Psychological correlates of mental health outcomes in looked after preschool children

Abstract

Background: Children who enter foster care usually do so because of maltreatment by their birth families. Early adversity such as this is associated with many negative outcomes, including disturbances of attachment and mental health in childhood and throughout the lifespan. Young children (under 5) are particularly at risk due to maltreatment rates being highest in this age range, and because of the vital brain development that occurs during this time. Improving the quality of existing relationships for young children is the most cost effective way to improve mental health outcomes. It is important that research investigates which relational and psychological variables that exist within the foster carer-child relationship may be protective against developing negative mental health outcomes, so as to inform carer training and future interventions for this vulnerable group. Aims: The aims of this research project were twofold. The first aim was to systematically review the existing literature on links between foster carer psychological variables (such as commitment to their foster child), and/or child psychological variables (such as their attachment style), and the mental health outcomes of children in foster care. The second aim was to investigate whether foster carer acceptance, commitment, awareness of influence and reflective functioning (RF) predict the mental health outcomes of Scottish preschool aged children who are looked after in foster care. Method: A systematic review of the existing literature was undertaken to address the first aim. The search strategy resulted in 12 quantitative studies that investigated links between child or carer psychological variables and child mental health outcomes. An empirical study of 179 pre-school aged children in foster care in Scotland was carried out to address the second aim. Participants were taking part in a wider RCT of a novel intervention to improve outcomes and permanency decisions for children in foster care. Foster carer acceptance, commitment, and awareness of influence was assessed using the This Is My Baby Interview, and scores of RF were coded from the transcripts of this interview using a computer-based algorithm. Child mental health information was gathered using the Infant Toddler Social Emotional Assessment. Data was gathered at 2 time points; baseline assessments occurred around 4 weeks after entry to care, and follow-up assessments were carried out a year later. Results: The systematic review found good evidence that foster child attachment security is linked to more positive mental health outcomes. It also found some evidence suggesting that foster carer psychological variables such as commitment and quality of caregiving also relate to child mental health outcomes, but this research is in its infancy and it is therefore difficult to draw firm conclusions around this. The results of the empirical study showed that carer commitment and awareness of influence predict child competence at baseline, and RF predicts internalising and externalising problems at follow up. No predictive relationships were found between carer variables and child mental health over time. Conclusion: The results from both studies suggest that carer psychological variables such as commitment to their foster child may relate to child mental health development. These results have implications in terms of foster carer training, and for intervention development for this vulnerable population. This research is however in its infancy, and the results suggest a complex picture with regard to carer psychological variables and child mental health. Large-scale high quality longitudinal research is needed to provide a clear understanding of these relationships.