TERMINATION OF LONG-TERM MENTAL HEALTH TREATMENT WITH FOSTER YOUTH Kimberlin Borca, Foster Care Research Group University of San Francisco April 29, 2012

Background Children who have a history of abuse and neglect can suffer several psychological and social difficulties Youth who are placed into the foster care system experience a multitude of stressors that increase the risk for various mental health problems Research has indicated that psychotherapy is a useful approach for treating foster youth Our previous work has demonstrated that long-term, relationship- based psychotherapy reduces the severity of mental health symptoms in foster youth The nature of treatment termination with foster youth has not yet been examined

Current Study: Termination of Treatment  A Home Within is a national organization that provides pro-bono, long-term, psychotherapy to current and former children “for as long as it takes.”  Foster Care Research Group collects data regarding treatment and patient progress from therapists  55 finished completed cases across California were examined to determine the nature of treatment termination

Methods: Participants  Participants N= 55 AHW Therapists who had provided pro-bono psychotherapy to a current or former foster child Sex: Female (72%) and Male (27%) Age: M = 49 years (SD = 9.96 years) Ethnicity: 90% Caucasian Experience Post Licensure: M = 9 years (SD = 6.27 years).

Types of Mental Health Licenses and Degrees Earned  MA or MS (38%)  Ph.D., Psy.D., Ed.D., D.M.H. (62%)

Methods: Measures Initial Telephone Questionnaire for Therapists ▫ Therapist and Patient Demographics ▫ Patient Mental Health Status Exit Telephone Questionnaire for Therapists ▫ Patient Demographics ▫ Patient Mental Health Status ▫ Treatment Parameters ▫ Nature of Therapeutic Intervention

Methods: Procedure  A Home Within provided therapist name and contact information to the Foster Care Research Group when a patient was matched to a therapist  Therapists who agreed to participate were scheduled for an initial telephone interview  Telephone Consent was obtained and an initial telephone interview was administered at the beginning of treatment  An exit telephone interview was conducted at the termination of treatment

Results: Patients Females (51%) and Males (49%) Primarily School Aged 10 years at start of treatment (SD=5.53)

Last Year of Treatment: A Snapshot  Parameters of Treatment  Mean length of treatment: 3 Years (SD = 2.97)  Patients were seen on a weekly (66%) or biweekly (18%) basis  Other forms of treatment occurring simultaneously Individual Psychological Therapy (7%) Family Therapy (16%) Group Therapy (11%) Medication Therapy(11%) Educational Treatments(5%)

Collaborative Work in the Last Year of Treatment

Major Obstacles in the Last Year of Treatment

Reasons For Treatment Termination “My patient’s family moved to a city 100 miles away.” “Patient relapsed into substance abuse.” “We were scheduled for a session but my patient never showed up.” “My patient was ready to move on from therapy.”

Conclusion Treatment end often comes prematurely as a result of several obstacles in the patient’s life Premature treatment conclusion may be linked to major obstacles over the last year of treatment Importance of interventions across all aspects of the foster child’s life Limitations of the study include a small sample size, potential bias from therapist informants, and lack of a comparison group Future studies should explore the long-term efficacy of treatment by studying foster youth after treatment termination.