Trauma Commons^™

Perspective: Restoring Rest-The Critical Role Of Sleep In Foster Care Well-Being, Jill Mcleigh, Anna Wani, Likhita Shaik

Health Status, Outcomes, and Literacy and Healthcare Utilization

In 2023, approximately 400,000 children were in foster care in the United States, a population disproportionately affected by trauma, instability, and systemic inequities.1 These children face chronic disruptions in sleep—an essential physiological process that underpins physical development, learning, emotional regulation, and overall health.²⁻⁴ Adverse Childhood Experiences (ACEs), including abuse, neglect, and household dysfunction, are prevalent in this group and contribute to significant sleep disturbances through pathways of hyperarousal, stress dysregulation, and recurrent nightmares. 3,4 Understanding the interplay between foster care, social determinants of health (SDOH), and sleep health disparities highlights opportunities for targeted interventions to improve outcomes.

For questions about …

Prenatal Substance Exposure And Positive Developmental Delay Screening Among Patients In Foster Care, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Prenatal substance exposure (PSE) is a known risk factor for negative birth outcomes and long-term health outcomes like neurodevelopmental problems. Children in foster care have increased exposure to PSE and higher proportions of developmental delay compared with the general population. It is unclear whether differences still exist among developmental delay screening among children in foster care with and without PSE.

For questions about this study or others, please email [email protected]

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Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

A Study Of Secondary Traumatic Stress In Health Care Professionals In Long-Term Care., Bethany Proudfoot

Doctor of Social Work Capstone Projects

Secondary traumatic stress (STS) is a significant concern for healthcare professionals in long-term care (LTC) settings. This study explores the impact of STS on clinical staff, addressing the research question: How has STS affected employees within the LTC sector, and what resources or support can be provided to mitigate its effects? The study utilized a mixed-methods approach, combining survey data from clinical staff across five LTC facilities in Ohio, incorporating the survey data measuring levels of STS and qualitative responses. Findings revealed that 64% of participants experienced high to severe levels of STS, with symptoms including anxiety, depression, sleep disturbances, …

Working With Foster Families: What Providers Should Know, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Foster parents play a vital, yet often challenging role in the lives of children who have experienced trauma and instability. Navigating the healthcare system for children in foster care can be particularly complex and overwhelming, requiring understanding, collaboration, and a unique approach from healthcare professionals. This page offers insights and practical ideas for healthcare professionals to effectively support foster parents, ultimately contributing to the well-being of the children in their care.

For questions about this publication or others, please email [email protected]

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Ensuring The Health And Well-Being Of Children After Adoption, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children in foster care have higher rates of health concerns and healthcare utilization than their peers who have not experienced foster care. For example, one study found that children in foster care had 2.5- and 2.3-times higher odds of having a mental health diagnosis and developmental disability diagnosis, respectively. Data on our patient population supports these findings, revealing that 70.4% of our patients had chronic or complex chronic health conditions.

For questions about this publication or others, please email [email protected]

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Resilience And Reality: Exploring The Lived Experiences Of People Living With Hiv In Texas During The Covid-19 Pandemic – A Qualitative Study., Ahmed F. Alanazi

Social Work Dissertations - Archive

This study investigated the lived experiences of individuals living with HIV (PLWH) in the Dallas-Fort Worth (DFW) area of Texas during the COVID-19 pandemic, using an Interpretative Phenomenological Analysis (IPA) framework. The research examined the intersection of health, social dynamics, and psychological resilience among PLWH, who faced compounded vulnerabilities due to systemic inequities and the dual public health crises of HIV and COVID-19. Through semi-structured interviews with ten participants from diverse backgrounds, the study captured the profound impacts of disrupted healthcare systems, heightened stigma, and social isolation on this marginalized population. The findings reveal that the pandemic exacerbated existing inequities …

Child Maltreatment And Behavioral Health Outcomes In Child Welfare: Exploring The Roles Of Severity And Polyvictimization, Lauren Malthaner, Jill Mcleigh, Gregory Knell, Katelyn Jetelina, Folefac Atem, Sarah Messiah

Behavioral Health/Developmental Delay

Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

For questions about this study or others, please email [email protected]

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Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

The Impact Of Health Status On Health Care Utilization Of Children In Foster Care, Jill Mcleigh, Gunjan Singh, Rong Huang

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization.

For questions about this study or others, please email [email protected]

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Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Barriers And Facilitators To Kinship Care In Texas: A Multi-Stakeholder, Mixed Methods Perspective, Lauren Malthaner, Jill Mcleigh, Hilda Loria, Erinne Conner, Mike Henson-Garcia

Caregiver Needs and Supports

Kinship caregivers face numerous barriers to providing care for children placed with them and limited facilitators to help ensure successful placements. Although the needs of kinship caregivers are being examined and prioritized in the legislature, operational and policy-level interventions are needed. Results from this study allow for interventions tailored to the needs of kinship caregivers in the State of Texas as identified by a multitude of stakeholder groups.

For questions about this study or others, please email [email protected]

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The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami

Adultspan Journal

This conceptual overview offers a comprehensive overview of systemic pathways that negatively impact the mental health of Black Men throughout their lives. Our argument highlights the importance for counselors and mental health professionals to utilize a thorough social risk assessment that considers these pathways in order to effectively address the mental health needs of Black Men while fostering positive working relationships. This overview strongly advocates for the use of context and structural determinants when evaluating mental health symptoms. Without an appropriate understanding of social risk and determinants, counselors may inadvertently perpetuate disparities by decontextualizing symptomology, and reproducing racist discourse.

Poverty And Commercial Surrogacy In India: An Intersectional Analytical Approach, Sheela Suryanarayanan

Dignity: A Journal of Analysis of Exploitation and Violence

The destination and source countries for commercial surrogacy match world patterns of inequality. India, Nepal, Thailand, Mexico, and Cambodia banned commercial surrogacy, moving the market to other less-developed countries in South Africa and South America. India had a commercial surrogacy boom until exploitative factors led to the passage of the Surrogacy (Regulation) Bill in 2019, which banned the practice. This paper examines surrogacy's monetary, health, and emotional effects on 45 surrogate mothers in Gujarat State, India. The study revealed that a majority (63%) of the very poor women remained very poor post-surgery. Surrogate mothers in poor households had to do …

Caregivers Of Youth In Foster Care In Texas And Their Role In Contraception Decision-Making For Adolescents In Care, Shelby Edmondson, Ana Belen Conrado, Hilda Loria, Jill Mcleigh, Jasmin Tiro, Simon Lee, Jenny Francis

Caregiver Needs and Supports

Few studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care.

For questions about this study or others, please email [email protected]

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Mental Health Disorders And Psychotropic Medication: Prevalence And Related Characteristics Among Individuals In Foster Care, Jill Mcleigh, Lauren Malthaner, Madeline Tovar, Mohsin Khan

Behavioral Health/Developmental Delay

This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables.

For questions about this study or others, please email [email protected]

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Addressing The Health Of Children In Foster Care, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Studies have shown high rates of physical, developmental and behavioral health concerns along with high rates of health care utilization, among children and adolescents in foster care. In 2016, the Rees-Jones Center for Foster Care Excellence produced a white paper entitled, Addressing the Health and Safety of Children in Foster Care (Children’s HealthSM, 2016), which drew attention to some of these needs and made recommendations for promoting improved health-related outcomes for this population. Much has changed during the last six years, and the purpose of this current white paper is to highlight progress made, draw attention to new and continuing …

Empowering Kinship Caregivers In Texas: A Call To Action For Policy Change, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Kinship care refers to the care of children and adolescents by relatives or close family friends, who are referred to as fictive kin. These relationships can be formal, meaning the child has been removed from a parent and placed by Child Protective Services (CPS) into the care of a relative or family friend, or informal, meaning the relationship occurs without any involvement from CPS. This brief focuses on the former and uses the term kinship care to refer to formal kinship caregiving.

For questions about this publication or others, please email [email protected]

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Integrating Feminist Approaches In Counseling Work With Adult Women, Kristen M. Toole

Adultspan Journal

The scope of ‘women’s issues’ in counseling is an ever-evolving landscape. Recent events such as the reversal of Roe v. Wade and the disproportionate impact of COVID-19 on women serve as powerful reminders of the necessity of this focus while underscoring a deep-rooted history of oppressive patriarchal structures. Therefore, counselors must remain informed of the unique considerations surrounding adult women in counseling and acquire proficiency in versatile techniques to meet this population’s nuanced needs. This article examines the complexity of contemporary womanhood and explores the fundamentals of Feminist Counseling Theory (FCT), a holistic, multiculturally conscious, social justice theory in counseling. …

Description Of Audiologic, Developmental, Ophthalmologic, And Neurologic Diagnoses At A Primary Care Clinic For Children In Foster Care, Jill Mcleigh, Lauren Malthaner, Melissa Reynoso, Kimberly Stone

Health Status, Outcomes, and Literacy and Healthcare Utilization

This study aimed to describe the prevalence of medically diagnosed audiologic, developmental, ophthalmologic, and neurologic conditions in a foster care primary care clinic and to identify any associations among these diagnoses and patient characteristics, placement type, and maltreatment type.

For questions about this study or others, please email [email protected]

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Paediatric Integrated Care In The Primary Care Setting: A Scoping Review Of Populations Served, Models Used And Outcomes Measured, Jill Mcleigh, Lauren Malthaner, Caitlin Winebrenner, Kimberly Stone

Integrated, Trauma-Informed Care

Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours.

For questions about this study or others, please email [email protected]

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Trauma-Informed, Integrated Primary Care: A Medical Home Model For Children With Prenatal Drug Exposure Who Enter Foster Care, Jill Mcleigh, Hilda Loria, Kelsey Craker, Susanna Bird

Integrated, Trauma-Informed Care

The rise in prenatal or childhood substance exposure diagnoses resulting from parental substance use has led to an increase in the number of children placed in foster care. Meeting the multifaceted health care needs of children with prenatal drug exposure (PDE) who enter foster care requires significant time, resources, and coordination. In addition to conditions resulting from their experiences of trauma, children in foster care often have unmet health care needs and experience disproportionate rates of adverse physical, mental and developmental health outcomes. This article outlines the barriers to providing comprehensive and high-quality care to this pediatric population and …

Developmental Status Of Young Children In Foster Care, Jill Mcleigh, Cecy Lazcano, Karlyn Tunnell

Health Status, Outcomes, and Literacy and Healthcare Utilization

Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains. This cross-sectional study used the Ages and Stages Questionnaire, Third Edition, demographic, and health-related data retrieved from electronic health records. The study included 796 children aged 1 to 66 months seen at an integrated primary care clinic exclusively serving CFC. Frequencies and percentages of …

“In This Industry, You're No Longer Human”: An Exploratory Study Of Women’S Experiences In Pornography Production In Sweden, Meghan Donevan

Dignity: A Journal of Analysis of Exploitation and Violence

Despite being a global, billion-dollar industry, very little is known about the conditions women face within the pornography industry. The aim of this study was to explore women’s experiences in pornography production, with a particular focus on structural antecedents to entrance, coercion, and violence within the industry, as well as current needs and any barriers to exiting the industry. Semi-structured, in-depth interviews were conducted with nine women with experiences in pornography production in Sweden. Participants identified young age, financial insecurity, earlier exposure to sexualized violence, and poor mental health as typical antecedents to entering the pornography industry. Once in the …

Transitioning From Foster Care To Adulthood: Supporting Adolescents And Young Adults, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children involved in foster care have significant trauma histories and have often experienced substantial neglect and/or abuse. Such adverse childhood experiences can lead to cumulative toxic stress, which if not buffered by support and a consistent adult caregiver, can negatively impact physical, mental and socio-emotional development. Such experiences can also result in a lack of trust in adults and systems of care, which can further reduce sources of support for children in foster care.

For questions about this publication or others, please email [email protected]

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Development Of An Integrated Medical And Behavioral Health Care Model For Children In Foster Care: The Rees-Jones Center For Foster Care Excellence, Kimberly Stone, Sara Moore, Sara Pollard

Integrated, Trauma-Informed Care

Children in foster care are classified as a population with special health care needs. They face multiple adverse childhood experiences and disrupted relationships, yet face barriers accessing consistent, high-quality health care. The American Academy of Pediatrics recommends integrated physical and behavioral health care for children in foster care, but little is known about the implementation of integrated care for this population. As a pediatrician, doctor of nursing practice, and psychologist in an academic medical setting, we describe the development and implementation of the Rees-Jones Center for Foster Care Excellence, emphasizing the role of medical and behavioral health providers in promoting …

Healthcare Utilization Patterns Among Children With A History Of Child Protective Services Investigations, Jill Mcleigh, Christian Carr, Heidi Roman, Jessica Fults, Jennifer Reingle Gonzalez, Corron Sanders, Michiko Otsuki Clutter, Ray Tsai, Katelyn Jetelina

Health Status, Outcomes, and Literacy and Healthcare Utilization

Examine whether children with a prior child protective services (CPS) investigation had different healthcare utilization compared to children without a history of CPS investigations.

For questions about this study or others, please email [email protected]

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Caring For Children In Foster And Kinship Care During A Pandemic: Lessons Learned And Recommendations, Hilda Loria, Jill Mcleigh, Erinne Conner, Valerie Smith, Rachel Keefe, Christopher Greeley, Kristin Wolfe

Health Status, Outcomes, and Literacy and Healthcare Utilization

Through qualitative feedback from professionals in healthcare, mental health, and child welfare, this study explored the impact of the COVID-19 pandemic on the health and well-being of children in the child welfare system. Positive outcomes and challenges related to the care of children in foster or kinship care in Texas during the COVID-19 pandemic are described. Themes identified included disparities in the child welfare system; utilization of telehealth; cross-sector communication and collaboration; safety considerations; and placement stability and support. The article concludes with recommendations in each of these areas for ensuring the health and well-being of children in foster and …

Caring For Children In Child Welfare Systems: A Trauma-Informed Model Of Integrated Primary Care, Jill Mcleigh, Laura Lamminen, Heidi Roman

Integrated, Trauma-Informed Care

Children involved with the child welfare system have high rates of behavioral health concerns, chronic health conditions, and developmental disabilities. Further, as a result of the complicated relationships among the court system, child protective services, and caregivers (i.e., biological, kinship, and/or foster caregivers) and the high volume of health-, behavior-, and development-related services children in care need, the services they receive tend to be fragmented and problem driven. On top of these challenges, children involved with the child welfare system have been exposed to trauma, and often more than one form of trauma. Taken together, these factors point to the …