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Sidney Carlson

IR I / 10 / GT /3
Jan. 21, 2020

Annotated Source List

Chan, Vivien, et al. “Transitional Age Youth and College Mental Health.” Child and Adolescent
Psychiatric Clinics of North America, vol. 28, no. 3, July 2019, pp. 363–75.

In this journal article, the researchers used an integrated case formulation model to discuss
the treatment of depression in transitional aged youth. They use the biopsychosocial model case
formulation and where it intersects with the four Ps (Predisposing, Precipitating, Perpetuating,
Protective) to develop a treatment plan. As psychiatrists are at the forefront of recognizing young
adulthood, transitional age, as a distinct developmental stage which requires unique approaches
to diagnose and treat mental health issues. Social considerations (culture, self, identity,
educational and vocational success, access to care), psychological considerations (insight,
trauma, emotional development and regulation, biological considerations (brain development,
neurovegetative symptoms) are discussed in depth with references to prior studies. They advise
child and adolescent psychiatrists to provide anticipatory guidance, treatment, resources, and life
skills through a developmental lens.
The strength of the article is heavily referenced and thorough mental health considerations
of the transitional age youth. The extensive references provide helpful information for health
care providers to use in the treatment of this population. It puts into context the mental health
needs of everyone in the young adult population. However, it is not specific to the foster youth
population aging out of the system, and the approach would need to be extrapolated to them
without specific data regarding benefit in their population. There is no bias, as everything is
supported with repeated trials and evidence. This source proves that it is difficult for transitional
age youth to pursue higher education, making it extremely beneficial for this topic.

Clemens, Elysia V., et al. “The Relationship between School Mobility and Students in Foster
Care Earning a High School Credential.” Children and Youth Services Review, vol. 68,
Sept. 2016, pp.193–201.

This journal article describes a study that sought to address three goals regarding school
moves for foster youth. First, the school moves for this population were characterized in terms of
type, timing, and distance between school districts. Then, this was compared with non-maltreated
children of similar age and socioeconomic status without a history of foster placement. Second,
they examined whether early elementary school moves mediated the effects of foster placement
on late elementary school outcomes, particularly when the children’s earlier behavior problems
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and learning skills were considered. Third, the study investigated whether children’s levels of
skills or behavior problems at the school influenced the extent to which school mobility affected
their subsequent school outcomes. It found that a greater number of early school moves were
associated with poorer social-emotional competence and partially mediated the effects of
maltreatment and out-of-home placement for children. However, this was only true for children
with poorer early learning skills in kindergarten. This study used prospective longitudinal data
from caregivers, schools, and child welfare records which allowed the researchers to follow the
mobility of the children across districts and states. Because they had information on the
children’s behavior prior to school, they were able to correlate baseline behavior with later
school adjustment.
This journal article moves the bar forward, building on the studies which preceded it that
demonstrated that early childhood adversity has effects on later childhood development. This
study had the advantage of comparing children in foster care with non-foster care children with
similar levels of adversity. This is a prospective study meaning the researchers followed the
children over time. As a result, no data was lost, giving the researchers no room to involve bias.
Limitations of the study include incompleteness of school records, a lack of diversity, and
inability to separate out school mobility from placement changes. Nevertheless, the data can still
be used to prove that more school moves lead to poorer social-emotional competence, later,
showing that foster youth are at a disadvantage when alone as an adult.

Felitti, Vincent J., et al. “Relationship of Childhood Abuse and Household Dysfunction to Many
of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE)
Study.” American Journal of Preventive Medicine, vol. 14, no. 4, May 1998, pp. 245–58.

This journal article shows a study that marks the beginning of the research on adverse
childhood events. The principle investigator based it on a high dropout rate of women in a
weight loss program and what they had in common was childhood trauma. The hypothesis was
that weight gain was a coping mechanism for depression, anxiety and fear resulting from their
childhood experiences. 26,000 members of Kaiser HMO were sent a survey asking their
experience with childhood trauma. They received over 17,000 responses from mostly well
educated, middle aged women. The study found that childhood adverse events were common,
often occur together, and are associated in a dose dependent manner with health problems later in
life, including several of the leading causes of death.
This study is exceptional in that it inspired the growth of research into how adverse child
events effect outcomes. Its strength is the large number of participants and access to their
medical records to document health outcomes. Its weakness is that it is a self-reported,
retrospective study based on a questionnaire that can only demonstrate associations, but not
causes of poor health outcomes. This can be used as background information. It is important to
acknowledge the sources that are used in future literature. There is no bias, as every claim is
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supported with evidence and there is no emotional syntax. In the paper, this study proves the
dose dependent response hypothesis and that adversity leads to future health issues.

Fishbein, Diana. Personal Interview. 30 Nov. 2019.

This interview was with Diana Fishbein who is the Professor of Human Development and
Family Studies at Penn State College of Health and Human Development and director of a
national coalition. Overall, the effects of stress and adversity are discussed. Stress is seen as a
final common pathway that causes neurological issues. Physiological and neurobiological effects
of stress are the ways the body and the mind process adversity. Resilience is a factor that can
help mitigate the negative effects of adversity. Interventions like the Positive Alternative
Thinking Strategy (PATHS) are crucial to building resilience in children, as it has
mindfulness-based and teaches kids to regulate their emotions. When testing interventions for
effectiveness, researchers look to the data. In data collection studies, effect sizes, which indicate
the extent to which kids are responding, determine statistical significance. Even with relatively
low or modest effect sizes, the intervention being tested can still miss most people that are not
responding well. Interventions do not just apply to infants and young children. The brain does
not completely coalesce until the late twenties, which means that the period of development from
childhood into adolescence is much more protracted than many ever realized. The brain is still
very dynamic, it is still developing very rapidly, and is still very sensitive to environmental input.
Program components are specifically targeted toward them in a developmentally appropriate
way, so kindergarteners and fifteen-year-olds do not receive the same interventions; it must be
much more sophisticated and detailed, very appropriate for them at their developmental stage.
This interview effectively communicates the importance of early interventions, making it
very useful when proving how much foster youth need more support. All information
corresponds with other sources like the topic. No bias is heard. Mrs. Fishbein’s statements were
backed up by science and her experiences. This source can be used to support the claim that
foster youth lack the proper interventions to mitigate the effects of adversity, as many are not put
into the system early enough and some face neglect in it. Compared to other sources, this
interview is very different as it directly answers this researcher’s questions and is first-hand
research.

Fisher, Philip A., et al, “Effects of Therapeutic Interventions for Foster Children on Behavioral
Problems, Caregiver Attachment, and Stress Regulatory Neural Systems.” Annals of the
New York Academy of Sciences, vol. 1094, 2006, pp. 215–25.

This journal article does three main things that evaluate children in foster care. First, it
synthesizes prior human and animal research on the neurobiology of early adversity. Second, it
applies a model that involves caregiver-based interventions in foster care. Third, it describes the
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elements of the model and shows how ongoing trials evaluate the effectiveness of the
interventions. The neurobiological pathway that this preclinical research focuses on is the
hypothalamic-pituitary-adrenal (HPA) axis, which is activated in response to stressors. As a
result, a cascade of hormones is released. Corticotropin stimulates the release of
adrenocorticotropic hormone which enters the bloodstream, ultimately stimulating the release of
cortisol in the adrenal cortex. The article goes on to describe the negative effects of these
glucocorticoids and the pathways it impacts. It presents the idea that the first 1-2 weeks of life
appear to have the greatest impact on the development of the HPA axis. An explanation for this
is found in rodents. During the first 1-2 weeks, extensive GR gene methylation is occurring that
is associated with maternal actions. Methylation results in being inactivated and unavailable for
stress modulation in the absence of maternal care. The source provides results to studies. Rates if
atypical HPA axis activity is higher in foster children than in the general population. From two
different experiments, results found that caregivers must detect signals of distress from the child
early on and should consistently respond to negative/positive behavior. Overall, the caregiver is
an extension of the infant’s regulatory system whose actions protect the infant from the effects of
stressors, thus, promoting resilience.
This journal article is very informative, providing immense detail on the HPA axis and
possibilities for foster care interventions. This researcher can use the source to focus her topic on
children in the foster care system. It presents unique information from experiments. This source
demonstrates a lack of bias, as there are many references and no emotional syntax. The only
issue would be that it involves infants and toddlers, while this researcher wants to focus on teens
and young adults. Nevertheless, the information can still apply to people who went into care at a
very young age and stayed in until emancipation. Additionally, this article describes attachment
to caregivers, behavior, and stress which applies to foster youth of all ages. It is an older source,
but the information is still valid. Overall, this is a great source and will be used again to prove
the importance of early interventions and the seriousness of caregiver interactions with children
in the foster system.

Fowler, Patrick J., et al. “Homelessness and Aging Out of Foster Care: A National Comparison
of Child Welfare-Involved Adolescents.” Children and Youth Services Review, vol. 77,
June 2017, pp. 27–33.

This journal article describes the first large scale, prospective study to determine if aging
out of the foster system contributes to homelessness risk in emerging adulthood. Two policies in
place to aid in the transition to adulthood (The Independence Living Program of 1986 and
Fostering Connections to Success and Increasing Adoption Act of 2008) have not been proven to
be effective at improving the outcomes of foster youth. In this study, a nationally representative
sample of adolescents followed by the child welfare system from the second cohort of the
National Survey of Child and Adolescent Well-being Study (NSCAW II) report of housing
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difficulties at 18 and 36 months of follow-ups. Housing problems were subdivided into literal
homelessness, unstable housing, and stable housing. Youth who reunited with their families had
the lowest probability of literal homelessness, but overall youth who aged out of foster care had
the same rate of literal homelessness as youth who were investigated by child welfare but never
placed out of home. No difference was noted between groups with unstable housing. Exposure to
independent living services and extended foster care did not prevent homelessness.
Multiple studies link aging out of foster care to homelessness, with 20% to 30% of
transitional youth experiencing some period of homelessness. This study is more complete
because it is not geographically limited and it compares the data from other at-risk youth,
formerly involved with child welfare, but who were not in foster care. The best thing about the
study is that it uses the only national database of children involved with child welfare and that it
was able to clearly document the risk of homelessness. Unfortunately, no benefit was seen with
our current policies to prevent homelessness in the population aging out of foster care. A
limitation of the study is that the policies are not utilized uniformly in all states and may be
helpful in when they are administered as designed. There is no bias, as the authors state that there
are no conflicting interests. This source can be used in the paper to prove that homelessness is a
reality for many foster alumni.

Franke, Hillary A. “Toxic Stress: Effects, Prevention and Treatment.” Children, vol. 1, no. 3,
Nov. 2014, pp. 390–402.

This article describes toxic stress and its impact on long-term health effects on children
who experience it. Childhood toxic stress is severe, prolonged, or repetitive adversity with the
lack of caregiver support to prevent an abnormal stress response. Toxic stress response occurs by
neurologic, endocrinologic, and immune system pathways that are implicated in long term
physical health, mental health, and societal outcomes. Large studies are presented showing
correlation of the number of adverse childhood experiences with health problems. The more
adversity, the more health issues in the future. The pediatrician may be best suited to screen for
toxic stress in the appropriate at-risk children and provide resources and recommendations to the
caregiver to offer support which has been found to reduce damage to the child. Interventions
studied in the literature to remedy toxic stress for children, families, communities are examined.
Raising national awareness is discussed due to the burden of toxic stress on society.
This article offers a thorough review of toxic stress, how it affects children, and
interventions shown to prevent problems. A few of the reference articles are dated from
1976-1996, but most are recent and published in well respected, national journals. There is a
good mix of basic science articles and clinically relevant medical and psychiatric literature.
There is no bias presented, as the author claims that there are no conflicting interests. This source
can be used to show the state the children are in preceding care. Additionally, it proves that foster
youth may have issues later due to early life stress.
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Herzog, Julia I., and Schmahl, Christian. “Adverse Childhood Experiences and the
Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the
Lifespan.” Frontiers in Psychiatry, vol. 9, Sept. 2018.

This journal article discusses the impact of adverse childhood experiences [ACE] on
neurobiology, mental and somatic health in later adulthood. This qualitative review presents a
concise overview of the present literature on this subject. Individuals with ACE appear to be at a
higher risk for developmental issues. Moreover, ACEs affect psychological and psychosocial
mechanisms known to contribute to mental disorders, causing disturbances in cognitive and
affective processing. These alterations are shown in the anterior cingulate cortex [ACC],
amygdala, and hippocampus through functionality. Nevertheless, morphological changes like a
volume increase of the amygdala and volume decrease of the hippocampus are seen. The
amygdala, hippocampus, and ACC are especially vulnerable to ACEs due to a high density of
glucocorticoid receptors. Moving on, this article demonstrates that specific ACEs target specific
sensory systems. For example, exposure to prenatal verbal abuse affects the arcuate fasciculus, a
region that interconnects the areas specialized in production and comprehension of human
language. Similarly, those who witnessed domestic abuse violence had an affected inferior
longitudinal fasciculus that interconnects visual and limbic systems. Somatic disorders such as
diabetes, inflammatory bowel disease (IBD), ulcerative colitis (UC), Crohn's disease (CD), and
obesity are prevalent in adults that experienced childhood adversity. Moreover, there is a
correlation between ACEs and increased levels of pro-inflammatory markers. Nevertheless, all
these effects depend on the type and timing of the ACE. The article concludes with the
suggestion that more longitudinal studies must be done to collect more accurate and concrete
data as well as validate the effect of certain variables like age and duration of maltreatment.
Overall, this journal article is somewhat helpful. It discusses the effects of ACEs which
encompasses the frame of study; however, it does not provide any new knowledge besides
vocabulary and a few minor ideas. The source is in no way bias since the author declared in a
statement that there is no conflict of interest or financial relationships to uphold. The article will
be used to support all the effects that external factors have on a child. For foster children, this can
prove that a large percent will have mental disorders that affect cognitive and affective
processing. As a result, barriers are placed on the transition into adulthood.

The Lancet Child and Adolescent Health. “Effects of Poverty on Child Development.” iTunes,
uploaded by The Lancet. 26 July 2017, www.podcasts.apple.com.

This podcast explains how difficult it is to study the effects of poverty on childhood
development. More than a deprivation of financial resources, poverty is correlated with other
exposures such as malnutrition, frequent infections, and higher levels of stress from financial
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hardship and psychosocial sources of stress. These exposures do not occur in an isolated fashion;
they interact with each other. All have been shown to be related to poor outcomes in cognitive
development. Furthermore, these biological factors and psychological stressors act both
independently and synergistically. Malnutrition, infection, and psychological stress work along
shared physiological pathways affecting neurological development. Cognitive development
varies for each child who grows up in poverty. There may be genes that provide protection and
others that incur risk. Environmental factors may also convey individual differences, for
example, how parents respond to some children. Another variable is the age of exposure,
maturational stage with respect to neural development affects how severe and what processes are
affected by a risk exposure. Prenatal and early postnatal development is often more severely
affected by risk relative to a child exposed later in life. There are three research approaches to
better understand the tangled interactions: subgroup analysis, randomized controlled studies, and
longitudinal studies. Identifying genes that confer risk or protection by studying populations
exposed to same risk and following their outcomes is a fourth approach. Finally, finding
biomarkers, physiologic evidence of an exposure which can be quantified in a measurable way
that can be followed, including nutrition, inflammation, and neuroimaging may help to study
these impacts on childhood cognitive development.
This podcast is helpful in that it explains how complicated the effects of poverty on child
development. It clearly explains how risk factors interact with each other, and how difficult it is
to assign outcome with a single risk factor of an impoverished child. It also explains the kinds of
studies that need to be done to understand the results of the individual risk factors. The weakness
of the podcast is lack of access to specific studies and reference articles from which the authors
base their conclusions. Nevertheless, there is no bias presented since the information is not
skewed in a manner to be for or against a topic; it is undoubtedly impartial. Connecting this to
foster care, many children who enter have experienced maltreatment that is or is very similar to
poverty. Additionally, the topics discussed in this podcast can be applied to foster youth. There
are many risk factors that affect foster youth that are very complicated and interconnected.

Lenroot, Rhoshel K., and Jay N. Giedd. “The Changing Impact of Genes and Environment on
Brain Development during Childhood and Adolescence: Initial Findings from a
Neuroimaging Study of Pediatric Twins.” Development and Psychopathology, vol. 20,
no. 4, 2008, pp. 1161–75.
This article touches on the gene and environment relationship in developing brains.
Understanding how these factors interact may help to identify how and when to intervene to help
children reach their fullest potential. Twins have long been used in research to study the heritable
factors in development. Brain structural features measured by neuroradiologic techniques are
being used to monitor development and changes after exposures. This article summarizes the
results from the ongoing National Institute of Mental Health child and adolescent twin study that
suggest that heritability of different brain areas changes over the course of development in a
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regionally specific fashion. Twins were enrolled nationally as part of a larger longitudinal study
of normal brain development. Following initial interview, physical examination, and baseline
testing, participants return for cognitive testing and MRI at two-year intervals. Initial studies
confirmed that all regions of the brain, minus the lateral ventricles and cerebellum, are largely
heritable, but highly variable with age. Determining how genetic and environmental factors
interact during development is essential to understanding the causes of psychopathology. Studies
have found that genetic risk increases depression after adverse life events in adults and
adolescent girls. Antisocial behavior occurs in children who have both genetic risk and adverse
life experiences. Maltreated children were more likely to develop behavioral problems if the also
had specific gene. Studies using brain structure to link genes and behavior will need to consider
age in the analysis, as certain developmental stages may affect it. Additionally, certain periods of
development appear more sensitive to the environment.
This article is a very thorough review of NIMH studies which demonstrate regionally
specific changes in heritability of brain structure and development. A strength of the paper is the
extensive list of references with great depth. A limitation of this review is that it assumes that
brain structure is equivalent to its function. No bias is presented, since every statement is backed
up by an extensive list of reliable references. Overall, this study is helpful since it proves that a
harsh environment, like the ones many foster children face, can have detrimental effects on
health.

Merrick, Melissa T., and Angie S. Guinn. “Child Abuse and Neglect: Breaking the
Intergenerational Link.” American Journal of Public Health, vol. 108, no. 9, Aug. 2018,
pp. 1117–18.

This journal article shows that children of parents who experienced adversity are also
likely to experience adversity. Violence, abuse and neglect are intergenerational and linked to
incomplete education and unemployment. Safe, stable, and nurturing relationships were found to
break the cycle of maltreatment and these relationships could be from community members other
than parents. This article focused on the data found with collaboration of the CDC and four
different research institutions. The findings provided needed evidence on the impact of
environment and the foundation for policies that enable safe, stable, and nurturing environments
for all children.
Strength of this article comes from the collaboration of the CDC with independent
research institutions studying a variety of populations. The results lead the way for government
policies that can change the lives of individuals, communities and society. The articles weakness
is that it described the original studies but did not clearly reference them, making it harder to
determine the bias possible in the individual studies. This source can be used to show that
policies that focus on nurturing maltreated children are necessary.
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Nguyen, Loney. Personal Interview. 10 Jan. 2020.

This interview was done with Loney Nguyen the Foster Youth Ombudsman for
Maryland. In it, the process a foster child must undergo when transitioning out of care as well as
the role that others play to assist him or her are examined. Further, the general issues that all
emancipated foster youth deal with were mentioned. These issues include a lack of permanency,
barriers in schooling, poor social and emotional well-being, absence of necessary resources, and
more. All cases are approached in a multidisciplinary team. There are people from all aspects of
the child’s life like therapists, social workers, family members, school representatives, resource
parents, etc. Certain milestones must be reached for all youth when becoming an adult; however,
if a foster child does not complete these tasks, caseworkers are not punished. Moreover, the
child’s case does not remain open if he or she is still in need of help. All foster youth are denied
more service when they are emancipated at either 18 or 21, depending on the state. Overall, there
is great ambiguity and variation in the system. All foster youth will have different paths when
leaving care. There are so many different populations in foster care that have their difficulties
and needs. There is no set course that these young adults can take; it all depends on the people in
their life, their education, and experiences in care. As a result, foster youth must go into the
world blindly.
This interview was very helpful in learning the basics about foster care emancipation.
Interviewing someone who is very experienced in the field helps make the aspects in other
papers and books more understandable. Her responses matched up with recent literature on the
subject, showing a correlation between sources and supporting this researcher’s claim. There
were many topics that she could not answer fully, as there are many different answers and she
did not have recent data in front of her. Her responses were quite vague, but there were pieces of
information that were new and interesting. Nguyen had a slight bias because she could not talk
very badly about a system that she works in, but she did think about both good and bad aspects.
This source is great to use as Nguyen had great insight and first-hand research. This researcher
will incorporate this interview into all parts of her paper, mainly in the section that discusses
resources.

Noll, Jennie G, and Idan Shalev. The Biology of Early Life Stress: Understanding Child
Maltreatment and Trauma. 1st ed. 2018. Cham: Springer International Publishing, 2018.

Psychological consequences of child maltreatment are the subject of chapter two in this
book. Evidence is presented associating childhood trauma with sensitization of the stress
response, glucocorticoid resistance, oxytocin activity, inflammation, reduced hippocampal
volume, and changes in cortical fields that are implicated in the perception or processing of the
abuse. Clinical studies are described which suggest that sensitization of the endocrine and
autonomic stress responses (via the hypothalamic-pituitary axis) and activation of
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pro-inflammatory pathways (via cytokines) may persist in people who had early childhood
trauma. Neuroimaging studies reveal structural and functional changes of the brain affecting
stress, emotions, and processing of experiences. Genetic studies reveal differences between
individual’s reactions to early life stress, listing several genes that may make certain people more
vulnerable to trauma and others more susceptible to interventions that mitigate the effects of
trauma. Molecular mechanisms, epigenetics of DNA methylation, histone modification, and
non-coding RNAs, are explained by which early environmental exposures can interact with DNA
to produce a vulnerable phenotype. The study of how genes interact with the environment will
enable the design of novel intervention strategies and for selecting individuals who may benefit
from them. Future longitudinal studies are needed to map the mechanics and timing of biological
changes resulting from early life stress as well as the ability to test interventions to counteract the
negative effects. Ultimately, what is learned of developmental plasticity may be used to help all
children optimize development, health, and longevity.
This book is very informative, providing immense detail on the neurological, epigenetic,
and clinical effects that result from childhood adversity. Further, it thoroughly reviews the
scientific literature of the field to date and is very recent. This is the first book in the researcher’s
source list. As a result, it presents more concrete information and references hundreds of other
studies. Because of this extensive list of references and lack of emotional tone in the writing, the
book does not contain any bias. It is very difficult to get information on the specific impacts of
ACEs since it is hard to test for; however, this book does an amazing job of providing as much
accurate data as possible. Overall, this is a great source and will be used again later to prove how
trauma leads to lasting changes, especially for children who experience immense amounts in the
foster care system.

Pecora, Peter J., et al. “Mental Health Services for Children Placed in Foster Care: An Overview
of Current Challenges.” Child Welfare, vol. 88, no. 1, 2009, pp. 5–26,
www.ncbi.nlm.nih.gov.

This journal article is an introduction to the special issue on best practices for mental
health in child welfare. It is based on the consensus guidelines created by the Casey Clinical
Foster Care Research and Development Project after the American Academy of Pediatrics and
Adolescent Psychiatry and the Child Welfare League of America formed a subcommittee to
determine guidelines for policy and best practices for the systems that serve foster children. The
article presents up to date statistics on the emotional, behavioral, and substance use disorders in
foster children and alumni, which are disproportionately high relative to the general population
and result in a financial and otherwise costly burden to society. Despite the high utilization of
health care services compared to community peers, 75% of children who came to the attention of
child welfare for investigation of child abuse or neglect and who clearly had impairment, had not
received mental health services in the 12 months following the investigation, demonstrating the
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tremendously high need and severe underutilization of services. The authors disparage the lack
of comprehensive mental health screening of all children entering foster care, the need for
identification of youth with emotional and behavioral disorders, and the insufficient access to
high quality mental health services. Evidenced-based practices are not being routinely utilized in
the foster care setting and guidelines on best practices need to be developed and implemented in
the child welfare program.
The strength of the article is the presentation of the results of the consensus guidelines
and abridged versions of the critical papers presented at the conference and used to generate the
consensus guidelines. Limitations of the article include the lack of detail regarding strategies that
may be promising to improve mental health access as well as integration into the child welfare
system. It is only an introduction to the other summaries in the series presented in the journal.
There is no bias being presented, as all claims are backed up with data. This researcher can
incorporate this source into her paper when discussing the challenges many foster youth face
when battling mental health issues along the challenges of being on his or her own.

Romano, Elisa, et al. “Adolescent Males in Out-of- Home Care: Past Adversity and Current
Functioning.” Developmental Child Welfare, vol. 1, no. 3, Sept. 2019, pp. 199–216.

This journal article interprets the findings from the Assessment and Action Record of 508
teenagers living out-of-home in Ontario, Canada. Adolescent males in out-of-home care have a
history of severe abuse and neglect, often with continued adversity and multiple victimizations
after removed from the home. Primary reasons for child welfare contact were in order of
prevalence: exposure to intimate partner violence (48%), neglect (24%), emotional abuse (13%),
physical abuse (13%), and sexual abuse (2%). It was discovered that adversity has
dose-dependent associations with psychological distress, mental health impairment, and fewer
resilient outcomes. Children and youth with maltreatment often experience impairments in
academic and mental health measures. This study revealed that neglect and emotional harm were
significantly associated with substance use. Surprisingly, the greater the number of maltreatment
types experienced by adolescent males, the greater the use of substances. Adolescent males were
at risk of continued adversity despite being removed from unsafe environments. In the future,
trauma-informed practices must address the child’s challenging emotions and behaviors through
the lens of their past maltreatment and adverse experiences rather than using strategies aimed at
behavioral control. Specifically, child welfare practitioners must regularly assess well-being,
safety, substance use, academic achievement, mental health, and the caregiver relationship, while
minimizing additional adversities (school transfer, suspension, additional maltreatment).
Overall, this journal article is extremely helpful and applicable to my topic. Compared to
other sources, this journal article is the first that interprets an experiment and data. There is no
bias since everything stated had a corresponding source and evidence from experiments. This
researcher can use the source to prove how ACEs affect a child later and the possible
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interventions. Additionally, it directly relates to the outcomes of foster youth. While it only
analyzes males, the data is still usable. Essentially, this source proves that children in the foster
care system face multiple adversities that lead to an increased risk for substance abuse.
Moreover, it was discovered that there are issues in the system like frequent moves and caregiver
relationships that contribute to poor outcomes later. Compared to other sources, this journal
article refers directly to foster children, making it especially useful for the paper.

Rubin, David M., et al. “The Impact of Placement Stability on Behavioral Well-Being for
Children in Foster Care.” Pediatrics, vol. 119, no. 2, Feb. 2007, pp. 336–44.

This publication studies the direct effect placement instability has on behavioral problems
of children in foster care, by removing the effect of baseline behavioral problems before entry
into the foster care system. They sampled 729 children who entered foster care in the NSCAW
report and divided them into groups based on their degree of baseline behavioral problems that
may put them at low, medium, or high risk of placement instability. They found that children in
foster care experience placement instability unrelated to their baseline behavioral problems, and
this instability has a significant impact on their behavioral well-being. This finding supports
efforts to find interventions that lead to placement stability as a mechanism to improve outcomes
for those in foster care.
The benefit to the study is that it provided the most compelling information available at
the time of publication that showed the risk of placement instability, independent of the child’s
baseline problems, on well-being for children in foster care. It showed that even children at low
risk of behavior problems at baseline had up to 63% increase in behavioral problems compared
with foster kids with stable placement. This supports efforts to come up with practices that will
improve placement stability. Limitations of the study include that it does not differentiate
between kin and unrelated placements and how that affects how stability affects future
well-being and that it is national data and may not be reproducible at the local level, where the
needs may be different. The authors claim that there is no conflicting interest, so no bias is
involved. In the paper, this can be used to prove that home instability hurts foster youth later
when they try to become independent adults.

Teicher, Martin H., and Jacqueline A. Samson. “Annual Research Review: Enduring
Neurobiological Effects of Childhood Abuse and Neglect.” Journal of Child Psychology
and Psychiatry, vol. 57, no. 3, 2016, pp. 241–66.

This journal article synthesizes neuroimaging findings and studies that describe the
neurobiological effects of childhood abuse and neglect. Further, this source provides preliminary
answers to questions regarding the importance of the type and timing of exposure, gender
differences, reversibility, and psychopathology. It discusses both stress-induced damages as well
Carlson 13

as adaptive modifications. Specifically, this section focuses on categories of maltreatment,


different hypotheses regarding maltreatment and brain development, and a morphometric
overview. In the morphometric overview, changes in the hippocampus, amygdala, cerebral
cortex, and cortical development are examined. Through comparing the major studies in this
field, the journal article demonstrates how specific these changes are. For example, some studies
showed that hippocampal volume decreased in maltreated children, while other studies showed
no change. This difference in data was all due to the type of adversity as well as the child's
gender, age, and genetics. Therefore, it is very difficult to make concrete claims about the impact
on the brain. Nevertheless, the limbic system, which includes all brain areas mentioned earlier,
possesses a high population of stress-hormone receptors. As a result, this system is very
susceptible to damage. Overall, fostering resilience is going to be the focus of future studies,
since many negative effects are apparent, even if the relationship is very complex.
This journal article is very informative, providing immense details on the limbic system
and many possible hypotheses. Since it includes an abundance of essential questions and a long
list of other studies, this source can guide this researcher in what ideas to cover in the paper. It
presents concrete information and references hundreds of other studies. This source demonstrates
a lack of bias, for every fact is followed up by an in-text citation. It is a difficult source to work
with as it contains an issue that this researcher finds in almost all sources on adverse childhood
experience. The issue is that data is very inconsistent. Since every person’s brain and experiences
differ, making a concrete claim about all children is not possible. Nevertheless, the data is still
usable as many other studies back it up. Overall, this is a great source and will be used again
later to prove the morphometric effects associated with maltreatment.

Traub, Flora, and Renée Boynton-Jarrett. “Modifiable Resilience Factors to Childhood Adversity
for Clinical Pediatric Practice.” Pediatrics, vol. 139, no. 5, May 2017, p. e20162569.

The journal article’s main goal is to identify proactive strategies to mitigate the impact of
adverse childhood experiences. Out of 54000 Americans, 60% suffered from at least 1 ACE,
signifying the need for an effective solution. There is a correlation between ACEs and mental
health consequences like emotional and behavioral problems, school failure, major depressive
disorder [MDD], anxiety, posttraumatic stress disorder [PTST], and dissociative disorders. Along
with mental effects, ACEs can lead to poor health outcomes including asthma, ischemic heart
disease, stroke, obesity, diabetes, chronic pulmonary disease, autoimmune disease, and substance
use disorder. On average, adults with higher ACE scores are seen to have overall lower
satisfaction with life and die nearly 20 years earlier. The source discusses 10 practices that
pediatricians can apply to enhance a child’s resilience, the ability to overcome and react to
adversity. Moreover, the effects of appraisal style, parenting, maternal mental health, and trauma
are referenced. Parenting measures have been linked to neuroendocrine activation, the opening of
pathways in the brain as a result of internal or external factors that affect the body’s homeostasis.
Carlson 14

Generally, families with high stress have parents that develop cold and insensitive caregiving
techniques, resulting in higher cortisol levels in their children. Mothers who face depression,
which is common after giving birth, are less responsive and less likely to establish consistent
routines, resulting in cognitive, social, and emotional deficits in the child. The article goes into
further detail regarding interventions.
Overall, this journal article is extremely helpful and applicable to my topic. It holds 119
very reliable references. Moreover, the article states that the authors have no conflicts of interest
and there is no external funding, meaning no bias or influence is present. Additionally, it was
written recently, only 3 years ago. This article contains both background information on the
effects of ACEs on a brain and possible solutions, unlike previous sources that state only
neurological effects. Applying this to the project, this researcher can use the source in a
conclusion to prove how a child’s resilience can improve through clinical pediatric practices.
Further, preceding entrance into care, foster youth experience severe maltreatment making their
ACE score very high. In this researcher’s paper, she can describe the susceptibility that this
population has to mental health, physical health, and behavior problems.

Vaughn, Michael G., et al., “Substance Use and Abuse among Older Youth in Foster Care.”
Addictive Behaviors, vol. 32, no. 9, Sept. 2007, pp. 1929–35.

This study explores the prevalence and predictors of current and lifetime substance use,
substance abuse disorder, and polysubstance abuse among older youth in foster care. Four
hundred and six youth in foster care were interviewed. Almost half of the participants had used
illicit substances sometime during their life and more than a third qualified for substance use
disorder. Foster children have a history of trauma and adversity that makes them more inclined to
resort to substances for recreational use. Youth who experienced post-traumatic stress disorder
and conduct disorder were found to use substances at a higher rate. Further, youth in independent
living environments had more freedom to participate in these activities. The conclusion found
that it is not safe to assume that this population is at a higher risk, but those who are using may
have serious substance issues that need to be addressed and treated.
This study is the first in its field to investigate substance use and abuse over a lifetime,
unlike other literature that examines the prevalence of care. The use of substances seen in this
study were at a rate considerably higher than in the previous study done by Aarons et. al. in
2001. Thus, this source is more accurate, and it shows that substance use across this population
may be increasing over the years. A limitation is that all data is based on a self-report, which
could have resulted in an over- or under-report. Additionally, this data is not generalizable.
Despite this, the study adds important knowledge of substance within the child welfare system.
There is a slight bias that could lead to under-reports, as some children interviewed may not want
to share if they had participated in the illegal activities. Nevertheless, this source will be used to
Carlson 15

prove that children in foster care do get access to substances and it could be detrimental
considering their pasts.

Williams-Mbengue, Nina. “The Social and Emotional Well-Being of Children in Foster Care.”
The Social and Emotional Well-Being of Children in Foster Care, 6 May 2016,
www.ncsl.org.

This report focuses on the social and emotional well-being of children and youth in foster
care. In addition, it examines a multitude of interventions with examples from real life. The
needs of children in care, the impact of maltreatment and trauma, and state and local practices
are discussed. While the number of children in foster care is decreasing by nearly a quarter each
year, there are still thousands in it. These children come from a background of trauma and are
often neglected. Neglect can be physical, emotional, or medical. As a result, children are
removed from the irresponsible caregiver and put into care. The longer the child is in placement,
the greater the chance he or she will move from one foster placement to another, placing the
child at further risk of negative social and emotional outcomes. Research from the National
Survey of Child and Adolescent Well-Being finds that youth in foster care have high levels of
mental health needs that are not met. There are ways that state legislators can promote child
well-being. They can develop policies that focus on prevention of maltreatment, improving the
foster care experience, increase access to social/emotional function assessments, ensuring
treatment of trauma and mental health problems, and investing in effective practices.
Nevertheless, a very important intervention is implementing trauma-informed practices and
policies. Trauma-Focused Cognitive Behavioral Therapy (TFCBT) is a practice that addresses
children’s behavior as a result of traumatic experience. TFCBT aims to improve children’s
behavior as well as parenting skills and parent-child communication. The key components
include behavioral, family, and cognitive therapy aimed at children ages 3 to 18. The report goes
on to talk about specific legislation that aims to support child well-being.
This report is very informative, providing immense detail on possible interventions for
children in foster care. This researcher can use the source to find specific instances where
policies ameliorated adverse conditions. It presents unique information from a multitude of
pre-existing literature. This source demonstrates a lack of bias, as there are many references and
no emotional syntax. With the need for effective solutions for issues in foster care, this source is
extremely important. It can be especially useful in the conclusion to leave the paper on a hopeful
note. Overall, this is a great source and will be used again to prove the importance of early
interventions and the seriousness of caregiver interactions with children in the foster system.

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