Children In Foster Care Research Articles

Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Are children in foster care in better psychological health than children in institutions? What factors influence the outcome?

AbstractThe aim of this study was to compare the psychological health of children in foster care with that of children in institutional care. Social workers were asked to assess the psychological health of the children as well as several other criteria on the basis of an analysis grid. Our sample consisted of 568 children placed in foster care and 661 children placed in institutions. Our results show that children in care who lived longer with their birth parents have a lower psychological health. Furthermore, the psychological health of children in residential care is lower than children placed in foster families. As children in institution are placed later than children in foster families, this may partially explain the lower psychological health of children in residential care. As a result, children in residential care have experienced more abuse and neglect and witnessed more domestic violence than children in foster care. In addition, children in residential care have more poor‐quality contacts with their birth parents than children in foster family. These contacts negatively influence their psychological health. Finally, the factor that most influences the psychological health of children in care is the quality of the relationship with the people who care for them on a daily basis. Again, children placed in foster families have better‐quality relationships with their foster families than children placed in institutions.

An updated examination of the predictors of running away from foster care in the United States and trends over ten years (2010–2019)

BackgroundAmong the more than 400,000 children in foster care, there is a small group who will run away from care and face increased risks of negative outcomes. Previous studies on the predictors of running away from care use limited samples or outdated data. ObjectiveThe present study replicates and extends prior research by presenting an updated analysis of predictors of running away from foster care as well as 10-year trends in the prevalence and predictors of running from care. Participants and settingThis study uses the Adoption and Foster Care Analysis and Reporting System (AFCARS) data to assess the runaway status of 597,911 children who were involved in foster care in 2019. Longitudinal trend analyses utilize AFCARS data from 2010 to 2019. MethodUsing chi-square/t-tests and binary logistic regression analyses, this study investigates individual- and case-level predictors of running away from foster care programs. ResultsFindings show that girls (OR = 1.29, p < .001), African American children (OR = 1.89, p < .001), and older children (OR = 1.61, p < .001) are at increased risk of running away from foster care. Removal reasons such as child substance abuse (OR = 1.65, p < .001), abandonment (OR = 1.38, p < .001), and child behavioral problems (OR = 1.31, p < .001) are also associated with an increased risk. Analysis of 10-year trends shows a steady decline in running from care: 1.40% in 2010 to 0.98% in 2019. The profile of risk factors is stable overall, with a few notable exceptions. ConclusionsThe percent of children running from foster care is at a 10-year low. Prevention and intervention efforts regarding running from care must focus on the needs of African American and Hispanic children, especially girls, as well as children with substance use or behavior problems. Given that programs rarely have prospective information regarding why children leave care and the negative consequences of labeling children as “runaways,” shifting language to “missing from care” should be considered.

Family Policing as Counterinsurgency and the Gathering Abolitionist Force

Family Policing as Counterinsurgency and the Gathering Abolitionist Force Dorothy Roberts (bio) I spent the first year of the pandemic writing a book about abolishing the so-called child welfare system—what I call the family policing system. When I heard Dylan Rodríguez’s remarkable presidential address, I was already proofing the galleys of Torn Apart: How the Child Welfare System Destroys Black Families—and How Abolition Can Build a Safer World.1 Every word Rodríguez spoke resonated with my thinking and activism around the need to dismantle the child welfare system and replace it with a radically reimagined way of caring for families and keeping children safe. The invitation to write a response to his address gave me the opportunity to frame my arguments in terms of his valuable conceptualization of counterinsurgency and the gathering abolitionist force. Conceptualizing family policing—US government surveillance and destruction of politically marginalized families—as state counterinsurgency usefully illustrates and illuminates his key points. A central theme of Rodríguez’s address is that “counterinsurgency not only is directed by the state’s repressive military, policing, and political might but—especially in moments like this—is commonly performed through narratives, aesthetics, rhetorics, and institutional solicitations of a scrambling reformism.” This seemingly contradictory stance of simultaneous repression and reform is essential to US family policing, characterized by inflicting violence on politically marginalized families under the pretense of protecting children from parental maltreatment. The US child welfare system has historically terrorized Black and Indigenous people in the United States by forcibly removing large numbers of children from their homes and placing them in state custody. It regulates even greater numbers of families by subjecting them to intense supervision under the threat of child removal. The legitimacy of family policing depends on maintaining the mirage that its brutal intrusion in families is a benevolent service for needy children. The origins of the US child welfare system lie in the oppression of Black, Indigenous, and impoverished white families by powerful white elites.2 The ideology of violent supervision of Black families by white people can be traced [End Page 221] back to the separation of enslaved family members at the whim of slaveholders, who had absolute legal authority over them. The mass removal of Native children from their tribes and their consignment to boarding schools was literally a weapon of war developed by the US military in the nineteenth century to overpower tribal resistance to its settler colonial project. The establishment and expansion of the formal foster care system were counterinsurgency initiatives against Black liberation struggles. After the Civil War ended, white judges ordered thousands of Black children to be apprenticed to their former enslavers in conjunction with other white supremacist mechanisms, such as convict leasing, designed to return newly emancipated Black people to a subservient status. In the 1950s and 1960s, southern states began dropping Black families from the welfare rolls and placing their children in foster care as part of a white supremacist backlash against gains won by civil rights activists and Black freedom fighters. The terror of family policing continues today. According to a 2014 study, 15.44 percent of Native children and 11.53 percent of Black children were placed in foster care before their eighteenth birthday.3 The rate for white children (4.86 percent) was much lower, reflecting America’s racial hierarchy, but still remarkably high. Almost all the children the state takes by force come from impoverished or working-class families. State child welfare systems engage in tactics akin to what Rodríguez refers to as “the military protocols for neutralizing resistance to US occupation,” which include “‘integrating civilian and military activities.’” Family policing operations—warrantless home investigations, intensive monitoring of families by state agents and civilians deputized to report on parents (“mandatory reporters”), forcible seizure of children followed by placing them in foster care, and permanent severing of family ties for failing to comply with agency dictates—reflect a carceral logic with parallels in the criminal punishment system. State child protection authorities increasingly use modern surveillance technologies and coordinate with law enforcement agencies to manage regulated populations more efficiently. Family policing is part of the prison industrial complex...

0078 Assessing Sleep Health in Children Recently Adopted from Foster Care

Abstract Introduction An estimated 450,000 children were in the U.S. foster care system in 2019. Early adversity including maltreatment and/or neglect renders this vulnerable population at high risk for negative outcomes, both physical and psychological. Burgeoning evidence suggests that children in foster care develop high rates of sleep disruption. Sleep disruption is associated with negative life outcomes including heart disease, diabetes, and psychiatric disorders. However, there is still a lack of knowledge examining sleep health in children adopted from foster care. Methods Sleep quality and problems were examined among a sample of children adopted from foster care (n = 234) within the past two years, ages 4 to 11 years (M = 5.94, SD = 1.97). Caregivers across the US were invited to complete an anonymous Qualtrics survey via private Facebook groups for foster families. The Child Sleep Habits Questionnaire (CSHQ) was completed by foster parents to assess child sleep problems (e.g., nightmares, bedwetting, snoring, etc.) and overall sleep quality. Caregivers endorsed sleep problems and frequency using responses “Never,” “Sometimes,” and “Usually; sleep quality was rated using a Likert scale from 1 = Very Poor to 10 = Excellent. Results Paired-samples t-test compared first month (i.e., when first arrived in the home) and current child sleep quality based on caregiver-report. Sleep quality showed significant improvement since arrival in the foster home; t(233) = 12.98, p &amp;lt; .001, d = 0.85. However, on the CSHQ, 99% of the sample scored above the clinical cutoff for this measure indicating elevated sleep problems. Conclusion Children adopted from foster care show some improvement in sleep quality after achieving permanency. However, these data suggest this population continues to experience clinical levels of sleep problems even after being adopted. Our results suggest a need for specialized intervention services targeting sleep health among children recently adopted from foster care. Support (If Any) None

Concurrent Planning: Understanding the Placement Experiences of Resource Families

Concurrent planning is a process by which all options for permanency are considered simultaneously for children in foster care. Children are placed with caregivers (resource parents) who are open to adoption if reunification with birth parents does not occur. This quantitative study explored resource parents’ perceptions of the concurrent planning process via surveys at two time points. Participants included resource parents of 77 infants assessed at 2 months and 1 year after placement. At Time 1, resource parents who had more birth parent visits, more concerns about legal issues, and more concerns about their interactions with the child welfare system had more negative perceptions of the placement. Although concerns decreased over time, specific concurrent planning concerns (i.e., legal issues, child welfare agency issues, birth parent visits) at Time 2 were associated with greater concerns among resource parents about the placement in general as well as about child development and behavior, perceived attachment, and their own parenting. Additionally, those with infants placed older held more concerns about their attachment to the child, the child’s attachment to them, and the child’s behavior. While concurrent planning is positive for infants in foster care, the process creates stressors for resource parents.

How Are the Sleep Problems of Children in the US Foster Care System Addressed?

Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps. Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well. Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night. Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.

Internal representations of attachment in Story Stems: changes in the narratives of foster care children

Children in care, whose early experiences have often involved significant discontinuity and adversity, are at risk of developing insecure attachments with negative internal representations. This study aimed to explore changes in their internal representations over a one-year period, as well as potential factors that could influence them. The Story Stem Assessment Profile (SSAP) was administered at two time points twelve months apart, to 19 children between five and ten years old (M= 7.55, SD= 1.84). Using the SSAP over two time points showed that security representations significantly increased, defensive-avoidance ones decreased, whilst children with fewer previous placements had lower increases in security. The SSAP demonstrates how secure representations can be developed in new situations with more reliable caregivers, but insecure and disorganised ones might be harder and slower to modify, pointing ultimately to the importance of placement stability.

Who are our caregivers? An assessment of the characteristics of foster parents at certain foster parenting milestones across two states

ABSTRACT The number of children in foster care in the United States has risen while new federal regulations in the USA require states to decrease dependence on congregate placements. As family-based settings are the preferred placement option, there is a pressing need to prioritize effective strategies to recruit and retain foster parents. The purpose of this study is to describe the demographic characteristics and life experiences of families who decided to become foster parents at various key points in time in two states: Missouri and Mississippi. A cross-sectional analysis was conducted at key milestones, which include pre-licensure training, completion of training and licensure, shortly after their initial placement, three months after initial placement, and after initial placement disruption occurred. A total of 656 prospective and current foster parents participated in the study. Survey results provide insight into the demographic characteristics of families who are attracted to fostering, those that are successful in obtaining licensure and accepted child placements, providing permanency to the children they care for, and those that decide to dissolve a foster care placement prematurely. Present in the discussion are concerns of those who have been left out of the recruitment process. Implications for policy and practice are also discussed.

Wykorzystanie podejścia skoncentrowanego na rozwiązaniach w pracy z wychowankami rodzinnej i instytucjonalnej pieczy zastępczej

Introduction: The aim of this part of paper is presenting the current official data on foster care. Research Aim : Presenting the possibilities of using the solution-focused approach in the work of a specialist with children in family and institutional foster care. Evidence-based Facts : Characteristics of foster care charges. Presenting the theoretical foundations of the trend, the therapeutic interactions and techniques used in the solution-focused approach will be discussed from the practical perspective of a psychologist and pedagogue. Summary : The author will present her own reflections from work in foster care, indicating the difficulties and chances of applying the discussed approach in working with children and young people outside their biological family.

The placement of children into foster care in Poland by foreign authorities

ABSTRACT Cross-border placement of children is addressed by the 1996 Hague Child Protection Convention, which is binding on the United Kingdom, and in EU law. The detailed procedures are governed by the domestic law of each country involved. However, it was not until 2018 that proceedings for placement of children in foster care by foreign authorities were introduced to Polish law. The fact that cross-border placements have become increasingly common has contributed significantly to the enactment of the new law. The available official data indicate that the British and German authorities are the most inclined to place children with Polish citizenship in foster care in their homeland. Although the regulations introduced in 2018 concern the basic rights of children, they have not yet been presented in detail to the involved parties abroad, including British local and central authorities, judges and social workers. Their familiarity with the relevant provisions of Polish law can undoubtedly contribute to speeding up the proceedings and ensuring that their outcome is harmonious with the best interests of the child.

Children of Mothers in Jail: Where Do They Go? How Do Mothers Perceive Their Placements?

The perceptions of 145 incarcerated mothers of minor children in a large Midwestern jail were examined to understand the correlation between where their children are living during their incarceration and the mothers’ feelings about these placements and relationships with their children. Mothers were most satisfied if children lived with maternal grandparents, and least satisfied if children were in foster care. Women with higher scores for the relationship with close relatives, those having contact with their child(ren) while incarcerated, and mothers with no children in foster care reported feeling better about these placements. The findings highlight the importance of women maintaining contact with their children and their children’s caretakers while incarcerated.

Social workers’ accounts of custody and custody transfers in cases of homicidal violence

ABSTRACT This article analyses Swedish social workers’ accounts of custody when a parent is in remand prison or prison due to homicidal violence that has resulted in the death of the other parent. How do social workers justify or excuse assessments of custody and custody transfers? What legal dilemmas can be discerned? The empirical material comprises six group interviews with 14 Swedish social workers based on two fictional vignettes. The interviews have been analysed using accounts theory and in relation to how social workers reason about their discretion. The social workers used four main accounts related to assessments of custody: Time and stability in foster care, Legal context, Deficient parenting and Kinship relations. The results show that although social workers believe that deadly violence is a serious risk factor and consider transferrals of custody to foster parents to be an important tool for safeguarding children in long-term foster care, custody decisions are also assessed in relation to possible rejections in courts, the legal basis for placement (compulsory care or voluntary placement) and the children’s age. The length of imprisonment of the parent appears to be an important factor for suggesting a custody transfer in cases of homicidal violence. The results are discussed in relation to the legal context and the protection of children.

A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.

Too high or too low? the role of educational expectations for children in out-of-home care

Low educational expectations for children placed in out-of-home care (OHC) are often proposed as a contributing factor to poor educational outcomes of children in OHC. However, very little empirical evidence exists on the association between educational expectations and educational outcomes of children in OHC, and the theoretical underpinnings of what drives a potential association are limited in the OHC literature. The purpose of this study is to contribute with theoretical and empirical knowledge about the relationship between educational expectations, individual characteristics and educational performance of children in OHC. We propose a theoretical model of the relationship between expectations and achievement and empirically test fundamental parts of the model using path analysis on survey, academic and psychometric data on 132–139 Danish children in foster care. Our findings show that educational expectations of teachers and foster mothers do matter for the children’s academic performance in math, while only the foster mothers’ educational expectations matter for reading performance. Educational expectations impact educational performance both directly and indirectly through the mediation of child characteristics. Importantly, our findings also show that the formation of the expectations of teachers and foster mothers draw on child age and observations of the children’s abilities and functioning including their level of IQ and psychosocial adjustment. Hence, we argue, that raising educational expectations alone is an insufficient measure to increase the educational performance of children in OHC. Instead, we must work to find suitable interventions to overcome the excessive prevalence of developmental and learning difficulties among children in OHC.

Considerations for Occupational Therapists in Developing Community-Level Interventions for Youth with High Adverse Childhood Experiences (ACEs)

Drug misuse likely contributes to the over 30,000 children in foster care and to the 24.2% of children who have experienced two or more adverse childhood experiences (ACEs). Twenty-five percent of children are living in poverty, with nearly half of those living in single-parent households. Among the national guidelines to preventing ACEs are connecting youth with positive activities and providing family relationship enhancement opportunities. We believe the profession of occupational therapy can help contribute to the mental and behavioral health care workforce in a greater capacity than is currently used. Many children are not afforded the opportunity to engage in novel leisure pursuits that are essential for positive mental health function and well-being. Occupational therapists can assist in creating a culture of health and equity for youth by harnessing the power of play and leisure to promote self-healing communities.

Interventions for Children and Adolescents Living in Foster or Institutional Care - A Systematic Review

Children or adolescents living in foster or institutional care received so far insufficient consideration in therapy intervention research. At the same time, they are a high-risk group for developing mental illness. The aim of this systematic review is to record evidence-based psychotherapeutic interventions of the past 15 years on a national and international level that address children and young people living in foster care and youth welfare institutions and their mental health. Through a systematic literature research, interventions for the target group described were identified and analyzed about their specificity and evidence. From 170 publications, ten interventions with sufficient evidence could be included in the present analysis. The result of the current literature research shows that further specialized psychiatric-psychotherapeutic interventions for children in foster care and youth welfare institutions are necessary. Regarding the transferability to the German youth welfare and health system, cross-system and interdisciplinary cooperation is needed. Hereafter further research is required to establish specific and evidence-based intervention approaches.

Timeliness and extent of health service use by Victorian (Australian) children within first year after entry to out-of-home care: Retrospective data linkage cohort study

BackgroundChildren in out-of-home care (OOHC) have high rates of health needs; consequently, many countries (including Australia) have policies and/or statutory requirements for health assessment upon OOHC entry. However, Australia has no data on health service utilisation or timeliness. We aimed to describe timing and extent of health service utilisation by children in the state of Victoria upon entry to OOHC, exploring demographic and specific service exposure variations. MethodsPopulation-based retrospective cohort study. Data from Victoria’s Child Protection dataset (2010–2015) were linked to federal (Medicare Billing Schedule (MBS)) and state (Community Health, Mental Health, Community Dental and outpatient clinic) health datasets. PopulationVictorian first-time entrants to OOHC (April 2010 – December 2015): 6,201 0 – 12 year old children. OutcomeProportion visiting health services within 12 months of entering care; proportion visiting within recommended timeframes. AnalysisDescriptive statistics, multivariable logistic regression, and Kaplan-Meier survival curves. Pre-post health service use following the limited introduction of health assessment clinics was compared with trends elsewhere in Victoria. Principal findings5,676 (92%) children were successfully linked to the MBS dataset. 41 children (<1%) had attended all recommended health services within 12 months of OOHC entry. While most (90%) within the linked cohort visited a General Practitioner, only 37% attended within the recommended 30 days. Around a third visited a paediatrician; fewer than 20% visited a community dentist, optometrist, or audiologist. Children in foster care had higher odds of attending services than those in kinship care. The pre-post trends in health service use in areas where a dedicated assessment clinic commenced were more positive than for areas without the clinic. ConclusionA minority of Victorian children in OOHC accessed health services according to national or state (Victorian) standards, very few in a timely manner. Children in kinship care were less likely to meet guidelines.

Ecological disruptions and well-being among children in foster care.

Bronfenbrenner's framework highlights the importance of considering ecological systems to understand child well-being. Children entering foster care often experience disruption across systems. Yet, prior research has focused on specific disruptions linked to outcomes. This longitudinal study examined the impact of multiple ecological disruptions (i.e., changes in or separation from siblings, friends, school, church, community) on children's internalizing symptoms and externalizing behaviors over time. This study included 211 children between the ages of 6 and 13 years (M = 10.23, SD = 2.37; 55.0% female; 57.3% African American). Children entered foster care for up to four reasons: Neglect (73.9%), physical abuse (29.4%), dependency (10%), and/or sexual abuse (9.5%). Most of the children experienced a change in school (64.0%), 46.9% were separated from siblings, 25.1% lost friends, 12.8% experienced community disruptions, and 10.0% were separated from church. Hierarchical Linear Modeling was employed to examine the association between ecological disruptions and longitudinal internalizing symptoms and externalizing behaviors, while controlling for baseline internalizing and externalizing, demographic variables (i.e., child age, gender, and race), and maltreatment severity. Maltreatment severity, along with school and community disruptions related to the presence of internalizing symptoms. Loss of friends was associated with the absence of externalizing behaviors, while community disruption was associated with the presence of externalizing behaviors. This study suggests that maintaining children's connections to their school and community is important for well-being. Under certain circumstances, separation from friends may relate to improved behavioral functioning. Future research should explore additional and interacting facets of children's ecological systems and related outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Primacy of Parents in Child-Rearing for a Child in Foster Care

This study investigates the legal status of parents of children placed in foster care, in view of the constitutional principle of the primacy of parents in child-rearing. It analyzes the legal status of parents in all possible cases when a child has been placed in foster care or in a childcare facility, especially the case based on a ruling that restricts parental authority, which is the most common circumstance and the most ambiguous in terms of the research problem explored here. Moreover, this study examines the thesis that both parents and foster carers jointly affect the child, making it difficult to defend the position that parents should enjoy the primacy. Nevertheless, the purpose of the provisions of the Family and Guardianship Code and the Act on Family Support and Foster Care System is clearly to restore the primacy of parents.