Children In Foster Care Research Articles

How collective interactions and institutional logics influence permanency planning in child protection in Quebec

BackgroundIn the Canadian province of Quebec, placing children in foster care is an exceptional measure whose ultimate goal is family reunification. When child-protection workers decide that reunification is unlikely, they must design permanency plans that ensure continuity of care and stable relationships for the child. Most studies of this important decision-making process have focused on individual practitioners as if they acted alone. This process is collective, interactive, and influenced by various contextual elements. ObjectiveThe objective of this exploratory study was to examine the collective, interactive aspects of the decision-making process involved in permanency planning. Participants and settingThe participants were key players involved in child-protection decisions at an Integrated University Health and Social Services Centre (CIUSSS). MethodsThe theoretical approach of this study combines Giddens's structuration theory with ethnomethodology. Data were collected through interviews with 16 key players and nine months of observing advisory-committee meetings. ResultsIn making permanent placement decisions, the participants must engage in extensive interactions with one another. They must also apply various institutional (clinical, legal, and managerial) logics with differing goals and differing operational frameworks, the tensions among which make the process more complex and challenging. ConclusionsOur findings highlight the complexity of making permanent placement decisions and the importance of interaction and collaboration in this process. These findings suggest that management of this process should focus not on holding practitioners accountable and penalizing them for mistakes, but rather on providing adequate conditions for practice to facilitate thoughtful collective deliberation and learning and ethical decision-making.

Characteristics, experiences, and mental health of children who re-enter foster care

Permanent placements that are safe and stable promote well-being of children leaving foster care; however, placement disruptions and reentry into the welfare system following placements that were intended to be permanent are common (Konijn et al., 2019). What is not known is whether disruptions during foster care stays are particularly risky for children’s emotional health if they occur in the context of more than one removal of the child from their parents or guardians (i.e., from home). Using the most current data available through the nationally mandated Adoption and Foster Care Analysis Reporting System (AFCARS), we explored characteristics and removal reasons of children who re-enter foster care and used hierarchical, binomial logistic regression to analyze the moderating effect of multiple removals from home on the link between placement disruptions during stays in foster care and emotional disturbance (ED). The sample consisted of 659,105 children served by the U.S. foster care system during Fiscal Year (FY) 2018. Findings suggest that children who re-enter foster care are more likely to be older, and disproportionately more were children of color. Children who re-enter foster care tend to experience more placement disruptions in subsequent removal episodes than children who have been removed from their home only once. Finally, we identified an interaction effect for placement disruptions and multiple removals on the likelihood of a child in foster care having ED. This study discusses implications for targeted permanency and post-permanency services.

Prevalence and associated factors of placement breakdown of unaccompanied children in Flemish family foster care. A follow-up study

This study examines the prevalence of placement breakdown in family foster care for unaccompanied refugee minors (URM). Furthermore, it investigates which foster child, foster family and case characteristics are associated with breakdown. Case files of 107 URM who were placed in 2016 in Flemish family foster care (Dutch speaking part of Belgium) were analyzed. In a research window of 2.5 years, 62 placements (57.9%) had terminated: 32 placements broke down (29.9%) and 30 placements ended positively (28.0%). An ongoing asylum procedure and lying or cheating were associated with an increased likelihood of breakdown. Contacts with birth parents, on the other hand, was a protective factor for placement disruption. Therefore, legal authorities should limit the term of asylum procedures, foster care services and guardians must facilitate contacts between the URM and their parents, and the building of trust between youngsters and foster carers should be a central theme in the support process.

Child Welfare Services Response to COVID-19: Addressing Face-to-Face Contacts.

During the onset of the COVID-19 pandemic, child welfare case managers faced contradictions in their responsibility to make regular in-person contact with children and families to promote safety, permanency, and well-being while following public health directives to avoid social contact in order to curb COVID-19 infections. In response, federal guidance was issued regarding the use of technology to maintain mandated contacts with children in foster care. States had to make decisions about how to handle other contact types. This study reviewed documentation of state child welfare agency practices regarding face-to-face contact between case managers and child-welfare involved families between March 2020 and May 2020. Using a point-in-time search to obtain publicly accessible documents related to caseworker face-to-face contact and COVID-19, data was located for 49 states and the District of Columbia (n = 50). Documents were analyzed in NVIVO 12 using document analysis. Within the context of face-to-face interactions by child welfare case managers, documents were analyzed in six themes based on the types of services provided to children and families: (1) investigations, (2) family preservation, (3) family team meetings, (4) foster care, (5) adoption, and (6) general child welfare. State decisions about how to manage these contacts varied. In several states case managers were directed to document both virtual and in-person contacts during this time as face-to-face; which may impact future evaluations of child welfare systems during COVID-19. Findings highlight a range of strategies used by state child welfare systems. By reviewing previous practice and hearing what other states are doing, child welfare service agencies have the potential to evaluate appropriately, strengthen their plans and address disparate impacts.

Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis.

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.

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

BackgroundThe use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits.MethodsA cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration.ResultsHigh-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate.ConclusionsConcerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

Support for Non-Relative Female Foster Parents in South Africa: Quality of Care and Placement Outcomes

Caring for and protecting vulnerable children in foster care continues to be an important realisation of the rights of children in South Africa. The weakening of the extended family and the increasing number of orphaned and vulnerable children give rise to the relevance of non-relative fostering. This article discusses the different sources of support used by female non-relative foster parents when caring for the children. The findings come from a broader doctoral study that explored the experiences of non-relative foster parents. The data were collected using semi-structured interviews and a focus group discussion. The findings indicate that the participants received the same support as relative foster parents, including financial support from the government in foster care grants, support from faith-based organisations, and support from nuclear family members. Most participants were self-supported through personal incomes and savings, which differed from relative foster parents who relied solely on the foster care grant. The participants received limited or no support from social workers or agencies. This article concludes that the type of support available to non-relative foster parents is the same as that for relative foster parents, and it influences the quality of care and placement outcome. With adequate support, the burden of caring is lessened therefore improving the quality of care. Therefore, it is necessary to provide holistic support to non-relative foster parents to secure their willingness to continue caring, thus improving the quality, recruitment, and retention of foster parenting.

Barriers to nutrition and physical activity participation for Australian children in foster and kinship care

Foster and kinship carers face unique and complex challenges in caring for Australia’s most vulnerable children. It is therefore necessary to ensure that home-based carers are adequately upskilled and supported to promote the health of children in their care. The aim of this paper was to better understand the barriers to developing healthy lifestyle behaviours (relevant to nutrition and physical activity) among children in home-based care, from the perspective of foster and kinship carers. Focus group sessions were conducted with 21 carers: eight foster carers and 13 kinship carers. Four key themes were identified: (1) Childhood experience and children’s healthy lifestyle behaviours; (2) There are personal costs of being a carer; (3) Carers require support to develop healthy lifestyle behaviours in children; and (4) Broader systemic factors impact healthy lifestyle development. Carers in the current study described their experience of key emotional, financial, and systemic barriers to facilitating healthy lifestyle behaviours among the children in their care. To address such challenges, carers recommended the development of trauma-informed support, education, and resources to prioritise and facilitate healthy lifestyle development among children in home-based care.

Are children and adolescents in foster care at greater risk of mental health problems than their counterparts? A meta-analysis

This meta-analysis aims at comparing mental health problems of children in foster care to those living with their biological parents while taking in consideration different protective and risk factors. Across 41 studies with a total of 72 independent effect sizes, a significant but small effect size was found between foster care placement and psychopathology (d = 0.19). Children in foster care showed higher levels of psychopathology compared to those from community samples or matched/at-risk samples. They were as likely to show mental health problems as maltreated children living with their biological parents or children from clinical samples. Results showed that foster children’s mental health problems also varied as a function of type of placement and study methodological characteristics. Being placed in kinship care, longer stay in the same foster home and fewer placement disruptions, all acted as protective factors limiting mental health problems of children in foster care.

Iron Status, Development, and Behavior in Young Children in the Pennsylvania Foster Care System, an Exploratory Retrospective Medicaid Chart Review

ObjectivesTo 1) quantify the prevalence of iron deficiency (ID), iron deficiency anemia (IDA), and/or anemia in children in the Pennsylvania (PA) Foster Care System and 2) examine if a child’s iron status is associated with the frequency of certain developmental and behavioral diagnoses. MethodsRetrospective cohort Medicaid chart review of children, from 6 mos to 10 yrs of age, in the PA Foster Care System using the most recently available data (2010–2015), extracted from the Medicaid Analytic eXtract database. Data from ICD-9 and ICD-10 codes which capture iron status and anemia, along with 16 relevant behavioral and 10 relevant developmental diagnoses were extracted. ICD codes for ID, IDA, and anemia cannot be differentiated; therefore, we used ID/anemia as a group label. The prevalence of ID/anemia was calculated and the prevalence of developmental delays and behavioral impairments among those diagnosed with ID/anemia was compared to those who were not diagnosed with ID/anemia. Group differences were determined using Pearson’s chi-squared tests. ResultsFrom 2010–2015, there were 50,311 children, ages 6 mos to 10 yrs, in the PA Foster Care System. Of these, 1,365 (2.7%) were diagnosed with ID/anemia. Specific delays in development (a category with several sub-diagnoses) were reported in 48% of children with ID/anemia and 19% of children without diagnosed ID/anemia (χ2 = 679.42, p < 0.001). Moderate, severe, and profound intellectual disability (IQ < 49) were each reported in 0.5% of children with ID/anemia, and in children without diagnosed ID/anemia, in 0.16% (χ2 = 9.84, p = 0.002), 0.1% (χ2 = 19.79, p < 0.001), and 0.08% (χ2 = 26.44, p < 0.001), respectively. Adjustment disorder with depressive mood was reported in 1% of children with diagnosed ID/anemia and 0.6% of children without (χ2 = 4.10, p < 0.05). Irritability was different between groups (χ2 = 59.91, p < 0.001; 0.9% of children with ID/anemia and 0.1% of children without). ConclusionsIn 2010–2015, 2.7% of children in PA Foster Care (6 mos-10 yrs old) were diagnosed as ID, IDA, and/or anemic. Frequency of developmental and behavioral diagnoses were generally greater in children with ID, IDA, or anemia, emphasizing the need for follow up of these children. Funding SourcesThe John L. Beard Endowment and the CHHD Limited Endowment Funds, The Pennsylvania State University.

Trauma-informed, integrated primary care: A medical home model for children with prenatal drug exposure who enter foster care

The rise in prenatal or childhood substance exposure diagnoses resulting from parental substance use has led to an increase in the number of children placed in foster care. Meeting the multifaceted health care needs of children with prenatal drug exposure (PDE) who enter foster care requires significant time, resources, and coordination. In addition to conditions resulting from their experiences of trauma, children in foster care often have unmet health care needs and experience disproportionate rates of adverse physical, mental and developmental health outcomes. This article outlines the barriers to providing comprehensive and high-quality care to this pediatric population and describes a trauma-informed, integrated primary care medical home model as a promising strategy to address these barriers. It concludes with a description of the limitations of the model and considerations in the implementation of trauma-informed, integrated primary care as a healthcare delivery model for children with PDE who enter foster care.

Measuring care coordination by social workers in a foster care medical home

ABSTRACT A social worker coordinated medical care for children in foster care in a foster care medical home (FCMH) and tracked care coordination (CC) activities using a modified Care Coordination Measurement Tool© (mCCMT). Of the 60 subjects, most were younger than 5 years, and 60% had a behavioral and/or medical condition. Primary CC activities included behavioral support for families and health system navigation. The CC prevented 11 emergency department (ED) visits, 9 placement disruptions, and 42 patient privacy violations. Children assigned to a FCMH have diverse CC needs and benefit from social workers’ specialized skills.

Social workers’ constructions of parents to children in foster care

Parents of children in out-of-home care receive little support from social services. Drawing on qualitative data collected in the project ‘Parent at a distance’, in which social services in seven municipalities in Sweden aimed to improve support to parents whose children are placed in foster care, this paper explores social workers’ discourses about parents to children in care. The analysis is based on focus group data in which a total of 52 social workers reflected on parents to children in care and how they can be supported by social services. The concept of interpretive repertoires was used to analyse how social workers in interaction construct parents and their support needs. The identified repertoires of change, acceptance, permanency, biology and non-biology may contribute to the understanding of why so few parents receive support, even though legislation stipulates that placements should be temporary. The paper concluded that discourses may shape support practices and thus it is crucial that social workers reflect on and develop their awareness about their constructions of parents and their role for children in out-of-home care.

Identifying the Patterns of Family Contact for Children in Care

ABSTRACT Contact between children in care and family members is complex and often emotionally difficult for all concerned. In the context of a wider Australian cross-jurisdictional intervention trial, focusing on contact between children in long-term care and their parents, a snapshot survey of 901 children in Victorian foster care and kinship care placements was undertaken. The aim was to determine which children had seen parents, siblings or extended family members within a 12-month period, and how practitioners explained lack of contact between children and their parents. The study found that most children had had contact with parents or other family members, though children in long-term care were less likely to have seen their parents than those where reunification was still a possibility. Practitioners’ views on why parental contact had not occurred for 18% of the sample illustrate the complexity of the issues involved in contact. IMPLICATIONS To support children’s best interests, professionals should be clear about the purpose of family contact and provide support appropriate to that purpose. With children in long-term care less likely to see their parents, professionals have a role in helping these parents adjust to a new role. Developing strategies to maintain meaningful connections between children in long-term care and their parents may be more effective for children’s best interests than the current emphasis on actual visits.

ADHD Symptomatology, Executive Function and Cognitive Performance Differences between Family Foster Care and Control Group in ADHD-Diagnosed Children.

Children in foster care have a high prevalence of attention deficit and hyperactivity disorder (ADHD) diagnosis, together with other difficulties in inattentive/hyperactive behaviors, executive and cognitive processes. Early exposure to adversity is a risk factor for developing ADHD via neurodevelopmental pathways. The goal of this research is (a) to study the cognitive and executive performance and inattentive/hyperactive behavior of ADHD-diagnosed children living in foster families in Spain, and (b) to analyze the role of placement variables in their performance. The sample was composed of 102 ADHD-diagnosed children aged 6- to 12-years-old, divided into two groups: 59 children living with non-relative foster families and 43 children not involved with protection services. Children’s executive function–inhibition, working memory, flexibility, attention, intellectual capacity, verbal comprehension, perceptive reasoning, working memory and processing speed were assessed using objective testing measures. At the same time, parents and teachers reported on children’s inattentive, hyperactive and impulsive behaviors. Children in foster care obtained lower scores in the general ability index than the control group after controlling the age at assessment. However, no differences were found in executive processes. Regarding placement factors, children with shorter exposure to adversities in their birth families and more time in foster care showed better executive performance. Professionals should consider the placement history of children in foster care and its influence on their symptomatology and cognitive capacities.

Interventions and programs that support the health and development of infants with prenatal substance exposure in foster care: a scoping review.

The objective of this scoping review was to describe the characteristics of interventions and programs that support the health and development of infants in foster care who have prenatal substance exposure, their foster care providers, and birth families. Infants in foster care may have experienced prenatal substance exposure, neglect, and maltreatment, as well as disruptions in their relationships with primary caregivers. Despite multiple vulnerabilities, they also have great capacity for overcoming early adversities. Enhanced foster care has been identified as a key influence on the positive development of infants in the child welfare system. This scoping review considered publications that described interventions and programs designed to support foster care providers who care for infants less than 12 months of age with prenatal substance exposure. This review included research studies and gray literature. This scoping review focused on sources that described caregiving interventions and elements of programs that took place within the context of family or home-based foster care. A three-step search strategy was used to identify publications in the English language from January 2000 to December 2019. A literature search was conducted using MEDLINE, Academic Search Premier, PsycINFO, and CINAHL databases. Titles and abstracts were initially screened to assess if publications met the inclusion criteria, followed by full-text review. Publications that met the inclusion criteria were assessed by two independent reviewers using a data extraction tool developed for this review. Findings were thematically analyzed on the basis of similarity in focus and descriptively presented with tables and figures to support the findings. Eighty-one publications were included, including 48 research papers and 33 gray literature sources. Thematic analysis of the focus of each publication resulted in identification of four core themes: i) mental health promotion for infants in care; ii) child welfare program elements; iii) identification of infants and families at risk of requiring foster care; and iv) outcomes for infants in care and their families. The interventions and programs identified during this scoping review were primarily focused on supporting social-emotional development. With the significant focus on infant mental health, supporting birth parents to stay attached to their infants was a key focus of the majority of publications. The concept of being able to proactively identify risk factors that were associated with infants requiring foster care emerged in relation to how family preservation could be supported. Strategies identified as contributing to the development of successful interventions and programs included having foster care providers participate as collaborators in designing services, designing services that are adaptable to a range of contexts, involving community partners outside child welfare, and having developmentally appropriate programs. Infants represent a significant proportion of children in foster care. A developmental perspective is needed for child welfare service planning to address their unique needs. Intervention during the early years holds significant potential for promoting positive developmental pathways and family preservation.

The reflective fostering programme: evaluating the intervention co-delivered by social work professionals and foster carers

Purpose There is little evidence regarding how to best support the emotional well-being of children in foster care. This paper aims to present the evaluation of an adaptation of the reflective fostering programme, a group-based programme to support foster carers. This study aimed to explore whether a version of the programme, co-delivered by a social work professional and an experienced foster carer, was acceptable and relevant to foster carers and to gather data on programme effectiveness. Design/methodology/approach In total, 38 foster carers attended the programme and took part in this study. Data was collected regarding carer- and child-focused outcomes at pre-intervention, post-intervention and four-month follow-up. Focus interviews were also conducted to further assess acceptability and relevance for foster carers. Findings Analysis of quantitative outcome showed statistically significant improvements in all outcomes considered including foster carers stress and carer-defined problems, as well as carer-reported measures of child difficulties. Focus group interviews with foster carers suggested that the programme as co-delivered by a foster carer and a social worker was felt to be relevant and helpful to foster carers. Originality/value These results provide a unique contribution to limited understandings of what works for supporting foster carers and the children in their care. Promising evidence is provided for the acceptability and relevance of the revised version of this novel support programme and its effectiveness in terms of carer- and child-related outcome measures. This work paves the way for further necessary impact evaluation.

How Anxious are German Preschool Children?

The experience of fear is universal and is among the earliest of all forms of psychopathology, if excessively present. To prevent negative developmental outcomes due to early-onset excessive fears in children, it is important to systematically assess these experiences as early as possible. Using the preschool anxiety scale (PAS), we aimed to assess the frequency and structure of anxiety symptoms of 489 preschool-aged children raised in their biological family and 88 raised in foster care (as a high-risk sample) in Germany. While these young children displayed the same types of anxiety most commonly as young children in other countries, the overall occurrence seems to be reported less often by parents in Germany compared to parents from other countries. Anxiety symptoms clustered into five correlated factors (generalized anxiety, social anxiety, obsessive–compulsive disorder (OCD), physical injury fear and separation anxiety). Young children in foster care exhibited more OCD and significantly less social anxiety symptoms indicating early repetitive and social disturbances in children in foster care.

In the face of a pandemic: adapting a mentalization-focused treatment that promotes attachment with birth parents and young children in foster care

ABSTRACT The central focus of the Building Blocks Program is to increase the mentalizing capacity of high-risk birth mothers whose young children under the age of five have been placed in foster care. In Building Blocks, therapists are trained to provide dyadic psychotherapy with a birth mother and her child during court-mandated supervised visits, with the aim of reducing cycles of trauma, abuse and neglect, and facilitating a more secure attachment. The program is psychoanalytically informed, grounded in theories of attachment, mentalization and reflective functioning. On March 14, 2020, due to the rapidly spreading coronavirus, it became clear that the birth parents could no longer safely visit with their children in person. In addition, court hearings that might have allowed the retention of parental rights were postponed, leaving many parents devastated. In this paper, we first describe how we adapted the Building Blocks approach during the pandemic. Second, two case examples are presented that highlight the pre-pandemic work of Building Blocks, as well as the innovative and creative ways the treatment model was adapted when it became unsafe to conduct dyadic therapy at the clinic. Using virtual video platforms, the Building Blocks Program has applied the model of ‘Nested Mentalization,’ providing support and scaffolding for the therapists, parents and children.

622 Bedtime, Sleep Duration, and Sleep Quality as Predictors of Externalizing Symptoms in Children in Foster Care

Abstract Introduction A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care. Methods Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s overall sleep quality over the last two weeks”), and sleep onset (e.g. “On weekdays, how long does it usually take for your child to fall asleep?”). Child behavioral issues were assessed via the Eyberg Child Behavior Inventory (ECBI) Parent Rating Form. Results A linear regression model was utilized to assess if child weekday bedtime, weekday total sleep duration, and overall sleep quality were unique predictors of externalizing symptoms when controlling for age. Results suggest that weekday sleep duration and bedtime were not significant unique predictors of child behavioral issues, though were significantly and positively correlated at the bivariate level (p=.02, p=.04). Sleep onset and overall sleep quality, irrespective of child age, were found to be significant unique predictors of child behavioral issues and accounted for 1% and 11% of the total variance, respectively. Conclusion Results suggest that delayed sleep onset and poorer sleep quality were predictive of increased behavioral issues for children in foster care. Findings persisted when controlling for age, which suggests that children in foster care experiencing sleep disturbances may benefit from more behaviorally focused sleep interventions to improve externalizing behaviors and increase sleep health. Support (if any):