Outcomes For Children In Care Research Articles

Is the Care System to Blame for the Poor Educational Outcomes of Children Looked After? Evidence from a Systematic Review and National Database Analysis

It is recognised internationally that children in out-of-home care (‘children in care’ or ‘children looked after’) generally have lower educational attainments than other pupils. This article provides two forms of evidence that challenge the view that care status in itself can explain this ‘attainment gap’. A systematic review of 28 studies was conducted to assess the evidence on whether being in care is detrimental to young people's educational outcomes. This is complemented by an analysis of administrative data from England, which compares the educational outcomes of children in care at age 16 to those of children in the general population and to other children supported by social services. Taken together, the findings suggest that while research demonstrates an important attainment gap between children in care and children in the general population, this difference is reduced and in many cases disappears when other important factors are taken into consideration to reduce selection bias. We find little evidence that being in care is detrimental to the educational outcomes of children looked after, but suggest that given the heterogeneity of the population, special attention should be paid to different groups of children and their particular needs while in care.

Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial

ObjectiveTo determine the effectiveness of the Spirometry 360 distance learning quality improvement (QI) program for enhancing the processes and outcomes of care for children with asthma. MethodsCluster randomized controlled trial involving 25 matched pairs of pediatric primary care practices. Practices were recruited from 2 practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network, Seattle, Wash. Study participants included providers from one of the 50 enrolled pediatric practices and 626 of their patients with asthma. Process measures assessed included spirometry test quality and appropriate prescription of asthma controller medications. Outcome measures included asthma-specific health-related quality of life, and outpatient, emergency department, and inpatient utilization for asthma. ResultsAt baseline, 25.4% of spirometry tests performed in control practices and 50.4% of tests performed in intervention practices were of high quality. During the 6-month postintervention period, 28.7% of spirometry tests performed in control practices and 49.9% of tests performed in intervention practices were of high quality. The adjusted difference-of-differences analysis revealed no intervention effect on spirometry test quality. Adjusted differences-of-differences analysis also revealed no intervention effect on appropriate use of controller medications or any of the parent- or patient-reported outcomes examined. ConclusionsIn this study, the Spirometry 360 distance learning QI program was ineffective in improving spirometry test quality or parent- or patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or may need to be tailored for those with higher baseline performance.

Dialogic literary gatherings and out‐of‐home child care: Creation of new meanings through classic literature

AbstractResearch on out‐of‐home child care has revealed that foster care programmes focused on educational attainment and reading have the potential to improve the academic outcomes of children in care. However, no studies have examined which elements of these programmes positively benefit children's emotional well‐being. This article presents evidence of the positive effects of implementing a successful educational action, dialogic literary gatherings, in a children's residential care institution. A qualitative study using a communicative‐oriented methodology was conducted and involved five participant observations and eight daily life stories with children in out‐of‐home care in Catalonia (Spain). The children's reflections demonstrated that reading classic books, such as Dickens' Oliver Twist, deeply influenced their feelings and self‐conceptions and created new and exciting meaning in their lives.

Using Linked Administrative Data to Examine the Educational Outcomes of Children in Care in Manitoba

ABSTRACT
 ObjectivesManitoba has one of the highest rates of children in out-of-home care in the world. Our aims were to: 1) describe characteristics of children in care; 2) determine differences in educational outcomes for children in care, children receiving in-home protection services and children not involved with child welfare; and, 3) identify factors contributing to educational success for children in care.
 ApproachPopulation-level administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy, were used. Several data sources were linked together at an individual level: child welfare services (e.g., in care, in-home services; hospital birth records (e.g., birth weight, gestational age); health status (e.g., from hospitalizations, physician visits); family risk factors (e.g., maternal prenatal smoking and/or drinking, maternal education); family characteristics (e.g., number of children in family, receipt of income assistance); education assessments at kindergarten, grades 3, 7, 8, 9 and 12. Children in care from 1998 onward were included. Number of children analyzed differed depending on the educational outcome examined: e.g., analyses at kindergarten include 1,893 children in care, 4,229 children receiving in-home services, and 32,280 children not involved with child welfare services; for high school completion these numbers were 11,234, 40,671, and 162,265 respectively. Multivariate regressions identified characteristics associated with educational outcomes for children in care.
 ResultsOver one-third of children in care first entered care as infants, and of those, close to half were apprehended at birth. 5.5% of children in Manitoba spent some time in care before their 15th birthday, with an almost tenfold difference for Indigenous (16.6%) and non-Indigenous (1.7%) children. Across the range of educational outcomes, children in care did more poorly than children receiving in-home services, who in turn did more poorly than children with no child welfare involvement. For example, only 33.4% of children in care completed high school compared to 66.8% of children receiving in-home services and 89.3% of children with no child welfare involvement. Adjusting covariates reduced differences but all remained statistically significant. Factors associated with positive outcomes for children in care differed depending on the outcome and included measures like poverty (at Kindergarten, p<0.05; at high school, p<0.0001) and total number of care placements (at Kindergarten, p<0.05; at grade 9, p<0.01).
 ConclusionsChildren in care are at risk of experiencing poor educational outcomes, from school entry onwards. Identifying factors associated with educational success for children in care can inform policy and program development.

Outcomes for children in care

Outcomes for children in care

“Could an Increased Focus on Identity Development in the Provision of Children’s Services Help Shape Positive Outcomes for Care Leavers?” A Literature Review

ABSTRACTThe focus for this literature review developed from reading American research by Oyserman and Destin around the theme of identity and possible selves. The intention of this review was to consider whether an identity-based perspective could be applied to investigate the multiple outcomes of UK care leavers. The aim was to explore the relevant literature to consider whether an increased emphasis on identity development in the provision of children’s services could help increase positive outcomes for care leavers. Children’s Services in this review is taken to mean all agencies involved in the provision of services to children and young people in and leaving care. Although outcomes for children in care have improved in recent years, there still remains a large widening gap between these and the outcomes for all children. Therefore understanding differences in how young people manage, can provide important policy and practice implications. The majority of articles reflected an interpretative epistemology where a phenomenological approach was used to gain data relating to the “lived experience” of the participants. A key objective was therefore to conduct a critical interpretive analysis of the literature using an ecological approach to uncover answers to the research question.

Effects of a book gifting programme on literacy outcomes for foster children: A randomised controlled trial evaluation of the Letterbox Club in Northern Ireland

The poor educational outcomes of children in care are a significant concern internationally. Whilst there have been many interventions developed to address this problem, very few of these have been rigorously evaluated. This article presents the findings of a randomised controlled trial that sought to measure the effectiveness of a book gifting programme (the Letterbox Club) that aims to improve literacy skills amongst children aged 7–11years in foster care. The programme involves children receiving six parcels of books sent through the post over a six-month period. The trial, which ran between April 2013 and June 2014, involved a sample of 116 children in Northern Ireland (56 randomly allocated to the intervention group and 60 to a waiting list control group). Outcome measures focused on reading skills (reading accuracy, comprehension and rate) and attitudes to reading and school. The trial found no evidence that the book-gifting programme had any effect on any of the outcomes measured. Drawing upon some of the emergent themes from the accompanying qualitative process evaluation that sought to determine foster carer/child attitude towards and engagement with the parcels, it is suggested that one plausible reason for the ineffectiveness of the Letterbox Club, as intimated by carers and children (rather than explicitly explored with them), is the lack of support provided to the carers/children in relation to the packs received. Reflective of an ecological model of children's development, it is recommended that for book-gifting programmes to be effective they need to include a focus on encouraging the direct involvement of foster carers in shared literacy activities with the children using the books that are gifted.

A Case Series of Acquired Drug Resistance-Associated Mutations in Human Immunodeficiency Virus-Infected Children: An Emerging Public Health Concern in Rural Africa

The acquisition of drug-resistance mutations among African children living with in human immunodeficiency virus on antiretroviral treatment has been scarcely reported. This threatens the overall success of antiretroviral programs and the clinical outcomes of children in care. We present a well characterized series of children from rural Tanzania with acquired drug-resistance mutations to contribute to the better understanding of this emerging public health concern.

Exploratory analysis of child protection mediation permanency placement outcomes

Using a merged data set constructed from empirical data obtained from Child Protective Services (CPS) and a nonprofit agency tasked with conducting an evaluation of a child protection mediation pilot project in the state in which this study was conducted, this study (N=311) explores how various child and family factors in child protection mediation cases affect placement outcomes for children in care. Results of the multinomial logistic regression (MLR) analyses found that children for whom parent/caregiver substance abuse and/or mental illness was an issue were less likely to be reunified with their parents than remain in care. Those children who experienced a higher number of placements and those who were male were less likely to be placed with relatives. Children whose parents experienced mental health issues were less likely to be placed with a relative. With regard to the permanency outcome of adoption, the findings showed that as the age of the child at time of removal increased, children were less likely to be adopted than remain in care. Additionally, African American children in the sample were less likely to be adopted.

Groupwork for Parents whose Children are in Care: Challenges and Opportunities

Until recently, the focus for child protection in NSW has been on risk assessment, supportive measures for parents, and ‘the best interests of the child’. The needs of the birth families, once their children have been removed have not received the same attention. An emerging body of research indicates a growing awareness of the importance of the link between good outcomes for children in care and positive ongoing links with their birth parents. Biological parents of children who have been removed invariably continue to have parenting relationships, if not with the removed child, then with subsequent birth children, step children and children in their extended family. Service provision for this group of parents is critical given the complexity and scale of their emotional needs, and the implications for the children they will care for. In this paper, we describe one such intervention: Kids in Care, a group program offered at Relationships Australia NSW, and consider the arising issues and dilemmas for both parents and group workers. Developed to address the particular needs of parents whose children have been taken into care, the group creates an environment of acceptance and support. This opens up possibilities for parents to consider issues of grief, stigma and trauma, as well as to develop skills in communication, assertiveness and emotional regulation.

Did Increased Availability of Pediatric Palliative Care Lead to Improved Palliative Care Outcomes in Children with Cancer?

Awareness for pediatric palliative care in children with cancer increased in the last ten years in Germany. In this study we sought to determine whether this change in awareness led to improved palliative care outcomes in children dying due to cancer. In 2005 we interviewed a cohort of 48 bereaved parents who had a lost a child to cancer approximately five years earlier (2000 cohort), and in 2010 we interviewed another cohort of 48 parents who had lost a child due to cancer approximately five years before (2005 cohort). Children of the 2000 cohort were cared for by six specialized oncology departments in North-Rhine-Westphalia (NRW), Germany, and children of the 2005 cohort by 16 specialized pediatric oncology departments in NRW, Germany. Parents of both cohorts were interviewed using the Survey of Caring for Children with Cancer (SCCC). The children of both parental cohorts were similar in terms of disease characteristics and sociodemographic variables. Children suffered in a very similar manner from core symptoms such as pain and dyspnea. However, symptom treatment increased for all symptoms. In case of treatment of anxiety the increase was statistically significant (p=0.035). Location of care changed with almost three-quarters of the 2005 cohort receiving palliative home care, significantly more than in the 2000 cohort (p=0.007). Additionally, fewer children of the 2005 cohort died in the intensive care unit. While the location of care during the end-of-life period shifted (from hospital to home), there remains substantial work to ease the suffering in children with cancer at end of life.

AB1207 Increasing quality of JIA treatment: The pediatric rheumatology care and outcomes improvement network (PR-COIN)

BackgroundChildren with juvenile idiopathic arthritis (JIA) do not receive optimal care. There is wide variation in selection of treatment, adherence with published guidelines, and the use of evidence-based care delivery...

What matters in fostering adolescents?

The White Paper Care Matters: Time for change (2007) sets out the British government's plans to improve outcomes for children in care. For example, a tiered model of placement types, structured around the level of complexity of children's needs, will inform placement commissioning. However, on the whole the White Paper does not differentiate between the needs of children according to age, even though evidence suggests that providing foster care for adolescents can be more challenging and complex than providing care for younger children. Drawing on a longitudinal study of adolescent foster care, this paper highlights some of the needs specific to adolescents, as opposed to younger children; the skills and strategies that carers need to develop to care for adolescents and the supports that children's services and other agencies should provide for such placements. The paper argues that increased attention to these issues would assist in sustaining the placements of the great majority of fostered young people who will not have access to highly specialised treatment foster care.

National pediatric cardiology quality improvement collaborative: Lessons from development and early years

The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) was established by the Joint Council on Congenital Heart Disease to dramatically improve the outcomes of care for children with congenital heart disease (CHD) through a national collaborative network of multidisciplinary clinical teams and families, working together to collect longitudinal data, use improvement science methods and conduct research intended to accelerate the development and translation of new knowledge into practice. The initial project selected for this learning network is focused on care processes and outcomes of the initial interstage period for infants with hypoplastic left heart syndrome. A practice-based registry is being used to understand variation in care and outcomes of infants and children with complex CHD. The NPC-QIC has effectively recruited and engaged a large number of U.S. centers caring for infants with complex CHD and provides the infrastructure needed to support the implementation of practice changes across the collaborative that will ultimately improve outcomes in this high-risk group of patients. We describe here the development and early years of NPC-QIC as well as the challenges this collaborative faces moving forward.

Part of the family: Planning for permanence in long-term family foster care

There are concerns for the stability and outcomes for children in care amongst policy makers in England and many other countries. The goal of permanence for children separated from their birth families and in the care of the state has dominated child care policy and practice in the UK, the USA and Canada since the 1980s, but the meanings of permanence in terms of stability, emotional security and family membership into adulthood are complex and the placements and legal status thought best able to achieve permanence are contested. This research was an investigation of planning for permanence in long-term foster family care in England, where it is accepted by policy makers that this is a legitimate permanence option. The aim was to consider the fit between the planning and reviewing systems designed to achieve permanence in foster care and the reality of planned permanent placements as experienced by foster children and foster carers. Results suggested that although committed relationships within the foster family were helping children to feel a sense of permanence and to become part of the family, planning and reviewing procedures required by corporate parenting were often not adapted to the special nature of these foster placements. It was concluded that although planning and reviewing systems need to be rigorous, they also need to be more child and family sensitive in permanent placements. ► Long-term foster family care can be a legitimate permanence option. ► Committed foster families enable children to feel fully part of the family. ► Planning and reviewing procedures need to adapt to permanent foster placements. ► Permanence procedures must be rigorous, but sensitive to the needs of each child.

Achieving Positive Outcomes for Children in Care - By Sean Cameron and Colin Maginn

British Journal of Special EducationVolume 38, Issue 3 p. 156-156 Achieving Positive Outcomes for Children in Care – By Sean Cameron and Colin Maginn Helen McCloskey, Helen McCloskey Adoptive parent and assistant advisory officer, Western Education and Library Board, Omagh, Co. Tyrone.Search for more papers by this author Helen McCloskey, Helen McCloskey Adoptive parent and assistant advisory officer, Western Education and Library Board, Omagh, Co. Tyrone.Search for more papers by this author First published: 12 October 2011 https://doi.org/10.1111/j.1467-8578.2011.00511_3.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume38, Issue3September 2011Pages 156-156 RelatedInformation

Improving Outcomes for Children and Families: Finding and Using International Evidence

This book is published in the ‘Child Welfare Outcomes’ series, which is tasked with producing publications that ‘draw from original research and current policy debates to help social work managers, policy makers and researchers to understand and improve the outcomes of services for children and young people in need’ (back cover) . The book is an edited volume and showcases the work of a number of research academics and practitioners from a variety of countries who are associated with organisations such as the International Association for Outcome-Based Evaluation on Family and Children's Services (IaOBERfcs, www.outcome-evaluation.org) and the European Scientific Association on Residential and Foster Care for children and adolescents (EUSARF). Both these organisations are concerned with improving the quality of research undertaken with children and families and, in particular, ‘promoting cross-national collaboration on outcome evaluation in the area of health and social services’ (IaOBERfcs). Under this umbrella, researchers are developing expertise in knowing what works within their own countries and across international borders, whilst also being cognisant of the difficulties in applying the results of robust research to ‘real world’ practice. This is welcome and is explored by Cinzia Canali et al. in Chapter Five of the book and is a repeated theme in many other chapters. In the Foreword to this volume, James Whittaker also discusses this issue: Recent contributions from a variety of international investigators and commentators have underscored the fact that the ‘science to service’ gap in children's services is not limited to North America and, indeed, will benefit from cross-national perspectives as many governments struggle with defining and measuring meaningful outcomes for children in care as well as in implementing what might be termed evidence-based or ‘best practices’ (p. 10).

Achieving positive outcomes for children in care

Professional Childcare: When? The Power of Parenting The Pillars of Parenting Managing Challenging and Self-Limiting Behaviour Supporting Adaptive Emotional Development The Education Dimension Psychological Consultation and Support Theory into Practice Into the Future

Participation and health - a research review of child participation in planning and decision-making

Effective child participation in child protection proceedings has proved difficult to achieve in Norway. Although participation is in principle accepted as a human right and something of benefit to children, when children’s health is at stake there is a tendency to view participation in decision-making processes by children as potentially disruptive to their well-being. The purpose of this study is to review the research evidence for effects, positive or negative, of participation on health outcomes for children in care. A scoping review of major health and social work research databases was undertaken. Searches in five databases yielded 1830 studies of which 21 were finally included in this review. Studies were included if a relationship between health and participation was evident from the data presented, even if this was not the main objective in the study at hand. We conclude that when participation is successful, it may have beneficial side effects. Chief among these are that participation may improve children’s safety, increase the success of care arrangements and increase feelings of well-being for children involved. Evidence for long-term effects of successful or failed participation attempts on subsequent health outcomes is however largely absent.

Looked‐after children placed in externally purchased residential care

In the desire to improve outcomes for children in care, the issue of those individuals placed by local authorities in residential establishments run by external agencies has become especially salient. In addition to questions of quality and value for money, there are concerns about children becoming detached from local services, especially as many of the placements selected are outside the local authorities' geographical boundaries. This study looks at 262 children so placed in eight English local authorities. It was found that although there were common presenting problems, such as a need for specialist therapy or to reduce difficult behaviour, the children's circumstances varied and four distinct groups of children with common needs were identified. The use of such placements also varied across the authorities and did not mirror their numbers of children in care. The factors associated with the use of externally purchased residential placements and differences between those placed internally and externally are explored. A framework for developing new approaches for difficult adolescents and suggestions about fruitful service development are offered.