Date of Award

12-2023

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Rob Lyerla, PhD

Second Advisor

Ben Atchison, PhD

Third Advisor

Mark Sloane, DO

Fourth Advisor

Richard Kagan, PhD

Keywords

Child welfare, congregate care, trauma screening, trauma-informed care

Abstract

The placement of foster care children into congregate care (CC) facilities has been debated regarding whether CC can provide safety and healing, or if it is harmful and retraumatizing to children. In recent years CC has come under scrutiny due to high per diem costs and increasing reports of abuse and even death of children. In response, the federal Families First Prevention Services Act (FFPSA) was enacted in 2018 with a goal of reducing the number of children in CC. Since then, efforts have been implemented nationwide to achieve this goal. This study explored the value of statewide trauma screening (CTAC- TSC) for children in foster care as a potential predictor of future CC placement. The CTAC-TSCs were completed by the child’s caseworkers. The sample consisted of 444 children between the ages of 13 and 18 that received a trauma assessment between 2018 and 2022 with males (226) and females (218) represented almost equally. Two hundred eighty-five children were in community-based foster care and 136 children were in CC.

Three research questions directed the study and analysis; 1) Do children placed in CC have a greater number of different traumatic events endorsed on the CTAC-TSC than children in community foster care placement? 2a) Are the total number of symptomology endorsements on the (CTAC-TSC) different for children in CC compared to children who are in community foster care? 2b) Are the total number of overall endorsements (traumatic events and symptomology) on the (CTAC-TSC) different for children in CC placement compared to those who are in community foster care? 3) Is there a grouping of traumatic events and behavioral, emotional, educational, and relational/attachment difficulties that increase the likelihood of CC placement compared to those who are in community foster care? Quantitative analyses were conducted including T-Tests, ANOVA, Chi-square, and Logistic Regression.

Analysis revealed no significant differences in the number of traumatic events endorsed between those in community-based foster care and those in CC (p= 0.653). There were significant differences in the total number of behavioral, emotional, relational/attachment, and educational symptoms with children in CC having statistically more endorsements (p =<.0.001) than children in community-based foster care. There were also significant differences in the overall endorsements (traumatic events and symptomology) between children in CC and children in community-based foster care (p=0.001). Sexual abuse and/or sexual exposure, physical abuse, and frequent/multiple moves increased the likelihood of children being placed in CC. Specific symptoms of trauma exposure also increased the likelihood of CC placement including; aggression toward others, aggression toward self, and sexual behaviors not typical for child’s age. Intense anger, lack of appropriate boundaries, and difficulty with authority and/or frequent behavioral referrals also increased the likelihood of CC placement.

The findings provide child serving systems and caseworkers utilizing the CTAC-TSC with tangible predictors that increase the risk of CC placement. Consequently, case planning can target specific traumatic events and symptomology to provide proactive interventions designed to reduce traumatic impact and facilitate resiliency to reduce the risk of CC placement.

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Dissertation-Open Access

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