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Decision-Making in the Foster Care System

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Decision-Making in the Foster Care System University of Missouri, St. Louis IRL @ UMSL Dissertations UMSL Graduate Works 12-6-2016 Decision-making in the Foster Care System Julie E. Bertram University of Missouri, [email protected] Follow this and additional works at: https://irl.umsl.edu/dissertation Part of the Educational Leadership Commons Recommended Citation Bertram, Julie E., "Decision-making in the Foster Care System" (2016). Dissertations. 634. https://irl.umsl.edu/dissertation/634 This Dissertation is brought to you for free and open access by the UMSL Graduate Works at IRL @ UMSL. It has been accepted for inclusion in Dissertations by an authorized administrator of IRL @ UMSL. For more information, please contact [email protected]. DECISION-MAKING IN THE FOSTER CARE SYSTEM Julie E. Bertram BSN, Saint Louis University School of Nursing, 1993 MSN, Saint Louis University School of Nursing, 1999 A Dissertation Submitted to The Graduate School at the University of Missouri- St. Louis in partial fulfillment of the requirements for the degree Doctor of Philosophy in Education May 2017 Defense of Dissertation Committee: Wolfgang Althof, PhD, Chair Paulette Isaac-Savage, EdD J. Curtis McMillen, PhD Lee Smith, PhD DECISION-MAKING IN THE FOSTER CARE SYSTEM 2 Abstract This study documented and analyzed the processes of mental health treatment decision-making, in the context of family support teams, within the foster care system. The research questions explored engagement, perceptions, and self-rated empowerment among family support teams that serve adolescent foster youth with mental health concerns. The sample consisted of 23 participants from core support teams and 36 other adolescent and adult team members who were involved in the study. Data collection methods included observations at family support team meetings and court hearings, 34 semi-structured individual interviews, a self-rated empowerment scale, and informal conversations in the field. Analysis of non-survey data included qualitative content analyses of meetings and grounded theory methods of analysis for the interviews. Three analytic categories were found in the data: the inter-related processes of decision- making, power, and mesosystem factors that support or hinder decision-making. The inter-related processes of decision-making was chosen as a conceptual label to capture the complexity of arriving at decisions. The second category was named power. Power was conceptualized as the ability to influence, or get another person to do something; also the ability to access and use resources. Power was further distinguished by the subcategories: qualities and responses to power. Mesosystem factors in this study were the factors within the Children’s Division and Court System that encourage or impede the youth and family DECISION-MAKING IN THE FOSTER CARE SYSTEM 3 support team’s deliberations. Mesosystem factors as a category was further differentiated into three subcategories: role, transparency, and standardization of practices and procedures. Three family support team exemplars are presented to illustrate these categories. The results of the study pointed to: a) a need to educate stakeholders about how to more fully engage in collaborative decision-making and b) a need to provide more opportunities for problem-solving and open dialogue among the youth and their respective teams. DECISION-MAKING IN THE FOSTER CARE SYSTEM 4 Table of Contents Abstract...................................................................................................................................................................... 2 LIST OF TABLES ........................................................................................................................ 15 LIST OF FIGURES ...................................................................................................................... 16 CHAPTER ONE: INTRODUCTION ........................................................................................... 17 Purpose .................................................................................................................................................................... 20 Rationale and Research Questions ................................................................................................ 20 Researcher Perspective .............................................................................................................. 25 Significance of the Study .......................................................................................................... 28 Methods ............................................................................................................................................................... 30 Sensitizing Concepts and Theoretical Frame ................................................................................ 31 Limitations .............................................................................................................................................................. 32 Summary ................................................................................................................................................................. 32 CHAPTER TWO: REVIEW OF LITERATURE ......................................................................... 34 Laws and Political Context of Child Welfare and Foster Care ..................................................... 36 The Adoption and Safe Families Act of 1997 ........................................................................... 37 Fostering Connections to Success and Increasing Adoptions Act of 2008 ............................... 39 Continuity of care and oversight issues .................................................................................. 39 Planning for the future ............................................................................................................ 40 Problems with Child Welfare Quality of Care and Poor Outcomes ............................................. 41 Well-Being ................................................................................................................................ 45 Mental well-being. .................................................................................................................. 46 DECISION-MAKING IN THE FOSTER CARE SYSTEM 5 Social well-being. ................................................................................................................... 48 Emotional well-being .............................................................................................................. 49 Cognitive functioning and well-being. ................................................................................... 50 Self-Determination Theory ........................................................................................................... 53 Decision-Making........................................................................................................................... 62 The Decision-Making Ecology ................................................................................................. 62 Group Process Theory ............................................................................................................... 65 Power ................................................................................................................................................................ 67 Scholarly findings about power and the foster care system. ................................................... 68 Empowerment ................................................................................................................................................ 72 Foster youth perspectives of empowerment.......................................................................... 74 Caseworkers’ perspectives of empowerment. ....................................................................... 76 Foster parent perspectives of empowerment ........................................................................ 77 Connections between adult education theories and shared decision-making. ........................ 82 Measuring empowerment........................................................................................................ 89 Models of Decision-Making ......................................................................................................... 89 Family Group Decision-Making ............................................................................................... 89 Shared Decision-Making ........................................................................................................... 92 Paternalism ...................................................................................................................................................... 95 Informed decision-making model ........................................................................................... 97 “Professional as agent” model. ............................................................................................... 98 DECISION-MAKING IN THE FOSTER CARE SYSTEM 6 Overall goals of shared decision-making in foster care .......................................................... 99 Shared decision-making approach: who, what, when and how. ........................................... 100 Shared decision-making for special populations .................................................................. 102 The benchmark.....................................................................................................................
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