بهداشت روانی و عوامل خطر مرتبط مدرسه هلندی فرزند خوانده بزرگسالان قرار گرفته شده در مرکز نگهداری

More than 20,000 children in the Netherlands live in foster families. The majority are in long-term foster family placements, which are intended to provide a stable rearing environment until the children reach adulthood. International studies have shown, however, that compared to children in the general population, foster children have more mental health problems and more negative developmental outcomes in their later life. Less is known about Dutch foster children, however. To fill this knowledge gap, the present study focused on the mental health of 239 foster children (aged 4–12) living in long-term placements in the Netherlands. Their behavior was assessed with the Strengths and Difficulties Questionnaire, which was completed by their foster parents. The results revealed a wide range of problem behavior (ranging from none to very serious problem behavior), and showed that a third of the children have total difficulty scores (TDS) in the clinical range. Higher TDS appear to have a positive univariate association with age of the foster child, age upon entering the current foster family, number of prior foster placements, non-kinship placement, and fostering experience of the foster parents. The more risk factors, the higher the TDS. These findings suggest the importance of the early detection of problems and potential risk factors in foster families, and the need to support a substantial number of foster children and foster families.

In 2012, 20,949 children in the Netherlands were living in foster families (Foster Care Fact Sheet, 2012). The majority (64%) were in long-term foster family placements, which are intended to provide a stable rearing environment until the children reach adulthood (Strijker, 2009).1 In the international literature, foster children are considered to be at increased risk of negative developmental outcomes in various areas, such as emotional and behavioral development, brain and neurobiological development, and social relationships with parents and peers (Bilaver et al., 1999, Leve et al., 2012 and Strijker et al., 2005). Various studies confirm an elevated prevalence rate of mental health problems among foster children. A national survey carried out by the child welfare system in the United States among a representative sample of almost 4000 children (aged 2 to 14 years) and their caregivers, found that nearly two thirds (63.1%) of the children placed with non-relative foster caregivers, and more than one third (39.3%) of children placed in kinship foster care, scored in the clinical range on the Child Behavior Checklist (CBCL) (Burns et al., 2004). A survey carried out in Great Britain also found that foster children aged 5–17 years had significantly higher rates of psychiatric disorders than children living in private households (Ford, Vostanis, Meltzer, & Goodman, 2007). A study performed in Denmark found that 20% of the children in foster and residential care suffered from at least one psychiatric diagnosis, compared to 3% of the non-welfare children (Egelund & Lausten, 2009). Almost half of the children (48%) in care scored within the clinical range of the Strengths and Difficulties Questionnaire (SDQ), compared to 5% of the non-welfare children. Even higher scores were found in a study carried out in Scotland: 57% of the foster caregivers of children aged 5–16 years reported mental health problems within the clinical range of the SDQ (Minnis, Everett, Pelosi, Dunn, & Knapp, 2006). Two Australian surveys among school-aged foster children found that they had significantly higher scores on all the broadband scales and subscales of the CBCL compared to the community means (Sawyer et al., 2007 and Tarren-Sweeney and Hazell, 2006). These elevated rates of mental health problems seem to persist in adulthood. Several international studies show that adults who were raised in foster families during their youth, tend to have more problems in various life domains – such as psychological and social functioning, education, employment, and delinquency – compared to adults who had an average childhood (Barth, 2005, Dumaret et al., 1997, Minty, 1999, Pecora et al., 2006, Reilly, 2003 and Vinnerljung et al., 2006). A limited number of studies (Strijker et al., 2011 and Strijker et al., 2005) have been conducted to assess the mental health of foster children in the Netherlands. These studies investigated the level of agreement between foster parents and foster children about problem behavior and how this is associated with the breakdown of a foster care placement (Strijker et al., 2011), and the relationship between behavior profiles of foster children, placement characteristics, placement outcome, and developmental outcome (Strijker et al., 2005). The aim of the present study was to gain more insight into the prevalence and backgrounds of the mental wellbeing of primary school-aged foster children. Factors associated with elevated emotional and behavioral problems and the social behavior of these children were also investigated.

Nearly half of all the foster parents in this study reported no mental health problems in their foster child. However, more than a third reported serious mental health problems in their foster child, which is triple the rate in the general population. Mental health problems appear to be positively correlated with age of the foster child, age upon entering the foster family, number of prior foster placements, and foster parents' number of years of experience. Children in kinship families appear to have fewer mental health problems compared to children in non-kinship placements. The foster care experience of the foster parents seems to be the most important predictive factor for mental health problems. Pro-social behavior appears to be positively related to length of placement, age of foster parents, and kinship placements. Further research should lead to clinical implications. The results of this study are in line with one of the principles of transactional theory, namely that no single risk factor has a profound effect on the wellbeing of a foster child; rather, it is the accumulation of risk factors in the child and its surrounding systems that results in more mental health problems. These findings suggest the importance of the early detection of problems and potential risk factors in foster families, and the need to support a substantial number of foster children and foster families.