Kinship Care Research Articles

Examining Different Types of Sleep Among Custodial Grandparents During COVID-19

Sleep is associated with healthy living. With increased age, sleep is harder to initiate and maintain. Currently, over two million grandparents have become primary caregivers to their grandchildren and are at risk for poor sleep outcomes. Research shows that grandparent caregivers are at risk for depression due to poor sleep quality. Thus, this study aimed to identify the sleep quality of custodial grandparents to gain a better understanding of sleep patterns during COVID-19 in 2020. Thirty-four custodial grandparents were recruited from the Georgia Division of Aging Kinship Care Support Groups from September through October 2020. Participants were between 42 to 78 years old with a mean age of 57. Participants completed the Pittsburgh Sleep Quality Index. Stata statistical software was used to analyze the relationship between the sleep quality subscales. Results showed a significant positive relationship for custodial grandparents between sleep quality and daytime dysfunction (χ2=25.993, p=0.002; Γ=0.495, p=0.039) as well as sleep quality and sleep disturbance (χ2=11.129, p=0.084; Γ=0.751, p<0.001). There is a significant positive relationship between daytime dysfunction and sleep duration (χ2=14.984, p=0.091; Γ=0.681, p<.001), where grandparents with daytime dysfunction have longer sleep duration. Findings suggest grandparents with poor sleep quality are more likely to experience daytime dysfunction and have more sleep disturbances in the COVID-19 environment. Our study will benefit researchers and practitioners caring for custodial grandparents and contribute to future research focused on custodial grandparents and sleep quality.

The EU Strategy on the Rights of the Child and the European Child Guarantee-Evidence-Based Recommendations for Alternative Care.

Protection and promotion of child rights are referred to as a central purpose of the European Union (EU). Therefore in 2021, the EU Strategy on the Rights of the Child and the European Child Guarantee were published to enable children to have the best possible life in the EU and worldwide. Member states were invited to implement the directions of both documents into practice. The present study analyses and showcases the evidence on how to progress implementation of the Strategy and the Guarantee regarding alternative care in Portugal. A literature review was conducted based on international literature. Evidence-based recommendations for the Portuguese transition process towards quality, family and community-based care are stated. De-institutionalisation and strengthening specific services—kinship care, special guardianship, and foster care—are advocated, namely specialising the workforce, and promoting training for kinship carers and prospective special guardians. To conclude, the revision and monitoring of the measures for children in need of alternative care are suggested as well as integrating and publishing data from the diverse services of the alternative care system.

Self-management of chronic disease in Latina Kinship caregivers: an integrative review

ABSTRACT In the United States, Latinos experience a higher prevalence of chronic diseases with concomitant complications when compared to Non-Latino Whites. Older Latina women often manage a chronic illness while also providing kinship care. This article presents an integrative review of Latina kinship caregivers’ self-management of chronic disease. An extensive review of the literature was conducted in seven databases. Four resulting studies included qualitative, quantitative, and mixed methods research and suggested health outcomes for Latina kinship caregivers were often worse when compared to other groups. A major gap in the literature identified an absence of disease-specific self-management behaviors for this population.

Kinship Care: State of the Nation Survey 2021

Kinship Care: State of the Nation Survey 2021

Waiting for “Good Care”. Biomedicine and the Elderly in North Sulawesi, Indonesia

Older persons in North Sulawesi (Indonesia) shared a long experience with biomedical health interventions during Soeharto’s New Order administration. These vertically and top-down structured development activities in health no longer fit current demographic, epidemiological, and social transformations in Indonesia. The rapidly aging communities, the sharp increase in non-communicable diseases, and aging impairments along with rapidly changing household assemblages call for a biomedical public health that ideally covers cure and care in equal shares. This understanding and vision of “good care” leads to a dynamic appropriation of biomedical services initiated by older persons. Here the monthly local health post sessions for elderly people occupy center stage of this appropriative process: a highly formalized and ritualized medical check-up based on the administration of drug which covers basic curative needs. In addition, the local cadres for aged persons play a significant role as intermediary and broker between an elderly patient, his/her caregiver(s), and the health professionals. Yet, except for the cadres’ home visits, the existing biomedical health system is not very concerned with eldercare (or social care) at household level—for ill older persons fully dependent on kin care truly a “missing link.” Biomedicine in turn increasingly attempts to appropriate elder health as its new market commodity. Thereby, the four fields of pharmaceuticalization, national health insurance scheme, biomedicalization as control and exercise of power in care, and commercialization of elder health support biomedicine in its pursuit of the hegemonic appropriation of older persons’ health and illness. However, dislocations and disjunctures due to the Covid-19 pandemic clearly reveal the structural vulnerability of this biomedical health system: Its sudden unreliability and unsustainability leads not only to a loss of trust in it, but also to a higher degree of vulnerability on the side of older persons in need of cure and care.

The Reflective Fostering Programme\u2014improving the wellbeing of children in care through a group intervention for foster carers: a randomised controlled trial

BackgroundThe needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer’s reflective parenting, may be an effective approach to improving the wellbeing of these children.MethodsThe study comprises a definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost-effectiveness, of the Reflective Fostering Programme. Randomisation is at the individual level using a 1:1 allocation ratio. The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged 4 to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional wellbeing of the child 12 months post-baseline, and secondary outcomes include the following: foster carer’s level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child’s capacity for emotional regulation, and achievement of personalised goals set by the carer.DiscussionA feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers.Trial registrationISRCTN 70832140.

Mental Health Symptom Profiles of Adolescents in Foster Care.

The article describes an investigation of the nature, patterns and complexity of carer-reported mental health symptoms for a population sample (N = 230) of adolescents (age 12-17) placed in long-term foster and kinship care following chronic and severe maltreatment. Two cluster analyses of Child Behaviour Checklist DSM-oriented (CBCL-DSM) and Assessment Checklist for Adolescents sub-scale scores of clinical cases were performed. The first yielded 8 profiles of attachment- and trauma-related symptoms as measured across eight ACA scales (N = 113 cases). The second yielded 11 profiles of a broader range of symptoms, as measured across five CBCL-DSM and five ACA sub-scales (N = 141 cases). The symptom profiles derived from both cluster analyses are differentiated more by symptom severity and complexity, than by symptom specificity - suggesting that trauma- and attachment-related symptomatology does not conform to a taxonomy of discrete disorders. Five of the 11 CBCL-DSM/ACA profiles describe severe and complex symptomatology that does not correspond to discrete DSM-5 or ICD-11 diagnoses. Accurate measurement and formulation of clinical phenomena is an essential component of evidence-based psychological and psychiatric practice. Clinicians who carry out mental health assessments of children and adolescents in care should be aware of the limits of the diagnostic classification systems for formulating complex attachment- and trauma-related symptomatology.

Opportunities for Positive Youth Development: The Organized Activity Participation and Educational Outcomes of Adolescents in Adoptive, Foster, and Kinship Care

Opportunities for Positive Youth Development: The Organized Activity Participation and Educational Outcomes of Adolescents in Adoptive, Foster, and Kinship Care

91 Health care needs and missed care among youth in care in British Columbia: A population study

Abstract Primary Subject area Adolescent Medicine Background Youth in care (YIC), including those living in foster care, kinship care, group homes, and youth agreements, are a vulnerable population with many risk factors leading to a high prevalence of mental and physical health needs. YIC are recommended to have more frequent health care encounters than the general adolescent population, though it is unknown how Canadian YIC perceive whether their health care needs are sufficiently met. Objectives To assess YIC's perception of their health care needs and frequency of missed care, defined as not having received needed health care. Design/Methods A representative sample of 38,015 students in Grades 7 to 12 across British Columbia was surveyed in the 2018 BC Adolescent Health Survey (McCreary Centre Society). Questionnaire items on demographics, mental and physical health, and health care access in the past year were examined. Frequencies and cross-tabulations were performed using IBM SPSS® Complex Samples module software. Results In the past year, 1.9% of respondents reported living in government care. YIC had a mean age of 14.76 years and were 50.9% female. YIC reported worse mental health (46.5% vs. 27.6% poor/fair rating, p &amp;lt; 0.01) and physical health (36.4% vs. 19.1% poor/fair rating, p &amp;lt; 0.01) compared to non-YIC, with female and non-binary YIC most severely impacted. YIC were less likely to report not needing health care (15.6% vs. 21.3%, p &amp;lt; 0.01) and more likely to report missed care (11.2% vs. 3.1%, p &amp;lt; 0.01) compared to non-YIC. Although the rate of any health care usage was not significantly different between the groups, nearly one-quarter (23.7%) of YIC accessed health care at 3 or more locations, compared to only 16.4% of non-YIC (p &amp;lt; 0.01), with YIC accessing counsellors/psychologists and youth clinics more frequently. YIC reported more missed mental health care (32.9% vs. 18.4%, p &amp;lt; 0.01) and physical health care (21.6% vs. 7.8%, p &amp;lt; 0.01) than non-YIC, with female YIC reporting more missed care than male YIC. Non-binary YIC also reported more missed mental health care than male YIC. YIC were more likely than non-YIC to have missed mental health care due to reasons such as prior negative experiences and lack of transportation. Conclusion YIC reported worse mental and physical health and greater frequencies of missed care compared to non-YIC, especially female and non-binary YIC. Further attention is needed in addressing systemic and individual barriers to health care in this vulnerable population.

Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care

BackgroundBreastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern. ObjectiveTo consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care. Participants and settingFoster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013–2018 completed an online survey. MethodsFoster carer's views were collected via an online survey and subjected to content analysis. ResultsRespondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal. ConclusionsThis study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them.

Factors associated with reunification and placement move for children placed in kinship care under the age of thirteen

BackgroundWhen a child needs to be placed in substitute care by child protection services, social workers are encouraged to use kinship care (KC), mainly because of the greater stability associated with it. However, current state of knowledge on reunification and placement stability is essentially based on studies that combined children in KC and children in other types of substitute care setting. ObjectivesThis paper aims to describe longitudinally the placement trajectory of children placed in KC and to identify the factors associated with the type of exit from KC (move to another substitute care setting or reunification). MethodAll children in a Québec child protection services agency who started a KC placement in 2014–15 under the age of 13 are observed for three years (N = 172). Data come from the child's casefile and from telephone questionnaires with the caseworker at the beginning and at the end of placement (or at the end of observation if the child has not exited). ResultsSeveral children remained in the same KC setting during the observation (39%). The others were reunified (34%) or moved to another substitute setting (27%). Multivariate regression analyzes indicated that reunification was mostly determined by higher frequency of parent-child contacts, less registrations in clinical programs and absence of parental mental health problems, while placement move was mostly associated with placement beginning as provisional measure, higher frequency of parent-child contacts and presence of parental mental health problems. ConclusionsThis study highlights determinants of stability and permanency that may be specific to kinship placements

Kinship navigation: Facilitating permanency and equity for youth in child welfare

Kinship care has come to be seen as a way to potentially minimize some risks of traditional foster care, provide an opportunity for youth to remain connected to their extended families, and facilitate ongoing relationships and development. Previous work has suggested potential benefits of kinship placements for youth, but also challenges in identifying viable kin caregivers and providing adequate supports and guidance for these families. Kinship Navigation has been developed to formally and systematically assure placement options and supports for caregivers. At present, however, there is relatively little empirical work on the benefits and outcomes of Kinship Navigation programs.This manuscript examines permanency outcomes for youth served by one kinship care agency: A Second Chance, Inc. (ASCI). Countywide data are used to compare episode-of-care permanency outcomes for youth served by ASCI’s Kinship Navigator program with those served by other agencies without Kinship Navigation, who were removed from their homes during the same 27-month period (January 2017 – March 2020). The sample includes 1108 youth (471 served via ASCI KN; 637 in non-KN programs). Kinship Navigation was associated with significantly higher rates of Permanent Legal Custodianship and decreased disparities in outcomes between African American and White youth. These results suggest that ASCI’s Kinship Navigator program is promising for securing family-centered permanency and increasing positive outcomes for African American children and adolescents. Additional work is needed to more fully explore the key processes, families’ experiences, and broader outcomes.

Outcomes of the Parent Advocacy Initiative in child safety conferences: Placement and repeat maltreatment

In the past years, peer support programs in child welfare have been used to increase family participation in the case decision-making, give voice to parents, promote parent engagement with services, and ultimately improve child and family outcomes. These programs employ peers, who are parents with lived child welfare system experience, and who offer advocacy and support to parents presently involved in the system. The current study examined the impact of one such intervention, Parent Advocacy Initiative in Initial Child Safety Conferences at the New York City Administration for Children’s Services, on case outcomes of families served by parent advocates as part of this intervention. A multivariable analysis compared cases receiving the intervention (calendar year 2016; n = 3224) to cases from pre-intervention period—prior to the Initiative implementation (calendar year 2013; n = 5598) and cases not receiving the intervention in 2016 (n = 3450), to determine whether the presence of a parent advocate was associated with positive case outcomes, such as (a) reduced foster care placements and (b) reduced or unchanged rates of repeat indicated maltreatment investigations within six months of initial investigation. The results revealed that the rates of out-of-home placements significantly decreased, and children remained at home at higher rates when a parent advocate was present at the conference. Whenever out-of-home placement was recommended, placements in non-relative foster care significantly decreased and kinship care placements increased. The rate of repeat indicated maltreatment investigations within six months was unchanged. The results demonstrate that parent advocacy could have a significant impact on placement decisions and thus improve the outcomes of children and families. Study implications and suggestions for future research are discussed.

How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review

Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia. The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity. A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC. There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.

Caring for children in foster and kinship care during a pandemic: lessons learned and recommendations

ABSTRACT Through qualitative feedback from professionals in healthcare, mental health, and child welfare, this study explored the impact of the COVID-19 pandemic on the health and well-being of children in the child welfare system. Positive outcomes and challenges related to the care of children in foster or kinship care in Texas during the COVID-19 pandemic are described. Themes identified included disparities in the child welfare system; utilization of telehealth; cross-sector communication and collaboration; safety considerations; and placement stability and support. The article concludes with recommendations in each of these areas for ensuring the health and well-being of children in foster and kinship care during a pandemic.

Understanding kinship care of older persons: social constructions of family preservation and survival in a South African Muslim community

ABSTRACT This study examined kinship care arrangements of older persons in a South African Muslim community. The aim was to understand kinship care in this community in the context of culturally sensitive welfare services delivery. Using a Grounded Theory approach, older persons and their caregivers living in intergenerational households were interviewed about their living and care arrangements. A societal context of family life in circumstances of a socio-historical legacy of colonialism and apartheid formed the backdrop of the research. Religion and the country’s poor socio-economic conditions emerged as important drivers of kinship care. Family preservation and survival, constructed through maintaining intergenerational living, reciprocity and mutual support, and the authoritative status of the older persons in the home, characterised this environment. Kinship care was a means of fulfilling a religious duty and living in accordance with an Islamic life. However, these arrangements occurred both in support and at the expense of the older persons. Kinship care arrangements are replicated globally in both Muslim majority countries and where Muslims live as minorities in secular societies; they are not static and are influenced by societal conditions that can impact on the lives of older persons. These findings thus have relevance for Muslim communities generally.

Trauma-Informed Care in Child Health Systems.

Trauma-Informed Care in Child Health Systems.

‘Their Mum Messed Up and Gran Can’t Afford to’: Violence towards Grandparent Kinship Carers and the Implications for Social Work

Abstract Child and adolescent violence towards grandparent kinship carers is a significant and yet under-researched phenomenon. This study draws on data from thirty-six in-depth interviews which include grandparent carers who are experiencing such violence, and professionals from a range of backgrounds whose work intersects with this problem. The study highlights how the kinship care context shapes the violence, its impacts and, in turn, carers’ help-seeking practices. The findings highlight that social workers must better understand the barriers that prevent grandparent kinship carers from asking for help, and improve their responses to such requests. Recommendations for social work practice include asking the right questions, engaging in effective risk assessment, taking a trauma-informed approach, avoiding the language of coercion and improving its response to grandparents’ own articulated support needs.

Risk and protective factors associated with grandparent kinship caregivers' psychological distress in COVID-19: Kinship license status as a moderator.

COVID‐19 and its related policy measures have increased the psychological distress of individuals, including grandparent kinship caregivers. Guided by the Resilience Model of Family Stress, Adjustment, and Adaptation, this study examines relationships between material hardship, parenting stress, social support, resilience and psychological distress of grandparent kinship caregivers during the COVID‐19 pandemic, as well as the moderating role of kinship license status on these relationships. Kinship care licensing is a prerequisite to receiving financial assistance and other supporting services from the government. We administered a cross‐sectional survey of grandparent kinship caregivers (N = 362) in the United States. Logistic regression results indicated that material hardship was associated with higher odds of experiencing psychological distress, whereas resilience and social support were associated with lower odds. Kinship license status moderated the relationships of social support and resilience with psychological distress. Results suggest that additional emergency funds and more tailored financial services should be provided to meet material needs, and interventions with a focus on resilience and social support are particularly needed. The moderating effects of license status indicate that some interventions should be specifically implemented among licensed kinship caregivers, whereas parallel services should be provided to kinship caregivers regardless of their license status.

Theoretical constraints: Science, caretaking, and the creation of normative ideals.

This review explores the dualism in evolutionary anthropology that both acknowledges a broad range of familial caretaking strategies, while also remaining tethered to theories scaffolded around notions of selfish genes that constrain our understanding of who provides adequate kin care. I examine the process of norm creation in the sciences by investigating how theory may limit which data are collected and how those data are interpreted. This paper serves as a literature review and critique of prominent biological, evolutionary, and psychological conceptualizations of parental investment and caretaking in humans, and how these studies shape what is considered normal behavior in scientific literature. Quantification, assessment, and theory building in evolutionary anthropology, and an oversampling of WEIRD communities in other disciplines, have limited our understanding of what constitutes both evolutionarily adaptive behaviors, and culturally specific human behaviors. A synthetic theoretical model of behavioral norms in childrearing must account for an exchange of psycho-social and cultural resources and skills, the transfer of energetic reserves via gestation and lactation, and the indirect benefits of genetic inheritance. The emphasis on tailoring data collection to fit evolutionary theories of the family has limited our ability to understand the diverse proximate mechanisms that humans employ in taking care of kin as biocultural reproducers.