Studies of children and adolescents in the child welfare system have traditionally focused on the mental health problems of this at-risk population. However, we know little about their health in terms not merely of the absence or presence of illness, but in terms of a more wide and integrated view of health as physical, mental and social wellbeing, as the WHO already stated in 1948. Furthermore, adolescence is an under-researched area in child protection compared to infancy and toddlerhood, despite that a large number of children in the system are in this developmental period. Adolescence is an important developmental stage as it entails critical changes in all of the core developmental areas. Moreover, adolescent children in the child welfare system should be of special concern. Breakups in adoption and foster care tend to occur more during adolescence and the adverse past of these youth can hinder their opportunities for a healthy and positive lifestyle during this crucial developmental period. Accordingly, this study focuses on the health of a sample of adolescents in adopted families, kinship care families and residential care, in comparison with community adolescents. The research is approached from an integrated perspective that includes subjective measures of life satisfaction, health-related quality of life, psychosomatic complaints and sense of coherence (SOC), a construct related to the capacity of coping in a positive and meaningful way.
Method
Participants: The sample was comprised of 28,998 adolescents between 11 and 19 years. Of them, 394 were adopted, 195 were living with theirs grandparents in kinship foster care, and 35 adolescents were living in residential care. The remaining 28,374 participants formed the control group of community adolescents. All of them took part in the 2014 Spanish edition of the WHO collaborative study Health Behaviour in School-aged Children (HBSC).
Instruments: The instruments used were Cantril's Scale for Life Satisfaction, Kidscreen-10 Index for Health-Related Quality of Life, Self-Reported Health, the HBSC-Symptom Checklist for Psychosomatic Complaints and the SOC-13 scale for sense of coherence.
Statistical analysis: Descriptive analysis with mean comparisons (ANOVAs) controlling for gender and age were used in all analyses. Cohen’s d was used to measure the effect size.
Results
Data analysis showed significant differences between each group and the control group in the majority of variables, with more negative scores especially in kinship and residential care. The adopted group showed more similarities to community adolescents, only showing significant differences with them in life satisfaction (p = .025). However, adopted adolescents showed differences with the kinship and residential groups in almost all variables.
Discussion
Coinciding with previous research as well as with certain preconceived expectations given their adverse past, adopted adolescents and those in the child welfare system showed a less positive health profile in comparison with the control group. However, adopted adolescents’ profiles were more positive in comparison to kinship care and residential care adolescents’, who showed a similar profile of deteriorated subjective health and quality of life. Our results stress the importance of applying a psychological health perspective instead of a risk or pathology-based approach to adopted, foster care and residential care youth.
Family foster care and adoption , Residential child care
