Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study

2022. Süheyla Seker (et al.). European psychiatry 65 (1)

Article

Background. Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood.

Methods. Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed.

Results. In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples.

Conclusions. Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

Placerade barns utbildningsvägar: Från mellanstadiet till medelåldern

2021. Hilma Forsman, Sten-Åke Stenberg. Socialvetenskaplig tidskrift 28 (3), 249-268

Article

Såväl svensk som internationell forskning visar att barn som placerats i samhällsvård har sämre skolresultat än andra barn. Däremot är kunskapen om hur deras utbildningskarriärer ser ut över en längre tid begränsad. Med hjälp av en femtioårig uppföljning av en kohort bestående av drygt 12 000 personer födda 1953, av vilka nästan 8 procent varit placerade före 13 års ålder, har vi följt deras utbildningsvägar över nästan hela livsförloppet. Analyserna fokuserade på hur de placerade barnens utbildningsambitioner, prestationer och val från årskurs 6 och framåt skilde sig från barn som haft barnavårdskontakt utan att placeras respektive barn utan barnavårdskontakt. Resultaten visade att de placerade barnen genomgående presterat sämre och gjort mindre ambitiösa utbildningsval än barnen utan barnavårdskontakt. Däremot var de placerade barnens utbildning lik och i vissa fall till och med bättre än utbildningen för dem som haft barnavårdskontakt. Våra resultat visade också att möjligheterna att återuppta studier i vuxen ålder tycks ha spelat en viktig roll för alla barn, inte minst de placerade barnen.

Cumulative Childhood Adversity and Long-Term Educational Outcomes in Individuals with Out-of-HomeCare Experience

2021. Hilma Forsman, Josephine Jackisch. British Journal of Social Work 00, 1-20

Article

Previous research has demonstrated a graded relationship between cumulative childhood adversity and adverse later outcomes. Individuals with out-of-home care (OHC) experience constitute a population characterised by both childhood and educational disadvantages. Based on a fifty-year follow-up of a Stockholm cohort born in 1953, the purpose of this study was to examine the associations between cumulative childhood adversity and long-term educational outcomes in this group. The cumulative disadvantage perspective suggests that there would be a negative association, while the disadvantage saturation perspective implies that cumulative adversity would be less consequential for disadvantaged individuals. By means of multigroup path analysis, we furthermore asked whether this association may differ in relation to individuals with child welfare contact (CWC) and to the general population (GP). Adjusting for socioeconomic conditions and cognitive ability, cumulative childhood adversity had a negative influence on midlife educational attainment in the GP. However, it did not seem to influence the educational outcomes of neither OHC experienced individuals nor individuals with other types of CWC. The results of this study thus lend support to the disadvantage saturation perspective. Further studies are needed to explore this relationship.

Exploring educational pathways over the life course in children with out-of-home care experience

2020. Hilma Forsman. Children and youth services review 111

Article

It is well-established that children with out-of-home care (OHC) experience perform poorly in the educational system. However, we know less about their educational pathways over the life course. Utilizing longitudinal prospective survey and register data with a follow-up to more than 60 years of age, this study compared educational outcomes over the life course between children with OHC experience and their same-aged peers. Moreover, by means of multi-group path analysis, the study explored differences in educational pathways. The results showed that the OHC group had lower school grades in sixth grade, in ninth grade as well as lower educational attainment in middle age. Cognitive ability and previous school performance had the largest associations with the outcomes in both groups. Yet, these predictors had significantly weaker influence in the OHC-group. Conversely, the birth family's attitude towards higher education was more important among children with OHC experience. Implications for policy and practice are discussed.

Inequalities in educational outcomes in individuals with childhood experience of out-of-home care

2020. Lars Brännström (et al.). PLoS ONE 15 (4)

Article

Background

Prior research has shown that individuals with experience of out-of-home care (foster family care or residential care) in childhood are educationally disadvantaged compared to their peers. In order to be better equipped to design interventions aimed at improving the educational outcomes of children for whom society has assumed responsibility, this study seeks to further our understanding about which factors that contribute to the educational disparities throughout the life course.

Methods

Using longitudinal data from a cohort of more than 13,000 Swedes, of which around 7% have childhood experience of out-of-home care, Peters-Belson decomposition is utilized to quantify the extent to which the gap in educational achievement in school (age 16) and midlife educational attainment (age 50) captures differences in the prevalence of factors influencing educational outcomes, and differences in the impacts between these factors.

Results

We find that the achievement and the attainment gap was around 13% and 9% respectively. These gaps were to a large extent explained by differences in the distribution of predictors. The major explanatory factor for placed children’s lower achievement was a lower average cognitive ability. Yet there were some evidence that the rewards of cognitive ability in these children differed across the life course. While the lower returns of cognitive ability suggest that they were underperforming in compulsory school, the higher returns of cognitive ability on midlife attainment indicate that–given previous underperformance–their attainment at age 50 reflects their cognitive capacity more accurately than their achievement at age 16 do.

Conclusion

The large influence of the unequal distribution of predictors suggests that policy efforts are needed to promote equity in the distribution of factors contributing to educational achievement and attainment. Since cognitive ability was found to be an important contributory factor, such efforts may include promoting cognitive and intellectual development among children in out-of-home care, preferably starting at a young age.

Exploring the Letterbox Club programme’s impact on foster children’s literacy

2019. Hilma Forsman. Oxford Review of Education 45 (4), 502-518

Article

The book-gifting programme, the Letterbox Club, was developed as a response to the increased interest in ways of improving the educational outcomes of children in out-of-home care. By reporting quantitative and qualitative findings from a Swedish trial, and compiling findings from previous British evaluations, the purpose of this paper is to further our understanding of the programme’s potential impact. Pre/post measurements of the reading age of 72 foster children showed an average improvement of 2.5 months in comparison to the national average. With some exceptions, interviews with children and carers showed that the programme was well received and indicated that it could increase reading engagement and carer involvement. The current empirical base knowledge suggests that the Letterbox Club has a small impact on foster children’s literacy. The results do not allow for causal interpretations. Long-term outcomes are unknown. The programme lacks a theoretical foundation, and the implementation is dependent on individual and contextual factors. However, the programme is simple to administer, low-cost, and can reach a large number of children. The article therefore suggests that the Letterbox Club could be seen as a general supportive measure, and promotion of carer involvement is proposed as a way of improving its potential impact.

A decade lost

2018. Ylva B. Almquist (et al.). Journal of Epidemiology and Community Health 72 (11), 997-1002

Article

Background: Past research has consistently identified children with experience of out-of-home care (OHC) as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, the empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success for the association between OHC experience and premature mortality.

Methods: Drawing on a Stockholm cohort born in 1953 (n=15,117), we analysed the associations between placement in OHC (ages 0-12), school performance (ages 13, 16, and 19), and premature all-cause mortality (ages 20-56) by means of Cox and Laplace regression analysis.

Results: The Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that these children died more than a decade, based on median survival time, before their majority population peers. However, among individuals who performed well at school, i.e. scored above-average marks at age 16 (grade 9) and age 19 (grade 12), respectively, the risks of premature mortality did not significantly differ between the two groups.

Conclusion: Educational success seems to mitigate the increased risks of premature death among children with experience of OHC.

Children Placed In Out-of-Home Care as Midlife Adults

2017. Lars Brännström (et al.). Child Maltreatment 22 (3), 205-214

Article

International research has consistently reported that children placed in out-of-home care (OHC) have poor outcomes in young adulthood. Yet, little is known about their outcomes in midlife. Using prospective data from a cohort of more than 14,000 Swedes born in 1953, of which nearly 9% have been placed in OHC, this study examines whether there is developmental continuity or discontinuity of disadvantage reaching into middle age in OHC children, compared to same-aged peers. Outcome profiles, here conceptualized as combinations of adverse outcomes related to education, economic hardship, unemployment, and mental health problems, were assessed in 1992–2008 (ages 39–55). Results indicate that having had experience of OHC was associated with 2-fold elevated odds of ending up in the most disadvantaged outcome profile, controlling for observed confounding factors. These findings suggest that experience of OHC is a strong marker for disadvantaged outcomes also in midlife.

Foster carers’ experiences of a paired reading literacy intervention with looked-after children

2017. Hilma Forsman. Child & Family Social Work 22 (1), 409-418

Article

Previous studies have shown that paired reading, a structured literacy intervention, is a promising method for improving looked-after children's literacy skills. The aim of this study was to explore variations in foster carers' experiences of conducting the intervention. Interviews were carried out with 15 Swedish foster carers with varying experiences in programme compliance and of practicing the method. Findings suggest that the intervention process starts with getting carers involved, which seems to be dependent on a positive carer attitude. Integrating the reading training in the everyday life is another important aspect, which evolves around motivating the child and prioritizing the reading sessions. Furthermore, the results emphasize the need of having a flexible approach when delivering the intervention. The results suggest that it is possible to engage foster carers in literacy training for looked-after children and that paired reading can provide a model for competent reading and also result in improved child/carer relations. However, participants need support, and in some cases adjustments in the day-to-day delivery of the intervention are required.

The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

2017. Lars Brännström (et al.). International Journal of Child Abuse & Neglect 67, 408-418

Article

Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.

Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data

2016. Hilma Forsman (et al.). International Journal of Child Abuse & Neglect 57, 61-71

Article

Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973–1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances.

Paired reading for foster children

2014. Bo Vinnerljung (et al.). Adoption & Fostering 38 (4), 361-373

Article

A UK literacy intervention – Paired Reading – was replicated in seven Swedish local authorities, with 81 foster children aged 8–12 participating in a 16-week trial. Ability was measured pre/post intervention with age-standardised literacy tests and a short version of the WISC-IV. Results confirm and expand findings from the UK, namely that: almost all foster carers and children completed the programme (attrition 2.4%), average improvement in reading age was 11 months, basically the same as in the UK; younger children (aged 8–9) improved significantly on all four administered standardised reading tests, and on the WISC-IV Vocabulary subtest. Older children (aged 10–12) improved significantly on three of five literacy tests and on the WISC-IV Vocabulary subtest. On the short version of WISC-IV, vocabulary improvements over time reduced the proportion of children who could be classified as having ‘weak cognitive skills’ (IQ <85) from 54% to 36%. This finding is in line with results from other studies, indicating that scores from cognitive tests of pre-teen children in out-of-home care should not be regarded as fixed and can be improved by effective interventions.

Interventions aiming to improve school achievements of children in out-of-home care

2012. Hilma Forsman, Bo Vinnerljung. Children and youth services review 34 (6), 1084-1091

Article

The educational underachievement of children in out-of-home care has been known for decades. In this scoping review, we compiled and analyzed – with a narrative approach – evaluated interventions that aimed to improve foster children's school achievements. Despite a comprehensive searching strategy, only eleven relevant studies were found, indicating that little has been done in intervention research to improve educational outcomes for children in public care. Nine out of the eleven interventions reported some positive results. Literacy was improved in most studies, while evaluated attempts to enhance numeracy skills yielded mixed results. Positive results came from a range of different interventions, e.g. tutoring projects and structured individualized support. We conclude that most focused interventions seem to improve foster children's poor academic achievements, but tutoring projects have so far the best empirical support from evaluations with rigorous designs. Also there's a definite need for more intervention research.

Timing of higher education completion in out-of-home care experienced individuals: On schedule or delayed?

2023. Hilma Forsman, Lars Brännström. Developmental Child Welfare 5 (4), 190-203

Article

It is well known that individuals with out-of-home care (OHC) experience tend to have lower educational attainment than their peers in young adulthood, and a number of interventions have been implemented to increase their higher education outcomes. However, the timing of their higher education completion, and whether they experience educational recovery over the life course, is largely unknown. Using longitudinal Swedish data from a birth cohort of more than 13,000 individuals, this study examined OHC experienced individuals’ chances of having a higher education, here defined as a record of postsecondary education of two years or more, in midlife (age 50) and whether the timing of completion differs between them and a group of individuals who had child welfare contact (CWC) without being placed, and a group of general population peers. Results from multivariable logistic regressions corroborated prior findings that individuals who have been placed in OHC were less likely to have completed higher education compared to their general population peers. However, among those who did, they were more likely to have completed it later in life. Overall, there were no differences between the OHC group and the CWC group, both groups may thus not only benefit from specific support but also from more general inclusive education policies that allow for life-long learning.

Hilma ForsmanLecturer

About me

Research projects

Publications

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study

Placerade barns utbildningsvägar: Från mellanstadiet till medelåldern

Cumulative Childhood Adversity and Long-Term Educational Outcomes in Individuals with Out-of-HomeCare Experience

Exploring educational pathways over the life course in children with out-of-home care experience

Inequalities in educational outcomes in individuals with childhood experience of out-of-home care

Exploring the Letterbox Club programme’s impact on foster children’s literacy

A decade lost

Children Placed In Out-of-Home Care as Midlife Adults

Foster carers’ experiences of a paired reading literacy intervention with looked-after children

The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data

Paired reading for foster children

Interventions aiming to improve school achievements of children in out-of-home care

Timing of higher education completion in out-of-home care experienced individuals: On schedule or delayed?