The Effects of Foster Care on Child Development - Thesis Example

? Developmental issues as emerging challenge in foster care Chapter Introduction The effects of children development in foster care have been a great concern in the United States in the past decades. According to the Center for Assessment and Policy Development (CAPD), “foster children have been faced with a number of risk factors including poverty, violence, abuse (emotional, physical, and sexual) and neglect” and “…they are at greater risk compared to other children whose experiences have not resulted in them being placed in out-of-home care…”(p. 1). In 2001, it was estimated that the number of children in foster care increased to 565,000. According to the Adoption and safe Family Act (ASFA), an order has been put in an attempt to provide children with permanent families. The Act order requires that states ensure foster children have a permanency plan within a year, and termination of parental rights for children who have been foster care for 15 of the most recent 22 months. The researchers found that children who were placed in foster care were more likely to have emotional and behavioral problems than those who were maltreated but stayed with their caregivers or other at-risk children, even when controlling for family income and functioning prior to the start of foster care placement. Length of time in foster care, age at placement, and number of foster care placements did not appear to affect outcome, just whether a child was placed in foster care or not. Foster care, although aimed at providing adequate and proper care for children, could be critical in their behavioral and emotional stability; the discontinuity of emotional connection for the biological parents and a weak foster care system could be the main reasons of such problem. Research Questions This research will look at several factors to determine, if any, what effects foster care contribute to children developmental. This research will focus on the following: 1. The impact of foster care on behavior problems, controlling for baseline adaptation and Socioeconomic Status (SES) including a comparative evaluation of the behavior problem of maltreated children reared at home and children who received adequate parental care. 2. Change in pre-placement and post placement adaptation through repeated measure design among the participants who experienced foster care and an examination of change in behavior problems over time among the maltreated participants and those who received adequate care. 3. What are long-term consequences of foster care on behavior problems, overall emotional health, and psychopathology in adolescence? 4. What is the difference in outcome for children placed in child protective service prescribe foster care versus care with an adult familiar to the child? 5. The impact of foster care on behavior placement as longer term placements that have been related to placement instability, number of placements to determine the age of first placement and to determine a possible relation between age of placement and the subsequent development of behavior problems. Problem Statement This research will look at several factors to determine, if any, what effects foster care have on child development. Chapter 2: Literature Review Behavioral Challenges of Children in Foster Care The outcome of being in the foster care may not be what is expected. Since the child is a stranger to the new home environment, he is expected to adjust. Considering that childhood is a very critical stage in human development, especially when pertaining to the emotional and behavioral aspects, foster homes may not entirely serve the benefits of having a family. In the case of James, he was forced to go into foster homes since his parents are not able to sustain for his medications (Webb, 2001). Tentative conclusions would basically say that foster homes are better than troubled homes because they serve as a chance for children to have better lives. However, studies show the contrary. Koch (2007) reports that children who were kept intact with their family members, despite of inconvenient situations, are less likely to be juvenile delinquents. A study which was funded by The National Science Foundation found out that "500,000 children in U.S. foster care are more likely to drop out of school, commit crimes, abuse drugs and become teen parents" (Koch, 2007). James is a Native American who grew up being attached to the native Indian culture. He did not come from an abusive family, but was sent to foster care anyway, because his parents are having medical neglect upon him. Because of this, James spent three years in two different foster families who were White. As a child, the Native Indian culture is not yet deeply rooted in James' case and living with White families who have different culture than his would influence him easily. When he finally went back to his biological family, he was found by his parents to be disrespectful and not interested in Native Indian-related activities. Webb (2001) contended that the negative change of behavior James displayed should be blamed more on the foster care unit than his parents. It should be taken into consideration the culture that James has. If the lack of supervision of James's medication is the main issue why he was sent to foster care, then a visiting nurse from the Indian Health Services could have been a better option. The child is not abused physically or emotionally, thus making the parents eligible to have their full parental rights. James's case is not as severe as other situations of children in the foster care, but if necessary actions will not be made, it will have several impacts on James's adult behavior. If it was preferred that James should be in his family, he could get more emotional support from his parents, though he gets medical attention from other people. The case of James could be intriguing, since the reason for foster parenting does not really count for a severe situation such as parents' substance abuse or maltreatment to children. Furthermore, the foster care unit was insensitive to the cultural factors which might affect the relationship of James and his family in reunification. However, one might ask what would be the grounds so that children are sent to a foster care or foster parenting program and its effects on the development of the child. In the case of children having abusive parents, it is generally expected that they are better off to be in a foster care than to be influenced negatively by their parents in a daily basis. The research about foster care outcome is surprisingly contradictory to this general belief. Consider this statement from a 17-year-old girl who stayed in foster care: "My biological mother used to beat me for no reason, just because she was angry...My foster mother doesn't know about my past... My brother has been adopted and I haven't seen him in years. Perhaps, he wouldn't have been adopted if I could have shown him that I love him. My mother abused me and I take some of the blame, I just wish I could have been a better child." (Adamec & Miller, 2007, p. 111) It can be said that this girl's relationship with her mother is very complex, and that complexity made her feel partly responsible of what happened. When she said that her foster mother does not know anything about her past, it could denote emotional restraint from girl. In this case, the girl is already developing emotional solitude. From here, there could be several potential risks that the girl would encounter, not to mention that childhood and adolescent years are critical in their development, biologically speaking. According to the Committee on Early Childhood, Adoption and Dependent Care (2000), "the anatomic brain structures that govern personality traits, learning processes, and coping with stress and emotions" are established during the early childhood while the negative physical and emotional environment would affect this growth negatively. This is the reason why child abuse could cause psychological trauma. On the other hand, it is equally important that children should have "continuity with their primary attachment figures and a sense of permanence" in her immediate biological family (p. 1145). Since emotional continuity is disrupted at the prime stages of emotional development, there could be several psychological consequences inflicted to the child. Black (2006) argues that "depriving a young child of a significant emotional bond could damage his ability to form intimate and trusting relationships." The drawn characteristic of an adopted child makes him prone to suffer a condition called Antisocial Personality Disorder. Since adopted children are most likely not to develop an emotional attachment because of care discontinuity, they tend to show inappropriate social behavior without the feeling of guilt and resentment on themselves. Such condition is not the only consequence that an adopted child should face. On the other hand, the extent of effects in which the adopted child is likely to experience depends on the baseline adaptation prior to placement and socioeconomic status at the time of placement. In the study by Lawrence, Carlson, and Egeland (2006), the effects of foster care on development were assessed. Initially, their study was centered on dissecting the relevance of length of time in care, age of first placement, and the risk of multiple placements. The results, however, noted that such factors show little to no relevance in developing behavioral problems. Because of this, the study shifted to studying the familiar and unfamiliar foster care (kinship care and foster care respectively) as baseline measures on adaptation and socio-economic status at time of placement. This time, the study showed significant results. It is concluded in the study that children who were raised in unfamiliar foster care tend to show "higher levels of behavioral problems...compared to children who receive adequate parental care within disadvantaged home environments" and continue to elevate during adolescence (p. 71). In the case of children sent to foster care as early as kindergarten, there were no significant difference when it comes to behavior prior to placement in the care; however, immediately following the foster care, these children are seen to have behavioral problems. Children adopted in kinship foster care are shown to have lesser tendencies of developing behavioral problems compared to those who were sent to unfamiliar foster care. This is no difference to the findings of the study of Winokur, Crawford, Longobardi, and Valentine (2008). The study entitled Matched comparison of children in kinship care and foster care of child welfare outcomes suggests that kinship care is a viable option for out-of-home care rather than foster care. Kinship care, however, comes in two forms: the paid and unpaid kinship care. Comparing the two types, it is found out that paid kinship care results to "more allegations of maltreatment" (Winokur, Crawford, Longobardi, & Valentine, 2008, p. 344). Because of such outcomes, it is suggested that kinship care should be monitored by foster care units and that resources for the kin and the child they take care are properly given. Independence of kin in kinship care should also be recognized, as it is their responsibility to bring up the child on the way they know best. Despite this, kinship care is still a preferred option than unfamiliar foster care. Although it is not assured that children in kinship foster care will not demonstrate behavioral problems, one could say that it is better. Aside from the ones mentioned, the cause of behavioral problems apparent in adopted children might be explained using Maslow's Hierarchy of Needs (see fig. 1 in appendix A). As seen at the third level of the pyramid, love and belongingness are human needs that if deprived, have significant consequences at some aspect. According to Watson (1994), this deprivation is not felt in the early days of being in the adopted care system, but there will come a point that the child would ask: "Why did my parents give me away?" (p. 9). When the loss of the original family and being in a substitute family finally sinks in, the adopted child is likely to experience emotional stress. On the other hand, Herring (2008) noted that if an out-of-home child is placed in kinship care, he is unlikely to be given his basic needs since most kin are financially incapable of supporting the child. Herring (2008) contends that most kin caregivers are old and have low paying jobs, making them less of an option compared to non-kin substitute parents. Such claim could be refuted by the process of the foster care system in choosing whether the child should be with a kin or a non kin care giver. In as much as the social environment is suited for the adopted children, the socioeconomic condition of the prospective foster parent should also be assessed. Socioeconomic conditions of adopted parents also have a significant role in determining the foster care outcome. This is especially important because of the prevalence of certain medical conditions among adopted children. R.E. Clark, J.F. Clark, and Adamec (2007) inform that about 80% of adopted children have chronic medical conditions. Among the illnesses mentioned were asthma, anemia, and sensory impairments. They are also seen to have psychological problems such as oppositional defiant disorder, ADHD or anxiety disorders. In an article by Orme and Buehler (2001), one of their assertions concerned about the socioeconomic condition of prospective adopted families. The scarce federal and state resources for adopted children are now becoming a problem while the caseworkers are having "low par and difficult working conditions." Because of such situation, the caseworker is forced to terminate the task which contributes to the turnover rates. There could be advantages of being in a troubled home over foster care or vice versa, but it is undeniable that adequate parental care is better compared to both. As noted, the family is an important aspect of as developing child. Children are naturally curious and adventurous. Furthermore in childhood years, the concept of morality is yet to develop; in this case, the role of parents becomes increasingly important. In fact, inadequate parental care poses different negative effects on the development of the young, especially in deprived areas where basic necessities are almost inaccessible. Behavior in adulthood is critical for the children who lack parental care. According to Maughan and McCarthy (1997), depressive mood in adults originates from the lack of parental care in childhood. The disruption of parental relationship, not only because of abusive parents but also early death and long separation, might have caused this problem. On this note, foster care is already included since children are taken away from their biological parents, and they are assessed unfit for parenthood. On the contrary, good parenting results to good mental skills of the children (Downs, 2008). It is known that there are many factors in the development of the child's mental skills and this includes financial background. It is a common perception that children who live in depressed areas are not doing well academically because they lack resources. However, the researchers of the University of Oregon stated that parents who live on or below poverty line still have chances of increasing their children's mental abilities through building a good relationship with them. According to Downs (2008), "fourteen children aged 3-5 were tested o n language ability and attention and had brain scans before their parents began their counseling." After the preliminary test, a group of parents were asked to do parent counseling and have frequent conversation with their children, while another group was asked to stick to their old parenting style. After the specified time given by the researchers, they retested the children and found out that children from those parents who were asked to alter their parenting style showed significant increase in "memory, language ability, attention, and I.Q." (Downs, 2008). The researchers concluded that there is more to the need of material resources for good parenting. Good communication towards their children also matters. In contrast to Lawrence, Carlson, and Egeland (2006) findings about multiple placement of the child while in foster care, Rubin, O'Reilly, Luan, and Localio (2007) asserted that instability of placement poses negative behavioral changes on the child even without a biological history of mental disorders. Consider the separate cases of Jack and Julie as noted by Berridge, Dance, and Beecham (2008): Jack has been in the foster care system since his toddler years. He also experienced multiple placements before he ended up with his present foster parents. Before, he had shown negative and self-harming behavior, but when he finally settled with a single foster family, his behavior and academic performance improved. Some of his negative behavior is still apparent but are slowly disappearing. The other case is the situation of Julie. Julie, like Jack, experienced multiple placements in foster care. However, the foster care system has failed to find suitable foster parents for her. While the research was ongoing, Julie is still in search of parents who can provide her a long term care. As a result, Julie engaged in certain self-destructive behaviors such as drug overdose and show of anger. The two cases are not the only ones mentioned by Berridge, Dance, and Beecham (2008). There are still other case study subjects which show similar situations and have similar outcomes. Thus, it can be noted that after all, multiple placement has adverse effects towards the child's psychological and emotional development. Age is another predictor of adoption success for adopted children (B.J. Sadock & V.A. Sadock, 2008). It is known that younger children who are adopted at an early age --from infancy to 11 years old--are less likely to exhibit behavioral problems. However, permanence of domestic adoption also contributes to this result. Late adoption causes detrimental effects on the child compared to those who had been adopted at a younger age. McMahon (2005) argued that although age is a predictor of adoption success in terms of behavioral and mental development of the adopted children, the number of placement still counts. According to him, every time the child changes foster home, a year is deducted to his developmental capability. In this case, for example, if a 17-year-old experienced change of placement 5 times, it is considered that his current state of behavior is that of a 12-year-old. The delay in cognitive and behavior is caused by the frequent adjustment that the child has to make every time he changes the foster home; although he can always patch up as soon as he finds a supportive home. However, if he were unable to find one, there are great chances of having delinquent behavior in adulthood. Change in Pre-placement and Post Placement Adaptation Knowing the disadvantages of being in foster care, it might be a wonder how the foster care system fails to bring out its duties as a real substitute home for foster children. The rarity of success among children who were in foster care is a fact. Kernan (2011) reports about Sukhom Mao, the new commissioner of the Alameda County Juvenile Justice/Delinquency Prevention Commission and a foster child himself. Mao said that the system needs a lot of work, from the basic resources down to the core of what children really need. He recalls that every day spend in the system is a struggle because no one actually understands what he is going through. Mao contends that almost all the children in the foster care have past issues and trauma and providing them with just material goods would do no good. Now that he is a commissioner of this system, he wants to change things at his best, including the process of choosing prospective foster parents. He wants to focus on this particular area since this is his frustration. He had been in two foster homes, but none has made him feel that it is a "home" for foster kids like him. Mao's story represents the lives of other foster children. In a report made by Bill Hancock (2009), it was made known that the foster system in the United States needs a reform, just as what Mao suggested. In the report, there are three crises that the system is currently experiencing: crisis of capacity, crisis of stability, and crisis of quality. These challenges are the core reasons why there are high rates of turnovers. The lack of support leads to the instability of the system--which results to an "increased emotional and behavioral problems in children and increased demands on foster parents" (p. 3). Although it has been mentioned that multiple placement of the child in different foster homes are irrelevant on behavioral problems, it contradicts what other studies have found. It should also be considered that Lawrence, Carlson, and Egeland's (2006) study is limited to 'normal children.' Smith, Stormshak, Chamberlain, and Whaley (2001) contend that placement disruption is toxic to child development. According the records, "38% to 57% " experience placement disruptions "during the first 12 to 18 months" (Berrick et al., 1998; Palmer, 1996; Staff & Fein, 1995; Stone & Stone, 1983 as cited in Smith, Stormshak, Chamberlain, & Whaley, 2001). This is particularly depressing for children with preexisting behavioral, mental, and psychological disorders as they find it harder to adjust than their normal counterparts. Hancock (2009) believes that these crisis especially in government-run foster care units comes from the fact that the government is preoccupied with finding its "energy and resources" to support the system rather than the individual needs of foster children and foster families" (p. 5). Definitely, financial resources are needed in foster care units. This thought saves the government from the blame, however, not completely. Pre-placement is an important factor in needs assessment of the foster child. Given the idea that children who are in the foster care generally have problems concerning their biological immediate family, the child's experiences prior to placement could also tell if the foster system suits him or not. The first case stated in this paper is about James and a proposition has been made that foster care is not a need for him, but a follow-up medical attention. Pre-placement assessment may have failed in the context of James' experience. In contrast is the research made by Armsden, Pecora, Payne, and Szatkiewicz (2000), where pre-placement assessment was used to document psychological functioning of the prospective foster children (as cited in Lawrence, Carlson, & Egeland, 2006). Using attachment quality, toddler-caregiver experience rating, persistence and ego control rating, and emotional health rank, the prospective foster children are observed. The observational data gathered will be used to compare the outcomes in post placement analysis in Lawrence, Carlson, and Egeland's (2006) study. The results, as what they hypothesize in their abstract revealed that the maltreated children showed an increased behavioral problem after the placement. Long Term Effects of Foster Care Placement and the Foster Care System Enough evidences were discussed to say that placement in foster care puts the child at risk of developmental constraints especially on the formation of desirable behavior. Although the legislation approves and thrives for reunification of adopted children and their biological parents in the right time, this does not help because emotional damage has been done. In fact, it has been acknowledged by Taussig, Clyman, and Landsverk (2001) that reunification would not benefit a troubled adopted child; instead there is high probability of resorting to risky behavior. Considering that most foster children are taken into foster care at an age which is very crucial on emotional development, these children are more likely to experience emotional, economic, and mental instability. R.E. Clark, J.F. Clark, and Adamec (2007) contend that the effects of placement could prevail until adulthood. Most adults who were in a foster care live in a rather miserable life because of their lack of education. Reportedly, only 50% of the foster children are able to graduate secondary education "compared to the 78% of the general population" (R.E. Clark, J.F. Clark, & Adamec, 2007, p. 122). Unemployment is also common for adults who were in foster care, probably because only a mere percentage is able to attain higher education and some were even an expense to the community (e.g. incarcerated). Former foster children are said to "comprise 20% of the prison inmates in the United States and 25% of inmates with prior convictions." On the other hand, those who are still in the system are "three times more likely to have STD's and four times more likely to have mental illness” (Doyle, 2008). The persistence of this damage to adulthood is especially alarming because these adults would eventually decide to have their own family. If they themselves are troubled, the more likely it is for them to have a 'damaged family' and the history repeats itself. The pervasiveness of foster care consequences is also detrimental to the future families of these children (Lowry as cited in "Foster Care," 2009). Although there were some who are able to achieve success, like in the case of Mao, these cases are a rarity. The report from the Human Rights Watch fully revealed the lives of the majority of adults in California who are already “emancipated” from the system. The term “emancipation” as the report suggested--the title of the report is My So-Called Emancipation: From Foster Care to Homeless Adults--connotes an ironic implication. Roberta, a former foster child in Los Angeles said: “On the day of my so-called emancipation, I didn’t have a high school diploma, a place to live, a job, nothing...The day I emancipated—it was a happy day for me. But I didn’t know what was in store. Now that I’m on the streets, I honestly feel I would have been better off in an abusive home with a father who beat me; at least he would have taught me how to get a job and pay the bills.” (as cited in Human Rights Watch, 2010) Following the trend of a normal household, a foster child is detached from the system as a full grown adult as soon as they reach 18 years old. The only difference is, emancipation in a normal family setting is adventure, while for a former foster child it is a struggle. Like Roberta, there are other teens that are sent away from foster care without something which can prepare them for independence, such as the completion of basic education. Knowing these things, the effects of foster care, therefore, is not limited to emotional and psychological development, but also to the sense of readiness to challenge the life outside the system. In a testimony made by Anya, she stated that foster care is not helpful enough for them to get ready for emancipation. She said that there are too many things which are restricted in the foster home and they “over-shelter” them (Human Rights Watch, 2010, p. 6). Just as the previous testimonies mentioned at the earlier part of this paper, foster homes does not feel like ‘home’ for the foster children. Having an ultimatum and an abrupt end of support for these children is not useful for their next endeavor. There are various factors why foster care is considered detrimental for child development. This is in contrast with the expected outcome of foster care systems as a viable alternative for out-of-home care programs. Behavioral and cognitive problems are apparent in foster children and former foster children, thus ruining this expectation. There are contrasting ideas made by different researchers on their findings about child development in foster care. For example, Lawrence, Carlson, and Egeland (2006) believe that multiple placement is not a predictor of behavioral problems among foster children while Rubin, O'Reilly, Luan, and Localio (2007) found out through their study that multiple placement has effects on the child. Meeting these two contrasting ideas could be difficult since they are dealing about exactly the same thing. However, the history of the child in terms of psychological and emotional condition, adjustment measures, and age. It is also important to consider a pre-existing condition of the child. On the other hand, the U.S. foster care system's process of choosing placement also matters. All of which contribute to the overall effect of foster care on the child. While it is true that foster care can cause disruptive effects on development, children can have better life if the right foster family for him is found; although this is a rarity. Success rates in terms of education, standard of living, and employment are slim for former foster children; however, this is due to the system and not with foster care itself. Just like in the case of Roberta, she testified that the way the system treats foster children does not really employ strategies on how to make them independent. Instead, the social workers, probably because of burn out, would prefer if the children would follow everything that they have instructed. Such approach is not beneficial in emancipation. These children should be taught how to live by themselves, in case no foster family is willing to adopt them. Furthermore, they should also be encouraged to go to school. The issue on attachment continuity of children could be a potential harm especially to special children, but this problem could be addressed by a complete screening of social workers or prospective foster parents. In some cases, foster parents maltreat their foster children instead of taking care of them. This, too, is a factor of a worsened behavioral problem of the child. If screening is more efficient, then children are less likely to change from one foster home to the other. Since it is known that multiple placements could affect the child negatively, proper screening and an assurance that children will not be maltreated in their new home is a way of preventing worsened behavioral problem. Theoretical and Conceptual Framework Negative perceptions of foster care on child development in this paper are based on two theories: the Attachment theory by John Bowlby and the Continuity of Caregivers as proposed by Cryer, Hurwitz, and Wolery (2003). The discontinuity of care and the disruption of attachment of children to their adult caregivers in foster homes due to multiple placement and detachment from the family is said to be the reason of negative developmental effects. Figure 1: Attachment theory and Continuity of Caregivers This diagram shows the role of the theory and the concept to the development of the child. In this paper, the importance of the two concepts is constantly applied to the arguments. References Adamec, C.A., & Miller, L.C. (2007). The encyclopedia of adoption. NY: Infobase Publishing. Berridge, D., Dance, C., & Beecham, J. (2008). Educating difficult adolescents: Effective education for children in public care or with emotional and behavioural difficulties. PA: Jessica Kingsley Publishers. Black, D. (2006). What caused antisocial personality disorder. Retrieved from http://psychcentral.com/lib/2006/what-causes-antisocial-personality-disorder/ Clark, R.E., Clark, J.F., & Adamec, C.A. (2007). The encyclopedia of child abuse. NY: InfoBase Publishing. Committee on Early Childhood, Adoption and Dependent Care (2000). Developmental issues for young children in foster care. Pediatrics, 106 (5), 1145-1150. Cryer, D., Hurwirz, S., & Wolery, M. (2003). Continuity of caregivers for infants and toddlers. Retrieved from http://www.vtaide.com/png/ERIC/ Continuity-Caregiver.htm Downs, M. (2008). Good parenting raises kids' mental skills. CBS News. Retrieved from http://www.cbsnews.com/stories/2008/02/16/health/webmd/main3840627.shtml Doyle, J. (2008). Child welfare and child outcomes: Measuring the effects of foster care. Retrieved from http://www.dcf.state.fl.us/initiatives/childsafety/ docs/measuringeffectsoffostercare.pdf Foster care outcomes. (2009). Institute for Psychological Therapies. Retrieved from http://www.ipt-forensics.com/journal/volume10/j10_10_20.htm Hancock, B.R. (2009). Changing foster care in America: From crisis to community. Faithbridge. Retrieved from http://www.faithbridgefostercare.org/media/ 1210/faithbridge_white_paper_042009.pdf Herring, D.J. (2008). Kinship foster care: Implications of behavioral biology research. Selected Works. 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Multiple choice and Maslow's Hierarchy of Needs [image]. Blogspot.com. Retrieved from http://marythemom-ayhem.blogspot.com/2010/05/ multiple-choice-and-maslows-hierarchy.html McMahon, J. (2005). Foster care placement disruption in North Carolina. Fostering Perspectives, 10 (1). Retrieved from http://www.fosteringperspectives.org/fp_v10n1/disruption.htm Orme, J.G., & Buehler, C. (2001). Foster family characteristics and behavioral and emotional problems of foster children: A narrative review. Family Relations, 50 (1), 3+. Rubin, D.M., O'Reilly, A.L., Luan, X., & Localio, A.R. (2007). The impact of placement stability on behavioral well-being for children in foster care. Pediatrics, 119, 336-344. Sadock, B.J., & Sadock, V.A. (2008). Kaplan and Sadock's concise textbook of child and adolescent psychiatry. PA: Lippincott Williams & Wilkins. Smith, D.K., Stormshak, E., Chamberlain, P., & Whaley, R.B. (2002). Placement disruption in treatment foster care. Journal of Emotional and Behavioral Disorders, 9 (3), 200. Taussig, H.N., Clyman, R.B., & Landsverk, J. (2001). Children who return from foster care: A 6-year perspective study of behavioral health outcomes in adolescence. Pediatrics, 108 (1), 1-7. Watson, K. (1994). Substitute care providers: Helping abused and neglected children. PA: DIANE Publishing. Webb, N.B. (2001). Culturally diverse parent-child and family relationships: A guide for social workers and other practitioners. NY: Columbia University Press. Winokur, M.A., Crawford, G.A., Longobardi, R.C., & Valentine, D.P. (2008). Families in Society, 89 (3), 338-346. Appendix A Figure 1: Abraham Maslow’s Hierarchy of Needs (“Multiple Choice,” 2010). Read More