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Science and the Potential for Policy Change
CHORI Investigator Receives Competitive CPAC Grant to Study the Impact of Foster Care in the Adult California Population

CHORI principal investigator Cheryl Zlotnick, RN, DrPH, has just received a competitive California Program on Access to Care (CPAC) grant in order to extend current research on the impacts of the foster care system on adult health and well-being.

"Many, many studies have shown that a significant proportion of adults who are homeless have a history of being in foster care," says Dr. Zlotnick. "The problem is that we don't know much else. This will be the first study to look for potential associations of being in foster care on an adult population rather than on adults who are homeless. It's filling in a major gap in our knowledge."

California as a state leads the numbers of children in foster care, with nearly a third of the over 250,000 children who enter foster care residing within its borders. As a result, California is fertile ground for Dr. Zlotnick's research; in addition, Dr. Zlotnick's data comes from the 2003 California Health Interview Survey (CHIS), an absolutely ideal data set on which to conduct her secondary analyses.

"What makes the CHIS survey so unique is that they go to a lot of trouble to include minority populations in the data - Asian populations, Latinos, African Americans - even providing surveys in multiple languages."

The 2003 CHIS yielded over 27,000 adults who answered the question as to whether or not they had ever been in foster care and will provide Dr. Zlotnick, and the colleague with whom she'll be working, Tammy Tam PhD, with a much larger picture of the potential impact of childhood foster care on adulthood emotional and financial stability than has ever been revealed.

"The big thing we're trying to identify is whether having this one experience of being in foster care results in a life course outcome," explains Dr. Zlotnick.

While there is already a myriad of data illustrating that children who have gone through foster care have more physical and emotional problems, if Dr. ZLotnick's study identifies a correlation between the foster care experience itself and adult well-being, the study could have significant impact on foster care policy.

"That will mean we'll have to think very carefully about our foster care system and what we can do to ameliorate its problems - how we take children away from their birth parents, for example, how we explain it to them, how we assess the children's physical and mental needs, and whether we're doing anything about those needs once they're identified," Dr. Zlotnick says.

While some children have good experiences in foster care, many times, children are traumatized from the experience of being removed from their parents and entering a stranger's home. Yet most children receive little help with the transition into foster care and no mental health treatment for the trauma. Currently, different counties in California all have their own different protocols for addressing the individual needs of these children - if their needs are addressed at all - and have very limited funds to do so.

"Assessments for every child would take serious funding - you need someone to assess the child and then you have to be able to conduct whatever interventions and follow-up are needed," says Dr. Zlotnick.

But the costs may be hitting the government in spending elsewhere, in homelessness, substance abuse, hospitalization and mental health problems of the adults who have histories of multiple foster care placements. Dr. Zlotnick's study, however, has the potential to shift policy from treating the problems that manifest in adults to a preventative approach in which early interventions are provided for children as they enter foster care.

"The science is in understanding," says Dr. Zlotnick. "If we can understand what the problems are in adulthood that are associated with the foster care experience, then we have the opportunity to help these populations earlier within the foster care system, before the problems take root."

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Monday, May 16, 2011 11:33 PM

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