple traumatic events which is the primary reason for their removal from their biological parents. A study estimated that about 26% of children in the United States around the age of four years will experience a traumatic event (Sadock, Sadock & Ruiz, 2014). Foster care is designed to be a temporary care for children outside of their home in which their immediate families are unable to care for them.
Psychological Issues with Foster Care
Alcohol, drug abuse in parents, neglect and abuse by parents, mental or cognitive or health problems, low socioeconomic status, and low social support are all family risk factors for placing a child in foster care (Sadock, Sadock & Ruiz, 2014). The child’s psychiatric and mental issues may also be a reason for the placement (Sadock, Sadock & Ruiz, 2014). About 40% of children who went home from foster care end up going back to foster care. These children struggle with problems such as neglect, abandonment, rejection, physical, emotional and sexual maltreatment (Sadock, Sadock & Ruiz, 2014). Early child abandonment, and neglect can cause excessive interpersonal concerns, including feelings of loneliness, weakness, helplessness and fears of abandonment. Attachment issues are common amongst these group due to the fact that they did not have the opportunity to form a secure attachment with consistent nurturing figures in early life (Sadock, Sadock & Ruiz, 2014). Children who are transferred from one foster home to another usually end up with compromised emotional attachments, and a lifelong trust issue. Children with past experiences of traumatic physical and sexual abuse often end up becoming impulsive, aggressive, hypervigilant, oppositional, and mistrustful (Sadock, Sadock & Ruiz, 2014).
The Most Effective Assessment Measure Used
Children in foster care experience higher levels and rates of psychosocial difficulties than children who are not. The Brief Assessment Checklists for Children (BAC-C) and Brief Assessment Checklists for Adolescents (BAC-A) are used to screen for and monitor attachment- and trauma-related difficulties among children in foster care (Goemans, 2018).
Treatment Options for Children and Adolescents Involved With
Foster Care
About 80% of children and adolescents in the welfare system have developmental, behavioral, or emotional issues requiring mental health treatment which has led to increasing trend in the use of psychotropic medications, specifically increased use of antipsychotics, antidepressants, and attention-deficit/hyperactivity disorder medications, increased polypharmacy, increased medication use in young children (Lee, Fouras & Brown, 2015).
Treatment options for children and adolescent in foster care include: Parent–Child Interaction Therapy (PCIT), an evidence-based treatment for disruptive behavior disorders focused on improving the quality of the parent–child relationship and changing parent–child interaction patterns. Cognitive-behavioral therapy (CBT), an evidence-based treatment is also used for improving relationships between children and caregivers in families involved in physical coercion or force and chronic conflict or hostility. Trauma-focused cognitive-behavioral therapy (TFCBT), an evidence-based treatment originally developed for posttraumatic stress symptoms resulting from childhood sexual abuse, has also been applied to posttraumatic stress symptoms related to other traumas. Multidimensional treatment foster care (MTFC), an evidence-based, intensive, community-based treatment has been adapted for youth involved with the child welfare system in need of out-of-home placement. It provides behavioral parent training and intensive support for MTFC foster parents, family therapy for the biological family, skills training and supportive therapy for youth, and school-based behavioral interventions and academic support (Lee, Fouras & Brown, 2015). In addition to being knowledgeable about effective treatments, NP’s should be aware of interventions with risk of harm (Lee, Fouras & Brown, 2015). The NP should follow professional practice guidelines for the treatment of identified psychiatric disorders in children and adolescents involved with the child welfare system.
Influence of Culture on The Treatment of Foster Care Children.
In addition to reviewing and assessing health needs and following through with recommendations to assess these needs, NP’s must also consider multiple cultural factors specifically, the culture of the family of origin. Children enter foster care based on extreme adversity thus, the foster child emerges from a family of origin immersed in a culture of adversity (McGuinness & Broome, 2007). When these children leave the only family environment known to them to enter a foster family, cultures often collide. Therefore, NP’s working with children from foster care should understand that the culture of adversity is the primary culture of the foster child (McGuinness & Broome, 2007).
References
Goemans, A., Tarren-Sweeney, M., van Geel, M., & Vedder, P. (2018). Psychosocial screening
and monitoring for children in foster care: Psychometric properties of the Brief Assessment Checklist in a Dutch population study. Clinical child psychology and psychiatry, 23(1), 9–24. https://doi.org/10.1177/1359104517706527
Lee, T., Fouras, G., & Brown, R. (2015). Practice Parameter for the assessment and management
of youth involved with the child welfare system. Journal of the American Academy of Child & Adolescent Psychiatry, 54(6), 502-517. Retrieved from https://www.jaacap.com/article/S0890-8567 (15)00148-3/pdf
McGuinness, T. M., & Broome, B. (2007). The culture of adversity: youth in foster
care. Urologic Nursing, 5, 441.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
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