Children In Long-term Care Research Articles

Formal long-term care, individualisation and filial responsibility: a multi-level analysis of 21 European countries

PurposeDue to the rapid ageing of the continent's population, a significant surge in long-term care expenses for the elderly is expected across Europe in the coming years. Could a potential solution to this challenge involve the increased informal care provided by adult children? In this context, we examined a general view or moral duty of European citizens regarding whether adult children should assume responsibility for providing long-term care to the elderly.Design/methodology/approachOur multilevel analysis draws on individual-level data from the 2017 European Value Study and country-level data from various European sources encompassing participants from 21 member countries of the European Union.FindingsThe findings reveal that in nations where public long-term care services are sufficiently available and of superior quality, there is a negative sentiment towards the notion that adult children should bear the responsibility for elderly care. In total, 71% of the country-level variance in our dependent variable was explained by the availability and quality of formal long-term care in a country. Furthermore, various individual-level attributes contribute to shaping attitudes towards care-giving responsibility. We observed that women, middle-aged individuals, those without religious affiliations, those with modern gender role attitudes and non-immigrants tended to hold unfavourable attitudes towards the responsibility of adult children in long-term care provision.Originality/valueThere are relatively many studies on the general attitude of the population towards filial obligation. However, so far there have been very few studies available that examine the population's attitude towards the obligation of adult children to commit to their parents' long-term care. Our research explains the variation of the phenomenon in Europe with both country-level and individual-level factors.

Parents’ supervised contact visits with their children in care: Factors associated with cancellations

IntroductionContact is an important part of the out-of-home care system and for maintaining birth family relationships, but little research has sought the parents’ perspective. It is important to understand parents’ experiences of contact and the reasons why they may cancel contact visits, in order to both reduce cancellations and improve the contact experience and associated outcomes for all involved. MethodsAs part of the larger Australian kContact trial of a contact intervention, 90 parents having supervised contact with their children in long-term care were interviewed at baseline. The parents’ description of their contact visits is provided. Logistic regressions were used to estimate the odds of parent cancellation of contact visits for the predictor variables. ResultsParents in the study reported a number of health, financial, and support issues, and had large numbers of children. Most of their children were in long-term foster care with visits primarily supervised by agency staff. In the multivariate analyses two significant results were found: parents were less likely to cancel visits when carers supervised contact and more likely to cancel when they, the parent, were on psychiatric medication. There was also a small effect suggesting that hosting contact visits away from an agency space may reduce parent cancellations. DiscussionThe need to provide supports for parents, particularly those on medication for mental health problems, to attend visits is an important finding from this study. Normalising contact visits by holding them in locations other than agency spaces and providing support for carers to supervise is recommended.

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.

Description and evaluation of a trial program aimed at reunifying adolescents in statutory long-term out-of-home care with their birth families: The adolescent reunification program

• The ARP appears to be a rare reunification program with few parallels in the world. • The ARP is a strengths-focused program tailored to the specific needs of families. • The trial program evaluation showed promising results for successful reunification. • Adolescent reunification programs may reduce numbers of children in long-term care. A significant international child protection issue is the gradual increase in the number of children in statutory out-of-home care (OOHC). This has led to strong policy interest in family reunification or family restoration; however, dedicated reunification programs that aim to reunify children who have been in care longer-term appear to be rare. In this paper, we describe the development, piloting and evaluation of a dedicated, intensive program for adolescents in long-term OOHC and their families of origin – the Adolescent Reunification Program (ARP). The ARP evaluation involved a mixed methods approach through the compilation of both quantitative data (the number and characteristics of families referred, and their outcomes) and qualitative interviews with participating families and ARP workers. Of the 36 participating families, two-thirds (66%) achieved successful reunification, with young people remaining at home for at least six months. Thematic content analysis of interview data provided insight into the factors that facilitated, or acted as barriers to, reunification. Overall, the evaluation indicated that strengths-focused, adolescent reunification programs have considerable potential to reduce the number of young people who remain in long-term care. Inspection of both national and international evidence suggests that by providing a dedicated, intensive reunification service for adolescents on long-term orders, the ARP is a very rare program that has few parallels anywhere in the world.

You and me and all of us: The significance of belonging in a continual community of children in long-term care in Norway

This paper examines the significance of children’s social lives and communities with other children, particularly for one group of children growing up in a care arrangement combining residential and foster care in Norway. Eight children (aged 11–17) living in care arrangements and three former residents (aged 18–27) participated in individual, paired, or group interviews. In addition, participatory observation at a social gathering of former residents was conducted. Sociocultural perspectives informed the analysis. Three overall stories were categorized: “we do” stories; stories of available communities; and stories of me, you, and us: a storytelling community. These stories highlight particular interconnected aspects of the children’s social lives and communities within their care arrangements, across contexts, and through time. The findings emphasize the significance of consistently belonging to a community of children in care as a source of vital social participation, learning, and development and supportive and lasting relationships among children. The findings also stress the necessity of professional facilitation to enable relationships among children. These findings have implications for the conceptions of children’s needs and developmental well-being while growing up in care and, accordingly, implications for the management of long-term care in terms of providing adequate developmental support and care for children dependent on the state as their overarching carer.

Working towards better education for children in care: longitudinal analysis of the educational outcomes of a cohort of children in care in Australia

ABSTRACTInternationally, reviews of educational outcomes of children in care reveal consistent findings highlighting the need for considerable policy attention to be paid to their education to ensure they achieve optimal economic and psychosocial life outcomes. Important to enhancing the educational achievement of children in care are support, stability of environment, teaching resources and the recognition by all stakeholders – birth parents, foster carers, social workers and statutory authorities — that education is paramount to a child’s future well-being. This paper highlights the perspectives of carers, teachers and children on the fostering experience with particular focus on educational outcomes drawing on a prospective longitudinal study of children in long-term care. Using a multimethod, repeated measures multi-informant design, children were assessed by carers and teachers using the Achenbach Child Behaviour Checklist and its companion, the Teacher Report. The findings indicate demonstrated gains in terms of improved scores and adaptive functioning at subsequent assessments following two years of stable care. Discussion of the findings and implications for practice will focus on the need for a coordinated strategy to improve placement continuity and focused professional and organisational support with respect to the emotional and educational needs of children in care.

A Critical Overview of the Significance of Power and Power Relations in Practice with Children in Foster Care: Evidence from an Irish Study

ABSTRACT This paper is based on findings from an Irish study of permanence and stability outcomes for children in long-term care which involved biographical narrative interviews with 27 children, young people, parents and foster carers. The study concluded that power and power relations featured significantly in the narratives of our interviewees. To advance guidance for practice, this paper aims to build on the findings of the study reported with an emphasis on the theorisation of power and power relations to inform practice. To do this, we use illustrative quotes from children, young people and their families to demonstrate how power markedly affected their experiences. The findings are considered in the context of an adapted version of Bronfenbrenner’s ecological model with a focus on the interaction between the social work system and individual social workers (exo system) the young person and their wider family (micro-meso system) as perceived by the latter. The wider impact of policy (macro system) and transitions and experiences over time (chrono system) are considered in the context of this interaction. In the discussion, the need for more explicit studies of power and power relations within the context of an ecological model to capture the complexity of layers and interactions of each child’s social system is highlighted. The contribution and limitation of the research is discussed. We end with a commentary about the importance of promoting an increased voice for children and young people in the development and improvement of public child welfare services.

Creating a learning environment for the children in long-term care in hospitals of medical facilities

Actual problems of realization of constitutional right for general education during the prolonged treatment in medical institution are discussed in this article. General characteristics of organizing model of valuable elementary school in the Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology and in the Russian Children’s Research Hospital are presented. Presented model of school in medical institution is created and realized in innovation area “Projection and application of educational environment for children on prolonged treatment in medical institutions (project Teach & Know)” for organization of medical and psycho-social rehabilitation of children and adolescents with severe diseases.

KContact, an enhanced intervention for contact between children in out-of-home care and their parents: protocol for a cluster randomised controlled trial

BackgroundWhen children are unable to safely live at home with their parents, contact between these children and their parents is considered, in most cases, important for maintaining children’s sense of identity and relationships with their parents. However, the research evidence on contact is weak and provides little guidance on how to manage contact and when it is beneficial or potentially harmful. The evidence in relation to contact interventions with parents and their children who are to remain in long-term care is the most limited. A small number of studies have been identified where interventions which were therapeutic, child-focused and with clear goals, particularly aimed at preparing and supporting parents, showed some promising results. This trial aims to build on the existing evidence by trialling an enhanced model of contact in multiple sites in Australia.Methods/DesignThis study is a cluster randomised controlled trial of an enhanced contact intervention with children in long-term care who are having supervised contact with their parents. Intervention sites will implement the kContact intervention that increases the preparation and support provided to parents in relation to contact. Baseline and follow-up interviews are being conducted with parents, carers and agency workers at intervention and control sites. Follow-ups interviews will assess whether there has been an increase in children’s emotional safety and a reduction in distress in response to contact visits with their parents (the primary outcome variable as measured using the Strength and Difficulties Questionnaire), improved relationships between children and their parents, improved parental ability to support contact, and fewer contact visits cancelled.DiscussionBy increasing the evidence base in this area, the study aims to better guide the management and supervision of contact visits in the out-of-home care context and improve outcomes for the children and their families.Trial RegistrationTrial registered on 7 April 2015 with the Australian New Zealand Clinical Trials Registry ACTRN12615000313538

Achieving Exits to Permanency for Children in Long Term Care

Despite the federal emphasis on achieving timely permanency for children who enter foster care, some children continue to remain in foster care for extended periods, with approximately 20,000 children a year “aging out” of foster care into adulthood without having achieved permanency in a family setting (Dworsky, 2008). This literature review focuses on the federal Child and Family Services Review measure that measures agency performance related to achieving permanency for children in foster care for long periods of time. The review summarizes the factors associated with timely discharges from care; while each child and family involved with the child welfare system brings a set of unique challenges and characteristics, research points to common individual and system factors that may be associated with long stays in foster care. Broad strategies that may be linked to achieving permanency are described, followed by explicit models developed to increase the likelihood of timely permanency.

Retrospective and concurrent predictors of the mental health of children in care

The paper reports retrospective and concurrent predictors of baseline mental health estimates for 347 children recruited to an epidemiological study of children in foster and kinship care in New South Wales, Australia. The study design addresses limitations of previous risk-related research with this population. While a large number of potential risk and protective factors were associated with children's mental health, most were confounded. Predictors identified in two-stage hierarchical regression models accounted for 0.31 of the variance of continuous mental health scores. The key predictors were: “age at entry into care”; developmental difficulties (intellectual disability and reading problems); three specific types of maltreatment; recent adverse events; and factors referring to placement insecurity or lack of permanence. Mechanisms accounting for these findings are proposed, with particular reference to cumulative exposure to adversity, attachment theory and foster care practices. Implications for social care policy include the need to identify children who are in need of care at younger ages, and the harmful effects of perceived impermanence for children in long-term care.

The Assessment Checklist for Children — ACC: A behavioral rating scale for children in foster, kinship and residential care

Population and clinical surveys of the mental health of children in foster, kinship and residential care have failed to account for a range of problems manifested by such children, largely because measurement has been restricted to standard parent-report checklists. These under-researched problems include attachment-related difficulties, anxiety and dissociative responses to trauma, age-inappropriate sexual behavior and self-harm. The Assessment Checklist for Children (ACC) was developed to measure such problems in a prospective epidemiological study of children in long-term care. The ACC is a 120-item carer-report psychiatric rating instrument, measuring behaviors, emotional states, traits, and manners of relating to others, as manifested by children in care. Content was developed systematically, with a view to measuring all clinically significant problems experienced by children in alternate care that are not adequately measured by standard parent-report checklists. Ten clinical and two low self-esteem scales were empirically derived via factor analysis, and labeled: Sexual behavior; pseudomature interpersonal behavior; non-reciprocal interpersonal behavior; indiscriminate interpersonal behavior; insecure interpersonal behavior; anxious–distrustful; abnormal pain response; food maintenance; self-injury; suicide discourse; negative self-image; and low confidence. Initial data indicate that the instrument has good content, construct and criterion-related validity.

The separation experience of children in long-term care: theory, research, and implications for practice.

Research and theory on how abused and neglected children in long-term care experience separation from their families and develop new attachments are reviewed. The thesis that children must mourn former caretakers in order to form new attachments is critically examined, and its validity for children in care is discussed. Implications of a modified model for child-welfare research and practice are discussed.

What might have been-what could be: Working with the grief of children in long-term care

Abstract “What might have been. what could be'. The stuff dreams are made of. However, the longing, searching, and yearning implied are, each in their own way, activities of anguish which shift the golden romantic dream to torment. Being near a child who is pining in this way is uncomfortable and causes us distress - and all the individual ways of dealing with that distress. We've all been children. We all know what it is to loose something, or to be separated from someone important to us. We know how it can consume us and feel as if it's the end of the world. “A child does not know death - only absence; and in absence, the parent may as well be dead, so overwhelming is the child's sense.of loss (Robertson, 1952);'

Follow-up survey of cases of child abuse seen at Newcastle General Hospital 1974–1975

Fifty-nine in-patient cases of child abuse were followed up at an interval of 2–4 years. Fifty-six of these were cases of non-accidental injury (NAI), and 3 were of neglect. Of the 59, 41 (69%) had initially been managed under legal sanctions, and 18 (31%) without. Of these 18, 7 (39%) subsequently suffered repeat child abuse. In addition, 3 children suffered repeat NAI while rehabilitation with natural parents was being attempted under legal sanctions. At follow-up there were 44 (75% children under legal sanctions. Of these, 12 (27%) had been rehabilitated with their natural parents. The remaining 32 (73%) were effectively in long-term care with no active plans for rehabilitation. In the 3–14 year group, NAI was often found to be a marker of severe family pathology; 15 out of the 20 (75%) of these children came into long-term care. There was a marked failure to provide family placements for 32 children in long-term care, only 14 (44%) of them having reached a family placement at the time of followup. Reasons for this failure are discussed, as is the probability that neglect/emotional deprivation is being under-diagnosed.