The association of foster care or kinship care with adolescent sexual behavior and first pregnancy.

Kinship Care

Assessing Quality of Care in Kinship and Foster Family Care

Women who spent any time living in foster homes or with relatives other than their par? ents during childhood have an elevated risk of engaging in high-risk sexual behaviors, ac? cording to an analysis of data from the 1995 National Survey of Family Growth (NSFG).1 They are nearly a year younger than other women when they first become pregnant, and they have elevated odds of having more than three sexual partners over their lifetime. Those who lived with relatives also begin having in? tercourse at a younger age than women who always lived with at least one biological par? ent. More than 500,000 children are placed in living arrangements outside their parents' home each year; the analysts note, however, that the extent to which this experience influences their sexual behavior has received lit? tle attention. The nationally representative NSFG data permitted researchers to examine patterns of sexual behavior among three groups of women: 89 who had ever lived in foster care, 513 who had ever lived in kinship care (that is, with relatives other than their parents) and 9,018 who had always lived with at least one parent (the comparison group). Women were excluded if they had never lived with their bi? ological parents, they were foreign-born or they had lived in a group home at any point in their childhood.

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 …

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

To examine the influence of kinship care on behavioral problems after 18 and 36 months in out-of-home care. Growth in placement of children with kin has occurred despite conflicting evidence regarding its benefits compared with foster care. Prospective cohort study. National Survey of Child and Adolescent Well-Being, October 1999 to March 2004. One thousand three hundred nine children entering out-of-home care following a maltreatment report. Kinship vs general foster care. Predicted probabilities of behavioral problems derived from Child Behavior Checklist scores. Fifty percent of children started in kinship care and 17% of children who started in foster care later moved to kinship care. Children in kinship care were at lower risk at baseline and less likely to have unstable placements than children in foster care. Controlling for a child's baseline risk, placement stability, and attempted reunification to birth family, the estimate of behavioral problems at 36 months was 32% (95% confidence interval, 25%-38%) if children in the cohort were assigned to early kinship care and 46% (95% confidence interval, 41%-52%) if children were assigned to foster care only (P = .003). Children who moved to kinship care after a significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset. Children placed into kinship care had fewer behavioral problems 3 years after placement than children who were placed into foster care. This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care.

BACKGROUND Children may be placed in either kinship or foster care, forms of out-of-home placement (OHP), if maltreatment is suspected. The American Academy of Pediatrics has identified them as children with special health needs requiring elevated care. While North Carolina has increased support for foster care, it is unclear whether similar support exists for kinship care. Child abuse medical providers (CAMPs) were interviewed regarding their understanding and assessment of the state of the kinship care system in North Carolina, and how it can be improved.METHODS CAMPs were individually interviewed using a semi-structured, open-ended question guide to assess their perspectives on kinship versus foster care in North Carolina. Data were coded, and the analysis was conducted in an inductive manner, allowing themes and then recommendations to emerge from interviews.RESULTS The following three themes were identified: 1) providers have a foundational understanding of the kinship care system, marked by knowledge gaps; 2) children in kinship care and foster care have equivalent, elevated health needs, but children in kinship care do not receive the same level of care; 3) individual and structural changes have to be made to the interprofessional teams working within the OHP system.LIMITATIONS The study sample was small, including eight CAMPs who had relatively homogenous demographic characteristics. CAMPs typically see the worst cases of maltreatment, which may bias responses. Additionally, the majority of children in kinship care are unknown to CAMPs and may not be fully represented in responses.CONCLUSION CAMPs' responses were summarized into a set of recommendations targeting four different components of the OHP team: the general interprofessional team, policymakers and state leaders, medical providers, and social workers.

The wellbeing of foster and kin carers: A comparative study

What are the factors associated with educational achievement for children in kinship or foster care: A systematic review

We assessed if there has been a decline in the median number of reported lifetime sexual partners in Kenya following the AIDS epidemic. The Wilcoxon rank-sum test was used to compare the median and interquartile range (IQR) of the number of lifetime sexual partners for men aged 20-54 years in the 1993 and 2008 Kenyan Demographic Health Surveys. The median number of sexual partners in 1993 increased rapidly to 10 partners reported at age 30 years then plateaued at this level. In 2008, the median number of sexual partners plateaued at around half the value of the 1993 plateau. The median number of lifetime sexual partners for men aged 20-54 years declined from 10 (IQR 4-20) in 1993 to 3 (IQR 2-7) in 2008 (P < 0·001). This decline could be due to a combination of the effects of AIDS mortality and a misreporting bias.

How does kinship and foster care differ on caregiver-child relationship quality and child and caregiver mental health?

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.

Understanding the distinctive features of kinship and non-kin foster care has sparked research interest aimed at developing policies and programs. This study analyses 930 cases of fostered children (35.5% in non-kin foster care and 64.5% in kinship care) based on the information provided by child care professionals and the evaluations made by 221 foster carers (34.8% in non-kin foster care and 65.2% in kinship care) using different questionnaires. Significant differences were obtained between kinship and non-kin foster care, indicating more favourable results on stability in kinship placements, although the less favourable results regarding the education and employment of kinship carers. Significant differences were observed in how foster carers perceived their role, with kinship carers reporting greater facility in raising the fostered child and higher satisfaction with the placement. However, they were less satisfied with the financial support. Cluster analysis confirmed these differences, identifying two groups based on the overall evaluation of raising foster children and satisfaction with the placement. The findings serve to provide evidence in support of kinship care and also indicate the need to re-examine the role played by the information made available to non-kin foster parents about the biological family and the impact on the foster placement.

This study examined socioemotional problems among children age 0 to 5 years in formal kinship and foster care across a northeastern state. Findings revealed that more than one third of children in both types of care showed socioemotional problems. More children were placed in kinship care when they lived in rural settings, were biracial, or spent time in the neonatal intensive care (NICU) after birth. Unique child and maltreatment characteristics predicted socioemotional problems scores for each placement type. Among children in kinship care, being biracial, spending time in the NICU, and being referred to child welfare for either caregiver substance abuse or neglect were related to socioemotional problems. When children were in foster care, spending time in the NICU, being referred to child welfare for child neglect, or being referred for intimate partner violence were all related to socioemotional problems. The results have implications for child welfare policy and practice, especially in light of increased efforts to place children with kin.

Interdependence. Bonds. Kinship. These and other sentient ties shape the themes of the articles in this issue's special focus on foster care. We learn about the connections between foster parents and birth parents, kinship and foster care, and caregiving grandparents and grandchildren. Such connections are peculiar to and distinguish social work's approach to understanding and working with human problems of living. The profession's hallmark has been its traditional commitment to context and relationship and to the precept of “person-in-situation,” beginning with the friendly visitor's concern with the family as a whole. This commitment was central in the era of the settlement house movement with its interest in the culture, community, neighborhood, and heritage of its members, as well as in group work, which drew attention to the dynamic interdependence of the individual and his or her milieu. In later years, this raw, almost intuitive awareness of the essential interdependence of people was translated in...