Caregivers' experiences with kinship care and Child Welfare Services

Kinship Care

Assessing Quality of Care in Kinship and Foster Family Care

Kin and non-kin foster care—findings from a National Survey

Introduction: A high number of children and adolescents receiving child welfare services are in need of mental health services. In Norway, child welfare services and mental health services are organized separately, and no formal mechanisms have existed to ensure collaboration and coordination of services across the organisations. Child welfare is organised under social services in the municipality, while mental health services are organised under the state financed specialist healthcare. For children and their families, in need of both services, this has led to fragmented and poorly coordinated services, and collaboration between providers have been based on ad hoc arrangements. Practice changed implemented: To create a more coherent service the municipality of Kristiansand developed a project – Inter-organisational acute services for children and adolescents (short: the Acute Project) – targeted towards children experiencing acute situations (e.g. suicidal attempts, domestic violence) where they potentially are in need of services from both child welfare and mental health services. Sub objectives in the project are to (a) develop common routines for providers in acute situations, (b) increase providers' competence (c) implement measures to strengthen parents' abilities to handle the acute situation in their own home (e.g. avoid institutionalisation), and (d) ensure coordinated follow-up after the acute situation has stabilised. Key stakeholders in the project are the child welfare guard and the acute-ambulatory unit in the hospital. The regular child welfare service, who takes over the responsibility for a case after the acute situation, is also partly involved. Various measures have been introduced to reach the objectives. The most significant is the abolishment of the professional secrecy across the organisations, meaning that child welfare and mental health services currently are allowed to openly exchange information, which was not the case previously. The Acute Project has received financial support from the Norwegian government, and it is the first (large-scale) attempt in Norway to improve integration across these services. The project period is 2013-2016. Key findings: As researchers we have followed the project since 2014, conducting interviews with a range of providers and children/families who have received combined services. We have also taken part in workshops and surveyed the number, content and outcome of acute case. The research will continue to the ending of the project period. Here we present findings with an emphasis on providers' experiences and perspectives. Employees in both child welfare and mental healthcare report of increased knowledge of each other, increased trust and an understanding of being more equal. The changes are related to their attendance in regularly held common seminars, including case discussions and lectures. Routines to support the integration of services have been introduced, and imply that the parts must telephone each other for each acute case. Furthermore, staff from the acute-ambulatory unit sits in with the child welfare guard once a week, thus bringing the collaborating partners closer to each other. The significance of abolishing the professional secrecy are debated among staff, but in sum it is safe to say that it provides a legal structure that makes communication across the sectors easier. At this point in the project period we will argue that the parties have increased their competence, in particular their 'collaboration competence', and the routines that have been introduced function quite well, but they are also subject to constant revision. Whether the objective of providing alternative measures and strengthening parents' capabilities to deal with the acute situation in their own home is reached within the project can be difficult to determine for a single provider, but there seems to be an agreement that the project helps preventing institutionalization. The follow up after the acute situation seems to have been less affected by the Acute Project. Improved integration and coordination of services is predominantly taking place within the acute situation, less after. Routines are currently being developed to ensure a smoother transition between the acute units and the regular child welfare service. Lessons learned: A number of factors (e.g. legal, fiscal and professional) hamper integration and coordination across child welfare and specialist mental health services. The Acute project removes some of these barriers. However, there is concern about how the collaboration will be affected when/if the abolishment of the professional secrecy ceases. Conclusion: The Acute project tests a form of service integration rarely seen in Norway, by trying to integrate services from the social- and the healthcare sector. If we are to address the complex needs of children and adolescents in need of help from both sectors, measures like the Acute project is highly recommendable.

From the child's perspective: A qualitative analysis of kinship care placements

1. Sandra H. Jee, MD, MPH 1. Department of Pediatrics University of Rochester Rochester, NY 1. Mark D. Simms, MD, MPH 1. Department of Pediatrics Medical College of Wisconsin Milwaukee, Wisc Improving the Odds for the Healthy Development of Young Children in Foster Care . Dicker S, Gordon E, Knitzer J. National Center for Children in Poverty: Columbia University Mailman School of Public Health. Promoting the Emotional Well-Being of Children and Families (Policy Paper No. 2). January 2002;1–28 Children and Family Services Reviews, Part V: Most States Fail to Meet the Mental Health Needs for Foster Children . Huber J, Grimm B. Youth Law News . 2004;Oct-Dec:1–36 CWLA Standards for Health Care Services for Children in Out-of-Home Care . Washington, DC: Child Welfare League of America; 1988. Educational Experiences of Children in Out-of-Home Care . Smithgall C, Gladden RM, Howard E, Goerge R, Courtney M. Chicago, Ill: Chapin Hall Center for Children at the University of Chicago; 2004:1–77 Fostering Health: Health Care for Children and Adolescents in Foster Care . 2nd ed. Task Force on Health Care for Children in Foster Care, American Academy of Pediatrics, District II, New York State. Elk Grove Village, Ill: American Academy of Pediatrics: 2005 Healthy Foster Care America . www.aap.org/advocacy/HFCA/ On any given day, more than 500,000 children are living in state-supported foster home care. In the course of a year, more than 800,000 children experience placement in a foster home. Many of these children return home quickly, but for some, placement may extend for years and may involve care in multiple foster homes. Most of the children have experienced serious family dysfunction prior to placement, including exposure to domestic violence and to their parents’ mental health disorders, addiction, or criminal activity. Serious neglect and abuse are the most frequently stated reasons for removing children from their parents’ care. Children entering foster homes have extremely high rates of physical and mental health problems, developmental delays, and educational underachievement. As a group, children in foster care …

This study used administrative child welfare data from California to examine the relationship of the characteristics of children and their families to whether children were placed in kinship foster care or in some other form of child welfare placement. It was found that many characteristics of children and their families--such as children's age and race, children's health status, type of family from which children were removed, AFDC eligibility of the family from which children were removed, and the reason for which the children were removed from their caregivers--are related to the type of foster care setting in which children were placed. Key words: administrative data; foster care; kinship foster care; logistic regression care is a large, growing, and often understudied social services program (Courtney, 1994c). The number of children in out-of-home care is clearly rising. Although there is B no centralized national registry of these children, all 50 states annually provide information on their out-of-home care populations to the Voluntary Cooperative Information Service (VCIS) of the American Public Human Services Association. According to VCIS information, the number of children in out-of-home care has steadily grown from 262,000 in 1982, to 400,000 in 1990, to 507,000 in 1996 (personal communication with P. Shapiro, American Public Human Services Association, January 15, 1999). 1997 and 1998 data are not currently available (Shapiro). One aspect of the substantial growth in the number of children in out-of-home care in recent years is the rise in what has come to be known as kinship care. Kinship care is a particular form of family foster care in which children are placed with foster parents who are biologically related to them. Certainly, it is true that throughout history kin often have cared for children on an informal basis. However, kinship care refers to a formal arrangement in which care for a child is legally transferred through a court order to the child welfare system, and in which the child's kin become his or her foster parents. Most often, these kinship foster parents are grandparents of the child or an aunt or uncle. Less often, these kinship foster parents are older siblings or some other relatives of the child. Some limited research suggests that kinship foster parents are more likely to be older, to be African American, and to have lower incomes than nonkin foster parents (Berrick, Barth, & Needell, 1994). Since the early part of the 1980s, kinship care has grown from a relatively rare form of child welfare placement to a very common one (Berrick et al., 1994; Berrick, Needell, & Minkler, 1999; Dubowitz et al., 1994; Gleeson & Craig, 1994; Goerge, Wulczyn, & Harden, 1994; Scannapieco & Hegar, 1999; Takas, 1992). GROWTH OF KINSHIP FOSTER CARE It often is argued that kinship care is a way for the child welfare system to deal with growing numbers of children in need of out-of-home care placements (Barth & Berry, 1994; Berrick, 1998; Gleeson & Craig, 1994). As noted, the number of children in need of foster homes has grown during the past decade. However, the number of available licensed foster homes has steadily declined nationwide during the same decade. In an article on the Foster Family Shortage the Child Welfare League of America (1995) reported that the number of family foster homes declined from 147,000 in 1985 to 125,000 in 1994. Placement with kin may thus represent a way of finding new foster homes at a time when the child welfare system is confronted with increasing demands for its services in the face of declining resources. The way for growth in kinship care also has been paved by developments in federal legislation. Enacted in 1980, the Adoption Assistance and Child Welfare Act of 1980 (P.L. 96-272) requires child welfare authorities to plan for a placement for a child that provides permanency and to evaluate these plans regularly through a set of administrative and court hearings. …

Purpose: This paper explores the experiences of youth in Nova Scotia, Canada, involved with child welfare and community services and the factors associated with stable or unstable housing during service involvement and after discharge. Method: This paper analyzes four case studies of two non-binary, one female, and one male youth selected for the diversity of their risk and resilience profiles from a longitudinal mixed-methods study of youth involved with child welfare and community services. Results: Findings show that intersecting risk factors, including childhood exposure to violence, multiple placements in the child welfare system, and failure in child welfare support and transition contributed to youths’ internalizing and externalizing problems and eventual experiences of precarious housing and homelessness. Resilience factors arising from support systems have been found to help youth transition to more stable housing. Conclusion: These purposefully selected case studies highlight both the risk and resilience factors associated with homelessness and stable housing for youth involved with child welfare services. Recommendations are provided to help prevent unstable housing outcomes for this population.

Kinship care and sibling placement: Child behavior, family relationships, and school outcomes

Recent child welfare research using administrative child welfare data has discovered that children who are placed in kinship foster care are re uni fied more slowly with their biological parents than children who are placed in foster care with nonrelatives. However, no research has examined the question of whether this effeet of placement into kinship foster care on re unification rates is due to selection bias. This research addresses this question by using a bivariate probit model and finds evidence that some of the effect of placement in kinship care on re unification rates can be attributed to selection bias.

Kinship foster care and the risk of juvenile delinquency

Child abuse and neglect are common problems across the world that result in negative consequences for children, families and communities. Children who have been abused or neglected are often removed from the home and placed in residential care or with other families, including foster families. Foster care was traditionally provided by people that social workers recruited from the community specifically to provide care for children whose parents could not look after them. Typically they were not related to the children placed with them, and did not know them before the placement was arranged. In recent years many societies have introduced policies that favour placing children who cannot live at home with other members of their family or with friends of the family. This is known as ‘kinship care’ or ‘families and friends care’. We do not know what type of out‐of home care (placement) is best for children.This systematic review was designed to help find out if research studies could tell us which kind of placement is best. Sixty two studies met the methodological standards we considered acceptable. Wherever possible we combined the data from studies looking at the same outcome for children, in order to be more confident about what the research was telling us. Current best evidence suggests that children in kinship care may do better than children in traditional foster care in terms of their behavioral development, mental health functioning, and placement stability. Children in traditional foster care placements may do better with regard to achieving some permanency outcomes and accessing services they may need. Implications for practice and future research are discussed.Executive summary/AbstractBACKGROUNDEvery year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out‐of‐home settings that will facilitate their safety, permanency, and well‐being. However, children in out‐of‐home placements typically display more educational, behavioral, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.OBJECTIVESTo evaluate the effect of kinship care placement on the safety, permanency, and well‐being of children removed from the home for maltreatment.SEARCH STRATEGYThe following databases were searched to February 2007: CENTRAL, MEDLINE, C2‐Spectr, Sociological Abstracts, Social Work Abstracts, SSCI, Family and Society Studies Worldwide, ERIC, PsycINFO, ISI Proceedings, CINAHL, ASSIA, and Dissertation Abstracts International. Relevant social work journals and reference lists of published literature reviews were handsearched, and authors contacted.SELECTION CRITERIARandomized experimental and quasi‐experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care, were compared with children placed in non‐kinship foster care on child welfare outcomes in the domains of well‐being, permanency, or safety.DATA COLLECTION AND ANALYSISReviewers independently read the titles and abstracts identified in the search and selected appropriate studies. Reviewers assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, outcome data were extracted and entered into REVMAN for meta‐analysis with the results presented in written and graphical forms.RESULTSSixty two quasi‐experimental studies were included in this review. Data suggest that children in kinship foster care experience better behavioral development, mental health functioning, and placement stability than do children in non‐kinship foster care. Although there was no difference on reunification rates, children in non‐kinship foster care were more likely to be adopted while children in kinship foster care were more likely to be in guardianship. Lastly, children in non‐kinship foster care were more likely to utilize mental health services.AUTHORS’ CONCLUSIONSThis review supports the practice of treating kinship care as a viable out‐of‐home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

This study examined the relationship between initiation of outpatient mental health service use and level of child welfare involvement. Three levels of child welfare involvement were examined: in-home care and no child welfare services beyond an initial investigation, in-home care and additional child welfare services, and placement in out-of-home care (foster care). Longitudinal data were collected for a subsample of children (N=3,592) aged two through 14 years who were enrolled in the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time. Hazard functions revealed a large increase in onset of mental health services immediately after the time of the initial contact with child welfare, varying by level of child welfare involvement and leveling off by three months after the initial contact. The multivariate Cox proportional-hazards model indicated that compared with children who were placed in out-of-home care, those in in-home care who did not receive any further child welfare services were about one-third as likely to use mental health services and those in in-home care who received additional child welfare services were one-half as likely to use mental health services. Other covariates in the model predicted mental health service use, including being older, being Caucasian, having a history of maltreatment (specifically, physical abuse, physical neglect, or abandonment), being uninsured, and need for mental health services, as measured by the Child Behavior Checklist. Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when need for such services is controlled for.

This Campbell systematic review examines whether kinship care is more effective than foster care in ensuring the safety, permanency and wellbeing of children removed from their home for maltreatment. The review summarizes findings from 102 studies involving 666,615 children. 71 of these studies were included in meta‐analyses.Kinship care is a viable option for the children that need to be removed from the home for maltreatment. However, policy issues remain to balance the cost‐effectiveness of kinship care with a possible need for increased levels of caseworker involvement and service delivery. A considerable number of the included studies showed weaknesses in their methodologies and designs. There is a need to conduct more high quality quantitative studies of the effects of kinship care based on robust longitudinal designs and psychometrically sound instrumentsAbstractBACKGROUNDEvery year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out‐of‐home settings that will facilitate their safety, permanency, and well‐being. However, children in out‐of‐home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.OBJECTIVESTo evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well‐being of children removed from the home for maltreatment.SEARCH METHODSWe searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index‐Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.SELECTION CRITERIAControlled experimental and quasi‐experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non‐kinship foster care for child welfare outcomes in the domains of well‐being, permanency, or safety.DATA COLLECTION AND ANALYSISTwo review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta‐analysis with the results presented in written and graphical forms.RESULTSOne‐hundred‐and‐two quasi‐experimental studies, with 666,615 children are included in this review. The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attrition bias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size ‐0.33, 95% confidence interval (CI) ‐0.49 to ‐0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well‐being (OR 0.50, 95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non‐kinship foster care. For permanency, there was no difference on reunification rates, although children in non‐kinship foster care were more likely to be adopted (OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non‐kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).AUTHORS' CONCLUSIONSThis review supports the practice of treating kinship care as a viable out‐of‐home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

In Norway, as elsewhere, child welfare services have long prioritised placing children in foster homes over residential care when children cannot live with their parents, to ensure upbringing in family settings. Today, it is also stated in the law that child welfare services must always consider whether anyone in the child’s family or close network could be chosen as foster parents. The idea has been that kinship foster care can safeguard the child’s cultural identity, continuity in social networks, and family connections. Parallel with the prioritisation of foster care and kinship foster care, foster care has become increasingly professionalised. In the Norwegian context, the possible unintended consequences of increased professionalisation have been minimally addressed. This article aims to contribute to vitalising this discussion about some of the unintended consequences professionalisation may have for safeguarding the values associated with foster care in general, and particularly for kinship foster care. For our discussion, focusing particularly on economic conditions, we draw on both our own and others’ research related to foster care. Using concepts from sociological theory on different rationalities or logics as a basis for action, we illustrate and discuss how instrumental rationality and the field logic of child welfare have increasingly influenced the conditions for foster homes.