The most beneficial research could come from utilizing the Health Belief Model (HBM) as a guide for analyzing foster parents decisions either to seek and not to seek mental health services for their foster children. The socioeconomic (Blumberg, & Landsverk, 1996), demographic (Garland, Besinger, & Bridgett, 1997), and educational variables (dosReis, Zito, Safer, & Soeken, 2001) that influence the utilization of mental health services by foster parents have been investigated. Previous research has not focused on beliefs and attitudes. It has been noted that getting foster parents to actively participate in the mental health treatment of their foster children is a reoccurring challenge (Bondy, & Davis, 1990). It would be useful to see if this reluctance was tied to attitudes. Understanding the beliefs and perceptions of foster parents could prove insightful into understanding why the mental health need of many current foster children are unmet. Such attitudinal insights could be useful if foster care professionals want to develop strategies for gaining foster parents’ compliance when it comes to using mental health services for their foster children.
Health Belief Model
History
The HBM has a definitive origin, but the originating author is sometimes misleadingly listed as Rosenstock. The Winter 1974 issue of Health Education Monographs is often viewed as the seminal authority for the original HBM. In the introduction, Becker explains the mandate that resulted in the explication of the HBM: a subcommittee for the 1971-1973 project entitled “Sociological Aspects of Health and Health Services” was charged to elaborate “the best model or models available for predicting such seemingly diverse activities as preventative health action, medical care utilization, delay in seeking care, and compliance with medical regimes” (Becker, 1974, p, ii). The resulting Health Belief model was an explication of a model developed in the early 1950s by a group of social psychologists working for the U.S. Public Health Service (French, & Kurczynski, 1992). Rosenstock (1974) clearly credits Hochbaum for the initial HBM research in his 1952 study of TB screening where Hochbaum was attempting to predict individual use of x-ray screening for this asymptomatic disease in the face of public apathy. In detailing the development of the HBM, Rosenstock goes on to chronicle Kegeles’ contribution with his studies of preventative dental care, and also mentioned is the 1960 Leventhal, Hochbaum, and Rosenstock study of Asian influenza. While Rosenstock’s article in the Winter 1974 issue of Health Education Monographs is often viewed as the seminal authority for the original HBM, another article in that same issue perhaps more accurately attributes the origins to “Hochbaum, Leventhal, Kegeles, and Rosenstock” (Maimam, & Becker, 1974, p. 336). Regardless of the possible confusion over the original authorship, the model has extreme clarity in the variables it views as predictive of health behaviors.
The variables of the original HBM are generally accepted and widely used in the research community although some modification has been deemed necessary. Perhaps due to the broad scope of the original mandate and the expertise and diverse fields of interest of the eight publishing authors of the seminal Winter 1974 issue, the resulting HBM is the theory used most often when studying health-related behaviors (Lai, Hamid, & Cheng, 1999; McIntosh, & Kubena, 1996; Petosa, & Jackson, 1991). Janz and Becker (1984) noted that among all the theoretical models of health-related behaviors, the HBM is the leader in terms of research projects and confirmation of constructs. The HBM articulated by Rosenstock in the Winter 1974 Health Education Monographs indicates that individuals’ health behaviors focuses on four cognitive dimensions: (1) perceived susceptibility, (2) perceived seriousness, (3) perceived benefits of taking action and barriers to taking action, and (4) cues to action. Rosenstock further points out that the first three variables had been researched previously, but the final variable of cues to action had not been carefully studied, but it was deemed essential to complete the model. However, it later became evident that the components of self efficacy were also influencing health behaviors, so many subsequent researchers modified the model slightly to include a self-efficacy variable to measure the individual’s perceptions about his/her ability to carry out the recommended course of action (Jurich, & Adams, 1992). In 1990, Rosenstock himself argued for including self-efficacy in an expanded HBM (quoted in Lux, & Petosa, 1994, p. 487). Often researchers using the Health Belief Model will routinely include a measurement of perceptions of self-efficacy (e.g., Eisen, & Zellman, 1992; McIntosh, & Kubena, 1996; Neff, & Crawford, 1998). This modification by some researchers has complimented the original variables of the widely used HBM.
The health belief model has been used with other variables of interest and in a variety of settings, but the basic utility of the components of the theory remain. The HBM is flexible enough to incorporate other variables, so various studies have incorporated variables such patient self-advocacy (Brashers, Haas, & Neigig, 1999), locus of control (Stein, & Fox, 1992), perceptions of physician efficacy (Becker, Maiman, Kirscht, Haefner, Drachman, & Taylor, 1979), the value placed on health (Becker, Maiman, Kirscht, Haefner, & Drachman, 1979; Girvan, & Reese, 1990), and optimism (Lai, Hamid, & Cheng, 1999), Within the health communication field, much work has been done on the demographic and HBM variables influencing specific health behaviors such as decreasing one’s blood pressure (Taylor, 1979), wearing a bike helmet (e.g., McAleese, & Scantling, 1996; Witte, Stokols, Ituarte, & Schneider, 1993), changing one's diet, (e.g., Chew, Palmer, & Kim, 1998; Frewen, & Schomer, 1994; McIntosh, & Kubena, 1996), practicing safe sex (e.g., Jurich, & Adams, 1992; Maticka-Tyndale, 1991; Mattson, 1999; Petosa, & Jackson, 1991; Wulfert, & Wan, 1995), and participating in health care decisions (e.g., Brashers, Haas, & Neigig, 1999; Kroll, Rothert, Davidson, Schmitt, Holmes-Rovner, Padonu, & Reischl, 2000; Rimal, Ratzan, Arntson, & Freimuth, 1997). Speaking to the resiliency of the HBM is the fact that although is has been implemented in a large variety of research settings and disciplines, the core components have not changed (Kar, Alcalay, & Alex, 2001; Lai, Hamid, & Cheng, 1999). In addition to remaining constant, the four main variables are also backed by decades of research. Janz and Becker (1984) reviewed 46 studies conducted from 1974 and 1984 and found that four main variables were well supported as predictive of health behaviors. The ranking of significant association was found to be as follows: barriers 89%, susceptibility 81%, benefits 78%, and severity 65% (Janz, & Becker, 1984). These four variables comprise three of the four originally articulated cognitive dimensions, with cues to action being the fourth, and decades of research have proven both the utility and versatility of the HBM as articulated by Rosenstock in 1974.
The broad utilization of this model since its inception has allowed for some basic trends to emerge regarding it’s utility in all settings. The model is less successful in when the health behavior is not connected with a specific threat, such as annual physical exams and flossing (McIntosh, & Kubena, 1996). Second, with preventative health behaviors, some components of the model are more useful than others in predicting behaviors (Janz, & Becker, 1984). Some studies have found that perceptions of benefits and barriers are more highly associated with health behaviors than perceptions of severity and susceptibility (McIntosh, & Kubena, 1996), and, in reviewing 46 studies between 1974 and 1984, Janz and Becker (1984) found severity to have the lowest association with behavior. Finally, The HMB has shown the greatest predictive value when investigating specific short-term health behaviors, e.g. genetic testing of fetuses (O'Connor, & Cappelli, 1999) or getting a flu shot (McIntosh, & Kubena, 1996). The components of the HBM are all useful in predicting behavior, but some components are more useful than others and the circumstances of the research also influence overall utility of the model.
Little research has been done in the health communication field applying the HBM to decisions to use mental health services. A basic belief of the HBM is that engaging in health behavior is a function of how motivated the person is to act (perceived susceptibility and perceived seriousness) and the perceived efficacy of the recommended behavior (perceived benefits and perceived barriers) (Chew, Palmer, & Kim, 1998). If this motivation to act and perception of solution efficacy help determine health related behaviors, then it would seem that they are involved in the decision to seek mental health services, which is a health related behavior. However, research relating the HBM to utilization of mental health services is lacking. In the social sciences, much work has been done on the help seeking-steps that people utilize prior to successfully attaining health care services (Blumberg, & Landsverk, 1996; Zima, Bussing, Yang, & Belin, 2000), and specific to this project, much work has been done on the use of mental health services by foster children (Bondy, & Davis, 1990; Schneiderman, & Connors, 1998; Takayama, Bergman, & Connell, 1994). What is missing is research on how foster parent perceptions and beliefs influence their willingness and ability to secure much needed health services for their foster children. If foster children are identified as needing mental health services, and Medicare provides payment for such services, why are researchers still reporting a large unmet need (e.g., Blumberg & Landsverk, 1996; Halfon, Mendonca, & Berkowitz, 1995; Zima, Bussing, Yang, & Belin, 2000)? The HBM could provide some insight into this problem.
Purpose and Constructs
The purpose of this study is to assess the how well the variables of a modified HBM -adding the variable of self-efficacy-can explain foster parents’ decisions to either utilize or not utilize mental health services for their foster children. The framework for this study will be 1) perceived risk appraisal 2) perceived benefits and barriers, 3) cues to action and 4) perceived self-efficacy.
Perceived risk appraisal
Perceived risk appraisal is a compilation of perceived susceptibility and perceived severity (Mattson, 1999) Perceived susceptibility is defined as a person’s subjective belief about vulnerability to a specific health condition (Rosenstock, 1974). Perceived seriousness is defined as a person’s belief about the severity of a specific health condition (Rosenstock, 1974).
H1: Foster parents' perceived susceptibility of foster children to mental health disorders will be positively associated with foster parents' use of mental health services for their foster children.
H2: Foster parents' perceived severity of the mental health needs of foster children will be positively associated with foster parents' use of mental health services for their foster children.
Perceived benefits of taking action and barriers to taking action
Perceived benefits are defined as a person’s belief about the relative effectiveness of proscribed methods to decrease susceptibility to or the threat of a specific health condition (Rosenstock, 1974). Perceived barriers are defined as any perceived negative consequences that interferes with the ability of an individual to engage in certain behaviors (Rosenstock, 1974). Researchers have enumerated several categories of barriers that are anticipated to appear in this study, and this list would include, but not be limited to, time, cost, social stigma, pain, and inconvenience (e.g., Chew, Palmer, & Kim, 1998; Rosenstock, 1974).
H3: Foster parents' perception of the number of benefits of mental health services by foster children will be positively associated with foster parents' use of mental health services for their foster children.
H4: Foster parents' perception of the number of barriers to the use of mental health service by foster children will be negatively associated with foster parents' use of mental health services for their foster children.
Cues to action
Cues to action are triggers that cue an individual to engage in a specific health behavior (Rosenstock, 1974). Rosenthal (1974) further states that such cues can be both external (e.g., media messages and interpersonal messages) or internal (e.g., perception of ill-health), but this study will focus on external messages because the foster parent is acting on the behalf of the foster children an will not be queried as to the internal cues of said children
H5: The number of cues to action received by a foster parent will be positively associated with foster parents' use of mental health services for their foster children.
Perceived self-efficacy
Perceived self-efficacy is the individual’s belief that s/he is able to perform certain behaviors (Bandura, 1977). Self-efficacy can be seen as perceived self-confidence (Kroll, Rothert, Davidson, Schmitt, Holmes-Rovner, Padonu, & Reischl, 2000). Bandura (1977) stated that individuals will attempt behaviors within their perceived capabilities and avoid behaviors that are perceived to be outside of their capabilities. The construct of self-efficacy has often been incorporated into studies utilizing the HBM (e.g., Eisen, & Zellman, 1992; Lux, & Petosa, 1994; McIntosh, & Kubena, 1996; Neff, & Crawford, 1998). The rationale for incorporating self efficacy into studies of the HBM is that self –efficacy is an impacting variable because when individuals are confident in their ability to perform a certain healthy behavior, those individuals are more likely to engage in health behavior than individuals with less self efficacy (Mattson, 1999).
H6: Foster parents' perceived self-efficacy in using the mental health system will be positively associated with foster parents' use of mental health services for their foster children.
Methods
Participants
The study takes place in a Northern-Midwest state in a county of approximately 238,000 residents, with a major metropolitan area of 120,000 people. The participants will be 60 foster parents from two large foster care agencies, one state run and the other privately run. All foster parents hold a current foster care license and either currently have children in their home or have cared for children within the past three months. All participants will have had at least one foster care placement that was at least three months in duration. The sixty participants will be solicited randomly, based on a combined alphabetical listing of the two agencies. In two-parent homes, the foster parent who self identified as being most active in the advocacy of medical and educational needs of the foster children will be the parent who participates
Survey Instruments
40 item Parent Rating Scale
Self-Efficacy Scale
Health Belief Model Scale
Interview Protocol
6-8 focus groups with 8-10 participants
Procedure
Explain clearly procedures for the laboratory or field. 2 pages
The participants will be solicited at random. The private agency utilizes 75 foster parents, and the state agency private agency utilizes 103 foster parents, for a total of 178 potential participants. The names of foster parents from both agencies will complied onto one list, and a computer program will be used to randomly select names until a total of 120 are selected. Invitations to participate will be mailed to these 120 licensed foster homes. (See Appendix A) The letter includes an explanation of the project, the requirement for participation, an appeal to the perceived need to enhance parent/worker communication, and an incentive of free movie tickets for the entire family upon completion of the focus interview. The letter ends with instructions to phone for an interview time. In addition, a phone call will be made 4 days after the mailings, inquiring about the foster parent’s willingness to participate, and appointments will be made for interview times. If more than 60 foster homes meet the requirements of the study and are willing to participate, then the interview schedule will be expanded. If fewer than 50 foster parents agree to participate, the names of the unsolicited parents will be used to randomly solicit 20 additional participants.
The primary foster parent of the participating foster children will be asked to complete a survey. A portion of the survey will include the Parent Rating Scale portion of the Child Behavior Checklist to help identify the degree of foster child behavior problems. This acting-out behavior subscale focuses on impulsivity, aggression, and disruptiveness (Hightower, Work, & Cowen, 1986) and these behaviors have been useful in identifying mental health disorders (Zima, Bussing, Yang, & Belin, 2000). The acting-out behavior subscale is a five point Likert-type scale, and previous users have identified participants “as being aware of a behavior problem if they rated the child at or below the 15th percentile” (Zima, Bussing, Yang, & Belin, 2000), so I will follow that model and rate children in the 15th percentile and below as having been identified with mental health needs. The Parent Rating scale is usually used in conjunction with the Teacher Rating scale which was implemented in study of “a large, ethnically diverse sample of children from 22 elementary schools” with a reliability Alpha of .85-.91 and a high validity (Acting Out domain: r = .85) (Hightower, Work, & Cowen, 1986 ). A later studies implied the usefulness of this scale for determining the mental health needs for children in foster care, but did not report an Alpha (Zima, Bussing, Yang, & Belin, 2000).
In addition to the acting-out behavior subscale (Parent Rating Scale), participating foster parents will complete a survey with open ended questioned measuring 1) perceptions of mental health issues 2) perceptions of the specific mental health needs of the children in their care 3) perceptions of the efficacy of the mental health care 4) perceptions of their ability to successfully advocate for mental health services 5) behavioral and emotional cues of children in their direct care.
Participating foster parents also will be part of a focus group. The questions will be open ended, and they will elicit answers about foster children in general. Interviews will be tape recorded and transcribed. A coding scheme will be developed to interface with the afore-mentioned five basic tenets of the HBM and will also include a code for self-efficacy. Two coders will code all transcripts and cross-referenced for agreement in coding.
Measurement
Survey Instruments
Closed-Ended Survey Questions. Perceived risk appraisal will be operationalized as perceived susceptibility plus perceived seriousness. On the surveys, perception of both susceptibility and seriousness are measured on a 5-point Likert-type scale. Once the reverse coded items are inverted, summing the numbers will reveal each individual’s perception of risk. Perceived benefits of taking action and barriers to taking action will be operationalized as perceived benefits minus perceived barriers. On the surveys, perceptions of both benefits and barriers are measured on a 5-point Likert-type scale. Once the reverse coded items are inverted, summing the numbers for each category and then subtracting the barriers total from the benefits total will produce an integer that reflects the individuals’ perception of benefits of taking action and barriers to taking action. Cues to action will be operationalized as the number of times an individual self-reports on an open ended survey question that a professional or non-professional recommended mental health services for the children in their care. Perceived self-efficacy I still need to develop this one
Open ended Survey Questions. Mental health problems will be operationalized as the number of concerns that a foster parent self-reports about a foster child’s behavior or feelings. In addition any foster parent who indicates at least one such concern will be classified as cognizant of a potential mental health problem. Perceived need for mental health services will be operationalized as the number of mental health services a foster parent indicates a foster child needs. In addition any foster parent who indicates at least one such service will be classified as cognizant of a need for mental health services. Referral to mental health services will be operationalized as the number of times an individual self-reports that a professional or non-professional recommended mental health services for the children in their care, and individuals reporting at least one professional recommendation will by classified as having been referred. In addition, these referrals to mental health services also will be categorized as cues to action. Use of mental health services will be operationalized by the number of self-reported use of the mental health service system, and individuals reporting the use of at least one mental health service, will be classified as having secured mental health services for the foster children in her/his care.
Interview Coding
Mental health problems. When asked what type of problems the typical foster child will have in school, parents who indicate a concern about a foster child’s behavior or emotions will be classified as cognizant of a potential mental health problem.
Need for mental health services. When asked what type of services the typical foster child need, parents who have at least one response of counseling for problems with feelings/behavior, medication for problems with feelings/behavior, psychiatric care, or training to care for the child's emotional or behavioral problems will be classified as cognizant of a potential need for mental health services.
Referral to mental health services. When asked who suggested that their foster children receive treatment for a problem with behavior or emotions, parents who have at least one response of a professional referral for counseling will be classified as having been referred to obtain mental health services.
Use of mental health services. When asked what treatments for a problem with behavior and/or emotions their foster children had received, parents who list a mental health service will be classified as having obtained mental health services for their foster child
Benefits
For perceived benefits of mental health services, foster parents will be asked, "Thinking about foster children in general, what are the benefits for getting kids mental health services?" follow up question, "On a scale of 1-5, with 1 being absolutely no benefit and 5 being tremendously beneficial, would you rate the benefits of the mental health services that foster children typically use?" Responses to the open ended questions will be coded into categories of educational benefit, recreational benefit, behavioral benefits, emotional benefits, and family peace benefits. Each participant will be asked to give an individual response to the closed-ended question, and the response will be treated like a response on a Likert-type scale.
Perceived Barriers
For perceived barriers to mental health services, foster parents will be asked, "Thinking about foster children in general, what are the negative aspects for getting kids mental health services?" follow up question, "On a scale of 1-5, with 1 being extremely negative and 5 being no negative aspects, how would you rate the negative aspects of using mental health services for foster children?" Responses to the open ended questions will be coded into categories of time, cost, social stigma, pain, and inconvenience. Each participant will be asked to give an individual response to the closed-ended question, and the response will be treated like a response on a Likert-type scale
Self-efficacy
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Appendices
The appendices should include all relevant supporting material. Figures and Tables should be included in separate sections. 3 pages of scales
*Note: These sections are not normally part of a method section but have been added for the purposes of this class.
Focus Group Questions-
Mental health problem
For mental health problems, foster parents will be asked, "In general, what types of problems do typical foster children have in school?"
Responses will be coded into categories of behavioral, socialization, emotional, and educational. Parents who indicate a concern about a foster child’s behavior or emotions will be classified as cognizant of a potential mental health problem.
Need for mental health services
For perceived need for mental health services, foster parents will be asked, "Thinking about foster children in general, what service or services do you feel the typical child in foster care needs most?" Up to four responses per person will be allowed. Responses will be coded into categories of educational needs, recreational needs, counseling, psychotropic medication, psychiatric care, or services for monitoring the child's emotional or behavioral problems. Parents who have at least one response of counseling for problems with feelings/behavior, medication for problems with feelings/behavior, psychiatric care, or training to care for the child's emotional or behavioral problems will be classified as cognizant of a potential need for mental health services.
Referral to mental health services
For referrals for mental health services, foster parents will be asked, "Thinking about the foster children you have cared for, who suggested that those specific children receive treatment for a problem with his or her behavior and/or feelings?" Follow up question "How common is such a referral/lack of referral with most foster children?" Responses will be coded into categories of professional referrals and non-professional referrals. Parents who have at least one response of a professional referral for counseling will be classified as having been referred to obtain mental health services.
Use of mental health services
For use of mental health services, foster parents will be asked, "Thinking about the foster children you have cared for, have those specific children receives treatment for a problem with his or her behavior and/or feelings?" Follow up question "How common is such a treatment with most foster children?" Affirmative responses will be encouraged to elaborate. Responses will be coded into categories of types of mental health treatment and duration. Parents who respond affirmatively will be classified as having obtained mental health services for their foster child.
Benefits
For perceived benefits of mental health services, foster parents will be asked, "Thinking about foster children in general, what are the benefits for getting kids mental health services?" follow up question, "On a scale of 1-5, with 1 being absolutely no benefit and 5 being tremendously beneficial, would you rate the benefits of the mental health services that foster children typically use?" Responses to the open ended questions will be coded into categories of educational benefit, recreational benefit, behavioral benefits, emotional benefits, and family peace benefits. Each participant will be asked to give an individual response to the closed-ended question, and the response will be treated like a response on a Likert-type scale.
Perceived Barriers
For perceived barriers to mental health services, foster parents will be asked, "Thinking about foster children in general, what are the negative aspects for getting kids mental health services?" follow up question, "On a scale of 1-5, with 1 being extremely negative and 5 being no negative aspects, how would you rate the negative aspects of using mental health services for foster children?" Responses to the open ended questions will be coded into categories of time, financial, emotional, and inconvenience. Each participant will be asked to give an individual response to the closed-ended question, and the response will be treated like a response on a Likert-type scale
Self-efficacy
********Service use could also be confirmed by medical or school records
Open ended Survey Questions-
Mental health problem
For mental health problems, foster parents will be asked, "Do you expect your foster child to have problems in school?" Responses will be coded into categories of behavioral, socialization, emotional, and educational. Parents who indicate a concern about a foster child’s behavior or feelings will be classified as cognizant of a potential mental health problem.
Need for mental health services
For perceived need for mental health services, foster parents will be asked, "Thinking about your foster child what service or services do you feel s/he needs most?" Responses will be coded into categories of educational needs, recreational needs, counseling, psychotropic medication, psychiatric care, or services for monitoring the child's emotional or behavioral problems. Parents who have at least one response of counseling for problems with feelings/behavior, medication for problems with feelings/behavior, psychiatric care, or training to care for the child's emotional or behavioral problems will be classified as cognizant of a potential need for mental health services.
Referral to mental health services
For referrals for mental health services, foster parents will be asked, "Who has suggested that your foster child receive treatment for a problem with his or her behavior and/or feelings?" Responses will be coded into categories of professional referrals and non-professional referrals. Parents who have at least one response of a professional referral for counseling will be classified as having been referred to obtain mental health services.
Use of mental health services
For use of mental health services, foster parents will be asked, "What types of treatment has your foster child received for a problem with his or her behavior and/or feelings?" Please indicate type and length of treatment. Responses will be coded into categories of types of mental health treatment and duration. Parents who respond affirmatively will be classified as having obtained mental health services for their foster child.
I will use letterhead from either Family Independence Agency or Family and Children Services.
Hello,
My name is Lin Marklin, and I have been a licensed foster parent since 1997. During that time I have had the opportunity to make a difference in the lives of many foster children. Over the years I have thought that the quality of my communication with my caseworkers greatly impacted my success as a foster parent, and I am interested in discovering if other foster parents have had similar experiences.
In addition to being a foster parent, I am also a Communication student at WMU, and it is in that capacity that I am writing this letter. I would like you to participate in a research study investigating communication between caseworkers and foster parents. The study will focus on our ability as foster parents to secure needed services for the children in our care. The goal of the study is to better understand and thus improve foster children’s access to beneficial services. Participants will receive one family pass to the Kalamazoo 10 Cinema.
To be eligible to participate, you must meet the following three requirements:
- currently hold a valid Michigan foster care license
- currently caring for children or have had a placement within the past 3 months
- have had at least one placement that lasted a minimum of three months
Participation involves a one-hour, one time visit to the Family and Children Services agency, located in Kalamazoo. During this time you will fill out a 40 question survey and participate in a 45 minute group interview with 10-12 other foster parents. Child-care will be provided on sight. The research project begins in approximately two weeks.
Tentative Interview times during the week of Month, Year
Monday Tuesday Wednesday Thursday Friday Saturday
7:00 p.m. 12:00 noon 1:00 p.m. 6:00 p.m. 11:00 a.m. 9:00 a.m.
I am really looking forward to hearing your input on how we, as foster parents, can better meet the needs of our foster children. I firmly believe that enhancing parent/worker communication is a step in the right direction, but I would like to hear your ideas as well.
Please call me, Lin Marklin, at 322-5756 to set up the time that is most convenient for you. The proposed interview times are tentative, and they could be adjusted to meet individual needs.
Remember, childcare is provided, and participants receive a one-time family pass to the Kalamazoo 10 Cinema.
Sincerely,
Lin Marklin
This checklist is a separate file on the computer.
Parent Rating Scale
Instructions: Below are a number of common problems that children have. Please rate each item according to your foster child's/children’s behavior in the last month. For each item, ask your self “ How much of a problem has this been in the last month?” and circle the best answer for each one
Never Rarely Occasionally Often Very Often
(Not (Seldom (Just a (Pretty (Very
True True) little much much
At all) True True) True)
- Angry and resentful…………………………………………………..
- Difficulty doing or completing homework…………………………..
- Is always “on the go” or acts as if driven by a motor………………..
- Timid, easily frightened……………………………………………...
- Everything must be just so…………………………………………..
- Has no friends……………………………………………………….
- Stomach aches……………………………………………………….
- Fights………………………………………………………………..
- Avoids, expresses reluctance about, or has difficulties engaging in work that require sustained mental effort (such as schoolwork or homework_………………………………………………………….
- Has difficulty sustaining attention in tasks or play activities………
- Argues with adults…………………………………………………..
- Fails to complete assignments………………………………………
- Hard to control in malls or while grocery shopping………………..
- Afraid of people…………………………………………………….
- Keeps checking things over again and again……………………….
- Loses friends quickly………………………………………………
- Aches and pains Restless or overactive……………………………
- Has trouble concentrating in class……………………………………
- Does not seem to listen to what is being said to him/her……………
- Loses temper………………………………………………………..
- Needs close supervision to get through assignments……………….
- Runs about or climbs excessively in situations where it is inappropriate ……………………………………………………….
- Afraid of new situations……………………………………………
- Fussy about cleanliness…………………………………………….
- Does not know how to make friends…………………………………
- Gets aches and pains or stomachaches before school……………….
- Excitable, impulsive…………………………………………………
- Does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions………….
- Had difficult organizing tasks and activities…………………………
- Irritable……………………………………………………………….
- Restless in the “squirmy sense” ……………………………………
- Afraid of being alone ………………………………………………
- Things must be done the same way every time………………………
- Does not get invited over to friends’ houses…………………………
- Headaches…………………………………………………………….
- Fails to finish things s/he starts………………………………………
- Inattentive, easily distracted…………………………………………
- Talks excessively…………………………………………………….
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- Actively defies or refuses to comply with adults’ requests…………..
- Fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities………………………………..
- Has difficulty waiting in lines or awaiting turn in games or group situations……………………………………………………………..
- Has a lot of fears……………………………………………………..
- Has rituals that s/he must go through………………………………...
- Distractibility or attention span a problem…………………………...
- Complains about being sick even when nothing is wrong…………...
- Temper outbursts…………………………………………………….
- Gets distracted when given instructions to do something……………
- Interrupts or intrudes on others (e.g., butts into others’ conversations or gamed) ……………………………………………..
- Forgetful in daily activities…………………………………………..
- Cannot grasp arithmetic……………………………………………...
- Will run around between mouthfuls at meals………………………...
- Afraid of the dark, animal, or bugs…………………………………..
- Sets very high goals for self………………………………………….
- Fidgets with hands or feet or squirms in seat………………………..
- Short attention span………………………………………………….
- Touchy or easily annoyed by others…………………………………
- Has sloppy handwriting………………………………………………
- Has difficulty playing or engaging in leisure activities quietly……...
- Shy, withdrawn……………………………………………………….
- Blames others for his/her mistakes or misbehavior………………….
- Fidgeting…………………………………………………………….
- Messy or disorganized at home or school……………………………
- Gets upset if someone rearranges his/her things…………………….
- Clings to parents or other adults…………………………………….
- Disturbs other children………………………………………………
- Deliberately does thing that annoy other people…………………….
- Demand must be met immediately—easily frustrated………………
- Only attends if it is something she is very interesting in…………….
- Spiteful or vindictive…………………………………………………
- Loses things necessary for task or activities (e.g., school assignments, pencils, books, tools, or toys) …………………………
- Feels inferior to others……………………………………………….
- Seems tired or slowed down all the time…………………………….
- Spelling is poor………………………………………………………
- Cries often and easily………………………………………………..
- Leaves seat in classroom or in other situations in which remaining seared is expected……………………………………………………
- Moods changes quickly and drastically……………………………..
- Easily frustrated in efforts…………………………………………..
- Easily distracted by extraneous stimuli………………………………
- Blurts our answers to questions before the questions have been completed…………………………………………………………….
Never Rarely Occasionally Often Very Often
(Not (Seldom (Just a (Pretty (Very
True True) little much much
At all) True) True) True)
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