Korunmaya İhtiyacı Olan Çocukların Psikososyal Durumları: Ergoterapinin Rolü ve Önemi

Öz

Kimsesiz çocuklar ; ebeveyn kaybı, güven, sevgi ihmali ve sosyal dışlanma gibi durumların etkisiyle psikososyal sorunlar yaşamaktadır. Ebeveyn kaybı sonrası yas süreci çocukların yaşına ve gelişim düzeyine göre farklılık gösterirken, sağlıklı bir yas süreci geçiremeyen çocuklar, travma sonrası stres bozukluğu gibi uzun vadeli sorunlarla karşılaşmaktadır. Kurumsal ortamlarda psikososyal çevrenin zayıflığı, çocuklarda ortam aidiyeti duygusunun kaybına, yalnızlığa ve düşük öz saygıya yol açmaktadır. Ayrıca, bakıcılarla sınırlı ve yüzeysel etkileşim ile ortamın sosyal, bilişsel ve duyusal açıdan yetersiz uyarımlar sunması, bu olumsuzlukları daha da derinleştirmektedir. Bu bağlamda, aile sıcaklığını taklit eden koruyucu aile modelleri, çocukların duygusal ve sosyal gelişimlerini desteklemek için çok daha elverişli bir seçenek sunmaktadır. Psikososyal yoksunluk, büyüme ve gelişimi olumsuz etkiler; bu durum, fiziksel büyümenin yavaşlaması ve beyin gelişimindeki yapısal bozukluklarla kendini gösterebilir. Aynı şekilde, bilişsel gelişimde de dikkat ve yürütücü işlevlerde bozulmalar gözlemlenmiştir. Duygusal olarak kimsesiz çocuklar, öfke, yalnızlık ve çaresizlik gibi hislerle mücadele ederken, bu duyguların düzenlenme sisteminde de problemler gözlemenir. Davranışsal sorunlar ise sosyal uyumsuzluk, agresyon ve riskli davranışlarla kendini gösterir. Tüm bunlar sonucunda çocukların akademik başarıları etkilenmekte ve akranlarıyla olan iletişim azalarak sosyal izolayasyona sebebiyet vermektedir. Ergoterapi, yalnızca psikososyal yoksunlukların sonuçlarını hafifletmekle kalmayıp, aynı zamanda çocukların öz yeterlilik algılarını güçlendirmek ve onlara hayat boyu kullanabilecekleri beceriler kazandırmak için de kritik bir rol üstlenir Ergoterapi yaklaşımları, teorik çerçeveyle bu çocukların yaşam becerilerini geliştirmek, bağımsızlıklarını artırmak ve sosyal katılımlarını desteklemek için etkili yöntemler sunmaktadır. Ergoterapinin kişi-çevre-aktivite uyumunu esas alan yaklaşımları, özellikle kurumsal bakım ortamında karşılaşılan psikososyal eksikliklerin giderilmesinde etkili bir çözüm sunmaktadır.

Anahtar Kelimeler

• Öksüz Çocuk
• Ebeveyn Yoksunluğu
• Bakım Kurumuna Yerleştirilmiş Çocuk
• Psikosoyal Yoksunluk

Psychosocial Status of Children in Need of Protection: The Role and Importance of Occupational Therapy

Öz

Orphaned children experience psychosocial problems due to loss of parents, neglect of trust and love, and social exclusion. While the mourning process after parental loss varies according to the age and developmental level of children, children who cannot go through a healthy mourning process face long-term problems such as post-traumatic stress disorder. The weak psychosocial environment in institutional settings leads to loss of a sense of belonging, loneliness and low self-esteem in children. In addition, limited and superficial interaction with caregivers and inadequate social, cognitive and sensory stimulation in the environment worsen these problems. In this context, foster care models that imitate the warmth of a family offer a much more favorable option for supporting children's emotional and social development. Psychosocial deprivation negatively affects growth and development, which can manifest itself in slowed physical growth and structural defects in brain development. Similarly, in cognitive development, impairments in attention and executive functions have been observed. Emotionally, orphaned children struggle with feelings of anger, loneliness and helplessness, and there are problems with the system for regulating these emotions. Behavioral problems manifest themselves in social maladjustment, aggression and risky behaviors. As a result of all these, children's academic success is affected and communication with peers decreases, leading to social isolation. Occupational therapy plays a critical role not only to alleviate the consequences of psychosocial deprivations, but also to strengthen children's perceptions of self-efficacy and provide them with skills that they can use for a lifetime. Occupational therapy approaches offer effective methods to improve the life skills of these children, increase their independence and support their social participation with the theoretical framework. Occupational therapy approaches based on person-environment-activity harmony offer an effective solution to the psychosocial deficiencies encountered especially in institutional care settings.

Anahtar Kelimeler

• Orphans
• Paternal Deprivation
• Institutionalized Child
• Psychosocial Deprivation

Kaynakça

1. Çocuk Koruma Kanunu. Resmi Gazete 2005;5395. Available from: http://www.mevzuat.gov.tr/MevzuatMetin/1.5.5395.pdf
2. Hailegiorgis MT, Berheto TM, Sibamo EL, Asseffa NA, Tesfa G, Birhanu F. Psychological wellbeing of children at public primary schools in Jimma town: An orphan and non-orphan comparative study. PLoS One. 2018;13(4):e0195377.
3. Association AOT. Foster care system: occupational therapy intervention from a public health perspective [Internet]. 2021 [cited 2024 Jan 10]. Available from: https://www.aota.org/publications/sisquarterly/children-youth-sis/cysis-2-222021
4. Caserta TA, Pirttilä‐Backman AM, Punamäki RL. The association between psychosocial well‐being and living environments: a case of orphans in Rwanda. Child Fam Soc Work. 2017;22(2):881-91.
5. Chisango T, Matewe T, Moyo WM, Matanga AA, Linjesa L. Psycho-social problems experienced by children living within an orphanage in Harare and the forms of psycho-social support available. Afr J Soc Sci Hum Res. 2023;6(6):40-55.
6. Soyobi VY, Obohwemu KO, Suberu PO, Omoregie J, Abayomi GO, Bewaji OA, et al. Psychosocial wellbeing of orphans in Kaduna State: A comprehensive assessment. The American Journal of Social Science and Education Innovations. 2024;6(11):13-31.
7. Msoka A, Holroyd E. Children’s perspectives of their psychosocial wellbeing in Tanzanian orphanages. International Journal of Nursing and Midwifery. 2018;10(5):41.
8. Venkatesan S. Loss, grief, bereavement, and mourning in children. International Journal of Recent Scientific Research. 2022;13(3):619-24.

9. Oliveira DP, Barros I. The experience of grief in a child orphaned by the pandemic of COVID-19. In: Psychological Applications and Trends 2023; 2023 [cited 2024 Jan 10]. Available from: https://doi.org/10.36315/2023inpact072
10. Evanthia Asimakopoulou R, Maritsa Gourni R, Vassiliki Krepia R, Alexandros Argiriadis R. Depression Screening in Orphaned Children: A Systematic Review. International Journal of Caring Sciences. 2021;14(2):1409-18.
11. Lytje M, Dyregrov A. The price of loss–a literature review of the psychosocial and health consequences of childhood bereavement. Bereavement Care. 2019;38(1):13-22.
12. Owaa JA, Aloka PJ, Raburu P. The influence of students’ interpersonal nature on adjustment to loss and grief on Kenyan orphaned secondary school students. Mediterr J Soc Sci. 2015;6(4S1):333-343.
13. Damiano JV, Muthami J. Grief Reactionsand Psychological Wellbeing of Parentally Bereaved Students in Public Secondary Schools in Kisumu Central Sub-County, Kenya. International Journal of Arts and Social Science. 2022;5:170-5.
14. Heuveline P, Clague AK. Parental Loss and Mental Health in Post-Khmer-Rouge Cambodia. Population research and policy review. 2024;43(4):50.
15. Swahn MH, Culbreth R, Staton CA, Kasirye R. Psychosocial health concerns among service-seeking orphans in the slums of Kampala. Vulnerable children and youth studies. 2017;12(3):258-63.
16. Mitchell MB. “No one acknowledged my loss and hurt”: Non-death loss, grief, and trauma in foster care. Child and adolescent social work journal. 2018;35(1):1-9.
17. Ntuli B, Sebola E, Madiba S. Responding to maternal loss: A phenomenological study of older orphans in youth-headed households in impoverished areas of South Africa. Healthcare. 2020;8(3):259. doi: 10.3390/healthcare8030259
18. Chen C, Wu Q, Zhao J, Zhao G, Li X, Du H, et al. Enacted Stigma Influences Bereavement Coping Among Children Orphaned by Parental AIDS: A Longitudinal Study with Network Analysis. Psychology Research and Behavior Management. 2023:4949-58.
19. Look A. The face of grief in foster care. Journal of Humanistic Psychology. 2023;63(1):126-39.
20. Ali A, Shaffie F. Bereavement and mental health issues for institutionalized children. Jurnal Pembangunan Sosial. 2021;24:53-73.
21. Aile ÇvSHB. Kimsesiz çocuklar için bakım ve koruma raporu. Aile ve Sosyal Hizmetler Bakanlığı [Internet]. 2022 [cited 2024 Jan 10]. Available from: https://www.aile.gov.tr/
22. Goldman PS, Bakermans-Kranenburg MJ, Bradford B, Christopoulos A, Ken PLA, Cuthbert C, et al. Institutionalisation and deinstitutionalisation of children 2: policy and practice recommendations for global, national, and local actors. The Lancet Child & Adolescent Health. 2020;4(8):606-33.
23. Shulga TI, Savchenko DD, Filinkova EB. Psychological Characteristics of Adolescents Orphans with Different Experience of Living in a Family. International journal of environmental and science education. 2016;11(17):10493-504.
24. Nsabimana E, Rutembesa E, Wilhelm P, Martin-Soelch C. Effects of institutionalization and parental living status on children’s self-esteem, and externalizing and internalizing problems in Rwanda. Frontiers in psychiatry. 2019;10:442.
25. Wade M, Fox NA, Zeanah CH, Nelson CA. Effect of foster care intervention on trajectories of general and specific psychopathology among children with histories of institutional rearing: A randomized clinical trial. JAMA psychiatry. 2018;75(11):1137-45.
26. Mukerji CE, Wade M, Fox NA, Zeanah CH, Nelson CA. Growth in self-regulation over the course of adolescence mediates the effects of foster care on psychopathology in previously institutionalized children: A randomized clinical trial. Clinical Psychological Science. 2021;9(5):810-22.
27. Humphreys KL, Guyon-Harris KL, Tibu F, Wade M, Nelson III CA, Fox NA, et al. Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16. Journal of consulting and clinical psychology. 2020;88(12):1079.
28. Maguire D, May K, McCormack D, Fosker T. A Systematic review of the impact of placement instability on emotional and behavioural outcomes among children in foster care. Journal of Child & Adolescent Trauma 2024;1-15.
29. Khoo E, Mancinas S, Skoog V. We are not orphans. Children's experience of everyday life in institutional care in Mexico. Children and Youth Services Review. 2015;59:1-9.
30. Gunnar MR, Bowen M. What was learned from studying the effects of early institutional deprivation. Pharmacology Biochemistry and Behavior. 2021;210:173272.
31. VanZomeren-Dohm AA, Pitula CE, Koss KJ, Thomas K, Gunnar MR. FKBP5 moderation of depressive symptoms in peer victimized, post-institutionalized children. Psychoneuroendocrinology. 2015;51:426-30.
32. Sonuga-Barke EJ, Kennedy M, Kumsta R, Knights N, Golm D, Rutter M, et al. Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet. 2017;389(10078):1539-48.
33. Christopher T, Mosha M. Psychological Challenges Facing Orphaned Children and Caregivers: A Case of Ubong Institutionalized Centers in Dar es Salaam, Tanzania. East African Journal of Education and Social Sciences. 2021;2(3):116-27.
34. Julian MM, McCall RB. Social skills in children adopted from socially-emotionally depriving institutions. Adoption Quarterly. 2016;19(1):44-62.
35. Humphreys KL, Gabard-Durnam L, Goff B, Telzer EH, Flannery J, Gee DG, et al. Friendship and social functioning following early institutional rearing: The role of ADHD symptoms. Development and psychopathology. 2019;31(4):1477-87.
36. Guyon-Harris KL, Humphreys KL, Miron D, Tibu F, Fox NA, Nelson CA, et al. Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation. Development and psychopathology. 2021;33(1):18-28.
37. Huynh HV, Limber SP, Gray CL, Thompson MP, Wasonga AI, Vann V, et al. Factors affecting the psychosocial well-being of orphan and separated children in five low-and middle-income countries: Which is more important, quality of care or care setting? PloS one. 2019;14(6):e0218100.
38. Misevičė M, Gervinskaitė-Paulaitienė L, Lesinskienė S. Helping Institutionalised Children through a Trusting Relationship—Findings from a One-Year Psychosocial Intervention Programme. Behavioral Sciences. 2024;14(7):595.
39. Yakubovich AR, Sherr L, Cluver LD, Skeen S, Hensels IS, Macedo A, et al. Community-based organizations for vulnerable children in South Africa: Reach, psychosocial correlates, and potential mechanisms. Children and youth services review. 2016;62:58-64.
40. Kamath SM, Venkatappa KG, Sparshadeep EM. Impact of nutritional status on cognition in institutionalized orphans: a pilot study. Journal of clinical and diagnostic research: JCDR. 2017;11(3):CC01-CC04.
41. Valge M, Meitern R, Hõrak P. Anthropometrics of Estonian children in relation to family disruption: Thrifty phenotype and Trivers–Willard effects. Evolution, Medicine, and Public Health. 2021;9(1):276-86.
42. Konijn C, Admiraal S, Baart J, Van Rooij F, Stams G-J, Colonnesi C, et al. Foster care placement instability: A meta-analytic review. Children and Youth Services Review. 2019;96:483-99.
43. Nelson CA, Fox NA, Zeanah CH. Romania’s abandoned children: The effects of early profound psychosocial deprivation on the course of human development. Current directions in psychological science. 2023;32(6):515-21.
44. Services USDoHaH. 32nd year of reporting child maltreatment: Child maltreatment 2021 [Internet]. 2021 [cited 2024 Jan 10]. Available from: https://wrma.com/2023/02/child-maltreatment-report-2021/
45. Hodel AS, Hunt RH, Cowell RA, Van Den Heuvel SE, Gunnar MR, Thomas KM. Duration of early adversity and structural brain development in post-institutionalized adolescents. NeuroImage. 2015;105:112-9.
46. McCall RB, Groark CJ, Hawk BN, Julian MM, Merz EC, Rosas JM, et al. Early caregiver–child interaction and children’s development: Lessons from the St. Petersburg-USA Orphanage intervention research project. Clinical child and family psychology review. 2019;22:208-24.
47. Mackes NK, Golm D, Sarkar S, Kumsta R, Rutter M, Fairchild G, et al. Early childhood deprivation is associated with alterations in adult brain structure despite subsequent environmental enrichment. Proceedings of the National Academy of Sciences. 2020;117(1):641-9.
48. Tang A, Slopen N, Nelson CA, Zeanah CH, Georgieff MK, Fox NA. Catch-up growth, metabolic, and cardiovascular risk in post-institutionalized Romanian adolescents. Pediatric research. 2018;84(6):842-8.
49. Reid BM, Miller BS, Dorn LD, Desjardins C, Donzella B, Gunnar M. Early growth faltering in post-institutionalized youth and later anthropometric and pubertal development. Pediatric research. 2017;82(2):278-84.
50. Debnath R, Tang A, Zeanah CH, Nelson CA, Fox NA. The long‐term effects of institutional rearing, foster care intervention and disruptions in care on brain electrical activity in adolescence. Developmental science. 2020;23(1):e12872.
51. Van IJzendoorn MH, Bakermans-Kranenburg MJ, Duschinsky R, Fox NA, Goldman PS, Gunnar MR, et al. Institutionalisation and deinstitutionalisation of children 1: a systematic and integrative review of evidence regarding effects on development. The Lancet Psychiatry. 2020;7(8):703-20.
52. Vanderwert RE, Zeanah CH, Fox NA, Nelson III CA. Normalization of EEG activity among previously institutionalized children placed into foster care: A 12-year follow-up of the Bucharest Early Intervention Project. Developmental cognitive neuroscience. 2016;17:68-75.
53. McLaughlin KA, Sheridan MA, Tibu F, Fox NA, Zeanah CH, Nelson III CA. Causal effects of the early caregiving environment on development of stress response systems in children. Proceedings of the National Academy of Sciences. 2015;112(18):5637-43.
54. Kyaruzi E. Psychosocial wellbeing of orphaned children in selected primary schools in Tanzania. Heliyon. 2022; 8(11): 1-6.
55. Dorsey S, Lucid L, Murray L, Bolton P, Itemba D, Manongi R, et al. A qualitative study of mental health problems among orphaned children and adolescents in Tanzania. The Journal of nervous and mental disease. 2015;203(11):864-70.
56. Barenbaum E, Smith T. Social support as a protective factor for children impacted by HIV/AIDS across varying living environments in southern Africa. AIDS care. 2016;28(sup2):92-9.
57. Humphreys KL, McGoron L, Sheridan MA, McLaughlin KA, Fox NA, Nelson CA 3rd, et al. High-quality foster care mitigates callous-unemotional traits following early deprivation in boys: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2015; 54(12): 977-83.
58. Vasileva M, Petermann F. Attachment, development, and mental health in abused and neglected preschool children in foster care: A meta-analysis. Trauma, Violence, & Abuse. 2018;19(4):443-58.
59. Zaccagnino M, Cussino M, Preziosa A, Veglia F, Carassa A. Attachment representation in institutionalized children: a preliminary study using the child attachment interview. Clinical psychology & psychotherapy. 2015;22(2):165-75.
60. Steenbakkers A, Ellingsen, I. T., van der Steen, S., & Grietens, H. Psychosocial needs of children in foster care and the impact of sexual abuse. Journal of Child and Family Studies. 2018;27:1324–35.
61. Humphreys KL, King LS, Guyon-Harris KL, Sheridan MA, McLaughlin KA, Radulescu A, et al. Foster care leads to sustained cognitive gains following severe early deprivation. Proceedings of the National Academy of Sciences 2022; 119(38).
62. Escueta M, Whetten K, Ostermann J, O’Donnell K, Team POfOR. Adverse childhood experiences, psychosocial well-being and cognitive development among orphans and abandoned children in five low income countries. BMC international health and human rights. 2014;14:1-13.
63. Wade M, Fox, N. A., Zeanah, C. H., & Nelson, C. A., III. Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning. Proceedings of the National Academy of Sciences. 2019;116(5):1808–13.
64. Asimina R, Melpomeni S, Alexandra T. Language and psychosocial skills of institutionalized children in Greece. The Open Family Studies Journal. 2017; 9(1):76-87.
65. Wade M, Carroll D, Fox NA, Zeanah CH, Nelson CA. Associations between early psychosocial deprivation, cognitive and psychiatric morbidity, and risk-taking behavior in adolescence. Journal of Clinical Child & Adolescent Psychology. 2022;51(6):850-63.
66. Colich NL, Sheridan MA, Humphreys KL, Wade M, Tibu F, Nelson CA, et al. Heightened sensitivity to the caregiving environment during adolescence: Implications for recovery following early-life adversity. Journal of Child Psychology and Psychiatry. 2021; 62(8): 1-21.
67. Camuñas N, Mavrou I, Vaíllo M, Martínez RM. An executive function training programme to promote behavioural and emotional control of children and adolescents in foster care in Spain. Trends in Neuroscience and Education. 2022; 27: 1-13.
68. Forsman H, Brännström, L., Vinnerljung, B., & Hjern, A. Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data. Child Abuse & Neglect. 2016;57:61-71.
69. Mihalec-Adkins BP, Christ SL, Day E. An exploration of placement-related psychosocial influences on school engagement among adolescents in foster care. Children and Youth Services Review. 2020; 108: 1-9.
70. Ssewamala FM, Karimli, L., Torsten, N., Wang, J. S. H., Han, C. K., Ilic, V., & Nabunya, P. Applying a family-level economic strengthening intervention to improve education and health-related outcomes of school-going AIDS-orphaned children: Lessons from a randomized experiment in Southern Uganda. Prevention Science. 2016;17:134–43.
71. Thomas T, Tan M, Ahmed Y, Grigorenko EL. A systematic review and meta-analysis of interventions for orphans and vulnerable children affected by HIV/AIDS worldwide. Annals of Behavioral Medicine. 2020;54(11):853-66.
72. Ssewamala FM, Nabunya P, Ilic V, Mukasa MN, Ddamulira C. Relationship between family economic resources, psychosocial well-being, and educational preferences of AIDS-orphaned children in southern Uganda: baseline findings. Global Social Welfare. 2015;2:75-86.
73. Tucker LA, Govender K, Kuo C, Casale M, Cluver L. Child prosociality within HIV-affected contexts: the impact of carer ill-health and orphan status. Vulnerable children and youth studies. 2016;11(4):352-62.
74. Elattar NFM, Alabd AMA, Mohammed RE. Impact of orphan children’s emotional and behavioral problems and length of institutionalization on their life satisfaction. EAS J Nurs Midwifery. 2019;1(3):76-82.
75. Munongi L, Mawila D. Risk factors of orphan and vulnerable children in a children’s home during the COVID-19 pandemic. Children and youth services review. 2023;145:106801.
76. Mahanta P, Das Thakuria K, Goswami P, Kalita C, Knower R, Rajbangshi MC, et al. Evaluation of physical and mental health status of orphan children living in orphanages in Sonitpur district of Assam: a cross-sectional study. BMC pediatrics. 2022;22(1):722.
77. Kopetz C, Woerner JI, MacPherson L, Lejuez CW, Nelson CA, Zeanah CH, et al. Early psychosocial deprivation and adolescent risk-taking: The role of motivation and executive control. Journal of experimental psychology: general. 2019;148(2):388.
78. Guyon-Harris KL, Humphreys KL, Miron D, Gleason MM, Nelson CA, Fox NA, et al. Disinhibited social engagement disorder in early childhood predicts reduced competence in early adolescence. Journal of abnormal child psychology. 2019;47:1735-45.
79. Niu Y, Buzzell GA, Cosmoiu A, Fox NA, Nelson CA, Zeanah CH, et al. Foster care leads to lower irritability among adolescents with a history of early psychosocial deprivation. Research on Child and Adolescent Psychopathology. 2024; 1: 1-10.
80. Mmolokoe KA. “Every foster parent is crying…”: Psychosocial challenges faced by appointed foster care parents in Bojanala, South Africa. African Journal of Social Work 2022; 12(6): 314-24.
81. Tang A, Fox NA, Nelson CA, Zeanah CH, Slopen N. Externalizing trajectories predict elevated inflammation among adolescents exposed to early institutional rearing: A randomized clinical trial. Psychoneuroendocrinology. 2019;109:104408.
82. Washington T, Wrenn A, Kaye H, Priester MA, Colombo G, Carter K, et al. Psychosocial factors and behavioral health outcomes among children in Foster and Kinship care: A systematic review. Children and Youth Services Review. 2018;90:118-33.
83. Kemmis-Riggs J, Dickes A, McAloon J. Program components of psychosocial interventions in foster and kinship care: A systematic review. Clinical Child and Family Psychology Review. 2018;21(1):13-40.
84. Saraswat A, Unisa S. An in-depth study of psychosocial distress among orphan and vulnerable children living in institutional care in New Delhi, India, and their coping mechanisms. International Institute for Population Sciences, Mumbai, 2017.
85. Shafiq F, Haider SI, Ijaz S. Anxiety, depression, stress, and decision-making among orphans and non-orphans in Pakistan. Psychology Research and Behavior Management. 2020; 13: 313-18.
86. Alem S. Exploring psychosocial challenges among orphaned children in primary schools. Current Research Journal of Pedagogics 2024; 5(08): 11-9.
87. Johnson RM, Strayhorn TL, Parler B. “I just want to be a regular kid:” A qualitative study of sense of belonging among high school youth in foster care. Children and Youth Services Review. 2020;111:104832.
88. Gypen L, Vanderfaeillie J, De Maeyer S, Belenger L, Van Holen F. Outcomes of children who grew up in foster care: Systematic review. Children and Youth Services Review 2017; 76: 74-83.
89. Villagrana M, Guillen C, Macedo V, Lee SY. Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni. Children and Youth Services Review 2018; 85: 26-34.
90. Yassin Z, Erasmus C, Frantz J. A model to understand HIV-related stigma and the psychosocial well-being of children orphaned by AIDS: A theory generative approach. Sahara-J: Journal of Social Aspects of HIV/AIDS 2021; 18(1): 131-48.
91. Dansey D, Shbero D, John M. Keeping secrets: How children in foster care manage stigma. Adoption & Fostering 2019; 43(1): 35-45.
92. Almeida ILDL, Rego JF, Teixeira ACG, Moreira MR. Social isolation and its impact on child and adolescent development: A systematic review. Revista Paulista de Pediatria. 2021; 40: 1-9.
93. Erango MA, Ayka ZA. Psychosocial support and parents’ social life determine the self-esteem of orphan children. Risk Management and Healthcare Policy 2015; 8: 169-173.
94. Cherewick M, Dahl RE, Bertomen S, Hipp E, Shreedar P, Njau PF, Leiferman JA. Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychology and Behavioral Medicine 2023; 11(1): 1-21.
95. Greeno EJ, Fedina L, Lee BR, Farrell J, Harburger D. Psychological well-being, risk, and resilience of youth in out-of-home care and former foster youth. Journal of Child & Adolescent Trauma 2018; 12(2): 175-85.
96. American Occupational Therapy Association. Occupational therapy practice framework: Domain and process (Vol. 74, No. 7412410010). Bethesda, MD, USA: American Occupational Therapy Association; 2020.
97. Smith MN. Occupational therapy’s role in the foster care system. Open Journal of Occupational Therapy. 2022;10(1):1-6.
98. Lynch A, Ashcraft R, Paul-Ward A, Tekell L, Salamat A, Schefkind S. Occupational therapy’s role in mental health promotion, prevention, & intervention with children & youth: Foster care. In: School Mental Health [Information sheet]. American Occupational Therapy Association; 2017. p. 1–3.
99. Parekh P. Foster care system: Occupational therapy intervention from a public health perspective. SIS Quarterly Practice Connections. 2021;7(1):2-4.
100. Williams E, Sweetman M. The Non-Traditional Role of Occupational Therapy Practitioners in Foster Care. The Journal of Foster Care. 2024;5(1):42-46.
101. Paul-Ward A, Lambdin-Pattavina, C., Haskell, A. Occupational therapy's emerging role with transitioning adolescents in foster care. Occupational Therapy in Mental Health. 2014;30(2):162–77.
102. Bester J, Kloppers M. Evaluation of outcomes associated with a leisure-time activity program for disadvantaged youth. The Open Journal of Occupational Therapy. 2016;4(1):9.
103. Wilburn VG, Huber ME, Senter D, Stoll HB. Considerations for occupational therapists in developing community-level interventions for youth with high adverse childhood experiences (ACEs). The Open Journal of Occupational Therapy. 2022;10(1):1-7.
104. Paul-Ward A, Lambdin-Pattavina, C. A. New roles for occupational therapy to promote independence among youth aging out of foster care. American Journal of Occupational Therapy. 2016;70(3).
105. Armstrong-Heimsoth A, Williamson HJ, Thornton A, Maloney S. Exploring interdisciplinary collaboration to support life skills education for young adults in extended foster care. Child Welfare. 2024;101(5):117-140.
106. Solomon C. Occupational therapy’s role in the success and positive outcomes of youth within the foster system: University of St. Augustine for Health Sciences; 2024.
107. Armstrong-Heimsoth A, Hahn-Floyd, M., Williamson, H. J., Lockmiller, C. Toward a defined role for occupational therapy in foster care transition programming. The Open Journal of Occupational Therapy. 2020;8(4):13.
108. Fernandez S. Occupational therapy toolkits empower the transition from foster care to adulthood: Texas Woman’s University 2024.
109. Ryan K, Lane SJ, Powers D. A multidisciplinary model for treating complex trauma in early childhood. Int J Play Ther. 2017;26(2):111.
110. Armstrong-Heimsoth A, Schoen, S. A., Bennion, T. An investigation of sensory processing in children and adolescents in congregate foster care. Occupational Therapy in Mental Health. 2021;37(3):224-39.
111. Knust EA. Fostering a loving connection: a foster parent’s toolkit for understanding and addressing behaviors for children placed in out-of-home care. Grand Forks (ND): University of North Dakota; 2023.
112. Skogen A. A guide for occupational therapists: Utilizing equine-assisted therapy for children in the foster care system dealing with trauma [master’s thesis]. University of North Dakota; 2023.
113. Fox A, Kollodge, E. An occupational therapy referral screening tool for children in adoptive and foster care placements: University of North Dakota; 2019.
114. Gnanadurai BR, Kumar MA, Deepika TRS. Effect of group therapy to improve self-esteem among adolescent orphans. Int J All Res Educ Sci Methods. 2022 Dec;10(12):929–34.
115. Walker PJ, Gee, B. M., Leonard, S. Occupational therapy’s psychosocial role for young children transitioning out of foster care. The Open Journal of Occupational Therapy. 2022;10(3):1-15.