Foster Placement Research Articles

P02-263 Institutionalized child and adolescent population in a psychiatric outpatient clinic: A review of 4 years

Background:The Convention on the Rights of the Child acknowledges that the family is the natural environment for the upbringing of a child and that the parents have the primary responsibility for the child's education. However, it also mentions the need to find adequate substitute care whenever the child is temporarily or permanently deprived of his or her family environment, or when the child's best interests cannot be secured within the family environment. This substitute care may include adoption, foster placement or, as last resort, placement in an institution suitable for child care. Although some institutions have high quality standards for child care, this is not always the case.Institutionalized children are likely to come from unfavourable family environments, where they were victims of multiple psychosocial adversities, and studies show they present high scores of emotional and conduct disorders, together with cognitive problems.Methods:We examined medical files of all the institutionalized children and adolescents who attended the outpatient clinic of the Department of Child and Adolescent Psychiatry in Coimbra, Portugal, between the years 2005 and 2008, in order to characterize this population.Results:There was a male excess in our sample. The majority of the children and adolescents were institutionalized due to abuse and/or neglect and had conduct or oppositional defiance disorder. A considerable number had cognitive deficits.Discussion:Mental health services should work closely with these institutions to identify their strengths and difficulties, facilitating prevention, diagnosis and treatment of psychiatric problems.

Solution-Focused Approaches to Caring for Children Whose Behaviour is Sexually Harmful

Judith Milner introduces the work of Barnardo's The Junction with children whose sexualised behaviour threatens their foster placement stability. A safety building approach to working with children, their carers and teachers is described, using examples of work carried out with children taken into care after discovery that they have been both sexually abused and abusive in their birth families.

‘One in, One Out’?: The Dilemma of having Multiple Children in Foster Placements

Practitioners in a specialist service for looked after children and their carers have indicated a tendency for children to be placed in households where there are multiple foster children. This has led to concern that previously settled children's placements were disrupting following the introduction of a new child into the household. A file audit was conducted to gather information regarding the incidence of disruption and the contributing factors, as reported in clients' files. While the study reported here by Germaine Ingley and Louise Earley did not show a high rate of movement into placements, it did indicate that when a new child was moved into the home of an already ‘established’ child, the ‘established’ child's placement often disrupted. In addition, qualitative information obtained from files and letters revealed that conflicts with another child in placement, either a sibling or unrelated child, was the most frequently cited factor associated with disruption. Attachment literature and ideas from the study of adoptive families and sibling relationships in birth families are drawn upon to explain these findings, and recommendations are made to lessen the potential difficulties associated with the multiple placements of children in foster homes.

A Social-Emotional Assessment Method for Young Children in Foster and Residential Care: The Attachment-Based Narrative Story-Stem Technique

Summary Standardized clinical assessments from the point of view of children are rare. A standardized narrative assessment measure, developed to assess children's perceptions of their caregiving environments, the Narrative Story‐Stem Technique (NSST), was used with two fraternal twins, age 8, with histories of severe maltreatment and multiple foster placements. Their responses to the NSST indicate that they perceived their caregiving environments as unstable and unpredictable, though in noticeably different ways. Representations of certain family strengths were also evident. The NSST can provide highly detailed information of great utility for treatment planning and intervention regarding children's perceptions of, and experiences in, their caregiving environments.

A Functional Approach to Reducing Runaway Behavior and Stabilizing Placements for Adolescents in Foster Care

Teenagers' running from foster placement is a significant problem in the field of child protection. This article describes a functional, behavior analytic approach to reducing running away through assessing the motivations for running, involving the youth in the assessment process, and implementing interventions to enhance the reinforcing value of placements for adolescents, thereby reducing the probability of running and associated unsafe periods. A case study illustrates this approach and a study compares 13 adolescents who ran away frequently and received interventions with a group of matched adolescents who had similar patterns of running but received only services as usual. The percentage of days on runaway status showed a significant pre-post reduction for those in the functional group, in contrast to no statistical change in the comparison group. Potential benefits this approach may have for foster care and child protection in improving youth safety, permanence, and connections for life are discussed.

Maltreated children's emotional availability with kin and non-kin foster mothers: A sociobiological perspective

Relationship differences between maltreated child–kin foster mother dyads and maltreated child–non-kin foster mother dyads were examined using Emotional Availability (EA) Scales. A sample of 106 maltreated children (2–8 years old), referred for mental health services, and their biological/kin ( n = 50) or non-kin ( n = 56) foster mothers were assessed for EA in semi-structured play sessions. After controlling for child's age, foster mother's age, foster mother's education, and placement duration, foster mother's status as kin or non-kin did not predict emotional availability between maltreated child and foster mother. Findings did not support the hypothesis of a sociobiological-based relationship advantage for kin foster placements. Limitations of the clinical sample of foster children and the lack of measurements for external support are discussed.

Effects of a Foster Parent Training Intervention on Placement Changes of Children in Foster Care

Placement disruptions undermine efforts of child welfare agencies to promote safety, permanency, and child well-being. Child behavior problems significantly contribute to placement changes. The aims of this investigation were to examine the impact of a foster parent training and support intervention (KEEP) on placement changes and to determine whether the intervention mitigates placement disruption risks associated with children's placement histories. The sample included 700 families with children between ages 5 and 12 years, from a variety of ethnic backgrounds. Families were randomly assigned to the intervention or control condition. The number of prior placements was predictive of negative exits from current foster placements. The intervention increased chances of a positive exit (e.g., parent/child reunification) and mitigated the risk-enhancing effect of a history of multiple placements. Incorporating intervention approaches based on a parent management training model into child welfare services may improve placement outcomes for children in foster care.

Children in Foster Care with Challenging Behaviour in Wales (UK): Key Themes and Issues for Practice and Research

Foster care in Wales (United Kingdom) engages frequently with children thought to present with challenging behaviour. It is essential we gain a deeper understanding of their behaviour in order to inform our thinking about how we provide support to children and carers. The paper presents key findings from research into a total population of fostered children in four neighbouring local authorities in South Wales who were considered to exhibit challenging behaviour. We examine children's characteristics and key processes in fostering and in doing so, we outline the very different behaviours and difficulties associated with these children as perceived by carers. We conclude with some reflection on the term challenging behaviour and its sufficiency to account for difficulties in foster placements.

A social‐emotional assessment method for young children in foster and residential care: The attachment‐based narrative story‐stem technique

Summary Standardized clinical assessments from the point of view of children are rare. A standardized narrative assessment measure, developed to assess children's perceptions of their caregiving environments, the Narrative Story‐Stem Technique (NSST), was used with two fraternal twins, age 8, with histories of severe maltreatment and multiple foster placements. Their responses to the NSST indicate that they perceived their caregiving environments as unstable and unpredictable, though in noticeably different ways. Representations of certain family strengths were also evident. The NSST can provide highly detailed information of great utility for treatment planning and intervention regarding children's perceptions of, and experiences in, their caregiving environments.

The Child Wise Programme: A Course to Enhance the Self-Confidence and Behaviour Management Skills of Foster Carers with Challenging Children

Looked after children with a history of maltreatment and abandonment are prone to develop high rates of mental health difficulties. They tend to suffer from multiple impairments, sometimes involving cognitive deficits and extremes of antisocial behaviour. Foster carers' management skills and emotional resources are tested to the limit. A further concern is the contribution of challenging behaviour to the unplanned termination of foster placements. Carers, if they are not to feel deskilled by the increasing numbers of children with special needs placed with them, require a more focused preparatory and follow-up training than they usually receive. A study by Martin Herbert and Jenny Wookey questioned whether a broadly based cognitive behavioural programme could, by increasing carers' behaviour management skills and self-assurance, reduce the challenging behaviour of looked after children and the resultant instability of placements. The answers were sought from a randomised controlled study of foster carers attending the parent training Child Wise Programme (CWP) designed by the authors. The programme combines course leaders' professional experience of working with challenging children and parent groups, and foster carers' personal expertise based on living with and caring for challenging children. The intervention, with an experimental group of 67 foster carers and a comparable waiting-list control group of 50 carers, succeeded in meeting just over half of its key aims. An increase in the confidence of the carers was a significant gain. Also positive was the majority of personal reports indicating improvements in looked after children's behaviour, changes generally attributed to the acquisition of new behaviour management skills. Although some of the statistical comparisons were disappointing in their failure to reach significance levels (eg in a reduction in placement breakdowns), they provided useful information about ways of improving the training. Qualitative methods were used to explore the subjective responses of participants to the Webster-Stratton and Herbert (1994) collaborative style of training employed. These produced valuable insights into the personal and professional dilemmas of a foster carer's role, as well as data which contributed to the evaluation of the training programme.

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

This study examined whether inpatient psychiatric treatment and forensic treatment and incarceration were reduced among adolescents and young adults with severe and persistent mental illness after they received services in the Program of Assertive Community Treatment (PACT). The pre-post evaluation compared length of inpatient treatment and forensic treatment or incarceration for the year before and after PACT enrollment. Participants (N=15) were their own controls. Annual psychiatric hospitalization fell from 66.2 days before enrollment to 8.7 days in the first year of PACT (p=.025, Cohen's d=.54). Similarly, combined days of inpatient psychiatric treatment and forensic treatment or incarceration fell from 104.1 in the year before enrollment to 24.1 days in the year after (p=.015, Cohen's d=.61). PACT services significantly reduced time in inpatient psychiatric treatment. These preliminary results may have implications for long-term treatment, service delivery, and cost of care for adolescents and young adults with severe and persistent mental illness.

Foster Parents’ Perceptions of Factors Needed for Successful Foster Placements

The purpose of the study was to describe the needs of foster parents for placement success. Sixty-three foster parents from a central Canadian province were asked the following question: “What do you need for a successful foster placement”? Foster parents grouped together all responses, which were analyzed using multidimensional scaling and cluster analysis procedures. Foster parents indicated that they needed the right personality and skills, information about the foster child, a good relationship with the fostering agency, individualized services, community support, linkages to other foster families, supportive immediate and extended families, as well as self-care skills. There were some differences between the existing literature and the needs identified by study participants. Differences included the need for information about policies and procedures, their treatment by professionals, and the need for formal foster parent organizations.

Maintaining sibling relationships for children in foster and adoptive placements

To better understand the nature of sibling relationships among children in foster or adoptive placement and the challenges and processes involved in maintaining these relationships, we conducted an exploratory analysis of data collected from semi-structured interviews with caregivers of 14 foster and adopted children. We identified three patterns of placement histories and living situations which appeared to impact the degree of contact maintained with siblings: (1) children who had never lived together and were not currently placed together; (2) children who at some point lived with or were placed together with their siblings, but were now separated from them; and (3) children who had lived with their siblings all their life and were placed together with at least some of their siblings at the time of the interview. Children's current living situations and placement histories, caregivers' experiences and perceptions of feasibility and desirability of sibling contact, and the sibling relationship itself are primary determinants in the development and maintenance of contact between siblings. Implications for child welfare policy and practice are discussed.

The Child's Own Story: Life Story Work with Traumatised Children

The Child's Own Story: Life Story Work with Traumatised Children

Economic Incentives and Foster Care Placement

Using micro‐level data on children entering foster care in 1998, we estimate how the financial compensation paid to foster caregivers affects the placement of foster children. Controlling for observable child and county characteristics as well as for unobservable state effects, our estimates indicate that a $100 increase in the basic monthly foster care payment reduces the number of children placed in group homes by 28.7%, with more children instead going to nonrelative foster homes. Further estimates indicate that the children moved out of group homes are equally likely to be placed in two‐parent and single‐parent homes, but they are disproportionately placed with caregivers who do not share the child's race or ethnicity. Finally, a $100 increase in foster care payment will decrease the number of times the average child is moved from one foster placement to another by 20%.

“Caught” versus “Taught”: Ethnic identity and the ethnic socialization experiences of African American adolescents in kinship and non-kinship foster placements

Theorists and researchers have long studied identity development among children, particularly during the period of adolescence, but most have focused on children residing with biological parents. Not only have identity issues facing foster children been little studied, but the effects of kinship foster care on identity, including ethnic identity, have received minimal attention. African American children are overrepresented in the child welfare system and specifically, in kinship placements. The growing practice of kinship foster care raises important questions regarding the benefits and challenges facing children in different placements. In particular, how do African American adolescents in kinship foster care differ in their sense of ethnic identity from African American adolescents in non-kinship foster care? This article explores this research question with a sample of 18 African American adolescents, residing in both kinship and non-kinship foster family placements. Using interview data, observations, and case records as well as results from a standardized measure of ethnic identity, findings are presented regarding differences in ethnic identity and ethnic socialization experiences, and implications for policy, practice, and future research are discussed.

Homesickness and Children's Adjustment to Hospitalization: Toward a Preliminary Model

To better understand the role of homesickness in children's adjustment to hospitalization, we culled self-report and observational data from hospital staff, primary caregivers, and children (n = 50) in a variety of inpatient units (psychiatric, burn, rehabilitation). Homesickness was more severe and less predictable than in comparable samples of children in less stressful environments (e.g., summer camp). The best predictors were negative hospitalization attitudes and previous separations from home, such as foster placements. Contrary to our hypotheses, insecure attachment and low perceived control did not predict homesickness. In the context of a “homesick disposition” model, prevention strategies should emphasize information provision, positive modeling, and coping skills training.

Foster parent perceptions of placement success

In this study a random sample of 61 foster parents from a central Canadian province participated in a telephone interview that included the question: “What in your opinion is a successful foster placement?” A total of 71 unique responses were obtained and grouped together by foster parents. The grouping data were analyzed using multidimensional scaling and cluster analysis. Six themes resulted: security for child, family connections, good relationships, positive family change, seamless agency involvement, and child grows. The results were generally consistent with the available literature. Differences between the literature and foster parents interviewed were discussed and implications made for foster care research.

Intervention Effects on Foster Preschoolers’ Attachment-Related Behaviors From a Randomized Trial

This study examined change in attachment-related behaviors among foster preschoolers participating in a randomized trial of the Multidimensional Treatment Foster Care Program for Preschoolers (MTFC-P). Measures of secure, resistant, and avoidant behaviors were collected using a caregiver-report diary at 3-month intervals during the 12 months following a new foster placement. Children randomly assigned to the MTFC-P intervention condition (n = 57) showed significant increases in secure behavior and significant decreases in avoidant behavior relative to children assigned to a regular foster care condition (n = 60). Both groups showed significant decreases in resistant behavior over time. Analyses also revealed a significant interaction between treatment condition and age at first foster placement on change in secure behavior. Results are discussed in terms of the importance of early intervention and prevention services for foster preschoolers.