In This Issue
Serving foster youth in the school setting: ethical considerations
By Jennica L. Rebelez, MEd
Youth cared for by child welfare services typically endure a host of adverse circumstances drastically different from the majority of their classmates. As a result, these youth often enter the school system with a variety of psychological and educational difficulties. This paper provides an overview of risk and protective factors for youth and addresses critical ethical principles that school psychologists must consider when addressing the needs of youth involved in the foster care system. Issues of informed consent, confidentiality, fairness, justice, and competency, as proposed by the American Psychological Association (APA) and the National Association of School Psychologists (NASP), are important ethical domains in which school psychologists must demonstrate proficiency when working with foster youth in a school setting.
According to the 2010 Adoption and Foster Care Analysis and Reporting System (AFCARS) and estimates by the U.S. Department of Health and Human Services, there are approximately 408,425 students in the foster care system throughout the United States. Often without a voice in the matter, children are placed into the foster care system after experiencing traumatic life events (e.g., abuse, neglect, maltreatment, homelessness, witnessing domestic violence and substance abuse, and other distressing circumstances) (Austin, 2004; Simmel, 2007). Oft times, when foster youth enter school, they are “different” from the majority of their classmates given the extent and severity of distressing life events they have endured.
For decades, researchers have investigated the mental health and educational outcomes of foster youth. Results from various studies have indicated from 40 percent to 85 percent of foster youth have exhibited behavioral or social difficulties that required mental health interventions (Austin, 2004; Landsverk, Burns, Stambaugh & Rolls- Reutz, 2006). More specifically, youth from the foster care system have displayed a range of behavioral and psychological difficulties, including interpersonal and coping difficulties, emotional disturbances, conduct disorders, attention disorders, aggression, self-destructive behaviors, depression, delinquency, autism spectrum disorders, and bipolar disorders (Kerker & Dore, 2006). Moreover these youth tend to exhibit higher rates of externalizing behaviors, such as aggression and self-destructive behaviors (Kerker & Dore, 2006). Alarmingly, a study conducted by Perora and colleagues (2005) indicated nearly a twofold prevalence of post-traumatic stress disorder (PTSD) among foster youth compared to that of U.S. war veterans.
In addition to mental health concerns displayed by foster youth, children for whom the state has custody also experience higher rates of adverse educational outcomes compared to classmates. Recent study results indicated a pattern of overrepresentation of foster youth in special education and among those who have been grade retained and/or referred for school discipline (Sherr, 2007). Although foster students have reported more school difficulties compared to non-fostered classmates, researchers have found that the school system plays an integral role in their lives (Hedin, Höjer & Brunnberg, 2011). More specifically, the school context often provides stable routines and offers supportive interactions (with teachers, staff, and peers) and opportunities to succeed. Such factors can help to provide a sense of security, personal pride, and a more hopeful outlook for the future (Hedin et al., 2011).
Given the large population of school-aged youth in the foster care system, it is imperative that school psychologists be aware of the effects of adverse life experiences on subsequent academic achievement(Sherr, 2007). Considering the severity of mental health problems displayed by foster youth, and the high probability of suboptimal future outcomes for these children, it is critical for them to attend schools capable of providing evidenced-based mental health services to better their chances of experiencing psychological well-being and educational success (Austin, 2004).
Pivotal APA ethical principles
For the majority of practicing psychologists in the United States, the ethical codes and principles established by the American Psychological Association (APA) govern their career obligations. The five main principles of the APA ethics code are aspirational goals that all psychologists should strive to uphold throughout the course of their career (APA, 2010). These principles provide an overarching ethical “compass” for psychologists to follow. Following is a delineation of three of these five principles that warrant especial consideration when providing services to foster youth in a school setting.
Principle A—Beneficence and Nonmaleficence—This principle describes a psychologist’s duty to protect the welfare and rights of clients, and perform duties in ways that will, to the greatest possible extent, avoid doing harm. When working with foster youth in a school setting, school psychologists must make purposeful decisions in the best interests of foster children who have likely encountered myriad life adversities that may be contributing to a host of negative experiences and outcomes. School psychologists should stay in frequent communication with foster youth who attend their school, and, when needed, connect them to resources that can help to ensure the wellbeing of these students (e.g., basic necessities such as access to nutrition, educational supplies, and psychological support). At the same time, school psychologists should be respectful of, and sensitive to, the privacy rights of these students.
Principle E— Respect For People’s Rights, Dignity, Worth, Privacy, Confidentiality, and Self-determination— This principle urges psychologists to be respectful of all individuals, regardless of culture, ethnicity, age, sex, socio-economic circumstances, sexual orientation, disability, language, and/or other factors that contribute to the unique identity of a person. This principle describes the importance of taking professional responsibility for eliminating any biases one may hold that might, intentionally or unintentionally, prejudice them against certain individuals with whom they work. Principle E details the ethical duty of psychologists to protect the rights and welfare of vulnerable individuals by having knowledge of the safeguards in place to ensure such protection. There are a number of laws and safeguards in place for ensuring the protection of foster children within a school context, and school psychologists must be aware of these laws and, when appropriate, where to refer students for services related to these laws (e.g., district foster youth liaison/advocate). Due to a drastically different life experience from most classmates, foster youth may encounter discrimination based on appearance, developmental delays, socialization difficulties, ethnicity, and/or many other factors. School psychologists must give voice to these vulnerable students by providing psycho-education to others about the possible adverse effects on youth that result from being tied to the foster care system. Additionally school psychologists must advocate for practices to promote healthy life trajectories for these youth.
Principle D – Justice – This principle requires that that all individuals be entitled to access and benefit from the contributions and quality of processes, procedures, and services being conducted by psychologists. This principle asserts that psychologists must “exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices” (APA, 2010). School psychologists working with youth in the foster care system must be sure to serve these youth as they would all other students, and ensure that foster youth are offered services that will likely benefit them.
School psychologists practicing in the United States are also subject to the ethical principles established by the National Association of School Psychologists (NASP), which overlap considerably with the APA Code of Ethics. Although this article does not detail each of these NASP principles, a few pivotal principles will be discussed in conjunction with related APA ethical codes as they are of primary importance when working with youth from the foster care system.
Respect for the dignity and rights of students in the foster care system
The first of the four principles set forth by NASP describes a psychologist’s duty to demonstrate respect for an individual’s autonomy, self-determination and privacy, and to treat others justly and fairly. Trapped in a web of complex legal, environmental, educational, and familial systems, students in the foster care system are often invisible as their lives are dictated by court decisions with little or no input from the child. School is one of the few contexts where foster youth can develop a sense of agency and experience success as a result of their own efforts which can be greatly enhanced by support from teachers, peers, and other school staff. Thus, it is crucial for teachers, counselors, and school psychologists to work together to help foster student autonomy, honor privacy, and create supportive and inclusive school atmospheres where students feel safe and welcomed.
NASP principle I.1: autonomy and self-determination (consent and assent). NASP principle I.1 describes how school psychologists should respect and support the rights of students to participate in the decision-making process regarding their welfare. Importantly, this principle makes it clear that school psychologists can take some actions without the explicit consent or assent from caregivers or students, such as reviewing school records, conducting classroom obligations, assisting with academic interventions, conducting educational screenings, and providing psychological assistance in emergency situations.
According to Principle I, school psychologists are ethically obligated to obtain “parental consent” for any mental health assessments, screenings, or services. For students in the foster care system, legal guardianship is often in flux, shifting among biological parents, foster parents, state courts, social workers, and in some cases state judges. Thus, questions regarding whom can provide informed consent can arise when responsibility for a child placed in state custody is legally shared between the state and biological and/or foster parents (Molin & Palmer, 2005). For example, when a foster child enters a new placement (e.g., foster home, residential/group home), the role of the “parent” is dispersed among multiple persons, with the state typically assuming legal custody, while all decision-making and planning is left to a social worker (Molin & Palmer, 2005). For this reason, obtaining informed consent to provide psychological services for youth in the foster care system can be extremely confusing and complicated. For instance, when working with foster youth, their biological parents often continue to have a legally protected relationship with the student. Biological parents typically have rights to visitation and to be informed of their child’s mental health treatment plan, except in situations where the court has terminated these rights to prevent harm (Molin & Palmer, 2005). In addition, it is the school psychologist’s responsibility to make sure the person who has legal rights to consent for the child is fully informed about the scope of services being implemented and is aware of any risks and/or benefits of the services (e.g., DIS counseling services, social skills groups). In all cases, school psychologists must remain flexible and sensibly determine who has the legal responsibility for providing informed consent (Fisher, 2012, p. 123).
APA standard 3.10: informed consent. Similarly, APA Standard 3, regarding human relations, details the practice of obtaining informed consent. The elements involved when obtaining informed consent include informing the client about the purpose of the intervention, risks, benefits, uncertainties, and alternatives, as well as voluntary choice to accept or refuse the intervention. When working with foster youth, the social worker typically has legal authority to give informed consent for children placed in state custody. Notably, social workers are also responsible for periodically reviewing the question of informed consent, including changes made to treatment or assessment plans, changes in mental health care providers, and addendums to the foster student’s Individualized Education Plan (IEP; Molin & Palmer, 2005). The ethical obligation to obtain informed consent may be superseded in cases of psychiatric or medical emergency, in which case the party who has physical custody of the child is obligated to inform the legal guardian (e.g., social worker) of the emergency (Molin & Palmer, 2005). The APA standard on informed consent recommends that psychologists exercise reasonable judgment when obtaining parental consent if there is doubt that the caretakers interests are not in the best interest of the child (such as in cases of suspected or known child abuse or neglect). There are consent advocates and waivers of parental permission that psychologists can provide foster students who demonstrate maturity and clear understanding of the evaluation or services being proposed (Fisher, 2012, p. 123). Having knowledge of these advocates and waivers will be especially useful for school psychologists working with foster youth who often have multiple individuals governing their lives with conflicting interests. In all cases, it is advisable to inform students of all services being proposed and, at a minimum, to obtain the child’s assent. Even though students under 18 years of age are not legally responsible for providing informed consent, the information regarding informed consent should always be presented at a developmentally appropriate level to ensure that the student fully comprehends the nature of the services that they will be receiving (Molin & Palmer, 2005). In cases where it is believed that the student is mature enough and has a clear understanding of what is in their best interest, school psychologists should advocate for the student’s ability to legally provide informed consent.
NASP principle I.2: privacy and confidentiality. With regard to students’ privacy and confidentiality, NASP describes the duty of school psychologists to “respect the right of persons to choose for themselves whether to disclose their private thoughts, feelings, beliefs, and behaviors” (NASP, 2010). When working with foster youth, school psychologists must respect confidentiality as much as legally permissible, and in cases where confidentiality must be broken, the psychologist should first disclose this with the foster student and attempt to facilitate open dialogue about the reasons for the break in confidentiality. School psychologists must also take actions that minimize intrusion of privacy, recognize the privileged communication with the student, and take care not to disclose information that could put them at unnecessary risk. It is critically important that school psychologists have thorough knowledge of this principle as there are often many parties involved in a foster student’s life, who may ask for access to confidential material or have questions about the student’s mental health. School psychologists must be sure that they clearly discuss the limits of confidentiality with all parties from the onset of services and not reveal any information without student assent and consent from the legal guardian (e.g., foster parent, social worker or biological parent if the student has been reunited).
In the event that a school psychologist must disclose confidential information, they should “do so within the strict boundaries of relevant privacy statutes” (NASP, 2010). Children in state custody should be informed of the limits of their confidential relationship with mental health providers (e.g., school psychologist) and apprised of instances when information about them might be disclosed to other people (e.g., foster or biological parents, other providers, or the legal system). Wishes of students regarding privacy should always be considered (Molin & Palmer, 2005).
APA standard 4: privacy and confidentiality. Standard 4 of the APA Code of Ethics recommends that psychologists make it a “primary obligation” to take precautions to maintain confidentiality and understand the legal repercussions that pertain to the limits of confidentiality. Standard 4.01 on maintaining confidentiality, explains the importance of protecting all mediums of confidential material (e.g., internet and other electronic media). School psychologists must fully understand the safeguards and mandates under the Family Educational Rights and Privacy Act of 1974 (FERPA), which provides guidelines to ensure the protection of educational and medical records and specifies circumstances where disclosures of records may be granted. Since foster youth frequently change schools during a school year, psychologists should ensure they obtain the student’s school records as soon as possible and review these files in order to better understand the child’s history and make appropriate educational placements.
Fairness and justice
NASP Principle I.3 states that school psychologists should engage in actions that promote fairness and justice for all students on campus, assist in cultivating school climates that are safe for all individuals, and be aware of the influence of diversity factors on development, behavior, and learning. Critically, this standard discusses school psychologists’ important role in ensuring that all students have equal opportunities to benefit from education and have access to all appropriate school services. Given this, there is an ethical obligation for school psychologists to be familiar with the myriad issues faced by students in the foster care system, including the negative impacts of their life experiences on developmental progress, behavior, learning and other cognitive processes, socialization, educational success, and psychological adjustment. To ensure that foster students are treated fairly and justly, school psychologists should not assume that all foster children’s experiences are the same. Instead, school psychologists should approach each student equally by asking them to share their story, following which the school psychologist can tailor assessments, interventions, and resources to fit a particular child.
APA standard 3: human relations. Related to the NASP principle of respecting the dignity and rights of all persons, APA defines the human relations standard as thus: “In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” (APA, 2010). Standard 3.04 on avoiding harm describes how psychologists should take reasonable steps to minimize harm when “foreseeable and unavoidable” (APA, 2010). When working with children in the foster care system, psychologists should always strive to protect the welfare of the students with whom they work. In situations where there are conflicting interests, the psychologist should always do what is in the best interest of the child’s wellbeing.
Competency and responsibility
NASP Principle II, on competency and responsibility, holds school psychologists accountable for ensuring that they are performing their duties only within their boundaries of expertise. Included in this principle are standards for engaging in responsible school-based record keeping and use of materials descriptions. School records are highly important for school psychologists as they provide information regarding places of residence, medical background, school enrollment, educational performance, discipline records, past psychoeducational evaluations, and previously implemented interventions. It is critical when working with a student in foster care that school psychologists take extra care to document everything that would be helpful for future professionals to know when working with a particular student in order to provide the most effective and streamlined services.
NASP principle II.1: competence. The mandate to provide services only within one’s realm of competency requires that psychologists recognize their strengths and limitations before providing referrals when it is clear that a student needs services beyond their scope of expertise. This standard regarding competence also makes it clear that school psychologists should be careful to avoid allowing personal problems to compromise the quality of their services. Further, this standard describes the importance of maintaining competency by continually engaging in the process of lifelong learning by attending professional conferences, gaining supervision or consultation as needed, and keeping current with the literature and best practices.
In a policies and values statement provided by the Child Welfare League of America and the American Academy of Child and Adolescent Psychiatry (2002), leaders provided a list of values and principles for mental health professionals to consider when working with children in foster care. Specifically, the CWLA and AACAP called for the following principles of competency: (a) child-focused supports, (b) family-driven supports, (c) integration, collaboration, and coordination of community-based mental health services and supports, (d) culturally competent, relevant, and strength-based services and supports provided by knowledgeable, providers who understand cultural diversity in community, and (e) timely, effective, evidence-based, outcome-driven mental health supports (CWLA and AACAP, 2002).
APA standard 2: competence. Similarly, Standard 2.01 of the APA Code of Ethics offers further details regarding working only within one’s area of expertise by providing services (applied or research) to populations with which they have received training and supervision. Although school psychologists have knowledge of assessment strategies and interventions for a wide range of student needs, school psychologists typically do not receive any training or education on providing direct services to children from the foster care system. In order to perform duties in line with this ethical principle, school psychologist should become familiar with best practices for assessing and providing interventions for this population. Additionally, consultation with professionals in the social work profession or other psychologists who have experience with this population may be necessary.
NASP principle II.3: responsible assessment and intervention practices. The NASP Principles of Ethics advises that school psychologists maintain integrity and engage in established best professional practices when administering educational and psychological assessments or interventions (either directly or indirectly). That is, school psychologists should only utilize assessment tools and strategies that have research supported reliability and validity for the intended individual. This includes using instruments with current and applicable normative measures and attending to population references. Thus, when choosing assessment measures for children in the foster care system, school psychologists should select evidence-based instruments that appropriately pertain to an individual student and their present levels of functioning. If psychologists choose to use an instrument that is not sufficiently validated for a particular individual or population, they should make transparent the results and clearly describe issues of validity, performance and interpretation accordingly.
In light of research demonstrating high rates of maladaptive psychological and educational outcomes for youth in the foster care system, this highlighted some of the ethical considerations important in providing assistance to this vulnerable population (Bruskas, 2008). School psychologists who work with youth from the foster care system should become familiar with both APA and NASP principles related to respecting the dignity and rights of students (including autonomy, self-determination, privacy, confidentiality, fairness, justice, human relations) as well as competency and responsibility. Psychologists working with youth in state custody must adhere to the guidelines set forth by the APA, specifically those pertaining to beneficence and nonmaleficence, confidentiality, social justice, and respect for people’s rights, dignity, self worth, self determination and privacy. In many cases, students raised in the foster care system have experienced a far greater number of traumatizing events compared to their more typically raised student peers. Thus, it is crucial for school psychologists to give thoughtful consideration before and while working with this at-risk population of students, paying special attention to what is in their best interests. To do so school psychologists must engage in practices that minimize the risk of harm, discrimination or intrusions of privacy while considering the child’s wishes to the greatest possible extent.
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from: http://www.apa.org/ethics/code/index.aspx
Austin, L. (2004). Mental health needs of youth in foster care: Challenges and strategies (PDF, 347KB). National Court Appointed Special Advocate Association, 20, 6-13. Retreived from: http://www.lisetteaustin.com/pdfs/CASA_MentalHealth.pdf
Bruskas, D. (2008). Children in foster care: A vulnerable population at risk. Journal of Child and Adolescent Psychiatric Nursing, 21, 70–77. doi: 10.1111/j.1744-6171.2008.00134.x
Burns, B.J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental heath need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 960-970. doi: 10.1097/01.chi.0000127590.95585.65
Child Welfare League of America (CWLA) & American Academy of Child and Adolescent Psychiatry (AACAP) (2002). AACAP/CWLA values and principles for mental health and substance abuse services and supports for children in foster care. Retrieved from http://www.cwla.org/programs/bhd/mhvaluesandprinciples.htm
Fisher, C.B. (2012). Decoding the ethics code: A practical guide for psychologists (2 nd ed.). Thousand Oaks, CA: Sage Publications.
Hedin, L., Höjer, I., & Brunnberg, E. (2011). Why one goes to school: What school means to young people entering foster care. Child and Family Social Work, 16, 43-51. doi:10.1111/j.1365-2206.2010.00706.x
Hines, A.M., Merdinger, J., & Wyatt, P. (2005). Former foster youth attending college: Resilience and the transition to young adulthood. Journal of Orthopsychiatry, 75, 381-394. doi: 10.1037/0002-94188.8.131.521
Kerker, B.D. & Dore, M.M. (2006). Mental health needs and treatment of foster youth: Barriers and opportunities. American Journal of Orthopsychiatry, 76, 138-147. doi: 10.1037/0002-94184.108.40.206
Landsverk, J. A., Burns, B. J., Stambaugh, L. F. & Rolls Reutz, J. A. (2006). Mental health care for children and adolescents in foster care: Review of research literature (PDF, 274KB). Casey Family Programs, 9-30. Retrieved from http://www.casey.org/Resources/Publications/pdf/MentalHealthCareChildren.pdf
Molin, R. & Palmer, S. (2005). Consent and participation: Ethical issues in the treatment of children in out-of-home care. Journal of Orthopsychiatry, 75, 152-157. doi: 10.1037/0002-94220.127.116.11
National Association of School Psychologists. (2010). Principles for professional ethics. Guidelines for the provision of school psychological services. Professional conduct manual (pp.13-62). Bethesda, MD: Author. Retrieved from: http://www.naspweb.org
Pecora, P.J., Kessler, R.C., Williams, J., O’Brien, K., Downs, A. C., English, E…..Holmes, K. (2005). Assessing the effects of foster care: Early Results From the Casey National Alumni Study (PDF, 1.14MB). Casey Family Programs. Retrieved from: http://www.inpathways.net/casey_alumni_studies_report.pdf
Scherr, T.G. (2007). Educational experiences of children in foster care: Meta-analyses of special education, retention, and discipline rates. School Psychology International, 28, 419-436. doi: 10.1177/0143034307084133
Simmel, C. (2007). Risk and protective factors contributing to the longitudinal psychosocial well-being of adopted foster children. Journal of Emotional and Behavioral Disorders, 15, 237-249. doi: 0.1177/10634266070150040501
About the author
Jennica L. Rebelez, MEd, is a doctoral candidate in the Department of Counseling/Clinical/School Psychology at the University of California Santa Barbara. She has served as assistant to the editor of the Journal of School Violence and as a reviewer of manuscripts for the International Journal of School and Educational Psychology.