Improved Foster Care Reduces Risk of Adult Mental and Physical Illness

In the first controlled follow-up study ever to examine the long-term health effects of foster care programs, researchers from Harvard Medical School showed that the extremely high rates of mental and physical disorders typically found among adult alumni of public foster care programs were significantly reduced among alumni of a private foster care program staffed by highly trained social workers with low caseloads and good access to quality services.

The study followed 659 foster care alumni into adulthood more than a decade after they left foster care. To make the comparisons meaningful, a control group of state-run public system alumni was created consisting exclusively of those eligible for, but not selected for, the private program because of limited openings. The most dramatic differences were approximately 50 percent reductions in rates of adult major depression and substance use disorders among private program alumni compared to the control group of public program alumni.

These findings were published in the June 2008 issue of Archives of General Psychiatry.

According to Ronald Kessler, Professor of Health Care Policy at Harvard Medical School and lead author on the study, “Concerns have been raised by many child welfare advocates that the $24 billon per year US child welfare system is at a crossroads for reform. The system has expanded dramatically in the past two decades, with nearly 800,000 children currently in foster care each year, more than 1 percent of all US children, over twice the number served two decades ago.”

Calls for system redesign to improve care have resulted in a number of public and private agencies developing foster care programs that offer higher quality services, lower caseloads, and higher salaries for workers. Until now, however, researchers have never systematically evaluated whether these program quality improvements make a difference to youth outcomes. “The results of this study show clearly that they make an enormous difference,” says Kessler.

The study was carried out among alumni of foster care programs in the states of Oregon and Washington in collaboration with state agencies in Oregon (i.e., the Department of Human Services; Children, Adults and Families; Community Human Services) and Washington (i.e., the Department of Social and Health Services, Children’s Administration, Division of Children and Family Services) and Casey Family Programs (a private operating foundation providing foster care services).

Case record files were used to select adolescents (14 to18 years of age) who were in either the public or private programs in Oregon and Washington between 1988 and 1998. Over 80 percent of alumni were traced up to 13 years after leaving care and 92.2 percent of those traced were interviewed. Post hoc matching of public program alumni to private program alumni, and of follow-up survey respondents to non-respondents was done based on information abstracted from case record files.