Out Of Home Placement Research Articles

Suicidal risk among adult survivors of childhood maltreatment: The role of parent–child contact during out of home placement

BackgroundChildhood maltreatment is associated with insecure/disorganized attachment and in turn with suicidal risk (SR). Despite maltreatment, contact with biological parents is maintained during out-of-home placement. However, its impact on SR remains unclear. ObjectiveExamine whether (1) contact with parents is linked with SR and (2) with insecure/disorganized attachment to parents, and whether (3) contact moderates the link between maltreatment and SR and (4) between attachment and SR. MethodNinety-one adults (64 females) placed during childhood passed the Childhood trauma questionnaire (CTQ), the Mini-International Neuropsychiatric Interview (MINI) (for SR), and the Attachment Multiple Model Interview (AMMI). Participants’ records were used to determine contact with biological parents and maltreatment. ResultsResults show that contact with both parents is positively linked with SR. Furthermore, contact with mother moderates (increases) the link between maltreatment and SR. It is also associated with insecure and disorganized attachment and moderates its effect on SR.Conclusions.Findings suggest that decisions to maintain contact with parents could be modulated as a function of attachment to biological parents. They bring new questions about the role of mother–child attachment and whether interventions aimed at improving this relationship are called for when contact is maintained. More research is needed to examine how this may be critical in terms of suicidal risk.

Feasibility of the NCTSN breakthrough parenting curriculum: A pilot study of an online trauma-informed training for birth parents involved in the child welfare system

Unresolved trauma can negatively impact parenting and increase chances of child maltreatment. With the passing of the Family First Prevention Services Act (FFPSA) in 2018, new attention has been focused on strengthening family connections and expanding the community-based service array focused on preventing maltreatment and out of home placement. The purpose of this paper is twofold: (1) to describe preliminary outcomes from a pilot evaluation of a new curriculum teaching parents trauma-informed strategies to address and resolve their own trauma while supporting healthy attachment; and (2) assess the feasibility of conducting a large scale study. Forty parents involved in the state child welfare system were recruited to participate. Statistical analyses included T-tests, propensity score analysis, and repeated measures MANOVA. Assessments, which occurred at Pre and Post for the intervention group and comparable times for the quasi-waitlist group, indicated the following: A high retention rate (72%) for the intervention group, an increase in parent knowledge of trauma, skills to address trauma behavior, and parent well-being for the intervention, relative to the waitlist comparison group; and a decrease in child problem behavior in the intervention, relative to the waitlist group. Fidelity data was strong, with trainers completing 100% of activities for each module. Parental satisfaction in the intervention group was also high and costs to implement the training were reasonable. The findings of this pilot study provide strong support for evaluating the BPC in a large-scale outcome investigation.

Considerations and Determinants of Discharge Decisions among Prenatal Substance Exposed Infants.

Limited research has examined a comprehensive set of predictors when evaluating discharge placement decisions for infants exposed to substances prenatally. Using a previously validated medical record data extraction tool, the current study examined prenatal substance exposure, infant intervention (i.e., pharmacologic, or non-pharmacologic), and demographic factors (e.g., race and ethnicity and rurality) as predictors of associations with discharge placement in a sample from a resource-poor state (N = 136; 69.9% Non-Hispanic White). Latent class analysis (LCA) was used to examine whether different classes emerged and how classes were differentially related to discharge placement decisions. Logistic regressions were used to determine whether each predictor was uniquely associated with placement decisions. Results of the LCA yielded a two-class solution comprised of (1) a Low Withdrawal Risk class, characterized by prenatal exposure to substances with low risk for neonatal abstinence syndrome (NAS) and non-pharmacologic intervention, and (2) a High Withdrawal Risk class, characterized by a high risk of NAS and pharmacologic intervention. Classes were not related to discharge placement decisions. Logistic regressions demonstrated that meth/amphetamine use during pregnancy was associated with greater odds of out of home placement above other substance types. Future research should replicate and continue examining the clinical utility of these classes.

The role of placement instability on employment and educational outcomes among adolescents leaving care

Placement instability negatively impacts the lives of youth placed in out-of-home care, and research on the topic indicates that it is related to negative long-term outcomes for youth in care. This study uses information gathered from two waves of interviews conducted with a representative sample of 1136 Quebec youths who were first met at around 16 years of age when they were still in out of home placement, and at around age 18 when most of them had left placement. The youths’ associated administrative child welfare data were also used to examine the relationships between placement instability, education outcomes, and occupational status. We find that youth who experience more placement instability have a much higher probability of dropping out of school early, and not to be acquiring work experience. Our results also indicated that these youths have a much lower probability to receive a high school degree.

Children in care of grandparents and non-grandparents: Which have greater odds of high academic performance?

Much literature exists on social, emotional, and behavioral outcomes for children in care of their grandparents (i.e., grandfamilies), however little is known about academic performance among children living in grandfamilies when compared to other types of nonparental care. We conducted a cross-sectional analysis using secondary data from the United States 2013 National Survey of Children in Nonparental Care. We compare the academic functioning in math and reading/writing of school-aged children (N = 809) cared for by grandparents with two other types of nongrandparental caregivers. Using logistic regression models, we found that compared to children in care of their grandparents, children in care of foster caregivers and nonrelatives in nonfoster settings were approximately 45% less likely to have high academic performance in math and reading/writing. With this research we add to the literature on academic performance of children in out of home placement, setting the stage to compare arrangement options.

Concrete services usage on child placement stability: Propensity score matched effects

Experiencing poverty and financial difficulties are significant barriers to outcomes of permanency and placement stability. This is particularly true for children who are in out of home placements. The provision of concrete services is intended to meet concrete needs of families to address this barrier. However, little is known about how concrete services meet the needs of families in need of these services or if the use of concrete services is a viable treatment for children who are in out of home placements. The present study examined differences between those who received and those who did not receive concrete services on factors of stability, child and caregiver traumatic stress, number of placements, and current out of home placement. Regression analysis examined the association between amount of concrete service spending and permanency. Then to test concrete services as an intervention for children in a current out of home placement, we used propensity score matching to match participants on characteristics that predicted whether they would receive concrete services. We then ran a hierarchical regression to test the treatment condition of concrete services with children who are in a current out of home placement. Participants who received concrete services were at a much higher level of need with significantly higher levels of traumatic stress and number of placements and lower levels of placement stability. The amount of money spent on concrete services was associated with increases in placement stability. And, children in a current out of home placement had an increase in placement stability when they received concrete services. The present study is the first to evidence concrete service as a treatment for placement stability for children in current out of home placements. Spending on concrete services in addition to child welfare services improves a child's current placement stability. This is an important finding with implications for improving child welfare services' approach to those in their care with financial burdens.

Moderating the Risk for Attention Deficits in Children with Pre-Adoptive Adversity: The Protective Role of Shorter Duration of out of Home Placement and Children's Enhanced Error Monitoring.

Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.

Adverse Childhood Experiences Associated with Children's Patterns of Out of Home Placement Over Time and Subsequent Negative Outcomes During Adolescence.

Out of home placement (OOHP) of welfare involved children is a critical problem associated with child abuse and neglect and household dysfunction. Few studies have also implicated greater instability in OOHP with more negative outcomes. However, several gaps remain. Objectives were twofold. To identify combinations of adverse childhood experiences that are associated with OOHP - based on both duration of OOHP and change in actual placement during each time point, among welfare involved youth. The second objective was to understand long-term negative outcomes during adolescence that are associated with greater placement instability. Data come from the National Survey of Child and Adolescent Wellbeing (n = 1,657). Multinomial logistic regression was used to evaluate adverse childhood experiences that were associated with specific patterns of OOHP. Multivariate regression models were estimated to evaluate delinquency, aggression as well as depressive and trauma symptoms during adolescence that were associated with specific patterns of OOHP. There were six categories of OOHP found in the sample: 1) no OOHP, 2) OOHP one time, 3) OOHP two times, 4) OOHP two times with change in placements, 5) OOHP three times, and 6) OOHP three times with change in placement. Longer duration of OOHP was associated with more adversity exposure. Longer duration and more change in placement were associated with the most negative outcomes. Findings demonstrate the need for future testing of these findings in prevention trials.

Placement decisions of families co-residing with an adult relative with an intellectual disability

ABSTRACTBackgroundPlacement behaviours of families of adults with intellectual disabilities has received little or no attention of researches to date.MethodsA prospective design was adopted to examine changes in placement decisions of 75 family carers over a 12-month period. Factors associated with changes were also examined.ResultsOver 12 months, 30 families moved closer to considering an out of home placement. Of these 14 had placed their relative in out of home care. Proactive coping strategies were significantly associated with an increased likelihood of continued home care.ConclusionWhile the results were similar to studies with children with intellectual disability (ID) or autism spectrum disorder (ASD), a move out-of-home occurred more quickly for adults. This may reflect current social policy and societal attitudes where moving out of home is more normative for adults with ID. The lack of association with all but one carer or care recipient factors suggest that changes in placement tendencies for adults may differ from that of children.

Experiences of (young) women after out of home placement: An examination of personality disorder symptoms through the lens of child maltreatment.

Child maltreatment has been associated with the development of various mental health problems, including the development of personality disorders. This study investigated the association between child maltreatment and personality disorder symptoms in 125 women who transitioned out of residential care. The Child Trauma Questionnaire was used for the measurement of child maltreatment, and Personality disorder symptoms were measured using the Personality Diagnostic Questionnaire 4 + . The Psychological Distress Index was used to control for symptoms of distress. A Stepwise regression analysis showed that the majority of the associations were found between self-reported emotional abuse, neglect and personality disorder symptoms. Emotional abuse was significantly related to the Paranoid (β = .42, p<0.001), Schizoid (β = .18, p <0.05), Schizotypal (β = .18, p<0.05), Histrionic (β = .22, p<0.05), Avoidant (β = .31, p < .001), Dependent (β = 0.31, p < .001), Obsessive Compulsive (β = 0.29, p = .001), Passive Aggressive (β = 0.23, p<0.01) and the Depressive personality disorder (β = .38, p < .001). Emotional neglect was significantly associated to the Borderline Personality Disorder (β = .32, p<0.001) and the Paranoid Personality Disorder (β =-0.22, p<0.05). The current study underlines the detrimental effects of childhood maltreatment, and in particular the effects of emotional abuse and neglect.

“I want to be there when he graduates:” Foster parents show higher levels of commitment than group care providers

Group care is a frequent placement for adolescents placed in out of home care when their birth parents' care is deemed unsafe. In the present study, we assessed whether foster parents show greater commitment to children than group care providers. Given that group care represents a number of living arrangements, we considered both shift care (where staff work shifts and do not live with the children) and cottage care (where staff live for extended periods of time with the children in a group living context). Commitment was assessed using the This Is My Child Interview (adapted for adolescents). Thirty-one foster parents, 18 shift workers, and 28 cottage care providers were interviewed. As predicted, foster parents showed higher levels of commitment than both shift care workers and cottage care providers, and the associations held when children's externalizing behaviors and the number of children the caregivers had cared for were controlled. The results suggest that foster care promotes greater commitment among caregivers than other out of home placements, and add to other findings that favor foster care as the out of home placement of choice for adolescents.

Children's academic achievement and foster care.

Poor school outcomes for children in out-of-home placement (OHP) raise concerns about the adequacy of child welfare and educational policy for this vulnerable population. We analyzed the relation between OHP and academic achievement, focusing on reading and math achievement in grades 3 through 8. Linked administrative data were used for our analytic sample comprising 529 597 child-year observations for 222 049 children who experienced OHP or were in a comparison group. Three models were estimated: a pooled ordinary least squares regression that considered placement status and test scores net of the full set of control variables; an identical model that added the previous year's test scores as an additional control; and a final model that included child-specific fixed effects. Children in OHP settings had achievement test scores at least 0.6 SD below average. However, we found similar deficits across children with past, current, and future exposure to OHP and, in our preferred model, OHP (past, current, or future placement) had no statistically discernible relation with either reading or math achievement. OHP by itself is not significantly related to school achievement; however, evidence reveals consistently low average math and reading achievement among children involved with Child Protective Services.

Child protection as surveillance of African American families

The over-representation of black children in US out of home care results from racial bias in placement decisions and a political choice to address startling rates of child poverty by investigating parents instead of tackling poverty's societal roots. The impact of state disruption and supervision of African American families is intensified when it is concentrated in inner-city neighbourhoods – the system's ‘racial geography.’ A small case study of a black neighbourhood in Chicago with high rates of out of home placement found profound effects on both family and community social relationships, as well as reliance on child protective services for financial assistance, linking surveillance of black families to the neoliberal shrinking of public programmes. The surveillance of African American women by the child welfare system is also intensified by these women's disproportionate involvement in the prison system. Acknowledging racial bias in child welfare reveals the need to radically transform the system from one that relies too much on punitive disruption of families to one that generously supports them.

A troubled group? Adolescents in a Canadian child welfare sample

ObjectivesTo examine factors associated with ongoing service and out of home placement for adolescents investigated by child welfare services in Canada. MethodsSecondary analysis was conducted using data from the Canadian Incidence Study of Reported Child Abuse and Neglect, 2008 (CIS-2008), specifically examining a weighted sample of 58,641 adolescents (age 12–15). Descriptive comparisons between adolescents, school-age children and pre-school age children were conducted. After identifying significant bivariate relationships between ongoing service and out of home placement and youth, household, case, and service characteristics, logistic regressions were used to determine the degree to which these characteristics predicted the investigation being transferred to ongoing child welfare services or out of home placement. ResultsInternalizing functioning concerns of adolescents in the sample were the most important contributors to decisions to provide ongoing service. Aboriginal status of the child and parent functioning concerns were also important contributors to the decision to provide ongoing service to adolescents and their families. Youths' externalizing behaviors were the most important contributors to placing adolescents in out-of-home care. ConclusionsThe results provide important information for child welfare agencies hoping to better understand decision-making processes and service provision to adolescents. ImplicationsFuture research should seek to better understand why youth behaviors drive ongoing service and placement decisions.

Public assistance receipt among older youth exiting foster care

There is increasing evidence that youth aging out of the foster care system encounter substantial challenges in their transition to adulthood. Receipt of public assistance following discharge from care is one important indicator of the extent to which these youth experience economic difficulties, but prior research on the topic has a number of key limitations. Building on existing research, this study examines public assistance receipt following exit from care among a cohort of 7492 youth who were discharged from an out of home placement in Los Angeles County between 2002 and 2004 and who were aged 16 or above at their time of discharge. Results show that approximately 28% of youth in the study sample received either CalWORKs, which is California's version of the Temporary Assistance to Needy Families (TANF) program, or General Relief (GR), which is LA County's general assistance program for indigent adults, at some point over the study's follow-up period. Additionally, “crossover youth,” who have a history of involvement in both the child welfare and juvenile justice systems are more likely than their counterparts who were only involved in the child welfare system to receive both types of public assistance. Differences in the risk profiles for GR and CalWORKs receipt centered around gender, as males were far less likely to receive CalWORKs but more likely to receive GR. Findings from this study provide additional evidence that older youth who age out of or otherwise exit foster care struggle to achieve economic self-sufficiency and also suggest that crossover youth constitute a distinct sub-group of youth exiting foster care who should be targeted for specialized forms of assistance.

Understanding extended involvement with the child welfare system

Abstract This exploratory study investigates the child, family, and system factors related to extended length of stay in out of home placement. Using a statewide sample of 1501 children and youth (ages 3 to 21 years) who had been in foster care for at least 37 months, we created three categories according to the years they had been in continuous foster care: 3–5 years, 5–9 years, and 9 or more years. Collectively, descriptive findings indicate the majority were African American, male, and living in non-kin family foster home settings and that their primary placement goal was adoption. When examined as separate groups by length of stay, placement settings are increasingly restrictive and placement objectives diverged from permanency-focused goals. A multinomial logistic regression analysis was conducted using the lower long staying group (3–5 years) as the reference group. Inferential findings showed that several child and parent related risk factors were associated with greater odds of lengthier stays in out of home care, along with race (African American) and gender (male).

Arab Parents' Attitudes toward Out-of-Home Placement of Their Adult Children with Psychiatric Disability

Background: The decision of out-of-home placement for the Arab population is a very stressful event that sometimes causes a real crisis situation for them, because of cultural assumptions and attitudes against placement. The tradition in the Arab culture is to take care of their offspring at home, no matter how serious the situation is. Mental health is also a case of chronic illness and it is very important for us to understand who are those who are willing to place their adult child and what the factors are that make them to do this decision. Better understanding will lead to better use of the services that the state offers them. The rate of placement in Arab society remains significantly lower than among the Jewish population of Israel. The aim of this study was to examine the attitudes of Arab parents who have an adult son or daughter with a psychiatric disability toward out-of home placement. Method: A convenience sample of 189 parents of adult children with a mental disability from the Arab population of Israel. The questionnaires included were assessing social support, emotional stress, cognitive appraisal of the situation, and various socio-demographic characteristics. Results: Parents who chose home placement reported being in a better financial position and were more religious than parents who chose out-of-home placement. Parents who chose to care for their children at home had a significantly higher perception of this as a challenge. The decision regarding the child's placement appears to depend mainly on the parents' education and financial situation. Conclusions: Financial situation, social support and perceiving the illness as a challenge are the most important factors in the process of the decision.

Suicide Ideation, Depressive Symptoms, and Out-of-Home Placement Among Youth in the U.S. Child Welfare System

The objectives of this study were to describe the association between type of placement, depressive symptoms, and suicide ideation among a sample of youth (7 years and older) as they entered the child welfare system and to examine the longitudinal effect of prior out-of-home placements and prior depressive symptoms on subsequent suicide ideation among these at-risk youth. Results supported a statistically significant association between prior depressive symptoms and subsequent suicide ideation, after adjusting for prior suicide ideation and prior out-of-home placements. Tests of mediation supported the role of prior depressive symptoms as a mediator between prior out-of-home placements and subsequent suicide ideation. These results suggest that youth who enter the child welfare system and are put in an out-of home placement may be at an increased risk for depressive symptoms, which in turn may increase their risk for suicide ideation.

Shifting definitions of emotional maltreatment: An analysis child welfare investigation laws and practices in Canada

Objective Although there is growing evidence that the emotional dimensions of child maltreatment are particularly damaging, the feasibility and appropriateness of including emotional maltreatment (EM) in child welfare statutes continues to be questioned. Unlike physical and sexual abuse where investigations focus on discreet incidents of maltreatment, EM is not as easily defined and delimited. Through a review of legislation and child welfare investigation practices in Canada, this paper examines (1) whether Canadian child welfare services respond to EM with the same level of perseverance as with other forms of maltreatment and (2) the extent to which the introduction in 2008 of a more specific EM taxonomy distinguishes between EM and family problems that could lead to EM. Method Following an analysis of the legislative framework for EM across Canada, investigations practices in Canada are examined using data from the 1998, 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Using data from the 2008 cycle, EM investigations are compared to other maltreatment investigations for all of Canada ( N = 15,980). Changes in EM investigations over time are then compared using data from the three cycles of the study, excluding Québec because of limited data availability in 2003 ( N = 5,360 in 1998, 11,562 in 2003 and 14,050 in 2008). Results EM is included as a form of reportable maltreatment in all provincial and territorial statutes in Canada. Over 11,000 cases of EM were substantiated in Canada in 2008, at a rate of 1.86 cases per 1,000 children. While EM investigations were substantiated at a lower rate as other forms of maltreatment, a higher proportion of EM cases were referred for specialized services, kept open for on-going child welfare services, lead to an out of home placement, and lead to an application to child welfare court. Using a broad definition of EM the number of investigations classified as EM in Canada, excluding Québec, nearly tripled from 1998 to 2003. In 2008, using more specific definitions focusing on caregiver definitions, the number of investigations classified as EM nearly returned to their 1998 level, with nearly twice as many cases being classified as risk of future maltreatment. Conclusion EM is a well established category for child welfare intervention in Canada, however, more emphasis should be given to distinguishing between EM and family problems that place children at risk of EM.

Examining the Social, Emotional and Behavioral Needs of Youth Involved in the Child Welfare and Juvenile Justice Systems

This study assesses the social, emotional and behavioral symptoms of 2,575 youth who were receiving behavioral health services from a private provider agency, either in an out of home placement (e.g., foster care home, a group home or a residential treatment facility) or in their own home (through the In-Home Services Program). the findings suggest the prevalence of symptoms in each of the domains (i.e., conduct problems, emotional problems, ADHD, and peer problems) were relatively high compared to the general population. Over 50% of the youth had conduct problems in the borderline or abnormal range, more than 35% had hyperactivity and peer problems subscale scores in the borderline or abnormal range, and almost 25% of the youth reported symptoms of emotional problems in the borderline or abnormal range. Youth's social, emotional and behavioral problems varied by gender, race/ethnicity and age group.