Last Updated: 2008-06-11 17:23:46 -0400 (Reuters Health)

NEW YORK (Reuters Health) – The placement of teenagers in private, enhanced foster care programs appears to improve their long-term mental and physical health compared with teens placed in public programs, according to findings published in the June issue of the Archives of General Psychiatry.

"Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses," Dr. Ronald C. Kessler, of Harvard Medical School, Boston, and colleagues write. "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."

In a quasi-experimental study, the researchers compared the physical and mental health outcomes of adults who were placed in a private, enhanced foster care program with adults who lived in public foster care programs. The adolescents who completed the public programs were eligible for the private program but were not selected because of limited openings.

The subjects were interviewed 1 to 13 years after leaving foster care for assessment of mental and physical health. The data were adjusted to control for the subjects’ preplacement characteristics.

Included in the study were 479 adults who were placed in foster care when they were between 14 and 18 years old, between January 1, 1989 and September 30, 1998; 111 were in the private "Casey" program and 368 were in public foster care programs.

The caseworkers in the Casey program had higher levels of education and higher salaries than caseworkers in the public programs. Casey caseworkers also had lower caseloads and access to a wider range of ancillary services for youth.

The adolescents in the Casey program were in foster care about 2 years longer than those in the public foster care program. The subjects in the Casey program also had significantly more stable placements than those in the public programs.

Compared with the adults from public programs, those from the Casey program had a significantly lower 12-month prevalence of mental disorders, including major depression (11.3% versus 24.3%); anxiety disorders (28.8% versus 43.0%), and substance use disorders (5.1% versus 11.1%), respectively.

The 12-month prevalence of ulcers (7.4% versus 13.0%) and cardiometabolic disorders (14.9% versus 22.6%) were also significantly lower among Casey alumni than public program alumni. A significantly higher prevalence of respiratory disorders was the only condition that more frequently affected the Casey alumni (28.8% versus 17.9%).

The researchers urge that similar analyses be conducted with public and private foster care systems nationally to identify the primary components of these programs that have positive effects on the children. These data could be used to develop a "blended model program" to provide state and federal legislatures further evidence of the benefits of high-quality foster care programs.

Arch Gen Psychiatry 2008;65:625-633.

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