Foster Care Placement Research Articles

Health Supervision for Children and Adolescents With Down Syndrome.

Health Supervision for Children and Adolescents With Down Syndrome.

Predictors of Parent-Child Contact During a Parent’s Incarceration

ABSTRACT Over 2 million people are currently incarcerated – the majority of whom are parents to minor children. The reentry process is often difficult for parents as they navigate reentry challenges such as finding housing and employment while also trying to develop and reestablish relationships with their children. Increased parent-child contact during incarceration is associated with improved incarceration and reentry outcomes for both the parents and their children. Using survey data from 252 parents exiting the prison system, this study uses structural equation modeling to examine predictors of parent-child contact during incarceration. Findings suggest incarcerated parents have higher levels of contact with their children when the parents had less exposure to childhood adversities such as parental incarceration, foster care, and group home placement. Mothers display higher levels of contact with children than fathers; similarly, younger parents display higher levels of contact than older, as do those who had recent contact in the month prior to incarceration compared to those who did not. These findings highlight specific factors and populations for practitioners to target to increase the level of parent-child contact during incarceration.

Parent and Caregiver Relationships and Mental Health Symptom Profiles of Youth in Foster Care.

Adolescents in foster care can be quite resilient, yet they also are at risk for developing internalizing and externalizing mental health concerns. Positive family relationships are central to adolescent mental health, and these relationships can be complex for youth in foster care placements. Accordingly, there can be significant heterogeneity in the mental health symptoms of youth in foster care. The aims of this study were to identify distinct subgroups of youth patterns of internalizing and externalizing symptoms and determine the extent to which positive biological and foster parent relationships predicted profiles of low youth mental health symptoms. Using data from the National Survey of Child and Adolescent Well-being II (N = 343) and a person-centered analytic approach, results revealed four distinct profiles of youths' mental health symptoms, those with: high internalizing and high externalizing symptoms, high internalizing and moderate externalizing symptoms, moderate internalizing and moderate externalizing symptoms, and low internalizing and low externalizing symptoms. Additionally, youth with better relationships with biological parents were less likely to be in the high symptoms group compared to the low symptoms group. These findings can be used to inform targeted intervention efforts aimed to lessen the mental health symptoms of youth in foster care.

Racial Matching in Foster Care Placements and Subsequent Placement Stability: A National Study

Racial Matching in Foster Care Placements and Subsequent Placement Stability: A National Study

Experiences during COVID-19: Needs of college students with a history of foster care

The effects of the coronavirus disease 2019 (COVID-19) have been nothing short of profound, with disparate impact among historically marginalized and under-resourced populations. Eighty undergraduate college students, with a history of foster care placement, describe their experiences during Shelter in Place due to COVID-19. Former and current foster youth already experience challenges in accessing and completing higher education; these challenges were exacerbated by the measures taken to deal with risks associated with the pandemic. Study findings build upon previous studies that indicated that former and current foster youth have unique and significant pandemic related financial, physical and psychosocial concerns, by using conventional content analysis methods to describe what participants identified as needed resources. Findings have implications for future research and policy development, as well as resource provision during ongoing remote learning, and in preparation for the eventual transition back to in-person instruction.

A longitudinal investigation of infants and out-of-home care

ABSTRACT Foster care placements for infants can be consequential. Research suggests that infants’ path through and beyond the care system is different than the experience for children of other age groups. Studying infants is important because of their unique needs for developmentally-sensitive care; because of the underpinnings of attachment theory; and because the long-term impacts of quality care can be pronounced. Prior research examining infants in care has typically focused on their first episode and the outcomes of that episode. This study offers a longitudinal examination of a population-based cohort of infants (n = 5789) born in 2001 who entered care during the first year of life and who were followed through multiple care episodes until age 18. Findings suggest that using single, first episode data overstates the proportion of children who successfully reunify and understates the proportion of children who are adopted, return to care, or live with guardians. This research also suggests that the experience of infants who enter care as neonates is different from that of infants who enter care after the first four weeks of life. The long-term outcome for neonates is much more likely to be adoption. Long-term foster care for all infants is an especially unlikely outcome.

Assessing students in foster care for autism spectrum disorders

AbstractThe intersection of children identified with autism spectrum disorders (ASD) and children within the foster care system who have experienced trauma can complicate timely assessment and eligibility for special education services, creating health disparities for this group of students. As students with ASD are over three times more likely to be involved in the foster care system than typically developing peers, school psychologists must be equipped to assess for ASD in this population. The complex clinical presentation of students with ASD within foster care contributes to delays in identification and access to special education services. In particular, schools may struggle to disentangle the symptoms of ASD from the consequences of trauma exposure that often accompanies foster care placement. This paper reviews the relation between students in foster care and those with ASD, outlines the similarities and differences in developmental profiles of these students, and provides recommendations for school practitioners associated with assessment practices, prevention strategies to reduce the risk of trauma subsequent foster care placement for students with ASD, as well as needed advocacy efforts and future research.

Moral Dilemmas in Foster Care Due to Religious Differences Between Birth Parents, Foster Parents, and Foster Children

Many ethnoreligious-minority foster children in several western countries, including the Netherlands, are placed and permanently live with ethnically and religiously non-matched foster families (i.e., in trans-religious foster care). We examine whether and which moral dilemmas exist around the issue of how religion should be weighted in trans-religious foster care to provide ethnoreligious-minority foster children with healthy identity development. We applied a thematic analysis to 17 qualitative interviews (seven foster parent/foster child dyads and three foster parents) taken from two pre-existing datasets. We retrieved five moral dilemmas in trans-religious foster care placements, which are discussed in relation to the following ethical arguments: (1) pressure from birth parents and parents of foster children to abide by their religious praxis; (2) objections of the foster family to the faith of the birth family; (3) a switch to the faith of the foster family by the foster child; (4) challenges to the religious identity searches of foster children due to ethnoreligious boundary drawing between majority and minority groups; and (5) the impact of religious traditions on the bodily integrity of foster children. We argue that it is in the best interest of foster children to have a foster family who, when making (some) religious choices on their behalf, is sensitive to the particular child and their developing identity with regard to their religious ideas and beliefs. Foster families need support regarding religious reflection and religious self-determinism in their foster children.

Are the Average Effects of Foster Care Placement Really Close to Zero?

In their provocative article, Barth and colleagues interrogate existing research on a series of claims about the child welfare system. In this reply, we focus on just one of their conclusions: that foster care placement does little, on average, to cause the poor outcomes of children who are ever placed in care. Our argument proceeds in three stages. In the first, we dispute the claim that the average effects of foster care placement on children are "settled" in any scientific sense. In the second, we note that the lack of agreement about what constitutes the appropriate counterfactual makes the idea of average effects of foster care placement in this area problematic. In the third, we problematize the idea that near-zero average effects equate to unimportant effects by showing how different types of effect heterogeneity may lead us to think differently about how the system is working.

Integrating organisational and individual performance management systems for improved foster care service delivery

Despite efforts by the South African government to manage public sector performance, the Department of Social Development (DSD) is facing lawsuits for failing to provide public value to the foster care placement beneficiaries. This article examines the integration of organisational and individual performance management systems to enhance foster care service delivery in Waterberg District, Limpopo Province, South Africa. A parallel convergent mixed‐method research design was adopted, and drew on the principal component analysis (PCA) and thematic analysis to analyse the impact of integrating organisational and individual performance management systems amongst social workers. The PCA findings accentuate the significant role of strategic human resources management, work experience and performance management delivery systems. Furthermore, performance targets as critical elements to enhance effective foster care service delivery in South Africa is highlighted. In complementing the PCA findings, the thematic analysis attributed the failure to manage and address the challenges associated with the backlog in foster care by the DSD as a consequence of misalignment between strategic intent, workforce and internal integration between different programmes at the operational level, in particular between social work and community development programmes. Peer review procedures should be designed to enhance the effectiveness of the performance management deployment system. Consequently, strategic human resource management practices should correspond with the department's resources and needs to enhance performance and service quality.

Foster children’s views of family: A systematic review and qualitative synthesis

BackgroundResearch reveals that children with childhoods characterised by placement(s) in foster care have particularly complex and multi-dimensional understandings of family. Given the changing nature of family forms and meanings, and the increased emphasis on children’s voices in decisions about their care and well-being, this review seeks to encapsulate how foster children and former foster children (“foster children”) understand family. ObjectiveThe aim of this review is to comprehensively identify, synthesise, and analyse three decades of qualitative research on current and former foster children’s understanding of family. MethodA systematic review was conducted, using three databases related to social sciences, social work, and family studies to identify relevant qualitative studies in English, Spanish, and Portuguese. Using the guidelines of PRISMA statement, 20 studies met the inclusion criteria. A thematic synthesis of the findings was carried out. ResultsFamily was understood by foster and former foster children (1) as biological relatedness, (2) associated with positive emotions, (3) as doing family, and (4) as a choice, reflecting multiple ways of family belonging, in three contexts – kinship, non-kinship, and a combination of the two. Discussion and conclusionFor most foster children (both former and current), biological bonds determine what constitutes family. Some emphasised acts of mutual love, care, support, as well as tolerance and communication as important in defining what constitutes family. Others, however, felt that family is an individual choice. Welfare regimes were highlighted as a possible factor in foster children’s construction of family. We argue that foster children’s meaning and understanding of family in relation to a particular welfare state or local context, would be a welcome addition.

Adverse Childhood Experiences and Foster Care Placement Stability.

To examine the impact of cumulative adverse childhood experiences (ACEs) on a child's foster care placement stability in Kansas. Secondary data analysis was conducted by using a purposive cohort sample of 2998 children, from 6 to 18 years old, in Kansas's foster care system between October 2015 and July 2019. Multivariate hierarchical logistic regression models were used to examine the influence of cumulative ACEs on a child's placement stability. ACEs were measured at foster care intake and self-reported by the child. Placement stability variables were obtained through the state administrative database. Children in foster care with greater cumulative ACE exposure were significantly more likely to experience placement instability. Compared to children with 1 to 5 ACEs, when controlling for all other variables, children with ≥10 ACEs had an increased odds of experiencing placement instability by 31% (odds ratio: 1.31; P < .05); and children with 6 to 9 ACEs had a 52% (odds ratio: 1.52, P < .001) increased odds of experiencing placement instability. A child's race, biological sex, age at episode start, and whether they had siblings in foster care all significantly influenced placement instability. Findings from this study, in conjunction with previous research on ACEs and foster care, highlight the need to proactively address ACEs and trauma exposure at foster care entry.

Prevention Adaptation of an Evidence-Based Treatment for Parents Involved With Child Welfare Who Use Substances.

Background: Parental substance use, especially opioid misuse and/or methamphetamine use, is a key driver for recent increases in family involvement with child welfare and foster care placements in the United States. There is an urgent need for programs that prevent parental substance use disorders, yet few prevention programs exist that target parents’ unique needs and strengths. Adapting evidence-based treatment approaches for prevention might be an efficient, effective way to address this gap. The current study informed the rigorous adaptation of an evidence-based treatment that supports families involved with child welfare due to substance use, Families Actively Improving Relationships (FAIR), to a prevention-oriented intervention: “PRE-FAIR.” FAIR entails four treatment domains: substance use, parenting, mental health, and ancillary services (e.g., housing, medical care, and food). FAIR significantly improved parenting and reduced parental substance use in three rigorous treatment trials, but FAIR’s effectiveness in preventing the initiation or escalation of opioid misuse and/or methamphetamine use is untested. To inform adaptation, particular attention was paid to operationalizing strategies underlying a key hypothesized mediator of successful parent outcomes—engagement.Methods: Graduated FAIR parents (n = 9) and FAIR administrators, clinical supervisors, and clinicians (n = 11) participated in semi-structured interviews. Content analysis was used to identify key variables driving FAIR engagement and parent outcomes. Causal loop diagramming, a qualitative systems science method, was employed to operationalize emergent themes, and describe how causal links between key variables interrelated dynamically over time.Results: Themes reinforced the value of FAIR’s treatment domains for supporting parent’s sobriety and parenting skills within a prevention orientation. Ancillary supports and strong relationships were particularly crucial for helping parents cope with stressors leading to substance use. Five engagement strategies were identified as essential to parent success: 24/7 clinician availability, in-person clinician advocacy, in-home delivery, strengths-based interactions, and urinalysis. Implications for PRE-FAIR engagement strategies and dosage were identified.Discussion: Traditional qualitative analyses and qualitative analyses based in systems science can inform rigorous adaptations of evidence-based treatment programs for prevention. Future research will explore additional required, fidelity-consistent prevention adaptations to FAIR, and the impact of PRE-FAIR on parental substance use and child welfare case outcomes.

State Spending on Public Benefit Programs and Child Maltreatment.

To determine the association between states' total spending on benefit programs and child maltreatment outcomes. This was an ecological study of all US states during federal fiscal years 2010-2017. The primary predictor was states' total annual spending on local, state, and federal benefit programs per person living ≤100% federal poverty limit, which was the sum of (1) cash, housing, and in-kind assistance, (2) housing infrastructure, (3) child care assistance, (4) refundable Earned Income Tax Credit, and (5) Medical Assistance Programs. The main outcomes were rates of maltreatment reporting, substantiations, foster care placements, and fatalities after adjustment for relevant confounders. Generalized estimating equations adjusted for federal spending and estimated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs). States' total spending was inversely associated with all maltreatment outcomes. For each additional $1000 states spent on benefit programs per person living in poverty, there was an associated -4.3% (adjusted IRR: 0.9573 [95% CI: 0.9486 to 0.9661]) difference in reporting, -4.0% (adjusted IRR: 0.903 [95% CI: 0.9534 to 0.9672]) difference in substantiations, -2.1% (adjusted IRR: 0.9795 [95% CI: 0.9759 to 0.9832]) difference in foster care placements, and -7.7% (adjusted IRR: 0.9229 [95% CI: 0.9128 to 0.9330]) difference in fatalities. In 2017, extrapolating $1000 of additional spending for each person living in poverty ($46.5 billion nationally, or 13.3% increase) might have resulted in 181 850 fewer reports, 28 575 fewer substantiations, 4168 fewer foster care placements, and 130 fewer fatalities. State spending on benefit programs was associated with reductions in child maltreatment, which might offset some benefit program costs.

'I was broken in so many different ways': The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being.

African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.

Contact with biological parents following placement in foster care: Associations with preschool child externalizing behavior.

Externalizing behavior problems are a salient issue in the context of child protection services, where associations with placement stability and caregiving behavior have been documented. Moreover, although research on the association between contact with biological parents and foster child externalizing behavior problems is scarce and has yielded mixed results, several studies have shown links between the two variables. The purpose of this study is to determine the association of face-to-face contact with biological parents and externalized behaviors, while taking into account placement instability and foster parent interactive sensitivity. Fifty preschoolers and their foster parents were visited at home. Child externalizing behavior problems were self-reported by foster parents, foster parent sensitivity was measured via play observations, and information relative to placement was collected through interviews with biological parents and gathered from social services data. Results reveal that more frequent contact with biological parents and lower levels of foster parent sensitivity are independently linked to greater levels of externalizing behavior problems even after controlling for placement instability. Discussion focuses on the importance of children’s relationship experiences during foster care and the necessity to investigate their role to more clearly understand foster child socioemotional development.

Love and belonging in foster carer recruitment materials in New South Wales, Australia

BackgroundIn order for foster care placements to be considered good, research has identified that children need to experience love and belonging in the home. It is therefore important that foster carer recruitment target individuals who are able and willing to attempt to provide love and belonging to the children placed with them. ObjectiveTo quantify the extent to which and how foster carer agencies represent love and belonging in foster carer recruitment materials. Participants and settingFoster carer recruitment material collected in New South Wales (NSW), Australia between August 2016 and March 2017. MethodsPhrases including the word “love,” “belong,” or “belonging” or text that described aspects of belonging were identified in recruitment materials and coded using conventional content analysis. ResultsEleven agencies (42%) did not address the need for children to be loved in foster care, ten agencies (38%), did not address the need for children to experience belonging in foster care, and eight agencies (31%) did not address either love or belonging in recruitment materials. Where recruitment materials included the word love, it was used in a very limited way. Belonging was more explicitly and practically addressed however, some recruitment materials contained content describing policy or encouraging practice that would undermine belonging. ConclusionsIn order to recruit foster carers who are willing to attempt to provide love and belonging to children, recruitment materials need to be clear that children in foster care need to be loved and to feel like they belong and that foster carers should seek to provide this.

Housing after care: understanding security and stability in the transition out of care through the lenses of liminality, recognition and precarity

ABSTRACT There is a well-documented association between histories of state care and housing instability. This paper examines care leavers’ experience of securing housing during the transition out of care through the lenses of liminality, Recognition theory, and precarity. Conducted in Ireland, sixteen care-experienced youth were recruited to a qualitative longitudinal study. The findings demonstrate how aftercare policies and a lack of affordable housing combined to create precarity for many, which also had implications for their feelings of recognition as young people. For those who remained in their foster care placements or transitioned to supported lodgings, housing stability engendered feelings of being cared for by creating a liminal space where growth was supported. Those, on the other hand, who left their foster care placements at the age of 18 or were forced to leave time-limited aftercare housing were pushed into precariousness, placing them at high risk for homelessness and housing exclusion. These young people felt misrecognised and disrespected by the state and the aftercare system. The findings highlight the deleterious consequences of time-limited aftercare supports for care leavers’ sense of security and their ability to achieve valued life goals. The implications of the study's findings for leaving care and aftercare policies are discussed.

Linking Foster Family Characteristics and Mental Health Symptoms of Youth in Care.

Youth in foster care are disproportionately at risk for developing internalizing and externalizing problems (Lawrence et al., 2006); however, a history of maltreatment prior to foster care placement does not automatically result in poor mental health outcomes. Among non-foster care youth, the quality of family interactions has been related to adjustment outcomes, such that low family cohesion and high family conflict is associated with poor mental health symptoms (Caples & Barrera, 2006). While little is known about these constructs in foster care placements, they may help explain the variance in internalizing and externalizing problems for youth in foster care. The present study aimed to examine whether characteristics of the foster care environment (i.e., conflict, cohesion) across various placement types (i.e., traditional foster homes, group-care settings) could help explain the link between previous maltreatment exposure and mental health problems. The sample included 178 youth in foster care (Mage = 15.18, SD = 1.76) and their foster caregivers living in the Midwest. Youth participants completed self-report measures about prior maltreatment history, current family environment characteristics, and youth internalizing symptoms. Foster caregivers completed measures on current family environment and youth externalizing symptoms. Results indicated that caregiver report, but not youth report, of family cohesion was negatively associated with youth report of internalizing problems. When examining the indirect effects, youth report of family conflict partially accounted for the link between youth self-report of maltreatment and internalizing symptoms (B = 0.106, 95% CI = 0.026–0.186). Caregiver report of family conflict fully accounted for the association between youth self-report of maltreatment and caregiver report of youths’ externalizing symptoms (B = 0.108, 95% CI = 0.005–0.211). Findings highlight the importance of utilizing multiple informants when measuring foster family environment and suggest that family conflict is particularly salient for the mental health of youth in foster care.

Impact of Medicaid expansion and methadone coverage as a medication for opioid use disorder on foster care entries during the opioid crisis

Between 2012 and 2018, incidents of opioid-involved injuries surged and the number of children in foster care due to parental drug use disorder increased. Treatments for opioid use disorder (OUD) might prevent or reduce the amount of time that children spend in the child welfare system. Using administrative data, we examined the impact of Medicaid expansion and state support for methadone as a medication for opioid use disorder (MOUD) on first-time foster care placements. Results show that first-time foster care entries due to parental drug use disorder experienced a reduction of 28 per 100,000 children in Medicaid expansion states with methadone MOUD covered by their state Medicaid programs. The largest reduction was found among non-Hispanic Black children and the youngest children (age 0–1 years). Policies that increase OUD treatment access may reduce foster care placements by reducing parents’ drug use, a risk factor for child abuse/neglect and subsequent home removal.