Mental Health Assessment of Infants in Foster Care

By Silver, Judith; Dicker, Sheryl | Child Welfare, September/October 2007 | Go to article overview

Mental Health Assessment of Infants in Foster Care


Silver, Judith, Dicker, Sheryl, Child Welfare


Infants placed in foster care are at high risk for emotional and behavioral problems. Assessment of their mental health must account for their often-adverse life experiences prior to placement and the involvement of multiple systems that shape their lives in lieu of parents' authority. This article presents practice guidelines for infant mental health evaluations with consideration of legal requirements and the unique issues conferred by foster care.

Early childhood presents an unparalleled opportunity to improve the mental health and developmental outcomes of high-risk infants1 (Shonkoff & Phillips, 2000). Much of what is published on early childhood assessment has focused on childcare settings or early intervention programs for infants with developmental delays and disabilities (Knitzer, 2000; Shonkoff & Meisels, 2000). The vast majority of these children reside with their parents. However, infants who experience maltreatment and placement in foster care2 face the greatest risk for emotional and behavioral problems.

This paper is intended to inform the professional practice of those involved in the mental health assessment of infants in foster care. It briefly summarizes existing guidelines for infant mental health assessment and recommends practice modifications based on legal requirements and other distinctive issues associated with foster care. Mental health evaluations of these infants must address the complexity contributed by their atypical life experiences and the involvement of multiple systems that shape children's lives in lieu of parents' authority. In 2003, the Child Welfare League of America and the American Academy of Child and Adolescent Psychiatry (AACAP) collaborated to develop guidelines addressing the mental health needs of children in foster care. The authors, a clinical child psychologist and a child welfare/disability attorney participated in and developed recommendations for assessment based on work with court-involved infants (Dicker & Gordon, 2004; Silver, DiLorenzo, Zukoski, Ross, Amster, & Schlegel, 1999a).

Why Assess Infants?

Infants in foster care experience longer placements, higher rates of reentry into foster care (experiencing recurrent maltreatment and disruption of family bonds), and high rates of behavior problems, developmental delays, and health problems (Blatt, Saletsky, Meguid, Church, O'Hara, & Haller-Peck, 1997; Goerge & Wulczyn, 1999; National Survey of Child and Adolescent Weil-Being, 2005; Silver et al., 1999a). Because of these risk factors, mental health assessment is critical.

Infants are exquisitely sensitive to the emotional tone of their environments. When confronted with episodes of abuse, domestic violence, and volatile adults, their brains respond by secreting atypical levels of stress hormones (Dozier, Manni, Gordon, Peloso, Gunar, & Stovall-McClough, 2006; Gunnar & Barr, 1998). Similarly, severe neglect, which leaves the infant isolated, hungry, and in pain and discomfort, also results in high levels of stress (Dozier et al., 2006; Gunnar & Barr, 1998). Infants experience heightened physiological arousal, manifested in symptoms of intense anxiety, such as exaggerated startle responses, sleep and feeding disorders, fearfulness, and irritability (Scheeringa & Gaensbauer, 2000). Infants also experience grief and depression in response to losing beloved family members due to foster placement, a parent's incarceration, death, or child abandonment (Zero to Three, 2005).

Infants express emotional distress in several ways. They may demonstrate physiological dysregulation (for example, intense irritability, heightened arousal, limited ability to self-soothe, feeding and sleep disorders). Often, toddlers also present with behavioral disturbances (for example, aggression, defiance, impulsivity, overactivity, or sexualized behavior). Toddlers may exhibit intense fears and anxiety related to situations associated with past trauma (for example, bathing, being left alone in a room, diaper changes) (Heller, Smyke, & Boris, 2002). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Mental Health Assessment of Infants in Foster Care
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.