Foster Placement Research Articles

Reunification of foster children: Factors associated with reunification outcomes in Flanders and the Netherlands

Although a significant number of foster children eventually return to their birth parents, evidence-based models for permanency planning are scarce, and there is a lack of clear decision-making criteria for reunification. This study aimed to establish further knowledge about reunification. Both reunification pace and factors which are associated with reunification were examined. The focus was on factors related to the foster child, the birth parents, the foster parents and the foster placement, and reasons for removal. Case file analysis was performed for 580 Flemish and Dutch foster children ages 0–18. Cox regression analyses showed contact with birth parents to be most strongly associated with reunification. Moreover, particularly placement related factors (e.g., legal framework, additional support services, contact with birth parents) increased the likelihood of reunification. Furthermore, over a period of six years approximately 15% of foster placements led to reunification notably during the first 2.5years of placement. Policy makers and foster care professionals are therefore encouraged to timely aim for permanency planning. Reunification efforts should be planned from the start of the foster placement. If subsequently reunification proves not feasible, permanency should be secured within the foster family.

Hearing the voices of kinship foster carers in Northern Ireland: an inquiry into characteristics, needs and experiences

This study describes an investigation into the characteristics, needs and experiences of kinship foster carers in Northern Ireland. By adopting a mixed-methods approach with 54 carers, a number of salient themes was captured. The respondents were predominantly grandparents who experienced a significant incidence of health-related issues. The cohort also endured high levels of stress, particularly at the beginning stage of the foster placement. Consequently, their need for practical, emotional and respite support was most evident. In terms of the children for whom they cared, many required help at school, and some presented with challenging emotions and behaviours. Overall, these findings emphasised the importance of relationship-based social work and demonstration of accurate empathy to the carer.

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.

Psychosocial functioning in Dutch foster children: The relationship with child, family, and placement characteristics

Foster care is the preferred alternative for out-of-home care, but not necessarily beneficial for foster children's psychosocial functioning. This dilemma leaves researchers with a challenge to find out more about the factors related to foster children's social and emotional functioning. In a sample of 446 Dutch foster children we examined the extent to which three clusters of characteristics, those akin to the foster child, the foster family, or foster placement, were related to foster children's functioning at the time of research. Multivariate three-step hierarchical regression analyses were performed for three outcome variables: externalizing problems, internalizing problems, and prosocial behavior. We found that all three clusters of foster care characteristics were significantly related to foster children's functioning. Foster placement characteristics, in particular interventions aimed at foster children, explained the largest amount of variance in behavior problems. Children receiving interventions had more externalizing and internalizing problems. A possible explanation is that interventions are indicated for those foster children who are in the highest need of additional support. Prosocial behavior was particularly related to foster family characteristics. The results were mostly in line with international research. Careful screening and monitoring of the social and emotional functioning of foster children may help to identify problems at an early stage. In addition (preventive) support should be offered to those foster children and families who are in need of it.

Antipsychotic Use and Foster Care Placement Stability Among Youth With Attention-Deficit Hyperactivity/ Disruptive Behavior Disorders

The objective of this study was to investigate the association between antipsychotic initiation and placement transitions among youth in foster care with attention-deficit/hyperactivity disorder and other disruptive behavior disorders (ADHD/DBD). Data were obtained from child welfare administrative records and Medicaid claims in one Mid-Atlantic state from January 1, 2010, through March 31, 2014. Cox proportional hazard model was conducted to estimate the risk of time to first placement transition during the 180-day follow-up among new antipsychotic users and propensity score matched nonusers. Results showed youth initiating antipsychotics had no significant reduction in foster placement transitions within the 180-day follow up (Hazard Ratio = 1.1; 95% CI = 0.7–1.6). Although antipsychotics are widely used for aggressive behaviors, a better understanding of clinical management of youth in foster care is needed to promote stable foster placement.

Foster children's attachment security in the first year after placement: A longitudinal study of predictors

The current study focuses on foster children's attachment formation and its factors of influence during the first year in foster placement. The sample consists of 55 children (1–6 years) and their primary foster caregiver. Analyses revealed a significant increase in foster children's attachment security. Multiple placement changes and mental illness of biological parents lowered attachment security in the beginning, while the professional background of foster parents fostered early attachment formation. Authoritative parenting was the main predictor for an increase in attachment security during the first year in placement with highly introverted children being specifically susceptible to the influence of parenting. Data point at the need of improved training and selection of foster parents.

Parcours et devenir de 128 enfants admis avant l’âge de quatre ans en pouponnière sociale

The purpose of this study was to determine the institutional trajectory and future of young children in child welfare. A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant. We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2±4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures. The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.

Children's participation in foster care placements

This article presents results from a study of the birth children of foster carers and their experiences of growing up with foster siblings. Data were gathered from focus groups (17 participants), discussion groups (16 participants), a questionnaire (684 responses) and eight individual interviews. The children's participation in the fostering placements is in focus. Accounts from the children show that several of them participate in care-giving activities in everyday life. Their participation in the official assignment is however limited and can lead to children taking on responsibility with no support from adults. The tension between children's agency and position in society is addressed. The study shows how power relations between children and adults come into play, how both children and adults (re)-produce positions where children's rights to have a say in questions that concern them are not reflected within fostering processes.

Medical Management and Trauma-Informed Care for Children in Foster Care

Children enter foster care with a myriad of exposures and experiences, which can threaten their physical and mental health and development. Expanding evidence and evolving guidelines have helped to shape the care of these children over the past two decades. These guidelines address initial health screening, comprehensive medical evaluations, and follow-up care. Information exchange, attention to exposures, and consideration of how the adversities, which lead to foster placement, can impact health is crucial. These children should be examined with a trauma lens, so that the child, caregiver, and community supports can be assisted to view their physical and behavioral health from the perspective of what we now understand about the impact of toxic stress. Health care providers can impact the health of foster children by screening for the negative health consequences of trauma, advocating for trauma-informed services, and providing trauma-informed anticipatory guidance to foster parents. By taking an organized and comprehensive approach, the health care provider can best attend to the needs of this vulnerable population.

Placement stability in non-kinship foster care: variables associated with placement disruption

In Spain research has been conducted into the outcomes of foster care, although there is a need for further analysis, especially as regards the variables associated with placement disruption. In 2008 (T1) was collated information on all foster placements that were registered in three Spanish provinces. In 2014 (T2), data were gathered by reviewing the children's case notes and through interviews with the social worker responsible for each case. The resulting sample comprised 104 non-kinship foster children in long-term foster care who were being fostered in 86 families. The results obtained at T2 showed that the percentage of children who were still living with the same family (68.3%) was greater than the proportion of children whose circumstances had changed (31.7%). The social workers considered that placement disruption had occurred in 27 of the 33 cases. One of the main finding was placement disruption was associated with the older age at the time of being fostered and the emotional relationship quality between children and foster carers. A regression analysis showed that low levels of warmth and communication in the relationship between child and foster carers were shown to be a predictor of placement breakdown. Implications for practice are discussed.

EXPLORING ADOLESCENTS’ PARTICIPATION IN DECISION MAKING IN RELATED FOSTER CARE PLACEMENTS IN SOUTH AFRICA

Since the United Nations Convention on the Rights of the Child was adopted in 1989, children have a right to express their views and participate in matters concerning them. This aspect of participation is also encompassed in legislation in South Africa. The country has adopted a developmental social work approach after becoming a democratic nation in 1994 to guide social work service delivery on all levels. The purpose of this paper is to explore the participatory decision making experiences that adolescents have relating to their foster care placements. Against this background, the theoretical premise of the paper is based on the principles of participatory decision making. A qualitative research study was conducted in which thirty-five adolescents in related foster care placements across South Africa were interviewed. The responses of adolescents indicate that these young people in foster placements feel they are not sufficiently included in the decision making aspects related to welfare service delivery to them. This presents a challenge to developmental social work, which aims to be democratic, inclusive, and participatory. The paper concludes with discussing the implications of these findings for foster care in South Africa and recommends that adolescents should be taken seriously in matters concerning them.

Accessing quality early care and education for children in child welfare: Stakeholders' perspectives on barriers and opportunities for interagency collaboration

Emerging evidence suggests that high quality early care and education (ECE) programs can improve children's developmental outcomes, particularly for at-risk children. Yet, ECE remains under-utilized by children in the child welfare system. This study illuminates some of the reasons for this by presenting findings from a series of ten focus groups with child welfare workers, ECE providers, and parents/caregivers of young children involved with the child welfare system (N=78). Fourteen themes emerged regarding organizational and system-level barriers to enrolling children involved with the child welfare system in ECE. These include generic barriers to inter-agency collaboration in human services, such as challenging work climates characterized by limited resources, high workloads and staff turnover, and lack of guidelines for collaborative infrastructure. Findings more specific to inter-agency collaboration between child welfare and ECE include the disruptive effect of foster placement changes and case closures on ECE stability, policies restricting ECE eligibility and availability for birth and/or foster parents, and child welfare workers' limited understanding of the value of high quality, learning based ECE programs versus custodial child care, particularly for infants and toddlers. Policy and practice recommendations to improve ECE utilization and service coordination among child welfare and ECE organizations are discussed.

Development of a radical foster care intervention in Glasgow, Scotland.

Services for maltreated children are inadequate and lack infant mental health input in many parts of the world. A recent audit of Glasgow services revealed that children frequently 'revolve' between maltreating birth parents and various temporary foster placements for many years. Addressing infant mental health in this population will require radical change to current services. The New Orleans programme developed by the Tulane Infant Team in Louisiana is one such radical programme. Prior to the design of a randomized controlled trial (RCT) to test this programme in Glasgow, it was essential that policy-makers had some insight into the local model of service delivery and how a New Orleans model could impact. This article explores the structure and costs of the current Glasgow system and the potential costs and consequence impact of implementing a New Orleans model in Glasgow, using data obtained from the research literature, Glasgow City Council audit data and expert's opinion. A New Orleans-Glasgow model would likely shift resources from social services on to the NHS. The resource intensive nature of this model could increase the cost of an episode in care from £66 300 in the current system to £86 070; however, the probability of repeated episodes in care is likely to fall substantially, making the cost per child fall from £95 500 in the current system to £88 600. This study informed the design of a phase II explorative RCT, identified appropriate outcomes for measurement and areas of uncertainty for further research.

Foster care assessment: A study of the placement decision process in Flanders

Family foster care placement decision-making has a weak scientific underpinning. Mostly a ‘variable-oriented approach’ is taken, which requires a lot of information that is not always available. The identification of clusters of foster children with similar characteristics may be a more viable decision strategy. In this study we investigated if foster children could indeed be clustered, which problems were identified at the time of placement, and the influence of placement history. It proved possible to group foster children into two clusters: (1) young children with familial problems and few behavioral problems, and (2) older children with prominent child problems and behavioral problems. For foster children with and without placement history, problems associated with placement proved identical. Considering that a foster care placement did not result in fundamental change in the problems present at time of placement, the importance is stressed of approaching foster care assessment as part of a decision making process which looks back as well as forward. Placement decisions should be based on an appraisal of the appropriateness of foster placement as a solution for the child. In conjunction with this appraisal a decision is required on how parents can be supported toward reunification. Or – if this is not an option – whether long term foster care is the best option for the child and if so, what conditions need to be met.

Planned and unplanned terminations of foster care placements in the Netherlands: Relationships with characteristics of foster children and foster placements

This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses demonstrated that behavior problems, parenting stress and a non-Dutch ethnic background of the foster child increased the likelihood of a placement termination. Furthermore, risk accumulation contributed to unplanned terminations. The results indicate that supporting foster parents in managing problem behavior of the foster child and reducing parenting stress may be a key to an effective prevention of disrupted foster care placements.

Characteristics of the Social Support Networks of Maltreated Youth: Exploring the Effects of Maltreatment Experience and Foster Placement.

Little is known about the social support networks of maltreated youth or how youth in foster care may compare with those who remain with their parent(s). Social network characteristics and perceived social support were examined between (1) maltreated and comparison youth, (2) maltreated youth who remained with their biological parent, those with a foster parent, or a those with a kin caregiver, and (3) youth in stable placements and those who have changed placements. Data came from a sample of 454 adolescents (241 boys, 9-13 years old at enrollment) who took part in a longitudinal study of child maltreatment. Participants completed three assessments approximately 1 year apart. Results showed that on average, maltreated adolescents named significantly fewer people in their network than comparison adolescents. At Time 2, comparison adolescents reported more same-aged friends. In the maltreatment group, youth with a foster parent reported significantly more older friends than maltreated youth with a kin caregiver. Fewer maltreated youth named a biological parent on the social support questionnaire at all three time points. More youth in kinship care described their caregiver as supportive than those in foster care. These findings indicate that despite heterogeneous placement histories, social support networks among maltreated youth were very similar.

Foster Care Profiles: A Guide to Identifying At-Risk Placements

Various studies have analyzed the variables that influence the outcome of family foster care. The research aimed to determine whether distinct profiles of foster placements can be identified on the basis of key variables, seeking at the same time to define a predictive function for the success or failure of foster care. Participants were the foster families of 104 non-relative foster children. A k-means cluster analysis identified three clusters, corresponding to high-, moderate-, and low-risk placements. The variables that formed part of these clusters were behavior problems and impulsivity/inattention in foster children, level of burden in the foster parents, an authoritarian parenting style, and criticism/rejection by the foster parents. A discriminant analysis confirmed the differences between the three clusters and enabled the researchers to create a function for classifying cases in each group. These results can be used to identify at-risk placements and may help to avoid situations that could undermine the foster child’s development. The findings could also be useful in terms of assessing the suitability of foster families, as well for identifying their training needs.

‘What happened next’: a study of outcomes for maltreated children following care proceedings

This is the first report from a study of outcomes for 114 children from 49 families assessed in an expert multi-disciplinary service during care proceedings. The study investigated the extent of children’s adaptation following judicial decisions made in the proceedings and what factors might be involved in changes in the children’s adaptation and well-being. We also aimed to investigate the reliability of the expert placement and treatment recommendations made to the court. The original assessment reports for the court were independently coded using a comprehensive child adaptation measure (Target and Fonagy, 1992). At follow-up, mean time of 26 months after their assessment, the researchers re-employed the child adaptation measure in semi-structured interviews with carers in birth, adoptive, foster and kinship placements. The data were independently coded and the results compared with the child’s original score as a measure of change in adaptation post proceedings in their substitute family or birth family. Researchers also collected information about the children’s placement(s) and any support or treatment received. The study found that children’s well-being significantly improved by an average of +6.7 points between initial assessment ( M = 68.13; SD = 9.86) and follow-up ( M = 74.82; SD = 7.84), ( t (67) = −5.0, p < .001, d = 0.76). Children whose global adjustment scores were clinically concerning at the time of assessment hardly improved their scores (.44), compared to children whose global adjustment scores were within the normal range at the time of assessment. Interestingly, the majority (88%) of expert placement recommendations had been accepted and implemented. However, less than 50% of the children and only 30% of parents received the support and treatment recommended in the experts’ reports in the proceedings. The implications for both policy and practice in working with children and their families during and after care proceedings are explored.

Siblings in foster care: A relational path to resilience for emancipated foster youth

Sibling relationships are a powerful influence on child development, one that takes on particular significance in contexts of familial disruption or adversity. This study examined the effect of sibling co-placements during foster care on subsequent educational competence, occupational competence, housing quality, relational adjustment, and civic engagement in a sample of 170 recently emancipated foster youth (66.5% female; Mage=19.63). Analyses evaluated direct relations between the proportion of time spent with a sibling in foster placement and young adult adjustment outcomes, as well as indirect effects from sibling co-placement to later competence through youth's coherence displayed in a narrative of experiences in foster care. The coherence of life narratives develops in the context of primary relationships, including those with siblings, through co-constructed meaning making and emotional discourse, particularly regarding difficult life events. Emancipated foster youth's verbal narratives about their experiences in foster care were evaluated for narrative coherence based on the organization, complexity, and balance of youth's narratives. Analyses documented significant indirect effects of sibling co-placement on young adult competence through narrative coherence. Moreover, moderation analyses indicated that these effects were particularly robust among males. Findings are discussed with respect to relational mechanisms underlying resilience, and the potential for sibling co-placement to provide a relational context for risk and resilience among emancipated foster youth.

'Am I damaging my own family?': Relational changes between foster carers and their birth children.

Foster placements are more likely to break down where the foster carers already have birth children. Studies that explore the impact of fostering on foster carers and their birth children have suggested that relational changes occur, but these changes have not been examined in depth. This study aimed to explore the impact of fostering on parent-child relationships within foster families. Nine foster carers (including three couples) were interviewed separately, and the data were analysed using constructivist grounded theory methods. Analysis indicated that birth children may attribute particular importance to their position in the family (e.g. oldest child, youngest child) and that this is a key element of the way in which they relate to their parents. Emotional security and parent-child relationships can therefore be strained by a foster placement not taking this into account. Foster children also introduce significant competition for parental resources, putting a strain on relationships. Foster carers seem to prioritise, consciously or not, the preservation of relationships within the biological family. Reflecting on relationships and making changes to maximise potential improvements in relationships can lead to positive outcomes, and this can have an impact on whether families continue fostering or not.