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Ronald C. Kessler, PhD; Peter J. Pecora, PhD; Jason Williams, MS; Eva Hiripi, MA; Kirk O’Brien, PhD; Diana English, PhD; James White, PhD; Richard Zerbe, PhD; A. Chris Downs, PhD; Robert Plotnick, PhD; Irving Hwang, MA; Nancy A. Sampson, BS

Arch Gen Psychiatry. 2008;65(6):625-633.

Context  Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth.

Objective  To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni.

Design  We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni.

Setting/Participants  A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed.

Intervention  Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs.

Results  Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni.

Conclusion  Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Author Affiliations: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Dr Kessler, Mss Hiripi and Sampson, and Mr Hwang); Research Services (Drs Pecora, and O’Brien, and Downs and Mr Williams) and Systems Improvement (Dr English), Casey Family Programs, Seattle, Washington; School of Social Work (Drs Pecora and English), University of Washington, Seattle; School of Social Work, Portland State University, Portland, Oregon (Dr White); and Evans School of Public Affairs, University of Washington, Seattle (Drs Zerbe and Plotnick). Mr Williams is now with the Social Work Evaluation Program, University of Alaska Anchorage.

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