Foster Placement Research Articles

Achieving Permanence in Foster Care for Young Children: A Comparison of Kinship and Non-Kinship Placements

ABSTRACT A number of child welfare policies have reinforced the use of kinship care as the most preferred placement for foster children, reflecting the philosophy that maintaining children within their own extended family system contributes to their stability and well-being. Given the growing utilization and legislative emphasis on kinship care along with the push for an immediate implementation of permanency plans for children in foster care, this study examines how the permanency goal under the 1997 Adoption and Safe Families Act (ASFA) is being implemented and achieved. The reunification and permanency placement (adoption or legal guardianship) outcomes of children in relative and non-relative care are analyzed, focusing on the experiences of young children. Based on public child welfare agency data from 2000 to 2003, child, case, and placement variables are explored to identify which set of factors best explains case outcomes. The present study identifies the total length of foster placement (kinship and non-kinship), the length of family maintenance services, and the number of placement changes as the most important variables in determining family reunification and permanent placement (legal guardianship and adoption) outcomes for young children.

The impact of placement stability on behavioral well-being for children in foster care.

The problems children have upon entering foster care can potentially explain prior research findings that frequent placement changes are associated with poor outcomes. This study sought to disentangle this cascading relationship in order to identify the independent impact of placement stability on behavioral outcomes downstream. Placement stability over the first 18 months in out-of-home care for 729 children from the National Survey of Child and Adolescent Well-being was categorized as early stability (stable placement within 45 days), late stability (stable placement beyond 45 days), or unstable (never achieving stability). Propensity scores predicting placement instability based on baseline attributes were divided into risk categories and added to a logistic regression model to examine the independent association between placement stability and behavioral well-being using the Child Behavior Checklist and temperament scores from the National Longitudinal Survey of Youth. Half (52%) of the children achieved early stability, 19% achieved later stability, and 28% remained unstable. Early stabilizers were more likely to be young, have normal baseline behavior, have no prior history with child welfare, and have birth parents without mental health problems. After accounting for baseline attributes, stability remained an important predictor of well-being at 18 months. Unstable children were more likely to have behavior problems than children who achieved early stability across every level of risk for instability. Among low-risk children, the probability of behavioral problems among early stabilizers was 22%, compared to 36% among unstable children, showing a 63% increase in behavior problems due to instability alone. Children in foster care experience placement instability unrelated to their baseline problems, and this instability has a significant impact on their behavioral well-being. This finding would support the development of interventions that promote placement stability as a means to improve outcomes among youth entering care.

Foster Placements. Why They Succeed and Why They Fail

Foster Placements. Why They Succeed and Why They Fail

Effects of Therapeutic Interventions for Foster Children on Behavioral Problems, Caregiver Attachment, and Stress Regulatory Neural Systems

Young children in foster care are exposed to high levels of stress. These experiences place foster children at risk for poor social, academic, and mental heath outcomes. The role of adverse events in stimulating neurobiological stress responses presumably plays a role in shaping neural systems that contribute to these problems. Systematic and developmentally well-timed interventions might have the potential to change developmental trajectories and promote resilience. Moreover, understanding how specific dimensions of early adversity affect underlying stress response systems and how alterations in these systems are related to later psychosocial outcomes might facilitate more precise and targeted interventions. Data are drawn from two ongoing randomized trials involving foster infants/toddlers and preschoolers. Consistent with prior animal models of early adversity, these studies have shown that early adversity-particularly neglect, younger age at first foster placement, and higher number of placements-is associated with altered hypothalamic-pituitary-adrenal (HPA) axis function. The interventions under investigation have produced evidence that it is possible to impact many areas that have been negatively affected by early stress, including HPA axis activity, behavior, and attachment to caregivers.

Can Foster Carers Help Children Resolve Their Emotional and Behavioural Difficulties?

Although foster care is generally seen as providing a positive experience for the children and young people for whom it caters, it is rarely conceived of as a place where the children are helped to address their emotional difficulties and modify their often difficult behaviour. Yet research evidence suggests that some foster carers are consistently less likely to have placements which break down, and that foster carers who show particular skills in parenting can make a difference to successful outcomes. The article draws on a large longitudinal study of foster care to argue that it is possible to learn from what these foster carers do in order to develop these skills in others. A model of successful foster care. developed from the main statistical part of the study is first described. Two cases from the qualitative, case-studies component of the research are then analysed to demonstrate a quality of responsive parenting. The model is further developed within the framework of the dynamic of attachment and interest sharing proposed by Heard and Lake (1997), to show how this can be used as a basis for future approaches to working with foster placements.

School Counsellors and Young People in Care

AbstractProtocols recently introduced by state education authorities require guidance and school counsellors to collaborate with other school personnel to developIndividual Education Support Plansfor students in the care of the state. Of the more than 20,000 young people in care in Australia, the majority are in foster home placements due to previous maltreatment or neglect by their parents. Young people in care are a diverse, vulnerable and, at times, challenging cohort of students who typically have academic, psychological, behavioural, social, and friendship difficulties — and for some, ongoing mental health issues. This article reviews the characteristics allied with young people in care as well as procedures and strategies school counsellors can consider that facilitate more positive outcomes for these students.

Foster parent perceptions of placement breakdown

The purpose of the study was to describe the perceived causes of placement breakdown by foster parents. Sixty-three foster parents from fifty families were asked to describe their challenges in response to the following question: “What would make you consider ending a foster placement”? The responses to this question were analyzed using multidimensional scaling and cluster analysis, to yield nine themes. Foster parents indicated that they would consider ending a placement if there was a danger to their family, if the child could not adapt to the home or if they could not handle the child's behavior. Participants reported that the complex health needs of a foster child, problems dealing with the foster agency, and several unsuccessful attempts to make the placement work would cause a placement to breakdown. Foster parents also indicated that they would consider ending a placement if their personal circumstances changed, their own health deteriorated, or there was a lack of appropriate external support in place. The results of the study point to gaps in the research on violence in general foster care, foster parent perceptions of contributions to a foster child's transition back to his or her birth family, and the process of foster parent decision-making in cases of placement breakdown.

Where Are We Now?

Little research on adoption disruption has been conducted in recent years, particularly with large populations and multivariate methods. Utilizing administrative data on 15,947 children, this study examines adoption disruption in a large state child welfare system in the United States in the three years leading up to and the three years following the passage of ASFA (Adoption and Safe Families Act), a federal law that mandates speedier movement to termination of parental rights and adoptive placement when parents do not make acceptable progress. Through a Cox proportional hazards model, the risk and protective factors associated with disruption are identified. Overall, the risk of disruption was 11 percent less for placements occurring after 1997. Among factors associated with higher risk were older age of the children entering foster care and placements with up to four siblings. Included in factors associated with a lower risk for disruption were racewhite children were at a lower risk than African Americans; relative home; and being placed with four or more siblings.

Fetal alcohol spectrum disorders in Finland: Clinical delineation of 77 older children and adolescents

The adverse effects of alcohol on the developing human comprise a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). We previously have proposed revisions to the 1996 Institute of Medicine Diagnostic Criteria for diagnoses in the FASD continuum [fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol related birth defects (ARBD), and alcohol related neurodevelopmental disorder (ARND)], allowing for more reproducible and accurate FASD diagnosis in a clinical setting [Hoyme et al., 2005]. The NIAAA recently has coordinated and funded an international consortium of projects aimed at more complete characterization of the teratogenic spectrum of alcohol. One of the projects sites is in Finland. The aims of this project are: (1) to completely clinically characterize the structural and learning/behavioral phenotypes of a large cohort of older children and adolescents with moderate to severe disability within the FASD continuum; (2) to correlate FASD dysmorphology and behavioral phenotypes with CNS structure and function (i.e., MRS, MRI correlations); (3) to compare the phenotype of a genetically homogeneous population of Finnish children with FASD to that observed in other populations. We have recently completed dysmorphology examination and parent/guardian interviews of the 77 children in the Finnish cohort. The purpose of this report is to present historical and morphometric data on these patients, thereby more completely delineating the clinical spectrum of FASD in older children and adolescents, contrasting the phenotype with that described in other populations and examining whether a weighted dysmorphology score could be used as a clinical and research adjunct when fetal alcohol exposure is being suspected. All children were previously diagnosed with FASD by an experienced pediatric specialist in Finland, and all were exposed to significant maternal alcohol abuse prenatally. The sex ratio of the cohort was 0.38 (male: female) and ages ranged from 8 to 20 years, with a mean of 13 years. After application of the Revised IOM Diagnostic Criteria, 53% of the subjects were diagnosed as having FAS, 30% PFAS, 12% ARND, and 5% other diagnoses. Of note, although a family history of mental retardation or birth defects was rare, 43% of the children had one or more sibling who also carried a diagnosis of FAS. Eighty-nine percent of the mothers smoked cigarettes during gestation; other teratogenic exposures were rare. Almost none had undergone genetics evaluation in the past. Almost all of the subjects had resided in multiple foster placements since early childhood and had been followed regularly by pediatric specialists. Although 11% were born prematurely, 70% demonstrated prenatal growth deficiency, and 45% were microcephalic. Other than growth deficits and the cardinal facial features, the most common major and minor anomalies noted were: camptodactyly (55%), "hockey stick" or other altered palmar creases (51%), refractive errors (40%), strabismus (38%), dental crowding (43%), nail hypoplasia (38%), GU anomalies (22%), and congenital heart defects (18%), "Railroad track" ears were not observed in this population.

Contact with Family Members and its Impact on Adolescents and Their Foster Placements

Sue Moyers is a Research Associate in the School for Policy Studies at the University of Bristol. She assisted in the development of the Looking After Children material and is currently under taking research with Elaine Farmer on kinship care. Elaine Farmer is Professor of Child and Family Studies and Director of the Centre for Family Policy and Child Welfare in the School for Policy Studies at the University of Bristol. Jo Lipscombe was a Research Associate in the School for Policy Studies at the University of Bristol. She recently completed a doctorate on Remand Foster Care and now works for Crime Concern.

Adoption and fostering

Adopted and foster children are a heterogeneous group. Though children adopted in infancy are over-represented in clinical populations, they show no consistent pattern of difficulties, and infancy adoption acts as a developmental protective factor against a number of risks. Apart from children adopted in early infancy, adopted and foster children share difficulties common to ‘looked-after’ children. This population is at high risk of mental health disorder, although the level of disorder varies by type of placement, and suffers the consequences of the maltreatment or adversity which necessitated their being ‘looked after’ in foster or other placements rather than their families of origin. Children placed for adoption after a period in care have been shown to be a particularly challenging group relative to the total population of children leaving care. The number of children adopted from care has risen very substantially in response to Government policy targets, and is set to rise further. Particular psychiatric sequelae of maltreatment, associated with foster children and those adopted from care, include posttraumatic symptoms and difficulties in forming attachments and relationships. Treatment interventions are outlined; it is important to note that there are no universally recognized mode of treatment for difficulties in attachment, no adequate evidence of effectiveness for various techniques which are publicized, and no reason to assume that the often associated behavioural difficulties necessarily derive from attachment difficulties or can be treated via this route. Adequate support for adoptive families is critical to the success of adoption but its provision is patchy.

Young Children in Foster Care

Young children who have been removed from their biological families and placed in foster care are at significant risk for poor developmental outcomes. Their vulnerability is often the result of adverse biological and psychosocial influences: prenatal exposure to alcohol and other drugs, premature birth, abuse and neglect leading to foster placement, and failure to form adequate attachments to their primary caregivers. Children younger than 6 years form the largest group entering foster care, and remain longest in care. Meeting the complex needs of this vulnerable group of young children and their families presents extensive challenges for early intervention service systems. The purpose of the following discussion is to describe the foster care population and the kinds of medical conditions, mental health problems, and developmental disabilities experienced by young children in foster care, and to explore implications for intervention. By increasing their understanding of risk factors, vulnerabilities, and complex service needs, early childhood professionals can become effective advocates and provide services that ameliorate risk and optimize outcomes for these children and their families.

Providing a secure base: Parenting children in long-term foster family care

This paper reports on a longitudinal study of children growing up in long-term foster family care. It focuses attention on the challenges for foster carers in providing a secure base for foster children in middle childhood and early adolescence, who have come predominantly from backgrounds of abuse, neglect, and psychosocial adversity. Separation and loss in the children's lives, often through multiple placements, increase the likelihood of difficulties across a range of development. These children tend to be wary, distrustful, and controlling when they enter foster placements, but need from their carers many of the caregiving qualities most commonly described as providing a secure base in infancy. This study describes a model of parenting which uses four caregiving dimensions that are consistent with attachment theory and research: promoting trust in availability, promoting reflective function, promoting self-esteem, and promoting autonomy. A fifth dimension, promoting family membership, is added, as it reflects the need for children in long-term foster family care to experience the security that comes from a sense of identity and belonging. Qualitative data from the study demonstrates the usefulness of this model as a framework for analysis, but also suggests the potential use of such a framework for working with and supporting foster carers.

A comparison of family functioning in gay/lesbian, heterosexual and special needs adoptions

The purpose of this study was to identify possible contributing factors to family functioning in three types of adoptive families: those headed by gays/lesbians, those headed by heterosexuals, and those involving the adoption of children with special needs. These three adoptive family types were examined concurrently so that commonalities and differences could be identified and considered for use in adoption practice. A multiple regression analysis was used to assess the relationship between the dependent variable (standardized family functioning score) and independent variables (child behavior scores, special needs adoption, gay/lesbian headed families, age at adoption and at interview, diagnoses of disabilities, total social support score, number of previous placements, previous abuse and co-sibling adoption). Results indicated no negative effects for the parenting of adopted children by gay/lesbian headed families. Higher levels of family functioning were found to be associated with special needs, younger, and non-disabled child adoptions. Gay/lesbian headed family adoptions of older children, non-sibling group adoptions, and children with more foster placements also experienced higher levels of family functioning. Implications include the need to (1) place a child in an adoptive family as early as possible, (2) ensure strong support networks for adoptive families of children with disabilities and with those who adopt sibling groups, and (3) encourage the practice of adoption by gay/lesbian headed families, especially for older children.

Correlates of the Randolph Attachment Disorder Questionnaire (RADQ) in a Sample of Children in Foster Placement

This study examined mental health and attachment problems in children in foster care. This study also obtained data concerning the validity of the Randolph Attachment Disorder Questionnaire (RADQ). Children were selected according to length of time in placement and age and screened for mental health symptoms using the Child Behavior Checklist and the RADQ. The findings showed that children in foster care have reported symptoms within the range typical of children not involved in foster care. The conclusion is that the RADQ has limited usefulness due to its lack of specificity with implications for treatment of children in foster care.

Typologies and Outcomes for Foster Children

This study reports on the use of the Child Behaviour Checklist for children aged 4–18 (CBLC/4–18) as a tool for creating typologies for children and relating these to foster care outcomes. Findings regarding outcomes were consistent with previous studies that focused on child variables rather than profiles, however profiles do appear to be helpful with identifying to categories of children who are most vulnerable to foster placement breakdown: withdrawn children and aggressive–delinquent children.

Beyond the continuum: New perspectives on the future of out-of-home care in Australia

In almost all current debates concerning services for young people in out-of-home care it has been customary to define services in terms of the so-called ‘continuum of care’, a hypothetical typology of placement options that differ in varying degrees from conventional family life. According to this philosophy, children should always be placed into family foster care rather than congregate care because foster placements are more normalised, nurturing, and place fewer limits on children’s individuality and freedom of choice. In this paper, we argue that this approach is limited because it fails to consider the diversity of actual services and structures possible at different points in the hypothetical continuum. In our view, future policies may be better served by a dimensional approach that views placement options as a configuration of factors including: the physical and living environment, service type, and staffing characteristics. In this system, the quality and suitability of placement options is no longer defined by names or labels (eg, family, group or residential), but by the actual nature of the placement provided. Appropriate combinations of these elements, rather than a choice between fixed categories, may assist in the development of innovative options better able to meet the needs of young people not suitable for existing care arrangements.

Stability, Permanence, Outcomes and Support: Foster Care and Adoption Compared

There are large numbers of children in the care system who are unable to return home and who need a stable permanent placement. Julie Selwyn and David Quinton report some of the findings of a Department of Health-funded study, which followed a complete sample of 130 older children, all of whom had had a best interest decision in favour of adoption as the chosen placement. In the event, not all the children were adopted, making it possible to compare the outcomes of children who were adopted with those who went into long-term foster placements. There were many similarities in the experience of offering an adoptive or foster home to the young people but some key differences were in the stability of placements, the amount of autonomy the adoptive parents/carers had and their views of how close they were to the child and their assessment of the child's closeness to them.

Pale, poor, and 'pretubercular' children: a history of pediatric antituberculosis efforts in France, Germany, and the United States, 1899-1929.

An international consensus emerged in the years between 1900 and 1910 regarding the need to refocus antituberculosis efforts away from treating tuberculosis in adults and toward preventing active disease in children. This paper uses social history as a framework to explore pediatric health experiments in France (foster placement of city children with rural farm families), Germany (open-air schools), and the United States (preventorium) for children considered 'pretubercular'. The scientific, social, and political variables that reshaped prevailing ideas and practice with regard to TB prevention during those years are described. The creation of the first preventorium in the United States is explained and the way in which French and German pediatric prevention strategies were adapted to address a specific population considered at high risk in the United States, indigent immigrants, is detailed. For each of these three nations, nurses were central actors. Their efforts provide a unique vantage point to study the cultural dimensions of risk and prevention embedded in nursing care and the interplay between science, culture, nurses, and the state.

Challenging children in kin versus nonkin foster care: perceived costs and benefits to caregivers.

This study uses social exchange theory as a framework for examining 102 kin and 157 nonkin foster parents' perceptions of their foster children, their relationships with them, and their own functioning. The authors argue that these perceptions reflect perceived costs and benefits of parenting these children, which may influence their investment in them. All children in the study were referred to Parent-Child Interaction Therapy (PCIT) for treatment of the children's behavior problems, participating with their foster parents. Analyses showed that nonkin caregivers rated their foster children's behavior problems as significantly more severe than kin caregivers but rated themselves as significantly less stressed. Analyses predicting early treatment termination showed that kin caregivers were more likely than nonkin caregivers to complete the course of treatment in PCIT, particularly if they reported elevated levels of parental distress. The authors discuss the implications of these findings for foster children's placement stability and long-term success.