Introduction
Foster care is government-subsidized and -regulated temporary care for children who have been removed from their families for reasons of abuse and neglect. Children can be placed either in family or residential care. While family foster care includes arrangements of children living with unrelated foster parents (nonrelative foster care), with relatives (kinship care), or with families who plan to adopt them (foster/adopt homes), residential programs encompass a type of living in out-of-home care placement in which specialized services for youth with emotional and behavioral problems or other special needs are provided in a highly structured environment. It was estimated that in 142 countries about 2.7 million children aged 0–17 could be living in institutionalized care worldwide (Petrowski et al., 2017).
In Austria, in 2021 a total of 12,871 minors were living in foster care (of which 31.5% only in Vienna): 61.3% of the children and adolescents were placed in institutional group care, while 38.7% were accommodated with foster families (Österreich, 2022). In terms of age, 44.3% of children in foster care, were between the ages of 6 and 14. Children placed into institutional care usually live together with 8–10 other children, cared for by a team of social pedagogues, each of them having one main contact person, called “caregiver.”
Although estimates vary widely, a detailed literature search suggests that parental substance use disorder plays a major role in the child welfare system (Seay, 2015).
Maltreatment, such as neglect, and placement into foster care are considered as traumatic affecting children’s immediate and future psychosocial development and mental health (Cicchetti and Toth, 1995; Bowlby, 1998; Cicchetti et al., 2006). Children placed in foster care might have experienced distressing feelings such as confusion, anxiety and sadness, due to the unfamiliar or previously experienced situation to which they are adapting as a result of their placement (Bruskas, 2008). High rates of internalizing problems (e.g., anxiety, depression), externalizing problems (e.g., aggression, impulsivity), poorer social skills, and lower adaptive functioning were also reported among foster children compared to children who did not experience replacement (Webb et al., 2010; Jones Harden et al., 2014).
Specifically, those children who experienced trauma frequently revealed underdeveloped mentalizing capacities (Ostler et al., 2010). Muller et al. (2012) specified that their ability to cope with physical, or emotional traumas highly correlated with the perceived quality of their current relationships, and that traumatic experiences had a major impact on attachment behaviors of out-of-home children toward their foster caregivers. As a result of the children’s adverse experiences with parental care, they may be inclined to avoid forming new and supportive relationships. This creates a complex situation for all individuals involved, including both the foster caregiver and the children. On the other side, foster parents and institutional caregivers know that foster care is mostly not permanent. This issue may interfere with attachment formation to the foster parents/caregivers (Åkerman et al., 2020).
Methods/design
2.1 Aims
The first aim of this study is to explore the development longitudinally of the children’s mentalization ability at three measure time points: before, after and 12 months after attending a newly developed group MBT-intervention. It is an adapted version of Midgley et al. (2017). Mentalization-Based Treatment for Children (MBT-C), which addresses the particular needs of children of substance using parents, who live in foster care during middle childhood, integrating the psycho-social background of children living in foster care. Second, we will explore the mentalization capacity of the caregivers, their attitudes on drugs and drug addiction, and their social skills (e.g., social orientation and reflexibility) with regard to the impact on the children’s mentalization at the beginning of the intervention to better understand whether it influence the development of mentalization over time.
2.2 Participants
In the study 30 children living in foster care (institutional or foster home) and their actual main foster caregiver will be included (N = 60).
Children’s inclusion criteria for participation are: (1) age between 6 and 12 years, (2) stable mental health status (e.g., no psychotic state), (3) living in foster care for at least 6 months. A minimum of time in a stable and persistent placement needs to be considered to assure the children’s ability to reorganize their internal world and behavioral outcomes (Cassibba et al., 2023). Caregiver’s inclusion criteria are (1) child lives in the same household and (2) 18 years of age or older. Children are excluded from the study if presenting neurological, cognitive, and/or psychiatric problems, and/or difficulties reported by their caregiver.
Children in middle childhood, aged between 6 and 12, are very common as primary target of mentalization-based treatments. However, middle childhood has received only limited attention regarding the ability to mentalize (Midgley et al., 2021).