Running head: Populations at Risk

Populations at Risk
By: Lindsay Britcher
DY5085@wayne.edu
February 15th, 2015
Wayne State University

Populations at Risk

ABSTRACT: Children in foster care are at-risk for many different reasons. Being a
woman in foster care with mental health diagnosis puts someone at an even higher risk. Johnna is
a young woman who has suffered a great deal since even before she was placed in foster care.
She is now having a difficult time adjusting to life in care. Johnna has refused to do the things
the workers ask like be accepting to a new foster home placement, stop her drug use, follow
rules, and many other issues. She also faces a long history of mental health problems that will be
discussed further in this paper.

While interning in a foster care and adoption agency called Spaulding for Children I have
seen many clients that are at risk. The agency is known for taking on the more difficult cases that
other agencies do not want to work with. Many of the cases that I personally have worked on
have had drug dependencies, children with learning disorders, lack of foster homes for these
children, and many other issues that foster children face on a daily basis. Older children who are
in foster care have a harder time being placed with a family due to their needs and ages. Foster
parents find it more difficult to work with these older children due to their lack of trust, bad
behaviors, low educational status, and many more issues that are faced by our foster children and
foster families daily. Spaulding for Children hosts many different meetings and mentor groups to
help assist foster families with these more difficult cases. Many of our youth are diagnosed with
a mental disorder which requires many doctors appointments, special education in schools,
behavioral issues which would require the foster parent to visit the school more often, and other
behavioral issues that have to be dealt with on a daily basis from out foster parents.
One of the cases that I have been assigned to, with the supervision of the caseworker, is a
female who is 14 years old named Johnna. Johnna is a very troubled youth who comes from a

Populations at Risk

background of abuse, neglect, substance abuse, and poverty. She came into care when her mother
signed over her rights to her and her brother after the older two siblings were taken into care. Her
siblings were taken into care because the mother had an issue with substance abuse, neglecting
the children, and no permanent housing. The two youngest were not removed at this time
because the maternal grandmother was mainly caring for them. After child protective services
took the eldest two into care, mom then decided she would just sign over her youngest two so
she did not have to worry about them anymore. The mother was also physically abusing all of
her children while she was taking care of them. During the time of the mothers substance abuse
issues, she would improperly care for her children. She would leave all of the children
unattended for long periods of time causing the older children to care for the younger ones. This
was also resulting in the children getting into trouble outside of the home since there was no
parental supervision in the home. The mother was found to be neglecting her children by leaving
them for these long periods of time. Johnna has two older sisters whom were already placed into
foster care homes. One of the sisters is residing with her father and the other has been adopted by
her paternal grandmother. Johnna is currently living in a residential treatment facility because
when she was placed in a foster home with her brother, there was a great deal of tension and lack
of trust created between Johnna and the foster family. Johnna and her brother were constantly
fighting and being physically aggressive towards each other and Johnna was being verbally
abusive and manipulative towards the foster parent. It was found that Johnna was causing these
issues and the foster parents did not feel comfortable working with Johnna but were still able to
care for the younger brother. Johnna stated that she does not want to live with her brother
because they do not get along when she is around. She also does not want to be the reason that

Populations at Risk

her brother is not adopted. The agency has also decided that Johnna and her brother are unable to
reside in a home together due to their behaviors.
Johnna has a history with substance abuse and started using when she was eleven years of
age. According to Vaughn (2007), when youth are in foster care it does not put them at risk for
higher usage than other youth their age who are with their biological parent. However, if a youth
is in care and using a substance it does put them at a higher risk for Substance Use Disorder. It is
found that the youth rely more on the drugs than their peers who are not in foster care. With
Johnna, she is allowed to have monthly passes to go and visit her family. During the month of
November when she used this pass, she returned to the residential facility and was drug tested as
routinely done. Johnna tested positive for marijuana use at this time. She was then re-enrolled in
substance abuse classes but has expressed to her worker that she will continue to smoke
marijuana whenever she leaves the premises. Unfortunately because she is in this residential
facility, they do not take away the youths pass to leave due to marijuana use but they do make
them participate in substance abuse classes. These classes do not seem to make a difference for
Johnna because she does not believe the substance use is an issue.
According to Bruskas (2008), it was found that more than 54.4% of foster care alumni
have a form of mental health problems that included depression, social problems, anxiety, and
Post Traumatic Stress Disorder. Johnna has also faced mental health issues. She is currently
diagnosed with depression, oppositional defiant disorder, Adjustment Disorder, Conduct
Disorder and attention deficit hyperactivity disorder (ADHD). She attends weekly therapy
sessions at her residential facility to work on learning to control and live with her disorders. She
does take medication for these disorders including Concerta for treating her ADHD, Abilify for
Depression, and Seroquel for depression. According to Narendor (2011) the use of psycotropic

Populations at Risk

medications for children in foster care is double the amount for children of the same age group
who are not in foster care. In this study, many youth had stated to the researchers, they feel like
the medications are being slapped on them after short evaluations by a doctor and are being
over medicated to where they are feeling drowsy. It was also reported by the foster care workers
that they feel like their clients are being given too much medication after very short exams by
doctors. It appears the main reason this is happening is due to the constant changing of doctors as
a child is moved from home to home. Their information from previous doctors is not always
being reported to the new doctor causing a lack of communication from previous health
professionals. When a child is moved from one agency to another, the new agency only gets a
very small amount of information from the previous agency. Children are moved to different
agencies due to a lack of available placements in their current agency.
Another important factor is that doctors or psychiatrists are prescribing high doses of
medications to children whom are on the brink of being moved to a new home due to their poor
behaviors. It seems like the doctor is using the medication to help control behaviors at the last
second before a child is removed from another possible permanent placement. It has also been
noticed that due to the large number of diagnoses children in foster care tend to pile up over the
years, they have a harder time being adopted or taken as a placement in a foster home. These
diagnoses follow the youth throughout their lives because anytime a new perspective adoptive
parent steps up with an interest for a child, they have to right to a full file disclosure. This gives
the pre-adoptive parent any non-identifying information about that youth. This includes all
medical history since the agency has had the case, reasons for removal from previous foster
homes, case notes, grades or Individual Education Plans is applicable, and much more
information about the child. The multiple diagnoses can scare away a pre-adoptive parent

Populations at Risk

because they think this child is going to have a great amount of needs. Even if the child is not
currently being treated for certain diagnosis they have had in the past, the illness is still part of
their record.
During her therapy sessions, Johnna is also working to become more trusting of women
in her life. She has had to deal with many women whom she becomes close with, leaving her life
such as her mother signing over her rights to Johnna and her brother, many different therapists
over the time she has been in care, a few caseworkers over the time, and a few different foster
homes that have all had her removed from their home due to bad behavior. This has greatly
affected Johnna and how she bonds with women. She is very afraid that she will become attached
to another woman and she will leave her life like the rest of the people that have left her behind.
Due to Johnnas trust issues, she has become unattached to others. The agency is having a
difficult time finding a foster care placement that will take a fourteen year old girl that has such
difficult issues. Johnna has also stated to her worker and me, that she does not want to be
adopted because she is afraid that this will be such a permanent placement. She also is afraid that
an adoptive family would tell her that she is no longer allowed to speak with her biological
family. Even though we have reassured Johnna multiple times that we will find her an adoptive
placement that will allow her to keep in touch with her biological family as long as they are
appropriate connections for her to keep in her life, she is still very hesitant in agreeing with
looking for an adoptive family. While in care, Johnnas maternal grandmother passed away and
Johnna was unable to go to the funeral because the family did not let the agency know of the
arrangements. This was very difficult for Johnna since her grandmother was more of a mother to
Johnna then her own mother was. Johnnas mother is a drug addict and alcoholic. Throughout
most of Johnnas life her grandmother was the one caring for them. Unfortunately, her

Populations at Risk

grandmother is not a fit caregiver for Johnna or her brother. This means that her grandmother is
unable to adopt either of the children.
While visiting with Johnna, she has tried to become very friendly with me. I think
because she knows that I am closer in age to her than her other workers, she feels more
comfortable with me. During our first visit in September of 2014, Johnna asked me if she could
get an iced coffee at the McDonalds we had taken her to. The caseworker and I didnt see a
problem with this and allowed her to order the drink she wanted. During the time of us driving
her back to the residential facility, she brought up the topic of jewelry. She then continued to ask
if next time we come to visit her, if we could take her to the mall and buy her some jewelry. The
caseworker interrupted her and let her know that if she wanted something she should put it on
her Christmas list since she was currently working on this list with her foster care worker. She
seemed to accept that answer and dropped the subject. I can see this being a conflict of interest
again though where she asks the caseworker and me to do something that other people would not
do for her. I will continue to follow the NASW Code of Ethics (2008) and not do these extra
things that are inappropriate for a worker to do. Another way I have seen the caseworker and
myself following the NASW Code of Ethics (2008) with Johnna is by commitment to clients. We
are committed to help find a foster care home and possibly an adoptive home for Johnna. By
doing this we are promoting the well-being of our client. Since Johnna is fourteen years old, she
has to consent to anything we do for her on her behalf. During our last visit, the casework wanted
to make a MARE profile for Johnna to help find potential adoptive families for her. In order to
do this we had to have informed consent signed by Johnna to allow us to submit her information
to the MARE website. Johnna agreed to allow us to put her information on this website which
will give her a better chance at being adopted.

Populations at Risk

Johnna has been undecided about the idea of adoption. Although she tells her workers
during one visit that she does not want to be adopted, she will then tell us the next visit that she
may be ok with it if she is part of the process and approves her foster parent. Johnna has been
with multiple foster parents due to her behaviors. She is currently in a residential facility because
there are no willing foster home able to care for her needs. According to Stott (2012) placement
instability while in foster care is one factor that could contribute to young adult risky behaviors
such as substance abuse, homelessness, pregnancy, or incarceration. Stott said that Foster care
placement instability has been shown to be problematic for adolescents in care. Low educational
achievement, school drop-out rates, identity confusion, low self-esteem, drug use, juvenile arrest
and incarceration rates, increased mental health care needs, and social network disruption have
all been correlated with placement instability. Johnna has not been in a stable foster home since
she came into care and this could be causing some of the issues she is having such as the low
self-esteem and increased mental health issues. Another risk Johnna faces, according to Stott
(2012) is engaging in risky sexual behaviors which are twice as likely to occur then her cohorts.
This is resulting in young teen pregnancy. Johnna would be vulnerable for teen pregnancy due to
her drug use impairing her judgment as well as her risk for sexual behaviors. It was also found is
Stotts research that it is less likely for youth in foster care to use contraceptives such as birth
control or condoms.

Populations at Risk

References
Bruskas, Delilah,R.N., M.N. (2008). Children in foster care: A vulnerable population at
risk. Journal of Child and Adolescent Psychiatric Nursing, 21(2), 70-7. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/232976398?accountid=14925

Youth in foster care are considered an at risk population due to the many issues they face
being in care. These youth have to deal with things like lack of permanency, many new
caseworkers, changing of foster parents, lack of trust, and many other issues. Due to these
issues the children face in foster care they are considered an at-risk population. This
population has a hard time building trust with others due to their lack of permanency.

Narendorf, S. C., Bertram, J., & McMillen, J. C. (2011). Diagnosis and medication overload? A
nurse review of the psychiatric histories of older youth in treatment foster care. Child
Welfare, 90(3), 27-43. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/918230612?accountid=14925

This article discusses the different issues that children in foster care face after they have
become diagnosed with a mental illness. It also explains how children are being over
diagnosed while they are in the foster care system. Many children are diagnosed with
multiple illnesses that will follow them the rest of their lives. This has become a major
issue in the last few years.

Populations at Risk

10

Stott, T. (2012). Placement instability and risky behaviors of youth aging out of foster
care. Child & Adolescent Social Work Journal, 29(1), 61-83.
doi:http://dx.doi.org/10.1007/s10560-011-0247-8
Foster care youth are at greater risk for risky behaviors when they are moved from foster
home to foster home. By not having this permanency in their lives they are vulnerable for
substance use disorders, pregnancy, and homelessness. This article was able to help me in
explain why youth in foster care are considered an at-risk population.

Workers, N. A. (2008). NASW Code of Ethics (Guide to the Everyday Professional Conduct
of Social Workers). Washington, DC: NASW.
The Code of Ethics helps social workers understand what is expected of them. Code 1.05
states that social workers should understand culture and its function in human behavior
and society. It then says that social workers should have a knowledge base of their
clients cultures and be able to demonstrate competence in the provision of services that
are sensitive to clients cultures and to differences among people and cultural groups.

Vaughn, M. G., Ollie, M. T., McMillen, C., Scott, L.,Jr, & Munson, M. (2007). Substance use
and abuse among older youth in foster care. Addictive Behaviors, 32(9), 1929. Retrieved
from http://search.proquest.com.proxy.lib.wayne.edu/docview/218962334?
accountid=14925
This study was used to look at how substance abuse is prevalent among youth in foster
care. It was found that substance abuse disorder is higher among youth who are in foster
care. It was also found that the more substance abuse that happens during this time in

Populations at Risk

foster care can lead to greater use after the youth leaves foster care.

11