Improving Academic Performance and Achievement of children and youth in foster care
Joanna Bermudez
Mercy College
Summer 2013

Introduction and Problem Statement
Approximately fifty percent of adolescents in this country’s foster care system are graduating from high school each year. In NYS, less than forty-four percent of adolescent’s in the foster care system graduate from high school yearly. The outcomes of youth who leave the foster care system between the ages of 18 and 21 are statistically grim; less than 50% of these youth are equipped with a high school diploma (Scannapeieco, Connel-Carrick, and Pinter, 2007), and with-in two years of leaving the system, 25% of them face unemployment, homelessness, and/or incarceration (Krinsky, 2007). For all children, especially children in foster care, having the proper advocacy, stability, educational coordination and guidance are vital in ensuring their academic success. Unfortunately, children in foster care are less likely to receive these components to assist them in becoming successful in academia, which in turn affects their chances to live a productive adult life.
The needs of the children and youth in foster care are in need of reformation across each state throughout the nation. Since the development of foster care, the focus of intervention has and continues to be a reactive approach, instead of a tactical approach. The intervention of foster care seeks to ensure the physical safety and well-being of each child and youth, which oftentimes leads to a neglect of their emotional and intellectual needs.
Studies conducted in New York, the Midwest, Chicago, Washington, and California have shown that children in foster care are particularly vulnerable to academic failure. Smithgall, Gladden, Howard, Goerge, & Courtney (2004) compared the likelihood of graduation between students in foster care versus non-foster care students. According to Smithgall et. al. (2004), 15-year-old students in foster care were about half as likely as non-foster care students to have graduated high school five years later, with significantly higher percentages of foster care adolescents having dropped out (55%) or become incarcerated (10%). This study which looked at children and youth in foster care indicated that this population was behind one academic year versus non-foster care students, however, some of this is attributed to the low-performing schools that many youth in foster care attend (Smithgall et. al, 2004). Almost 50% of third to eighth grade students in out-of-home care scored in the bottom quartile on the reading section of the Iowa Tests of Basic Skills (ITBS) test (Smithgall et. al, 2004).
Studies done in the Midwest which showed that youth in foster care who completed the 10th and 11th grades, on average read at a seventh grade level (Courtney, 2004a). Approximately 44% of them read at a high school level and few excelled in academic subjects, when compared to a national sample. This study showed that less than 1 in 5 foster care youth received an “A” grade in the primary subjects (Mathematics, English, Science, and History). Foster care youth who attended public schools scored 16-20% below non-foster care students in statewide standardized testing (Courtney, Grogan-Kaylor, & Nesmith, 2001). These percentages were of students in grades three, six and nine. These nationwide studies show that many of the children and youth in foster care will continue to be unsuccessful in school and are less likely to attain a post-secondary education. For example, a longitudinal study that followed a sample of more than 700 17- and 18-year olds from Iowa, Wisconsin and Illinois as they transitioned out of foster care, found that less than one third had completed at least one year of college by age 23 or 24 compared to 53% percent of a nationally representative sample of 23 and 24 year olds (Courtney et al., 2010). Research suggests that children and youth in foster care are less likely to complete their homework assignments, receiving tutoring or other academic support services, participate in college prep courses, graduate high school or go to college. The factors that attribute to these negative experiences are trauma due to the displacement from their natural homes, placement into the foster care system and subsequently leading to numerous foster home placement changes, which frequently results in school changes and possible delays in school enrollment. These children and adolescents suffer from untreated psychological trauma, and misdiagnosis of behavioral issues. Their foster care placement often leads to loss of their education records, inconsistent responsibility and accountability for educational progress and advocacy. Finally, there is a severe lack of coordination in creating a supportive network between child welfare agencies, schools, and other service providers to create an educational plan for each student.
A major cause of trauma and stress in the lives of foster children and youth is the constant instability they face daily. According to the Children’s Bureau of the U.S. Department of Health and Human Services, the average time spent in foster care is 29 months (the median time is 16 months), with 15 percent languishing in care for 5 years or more (Pecora, et. al, 2003). On average, children and youth in foster care change their foster home placement two a year and these home transfers often result in a change in school placement. School mobility rates for foster children and youth are usually higher when they are first placed into care. In 2004, 16,000 children and youth in NYC Public School system switched schools soon after their placement into foster care. A 2003 study of 1,087 Casey Family Programs alumni of foster care served across the country (the Casey National Alumni Study) found that over two-thirds (68%) of them had attended three or more different elementary schools and a third (33%) had attended five or more (Pecora et.al, 2003).
Another important factor to be recognized is disproportion of children of color versus Caucasian children in the foster care population. In 2005, the proportion of children of color was 58% compared to 42% of all U.S. children, with African American children comprising 32% of the foster care population (U.S. Department of Health and Human Services, 2006). Also, these children are disproportionally from low-income families and are mostly placed in low-income foster homes. Not surprisingly, then, like other low-income youth of color, children in foster care tend to be concentrated in high-poverty, underfunded, and low-achieving schools (Smithgall et al., 2004).
The Advocates for Children of New York, Inc. (2000) study of seventy foster care children and youth found that they did not begin attending school immediately upon their entry into foster care. These children and youth (42%) were kept out of school because of lost or misplaced school records. Nearly 45% of youth in care in the New York State study reported being retained at least once in school (Advocates for Children, July 2000). Studies across the country have found that children and youth in foster care are significantly more likely to have school behavior problems and that they have higher rates of suspensions and expulsions from school. One third of youths in out-of-home care will age out of the system with psychological problems including “posttraumatic stress disorder, alcohol and substance abuse, and major depression” (Krinsky, 2007, ¶ 7). One quarter of foster youth will be arrested with-in two years of aging out of the foster system and as many as 25% youth report being homeless within four years of release from the foster care system (Krinsky, 2007). Nearly 60% of female foster alumni have babies within 4 years of release and in most cases without marriage (Scannapieco, et al., 2007).
There have been efforts across the country to improve the school experience for children and youth in foster care, as well as to improve the academic outcomes for the children and youth in this population. The focus of these efforts has been in the following four areas: (1) stability of educational placement (i.e., maintaining students in their schools of origin); (2) educational rights and opportunities (i.e., information and training on educational rights, special education, and college or workforce preparation); (3) advocacy and cross-system liaisons (i.e., advocacy resources to assist youth and families with enrollment, suspension/expulsion, special education or other barriers); and (4) quality of educational programming (Burrell, 2003).
There are federal, state and local programs that are working towards creating policies and procedures to protect the vulnerable individuals of this population. One such program is The No Child Left Behind Act, also known as Federal Elementary and Secondary Education Act, was enacted in 2001and aims to improve the quality and performance of education for children in the U.S.. This act ensures the accountability standards for states, school districts and schools are increased so as to ensure the academic needs of all children are being met. The intent of this act is to ensure that all children will be able to meet the academic achievement standards to reach their potential through improved educational programs. Specifically, Title I ("Title One") of the No Child Left Behind Act, distributes funding to schools and school districts that serve students from low-income neighborhoods by the U.S. Department of Education.
The problem with this act is underfunded at the state level and the federal government has a list of provisions they must meet in order to receive benefits or they risk losing the federal funds. Another disadvantage of the NCLB act is it encourages and rewards teaching children how to score well on the standardized state exams, rather than teaching so the children will learn. This limits the range of information and knowledge the teachers can share with the children in their classrooms; it also ignores other vital subjects such as science, foreign languages and history. In addition, this act tends to fault schools for the failure of its students, but does not take into account other factors that affect the students’ lack of achievement, such as larger class sizes, old and damages school buildings, lack of health care, disruptive home lives and hunger.

Hypothesis
Students who receive Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) are more likely to improve academically than those students who receive peer counseling.
Specific Research Questions
This study will seek to answer the following questions: * Is there a statistical significant relationship between treatment outcomes (academic achievement) and length of time in foster care? * Will treatment outcomes (academic performance and self-efficacy) differ by parent status? * Will treatment outcomes (academic achievement and academic performance) vary by socioeconomic status?
Theoretical/Conceptual Framework
This study, specifically the hypothesis, is informed by cognitive behavioral therapy, specifically, the Trauma Focused-Cognitive Behavioral Therapy model, developed by Esther Deblinger-Ph.D, Judith Cohen-M.D., and Anthony Mannarino, Ph.D. This theory posits that the change in our cognition can positively change emotions, which can influence our actions. TF-CBT uses psychotherapy surrounding traumatic events, which can be effective in reducing negative emotional and behavioral responses, which will increase the likelihood of positively coping with life stressors. This model can be used with children and adolescents residing in various settings, including biological parent homes, foster care, kinship care, group homes, or residential programs.
Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based practice and empirically supported treatment for trauma-related symptoms in children. Children who have experienced traumatic events may have a few or many post-traumatic stress disorder (PTSD) symptoms, and meet the criteria for full-blown PTSD. Thus, the experience of a trauma does not necessarily lead to PTSD, and might in fact result in other emotional or behavioral symptoms, such as disruptive behaviors, depression, or anxiety due to trauma. The goal of TF-CBT is to help address the unique bio-psychosocial needs for children with Post Traumatic Stress Disorder (PTSD) or other problems related to traumatic life experiences, and their parents or primary caregivers.
Rationale
This study will help to identify variables and treatments that are effective for adolescents in foster care, specifically such information will allow us to develop targeted interventions to address cognitive, emotional and behavioral needs. Such program/interventions can be integrated within the existing foster care infrastructure making it more feasible and practical to be administered.
As part of the treatment process, individual sessions are conducted for the child/youth and for the natural parents or caregivers, as well as joint sessions between the caregivers and children/youth. A vital component of this therapy model is forming a therapeutic relationship with the child/youth and parent to continue engagement and encourage participation in therapy sessions.
Methodology
This experimental study will investigate the relative effectiveness of treatments (TF-CBT and peer counseling) in treating children and adolescents in foster care with low self-efficacy.
Design
This study will utilize a between group experimental design. One group (experimental) will receive TF-CBT and the other group (control) will receive peer counseling. All subjects and participants will be assessed based on criteria set forth in standard diagnostic classifications, such as the DSM-5, ICD 10 and other nosological guidelines.
Inclusion Criteria
All participants in this study will have to meet the following criteria in order to be eligible to participate. They must be: * Children and youth currently in the foster care system. * Between the ages of 10-17 years old. * Enrolled and participate in school full-time * Not enrolled or participating in therapy, counseling or other mental health services
These criteria were selected because this study will focus on children/youth in foster care, who are having difficulty meeting academic standards or making academic achievements.
Exclusion Criteria Participants will be excluded from the study if: * Have been discharged or have signed themselves out of foster care * Are receiving mental health services (therapy, counseling, etc.) * Are not enrolled or participating in school full-time * Are receiving tutoring services.
Recruitment and Sampling
A convenience sample of about 100 subjects or participants (50 in each group; experimental and control) will be recruited. All potential participants will be screened based n the inclusion criteria. Once they are found eligible and willing to participate, they will be randomly assigned or allocated to either experimental or control treatment. All necessary IRB approval, as well as informed consent, will first be obtained before the start of the recruitment and participation. Given that the study participants will be of ages 17 and under and are minors, their assent will also be obtained.
The following recruitment strategies were used to obtain subjects/participants: * Referrals from case planners, other foster care agency staff, mental health staff, and school staff * Casework contacts with foster parents and children/youth
All confidential information needed for this study will be obtained through the appropriate HIPAA guidelines, as well as approval from the IRB to utilize and publish information from the NYC Administration for Children’s Services and NYC Board of Education databases.
The subjects or participants in this study will not receive compensation. They will receive the following incentives for their participation in this study: * Movie theater vouchers (valued at $50.00) * Barnes & Noble Bookstore gift cards (valued at $30.00)
Intervention and Procedures
In this study, the experimental group will receive Trauma Focused-Cognitive Behavioral Therapy, whereas the control group will receive peer counseling. Please see below for a description of each therapy model:
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidenced-based model of psychotherapy that focuses on children diagnosed with Post-Traumatic Stress Disorder. This model addresses the unique needs of these children who suffer from depression, behavior problems, and other difficulties related to their traumatic life experiences. Removal from a child’s natural home environment and placement into foster care is a traumatic life event. The TF-CBT model incorporates trauma-sensitive interventions using cognitive behavioral techniques, family and humanistic principles and techniques. Within this model, children/youth and their caregivers undergo cognitive restructuring to improve their negative thought processes, learn how to manage and resolve their troubling thoughts, feelings, and behaviors that are related traumatic life events; improve depression and anxiety symptoms.
In addition to the cognitive restructuring benefit of TF-CBT, this model also has neurobiological benefits. Research has discovered an association between TF-CBT and decreased heart rate, blood pressure and some changes in frontal brain structures and the amygdala. Neurobiological changes correlated with changes in symptom severity (Zantvoord, Diehle, Lindauer, 2013).
Zantvoord et. al (2013) stated:
TF-CBT was associated with a reduction of physiological reactivity. The review found preliminary evidence that TF-CBT influences brain regions involved in fear conditioning, extinction learning and possibly working memory and attention regulation; however, the researchers write, these effects could be nonspecific psychotherapeutic effects.
Peer counseling posits that individuals are capable of finding solution to their own problems by providing them with guidance and support. Peer counselors work with their fellow peer counselors, other mental health practitioners, children/youth and the parents/caregivers of children with serious emotional disturbances. Certified peer counselors help children/youth and their parent/caregivers identify goals that promote resiliency and self-efficacy and then assist them in identifying services and extracurricular activities to help them achieve these goals. They assist their families with achieving their goals by helping them create an action plan, which involves steps to build a supportive network with family, friends, community resources, etc. and identifying and controlling internal and external stress. Peer counselors often times have experienced similar situations as their consumers and use their experiences as part of their counseling method. Throughout the counseling process, the peer counselors share their own experiences as a means of encouragement to the children/youth and their parent/caregivers. The goal of the peer counselor is to help the consumers regain control over their own lives by promoting positive thinking, consumers taking personal responsibility and learning to advocate for themselves. The peer counseling sessions can be conducted individually or in groups, depending on the needs of the clients. Peer counselors are often employed with community mental health centers, schools and other subcontracting agencies.
Setting
Both the experimental and control groups will receive their treatments in the clinician’s office at the foster care agency.
Duration
Recommended TF-CBT treatment last 12-18 sessions and each session occurs weekly for 30-45 minutes for the child/youth session, as well as the parent/caregiver session. The TF-CBT model also includes joint parent/child sessions, set to begin closer to the end of the treatment process and the session are approximately 30-45 minutes.
Personnel and Training
Training of the TF-CBT model will be provided to all personnel, as well as the development of a manual, so that the treatment can be administered in a standardized manner. Additional personnel training will include Post-Traumatic Stress Disorder, emotion identification and emotion regulation, and behavior modification. This is a quality control measure. Following the intervention or treatment, all participants will be evaluated and assessed for academic performance, self-efficacy and academic achievement.
Instrumentation
In this study, a questionnaire will be developed and pre-tested or piloted before being finalized. This questionnaire will include items or questions related to personal and sociodemographic factors, as well as selected scales which are detailed below. Specifically the General Self-Efficacy Scale (GSE) will be used to obtain a self-esteem score. This scale is considered reliable and valid for the sample being studied. The General Self-Efficacy Scale was created as a tool to assess an individual’s sense of perceived self-efficacy by predicting how the individual copes with daily life stressors and how he/she adapts after each stressful experience. The construct of Perceived Self-Efficacy reflects an optimistic self-belief (Schwarzer, 1992). This is the belief that an individual has the ability to cope with any difficulties that arise or can accomplish any task, whether it be minor or challenging, in all aspects of their lives. People with higher levels of self-efficacy are more likely to set goals, invest time and effort in reaching these goals, and are more persistent in facing barriers. This scale has ten items that are designed to measure this construct and each looks at the individual’s intrinsic values of success. Perceived self-efficacy is an operative construct, i.e., it is related to subsequent behavior and, therefore, is relevant for clinical practice and behavior change (Schwarzer & Jerusalem, 1995). Schwarzer & Jerusalem’s (1995) study found the following:
In samples from 23 nations, Cronbach’s alphas ranged from .76 to .90, with the majority in the high .80s. The scale is unidimensional. Criterion-related validity is documented in numerous correlation studies where positive coefficients were found with favorable emotions, dispositional optimism, and work satisfaction. Negative coefficients were found with depression, anxiety, stress, burnout, and health complaints. In studies with cardiac patients, their recovery over a half-year time period could be predicted by pre-surgery self-efficacy.
The Wechsler Scales of Intelligence were developed by clinical psychologist Dr. David Wechsler. Dr. Wechsler’s initial intelligence test only measured the intellectual performance by adults and was published in 1939. He later revised his intelligence scales to measure the cognitive abilities of children and adults. The revised versions are as follows: Wechsler Adult Intelligence Scale-III (WAIS-III) is used with adults, The Wechsler Intelligence Scale for Children-IV (WISC-IV) used for children between the ages of 6 - 16, and The Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) is used for children age 4 - 6 1/2 years. For the purposes of this study, we will be looking at the Wechsler Intelligence Scale for Children-IV (WISC-IV). The WISC-IV is an inclusive scale, in that the child or youth can complete the test without reading or writing and can take anywhere between 65-80 minutes to administer. The WISC-IV generates a Full Scale IQ (FSIQ). The full scale IQ represents the subjects overall cognitive ability, as well as four other composite scores such as Verbal Comprehension, Perceptual Reasoning, Processing Speed and Working Memory Index (Wechsler, 2003). The WISC-IV has undergone tests to measure its reliability and validity (see Appendix A for reliability and validity information).
Data Analysis

The objective of this analysis is to determine if there is a statistically significant difference between TF-CBT and Peer Counseling with respect to levels of self-efficacy and academic performance. The independent variable in this study is TF-CBT and Peer Counseling, whereas the dependent or outcome variables are academic performance and self-efficacy, which will be measured using the General Self-Efficacy Scale and the Wechsler Scale of Intelligence. Given that the dependent variable is numbered, the independent samples t-test or one-way ANOVA will be used for comparing the means of the two treatment groups to determine if there is a statistically significant difference. An alpha level (level of significance) of .05 will be used to determine whether to reject or accept the null hypothesis. All data entry and analysis will be performed using the statistical software Statistical Package for the Social Sciences (SPSS). The results of the analysis will be interpreted and presented using tabular and graphical formats, an example of which is given below.

Comparison of Self-Esteem Score by Treatment Treatment | Self-Esteem Score N Mean SD | | | Experimental (TF-CBT) Control (Peer Counseling) |

References
Advocates for Children of New York, Inc. (2000, July). Educational neglect: The delivery of educational services to children in New York City’s foster care system. New York: Advocates for Children.

Bruskas, D. (2008). Children in Foster Care: A Vulnerable Population at Risk. JCAPN, Volume 21, Number 2. Retrieved June 25, 2013 from http://www.alumniofcare.org/assets/files/jcap_134.pdf

Burrell, S. (2003). Getting out of the “Red Zone”: Youth from the juvenile justice and child welfare systems speak out about the obstacles to completing their education, and what could help. San Francisco, CA: Youth Law Center.
Courtney, M. E., Piliavin, I., Grogan-Kaylor, A., & Nesmith, A. (2001). “Foster Youth
Transitions to Adulthood: A Longitudinal View of Youth Leaving Care.” Child Welfare
80 (6). 685–718.
Courtney, M.E., Terao, S. & Bost, N. (2004a). Midwest evaluation of the adult functioning of former foster youth: Conditions of youth preparing to leave state care. Chicago, IL: Chapin Hall Center for Children at the University of Chicago.

Krinsky, M.A. (2007). A case for reform of the child welfare system. Family Court Review, 45(4), 541-547. doi:10.1111/j.1744-1617.2007.00169.x.

Lips, D. (2007, June 5). Foster Care Children Need Better Educational Opportunities. Retrieved from http://www.heritage.org/research/reports/2007/06/foster-care-children-need-better-educational-opportunities

Pecora, P., Williams, J., Kessler, R.C., Downs, A.C., O’Brien, K., Hiripi, E., & Morello, S. (2003). Assessing the effects of foster care: Early results from the Casey National Alumni
Study. Seattle, WA: Casey Family Programs.
Scannapieco, M., Connel-Carrick, K., & Painter, K. (2007). In their own words: Challenges facing youth aging out of foster care. Child & Adolescent Social Work Journal, 24(5), 423-435. doi:10.1007/s10560-007-0093-x.

Schwarzer, R. (Ed.) (1992). Self-efficacy: Thought control of action. Washington, DC: Hemisphere.

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON.

Smithgall, C., Gladden, R.M., Howard, E., Goerge, R., & Courtney, M. (2004). Educational experiences of children in out-of-home care. Chicago, IL: Chapin Hall Center for Children at the University of Chicago.

U.S. Department of Education (2001). No Child Left Behind Legislation and Policies. Retrieved June 24, 2013 from http://www2.ed.gov/policy/elsec/guid/states/index.html

U.S. Department of Health and Human Services (2006). Administration for Children and Families, Children’s Bureau, Research and Statistics.

Wechsler, D. (2003). The Wechsler intelligence scale for children—fourth edition. London: Pearson Assessment

Zantvoord J.B., Diehle J., Lindauer R.J.L. (2013) "Using Neurobiological Measures to Predict and Assess Treatment Outcome of Psychotherapy in Posttraumatic Stress Disorder: Systematic Review." Psychotherapy and Psychosomatics 2013; 82(3):142-51. doi: 10.1159/000343258. Epub 2013 Mar 21

Appendix A

Reliability and Validity Information for Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)

Publisher/Date: * Pearson Assessment, 19500 Bulverde Road, San Antonio, TX. 78259.
Published, 2003.

Standardization Issues: * 2,200 examinees (n=200 in each of 11 age-groups), representative of the
March 2000 US Bureau of the Census data, by age, gender, race, ethnicity, parent education level, and four major geographic locations. The
Arithmetic subtest’s sample size was about half that of the rest of the test.
Sample sizes for many of the “special group” analyses were small (Autistic
Disorder n=12 to ADHD n=89) and their representativeness, questionable.

Reliability and Validity Issues: * Composite scores appear to be highly-reliable, and most reliability coefficients from the 10 subtests retained from its predecessor (WISC-III) have improved substantially. Validity statistics reported in the manual appear strong. One issue arises with regard to validity toward the deaf population, with the absence of deaf children in statistical validity studies
(although a consultant and “experienced specialists” provided clinical input regarding subtest appropriateness).