Children In Out Of Home Care Research Articles

Exploring moral injury among parents with children in out‐of‐home care

AbstractThis article brings together the experiences of parents whose children are placed in out‐of‐home care (OHC) with the theoretical concept of moral injury. The findings are based on empirical data from a research and development project conducted in seven Swedish municipalities with the aim of developing support for such parents. This article draws on a data set of qualitative interviews with 40 parents, 30 mothers and 10 fathers, with children in OHC. The interview transcripts were analysed thematically, with an abductive approach to theories and the empirical data. The findings illustrate how parents of children in OHC experience moral injury in relation to seven aspects: professionals' morally problematic and distressing behaviour, problematic services, an adversarial system, systemic bias, parent's actions, children's withdrawal and feeling excluded. The injuries are related to events in several periods—prior to the child's removal, during the execution of removal and during OHC—and tend to last for many years. These findings stress that the social services must be aware of the injuries parents experience and must minimize the possible harm and moral injury. We also suggest that parents of children in OHC should have an appointed social worker as a means of support.

Changes in parents' mental health related to child out-of-home care placements: A Swedish national register study

BackgroundLiterature on outcomes of children in out-of-home care (OHC) is extensive. However, less is known regarding associations of such placements with parental mental health disorders (MHD). ObjectiveThis study investigated changes in hospitalization rates due to MHD among parents, four years before and after placement of their child in OHC. Participants and settingWe used data on 4067 members (Generation 1) of the RELINK53 cohort (individuals born and living in Sweden in 1953) and their 5373 children (Generation 2) in OHC. MethodsUsing random effects regression models, associations between OHC and MHD were examined separately for fathers and mothers. Nested models were tested exploring associations with parent and child/placement-related factors. Marginal effects were computed to assess mean rates of hospitalization annually. ResultsOverall, mothers had higher mean hospitalization rates than fathers. Compared to the year of placement, hospitalization rates were significantly lower in the four years before placement for mothers (9.9 %, 9.5 %, 10.5 %, 12.1 %, respectively) and fathers (5.9 %, 7.6 %, 8 %, 9.8 %, respectively). Mothers showed highest hospitalization rates at the year of placement (26.6 %), while fathers, one year after placement (13.4 %). Hospitalization rates declined significantly directly after placement among mothers, but an unclear and non-significant pattern of results was found among fathers. ConclusionsMost parents have higher hospitalization rates at and directly after placement. Potential hypotheses underlying these findings are discussed, including psychosocial gender differences and opportunities to seek care as means of reunification. There is an urgency to develop strategies to better support these parents throughout the process.

Providing patient-centred care as Medical Radiation Practitioners to children and young persons in out of home care.

Modern healthcare focuses on patient-centred care where patients' needs, beliefs, choices and preferences are valued and lead to better health outcomes. Children and young persons in out of home care (OOHC) require more health care services compared with children from similar social and economic backgrounds. Each state and territory government are responsible for statutory child protection in Australia. If a child is unsafe in their current environment, they may be removed and placed into OOHC where they have ongoing case management with either a government or non-government agency. Complex trauma is the prolonged and uncontrolled exposure to traumatic events, like those experienced by maltreated children. Complex trauma can create a toxic stress response that produces biological alteration to the developing brain and affects the lives of the child, other family members and their descendants. Children with complex trauma often do not have the ability to regulate their responses to stimuli, reacting to minor triggers with disproportionate reactions. Many of these children will present with challenging behaviours. Trauma-informed care is a method of service delivery that seeks to actively minimise re-traumatisation. Creating a safe space is an essential element of trauma-informed care. Children with a history of complex trauma have life experiences that may be re-lived in a healthcare setting. There are ethical and legal considerations like privacy, consent and mandatory reporting when dealing with children in OOHC. By practising trauma-informed care Medical Radiation Practitioners can minimise further trauma to one of the most vulnerable population groups in Australia.

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.

The association between treated psychiatric and neurodevelopmental disorders and out-of-home care among Finnish children born in 1997

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6–3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9–7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5–61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.

Experienced support from family, school and friends among students in out‐of‐home care in a school‐based community survey

AbstractYouth in out‐of‐home care have elevated risks for adverse events and detrimental circumstances possibly affecting their development. Responses from 311 students in out‐of‐home care (OHC) were compared with peers living in birth parent care (BPC) and in single birth parent care (sBPC) in a regional school survey, directed to students in compulsory school eighth year and upper secondary school second year. Results indicate OHC students to experience less satisfaction with friends, leisure time, and families. They state less trust in support from friends and families but a more similar level to teachers, counsellors or nurses. OHC students also express being more exposed to abusive experiences online and perceive less sense of security at home and in school. We conclude that welfare institutions need to recognize the components in building trust and safety for students in OHC and that school and other professional institutions have an important role in serve resilience and promote well‐being for children in OHC.

School Mobility and Achievement for Children Placed and Not Placed in Out-of-home Care

ABSTRACTThe aim was to investigate the effects of school mobility on achievement in compulsory school in Sweden for children in out-of-home care (OHC) and not in OHC (NOHC). Register data on background variables from four birth cohorts in the cohort-sequential longitudinal project ETF was relied upon, along with student performance on a test of cognitive ability, and school grades according to the leaving certificate. Yearly data concerning school mobility also was available. Results showed that relocation was associated with lower grades for both the OHC and the NOHC groups. The mean effect of one school relocation was 5 percentiles lower grades, but the effect of relocation was twice as large at the end of compulsory school. Given a higher frequency of relocation for children in OHC, they were more negatively affected. School mobility thus is one of several factors which contribute to the poor school achievement of children in OHC.

Dental healthcare utilisation among young adults who were in societal out‐of‐home care as children: A Swedish National Cohort Study

We used Swedish national registers to analyse dental health care among young adults with childhood experience of out‐of‐home care (OHC), in Cox regression analyses. All 1.7 million Swedish residents born in 1980–1994 were included, of whom 4% had been in OHC. The population was followed up in the Dental Health Register from age 20 to 29, during the period 2009–2014. We found that persons with short or long OHC experience made emergency dental care visits more often than their majority‐population peers: 17–23% versus 9–10%, (adjusted Hazard ratios [HR:s] 1.60–2.02); they more often had tooth extractions, 9–12% versus 3% (HR:s 2.33–3.03); but less regularly visited a dentist for planned check‐ups, 61–77% versus 80–87% (HR:s 0.76–0.78). Since dental health in young adulthood reflects dental health and dental care in childhood, the findings of this study call for improved preventive dental health care for children in OHC.

Considering the impact of maltreatment on children in Out of Home Care when providing speech language pathology intervention: case examples

ABSTRACTPurpose: As the number of children entering into Out Of Home Care (OOHC) increase, an increasing body of evidence is emerging, exploring the impact of maltreatment on a range of child development domains, for example, communication, behaviour, and cognition. Current research identifies the negative impacts of maltreatment on communication development, however to date, there is limited research relating to speech-language pathology (SLP) services with children in OOHC, including implementation and recommendation of modifications in SLP intervention.Method: A retrospective clinical audit of eight clients in OOHC who had accessed SLP services was conducted. The medical files were reviewed and general demographic data and clinical information was gathered. The files were reviewed for specific strategies that had been used or modified based on considerations of the child’s situation. These strategies were analysed across the cases by the authors in regards to patterns that emerged for successful implementation.Results: These children were more likely to present with a language delay, with improvements evident once the child had been in a stable language environment for 6 months. Careful selection of assessment tools and therapy resources by the speech-language pathologist along with the benefits of working with Foster Carers is discussed.Discussion: This paper builds upon previously identified challenges and strategies for working with children in OOHC and provides case examples of the journey through a SLP service. It provides preliminary discussions relating to the implementation of trauma-informed practice into the SLP therapeutic context, whilst also offering the learning and experiences of a specific SLP service as knowledge transfer. Finally, it also aims to promote further discussion and potential research into effective trauma-informed speech pathology practice for this vulnerable group of children.

Exposure to out-of-home care in childhood and adult all-cause mortality: a cohort study.

Background: Children placed in out-of-home care (OHC) have exceedingly high rates of health problems. Their poor health tends to persist across adolescence and into young adulthood, resulting in increased risks of mortality. Yet, very little is known about this group’s mortality risks later in life. The aim of this study was to investigate whether OHC was associated with the risk of all-cause mortality across adulthood, and whether these risks varied across different placement characteristics. Moreover, the study addressed potential confounding by including two comparison groups with children who grew up under similarly adverse living conditions but did not experience placement. Methods: Data were derived from a 60-year follow-up of a Stockholm cohort born in 1953 (n = 15 048), of whom around 9% have had experiences of OHC. The associations between OHC and subsequent all-cause mortality were analysed by means of Cox’s proportional hazards regression models. Results: Individuals who were placed in OHC at any point during their formative years had increased mortality risks across ages 20 to 56 years. Elevated risk of mortality was particularly pronounced among those who were placed in adolescence and/or because of their own behaviours. Children who were exposed to OHC had increased risks of mortality also when compared with those who grew up under similar living conditions but did not experience placement. Conclusions: Children in OHC constitute a high-risk group for subsequent mortality. In order to narrow the mortality gap, interventions may need to monitor not only health aspects but also to target the cognitive and social development of these children.

Factors associated with re-entry to out-of-home care among children in England

Exiting and re-entering out-of-home care (OHC) is considered a disruption to permanence which may have long-lasting, negative consequences for children due to a lack of stability and continuity. Each year approximately one-third of children in OHC in England exit, but information is lacking on rates of re-entries and associated factors. Using national administrative data, we calculated rates of re-entry among children exiting OHC from 2007 to 2012, identified key child and care factors associated with re-entry using Cox proportional hazards modelling, and developed a simple probability calculator to estimate which groups of children are most likely to re-enter OHC within three months. Between 2007 and 2012 re-entries to OHC in England decreased (from 23.3% to 14.4% within one year of exit, p<0.001), possibly due to concurrent changes in the way children exited OHC. Overall, more than one-third of children exiting OHC in 2008 re-entered within five years (35.3%, N=4076), but rates of re-entry varied by child and care characteristics including age, ethnicity, mode of exit, and placement stability. Based on these associated factors, we developed a calculator that can estimate the likelihood of rapid re-entry to OHC for a group of children and could be used by social care practitioners or service planners. Our findings provide insight into which groups of children are most likely to re-enter OHC, who may benefit from additional support or ongoing monitoring.

The outcomes of foster care in South Korea ten years after its foundation: A comparison with institutional care

This study is one of the first longitudinal investigations of outcomes from different types of out-of-home foster care services in Korea. The main purpose of the study is to compare foster care with institutional care by focusing on two concerns: (1) children's perception of the caregiving services and (2) developmental outcomes of such services. Study participants included 342 children in institutional and foster care in Korea, all of whom participated in both the first and the second wave surveys for the Panel Study on Korean Children in Out-of Home-Care. The first-wave survey was conducted in 2010; the second wave survey was conducted in 2011. The data were analyzed using the Generalized Estimating Equation (GEE), the Chi-square test, ANOVA, and descriptive data analysis.The results from GEE showed significant relationships between placement types and placement outcomes. In particular, children in foster care groups perceived caregiving services more positively than those in institutional care overall. In addition, each of the foster care groups revealed more positive developmental outcomes compared to the institution group. We did not find major differences among different types of foster care placements. In summary, our findings suggest that the effects of foster care are more positive than those of institutional care. Based on the results, we discuss practice implications, including the concern of using institutional care as a major out-of-home care service in Korea.

Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families

Decision makers typically face uncertainty in determining whether the outcomes of promising child welfare interventions justify the investment. Despite repeated calls for cost analysis in child welfare, original studies that evaluate the costs and effects of child welfare programs have been limited. Moreover, no cost analyses have focused on family reunification programs that address the needs of substance-affected families. The purpose of this study was to evaluate the costs and effects of a federally funded implementation of the Strengthening Families Program (SFP), a 14-week family training curriculum, on time to reunification with a substance-involved child welfare population. Based on event history analysis, we find the typical child participating in SFP spends 190 fewer days in out of home care when compared to a propensity score matched comparison group of children in out-of home care receiving treatment as usual. Re-entry rates between the two groups were not significantly different at follow-up. At an average out-of-home care rate of $86 per child per day in this state, SFP saves approximately $16,340 per participating child in out-of-home care costs. From a cost–benefit perspective, every $1 invested in SFP yields an average savings of $9.83 in this Midwestern demonstration. ► Cost analyses of child welfare interventions have been limited. ► Few studies have evaluated reunification programs with substance-affected families. ► The Strengthening Families Program (SFP) was evaluated in a child welfare setting. ► SFP decreases days in out-of-home care among children in substance-involved families. ► Every $1 invested in SFP yields an average savings of $9.83 in this demonstration.

Turning away from the public sector in children's out-of-home care: An English experiment

This paper reports on the evaluation of an English experiment which, for the first time, moved statutory social work support for children and young people in out-of-home care from the public to the private or independent sector. Five social work practices (SWPs), independent or semi-independent of local government, were established and evaluated using a matched control design with integrated process evaluation. Social work teams in the public sector, selected to correspond to key characteristics of the SWP sites, provided control sites. While most SWPs were perceived to be accessible and user-friendly organizations, children's and young people's accounts showed no differences between pilots and control sites in terms of workers' accessibility and responsiveness. Perceptions of SWP staff's decision-making were mixed. SWP staff reported spending more time in direct face-to-face work with children and families but this was attributed to reduced caseload size and a tight remit which excluded child protection work rather than to decreased bureaucracy. SWP staff morale was generally found to be high in terms of depersonalization and social support, reflecting an emphasis on staff supervision in these organizations. However, this was offset by slightly higher job insecurity which reflected the precariousness of employment in the independent as opposed to state sector. Staff retention varied between the SWPs, but although children and young people in the pilots were more likely to retain their key worker than those in control sites, they experienced disruption in the move into SWPs and back to public services when SWP contracts were not renewed. While some SWPs succeeded in reducing placement change rates for children and young people, a policy of switching placement providers to achieve flexibility and savings increased placement change rates in some SWPs. SWPs did not achieve financial independence from the local authority commissioners with only one assuming full responsibility for managing the placement budget. Payment by results was not used consistently. None of the commissioners interviewed considered that the SWP model had resulted in savings. The study highlighted the interdependence of public and private sectors. As small organizations, most of the SWPs succeeded in offering an accessible and personalized service, and public services should consider reorganizing to achieve similar outcomes. However, this evaluation found that contracted-out organizations struggled to provide children in out-of home care with the consistency and continuity they require. ► This paper reports on a national evaluation of a policy experiment in England. ► Social work for children in out-of-home care was moved to independent organizations. ► The evaluation employed a mixed methods, matched control design. ► Social workers in the new services enjoyed lower caseloads and greater autonomy. ► Privatization led to job insecurity and did not increase continuity for children.