Child abuse and neglect have long-term negative effects on both physical and mental health, according to background information in the article. "Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth," the authors write.

Ronald C. Kessler, Ph.D., of Harvard Medical School, Boston, and colleagues assessed 479 adults (average age 23.7 to 25.6) who were placed in foster care between 1989 and 1998, when they were age 14 to 18. Of these, 368 were placed in public foster care programs in Oregon or Washington, and 111 were placed in a private foster care program. The program, administered by Casey Family Programs, had caseworkers with higher levels of education, lower caseloads, higher salaries and access to a wider range of services for youth than those in public programs. The private program also offers financial assistance with higher education to alumni.

The adult alumni of the private program, when compared with those of the public program, were less likely to have experienced foster parent neglect, physical abuse or sexual abuse. In addition, over the previous year, they:

Had 44.7 fewer mental disorders and 20.1 fewer physical disorders per 100 individuals
Were less likely to report major depression (11.3 percent vs. 24.3 percent), anxiety disorders (28.8 percent vs. 43 percent) and substance abuse disorders (5.1 percent vs. 11.1 percent)
Were less likely to have had ulcers (7.4 percent vs. 13 percent) and cardiometabolic conditions such as diabetes, hypertension or heart disease (14.9 percent vs. 22.6 percent) but more likely to have had respiratory conditions (28.8 percent vs. 17.9 percent)

"The finding of significantly more respiratory disorders among Casey alumni than public program alumni might reflect the fact that some physical disorders become more prevalent in conjunction with otherwise positive outcomes," the authors write.

The results suggest that similar analyses should be performed on public and private programs nationwide to pinpoint particular core program components that lead to positive effects. "This information could then be used to develop a blended model program for implementation in demonstration sites and subsequent dissemination to public programs throughout the country if state and federal legislatures could be convinced of the importance of this undertaking," they conclude. "Although these results constitute only a first step in promoting this envisioned dissemination effort, they clearly document the substantial positive effects of model foster care in the domains of mental and physical health that encourage further exploration in other outcome domains." -JAMA and Archives Journals