Despite recent findings that targeted assistance to youth, foster parents, and birthparents can exert salutary effects on youth and adult foster care alumni’s mental health (e.g., Kessler, Pecora, Williams, Hiripi, O’Brien, English, White, Zerbe, Downs, Plotnick, Hwang, & Sampson, 2008
), evidence-based practices are not being used routinely in foster care settings (Landsverk, Burns, Stambaugh, & Rolls-Reutz, 2006
). Given this need and the shared interest of policymakers and advocacy groups to improve existing child welfare practices, guidelines on best practices for overall mental health approaches within child welfare are necessary.
In 2001, the American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) formed a foster care mental health values subcommittee to establish guidelines on improving policy and practices in the various systems that serve foster care children (AACAP and CWLA, 2002
). Because of the excellent quality and comprehensiveness of these statements, the Casey Clinical Foster Care Research and Development Project undertook consensus development work to enhance and build on these statements. The following strategy was implemented.
Step 1: Formed a Steering Committee
A small steering committee (12 to 15 people) was formed, consisting of researchers from the Center for the Advancement of Children’s Mental Health, Casey Family Programs, the Annie E. Casey Foundation, and representatives from key child welfare organizations such as the AACAP, CWLA, National Clearinghouse on Child Abuse and Neglect (NCCAN), and others. This steering committee guided the overall guideline development process, and assumed all organizational, leadership, and primary writing responsibilities.
Step 2: Prepared Expert Papers
We commisioned experts in the field of mental health to write critical papers on the following mental health issues in child welfare: (a) optimal mental health screening and assessments, (b) effective psychosocial interventions, (c) appropriate psychopharmacologic treatment, (d) parent engagement, and (e) youth empowerment.
Step 3: Surveyed Experts in the Field
To answer questions not directly addressed in the literature, a purposive sample of about 43 research and clinical experts with 10 or more years clinical and research experience with child welfare completed a brief survey on preferred practices for psychosocial intervention strategies for youth in foster care, based on the accepted RAND consensus survey methodologies (Brook, Chassin, Fink, Solomon, Kosecoff, & Park, 1986
; Kahn & King, 1997
). Survey responses were aggregated to identify those items demonstrating a high degree of consensus (mean > 8.0) as potential candidates for best practice guidelines.
Step 4: Held a Two-Day Expert Consensus Conference
The two-day conference was a forum for presenting the critical papers and the results of the consensus survey. Following these presentations, conference participants were each assigned to one of five work groups corresponding to the topic areas (a through e) mentioned previously. Each work group formulated preliminary guidelines in their respective area based on their synthesis of the evidence, expert consensus data, and clinical sensibility and feasibility.
Following the work group discussions, the chair and reporter of each work group presented their preliminary guidelines to conference participants for feedback. Work groups were given the opportunity to revise and refine their guidelines based on this feedback. By the end of the two-day conference, each work group had a preliminary set of guidelines that had been reviewed by all conference participants.
Step 5: Refined Consensus Guidelines
Following the consensus meeting, candidate consensus recommendations derived from Step 4 were further refined, and redistributed to the smaller steering committee for approval.