Private foster care program leads to better long-term health

Adults who were placed in a private, enhanced foster care program as teenagers appear to have significantly fewer mental disorders, ulcers and cardiometabolic problems (diabetes, hypertension or heart disease) but more respiratory disorders than those who were placed in public programs, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Child abuse and neglect have long-term negative effects on both physical and mental health, according to background information in the article. "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," the authors write.

Ronald C. Kessler, Ph.D., of Harvard Medical School, Boston, and colleagues assessed 479 adults (average age 23.7 to 25.6) who were placed in foster care between 1989 and 1998, when they were age 14 to 18. Of these, 368 were placed in public foster care programs in Oregon or Washington, and 111 were placed in a private foster care program. The program, administered by Casey Family Programs, had caseworkers with higher levels of education, lower caseloads, higher salaries and access to a wider range of services for youth than those in public programs. The private program also offers financial assistance with higher education to alumni.

The adult alumni of the private program, when compared with those of the public program, were less likely to have experienced foster parent neglect, physical abuse or sexual abuse. In addition, over the previous year, they:

• Had 44.7 fewer mental disorders and 20.1 fewer physical disorders per 100 individuals

• Were less likely to report major depression (11.3 percent vs. 24.3 percent), anxiety disorders (28.8 percent vs. 43 percent) and substance abuse disorders (5.1 percent vs. 11.1 percent)

• Were less likely to have had ulcers (7.4 percent vs. 13 percent) and cardiometabolic conditions such as diabetes, hypertension or heart disease (14.9 percent vs. 22.6 percent) but more likely to have had respiratory conditions (28.8 percent vs. 17.9 percent)

"The finding of significantly more respiratory disorders among Casey alumni than public program alumni might reflect the fact that some physical disorders become more prevalent in conjunction with otherwise positive outcomes," the authors write.

The results suggest that similar analyses should be performed on public and private programs nationwide to pinpoint particular core program components that lead to positive effects. "This information could then be used to develop a blended model program for implementation in demonstration sites and subsequent dissemination to public programs throughout the country if state and federal legislatures could be convinced of the importance of this undertaking," they conclude. "Although these results constitute only a first step in promoting this envisioned dissemination effort, they clearly document the substantial positive effects of model foster care in the domains of mental and physical health that encourage further exploration in other outcome domains."

(Arch Gen Psychiatry. 2008;65[6]:625-633. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by an unrestricted contract from the Casey Family Programs (an operating foundation) and in-kind support from the states of Oregon and Washington. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

"Of the various stressors shown to lower an individual's threshold for development of a syndromal episode of depression or anxiety disorder, including job loss, marital discord and poverty, few are as robust in their impact as child abuse and neglect," writes Charles B. Nemeroff, M.D., Ph.D., of Emory University School of Medicine, Atlanta, in an accompanying commentary.

The lower rates of mental health problems for Casey program alumni "have important implications for the pathogenesis and treatment of major psychiatric disorders," he writes.

"It is now clear that the genetic contribution to vulnerability for mood disorders is at least in part mediated by genetic polymorphic variants of certain critical genes," Dr. Nemeroff concludes. "Future studies should determine the effects of optimal foster care in individuals genetically at risk for these devastating psychiatric disorders." (

Arch Gen Psychiatry. 2008;65[6]:623-624. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Dr. Nemeroff is supported by grants form the National Institutes of Health. Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.