Placement Breakdown Research Articles

The Role of the State in Community-Led Welcome: Lessons from Homes for Ukraine

AbstractCommunity-led routes to welcome refugees and migrants, such as community sponsorship, are often viewed as the devolution of the state’s resettlement and integration responsibilities to non-governmental actors. Yet, there remains a significant role for the state. This paper outlines the role of central, regional, and local government in community-led welcome by drawing from learning from Homes for Ukraine in the UK and the engagement of UK local authorities in the scheme using theories of the multi-level governance of migration. Launched in March 2022 in response to the Russian invasion of Ukraine, Homes for Ukraine allows sponsors to ‘name’ Ukrainians to host in their homes for a minimum of 6 months. While the public and community support for the scheme was unprecedented, our analysis shows the state plays a key role in the scheme. The central government retains overall control of the scheme’s governance by regulating immigration status and the funding parameters for support. Local authorities have specifically defined responsibilities, including checking sponsors’ suitability, wider integration responsibilities, and acting as a ‘backstop’ in case of placement breakdown or beyond the lifetime of the support programme. Ultimately, we suggest that whilst community-led welcome widens the scope of actors involved in resettling and integrating newcomers, it cannot be viewed solely as a community alternative to government-led refugee resettlement and integration. Instead, we propose a conceptualisation of community-led welcome as an approach to resettlement and integration which requires effective multi-level governance for it to offer a durable solution to refugees and newcomers.

Preventing risk of placement breakdown and hospital admission in the management of distressed behaviour in dementia care: A qualitative case study with family and care-home staff.

Objectives: Behaviours such as hitting-out and declining personal care are commonly exhibited by people living with dementia and are associated with care-giver stress and anxiety and care home placement breakdowns. Traditionally, pharmacological approaches have been used to manage behaviour; however, research indicates limited effectiveness. National guidelines recommend use of non-pharmacological interventions as first line treatment for distress, but further research is required to elucidate the components that lead to improved care for people living with dementia. This study aims to explore what works, examining case studies in which a non-pharmacological clinical intervention, the Newcastle Model, was used to understand and manage distressed behaviour in dementia care within care home settings. Method: A qualitative case study design was used. Three cases were selected from the Edinburgh Behaviour Support Service for their success in preventing care home placement breakdown during a distressed behaviour intervention in NHS Scotland. Family members and staff involved in the interventions within these cases were interviewed (N = 6). Thematic analysis was used to analyse data. Findings: All participants reported positive outcomes from the intervention. Three key themes were identified, each with subthemes. Participants described a supportive, non-judgmental environment which allowed them to integrate knowledge about dementia and tailor interventions to the specific needs of the individual living with dementia. There was also a sense of family and staff coming together to unite with shared goals. A preliminary model of all of themes and their interactions is presented. Conclusion: The study supports use of biopsychosocial, formulation-led approaches in the understanding and treatment of complex behavioural presentations in community care settings. It suggests that clinicians should endeavour to facilitate safe and open environments for care home staff and family members, in order to promote attribution change and person-centered care, and to help mediate differences and conflict between staff and family members.

Keeping Siblings in Care Connected: Improving Relationship Stability via the Mockingbird Family Model

ABSTRACT Children and young people in Australian foster or kinship care are separated from their siblings for a range of reasons. These may include issues that are behavioural, sibling-related, the capacity of carers to host multiple children, or policies that enforce a one-child-per-bedroom rule. This study investigated strategies enhancing stability and meaningful connections among siblings within the Mockingbird Family, a social network model of foster and kinship caring. Case examples, network mapping, and visualisation of the Mockingbird Family networks are presented alongside results from thematic analysis of qualitative data. The findings suggest that the Mockingbird Family facilitates meaningful contact and sibling connections, even when coplacement was not possible. Sibling coplacement and contact provide crucial benefits such as emotional support, stability, shared experiences, and a sense of belonging, contributing to children’s and young people’s development, healing from trauma, and overall wellbeing. IMPLICATIONS Keeping sibling groups connected and in contact can reduce placement breakdown and contribute to their overall wellbeing. The Mockingbird Family model of foster care provides a range of options for keeping siblings meaningfully connected through coplacement within the same constellation and opportunities for other siblings to join in Mockingbird Family activities.

Professional quality of life of Australian Mockingbird FamilyTM foster carers: Compassion satisfaction, burnout, and secondary traumatic stress

BackgroundChildren’s behaviours and support system typology are potential predictors of foster carer compassion satisfaction, burnout, and secondary traumatic stress (i.e., Professional Quality of Life, ProQOL). Little is known about the ProQOL of Mockingbird FamilyTM foster carers compared to foster carers caregiving as usual. ObjectiveThis study aimed to: Examine ProQOL of Mockingbird FamilyTM carers compared to other carers; Explain associations between ProQOL, demographic characteristics, and determinants of ProQOL.Participants and setting: Two groups were studied: Mockingbird FamilyTM carers (n = 27) and other carers (n = 89) of children < 18yrs. The sample was drawn from a single registered foster care agency following implementation of the Mockingbird FamilyTM in Australia. MethodsCross-sectional, comparative mixed method design. Participants completed self-report questionnaires incorporating demographic questions, ProQOL instrument developed by Stamm (2010), and qualitative questions, analysed using SPSS 28.01 and thematically. ResultsPearson correlation, t-test and ANOVA showed Mockingbird FamilyTM carers had a better ProQOL compared to carers caregiving as usual, with associations identified between ProQOL and socio-demographic aspects including gender, ProQOL and foster caring experience, and ProQOL and carers’ engagement of the children in community activities. Qualitative data showed that communication, relevance of training, and the quality of statutory and agency supports to members of the Mockingbird FamilyTM were key determinants of ProQOL. ConclusionsOur findings showed that the Mockingbird FamilyTM model of foster care may improve the ProQOL of carers, compared to carers undertaking caregiving as usual. We recommend further research to examine associations with placement breakdown and carer attrition rates.

Placement breakdown in Flemish family foster care for unaccompanied refugee minors. Experiences of non-kinship foster parents

This qualitative study using semi-structured interviews with twelve foster parents who took care of unaccompanied refugee minors (URM; mainly Afghan boys aged 15 to 16 years old) examines two research questions: “How do non-kinship foster parents of Caucasian ethnicity experience placement breakdown of unaccompanied children?”, and “What could have prevented placement breakdown?” Foster parents perceived breakdown as a failure and reported a major emotional impact on themselves, their children and on their family life. Although most of them thought breakdown could not have been avoided, three factors were reported: not assigning a study grant if the youngster is going to live independently, more psychological support for the URM, and connections to potential individuals or support systems who share the youths’ culture and traditions and who support the placement. All foster parents described multiple and various difficulties related to the care system, the URM and the social context that troubled the foster placement. Based on the experiences of foster parents several implications for practice and policy were formulated such as a better preparation, training and matching of the foster family and the URM, care planning that includes the needs of foster carers, their biological children and the URM for specialized support and adapted care; facilitating fellow contacts for foster parents and URM; organizing specialized training for foster care workers, and developing a post-intervention program for foster families who experienced breakdown.

Holding a foster child’s mind in mind: study protocol for a cluster-randomized controlled trial of mentalization-based therapy (MBT) for foster families

BackgroundChildren in foster care are psychologically vulnerable and show more social, developmental, and behavioral problems than those living with their family of origin. Many foster parents struggle to care for these children, some of whom have experienced severe adversity. Research and theory suggest that developing a strong and supportive foster parent–child relationship is essential for foster children to become more well-adjusted and experience a decrease in behavioral problems and emotional maladjustment. Mentalization-based therapy (MBT) for foster families aims at increasing the reflective functioning of the foster parents, thus promoting the development of more secure and less disorganized child attachment representations, which is subsequently proposed as a factor that reduces behavioral problems and emotional maladjustment in children and promotes their overall well-being.MethodsThis is a prospective cluster-randomized controlled trial with two conditions: (1) the intervention group participating in MBT, and (2) the control group who receive usual care. Participants are 175 foster families with at least one foster child aged 4–17 years with emotional or behavioral problems. The intervention will be offered to foster families by 46 foster care consultants from 10 municipalities in Denmark. The foster care consultants will be randomized to MBT training (n = 23) or usual care (n = 23). The primary outcome is the psychosocial adjustment of the foster child measured by the Child Behavior Checklist (CBCL) as reported by foster parents. Secondary outcomes include child well-being, parental stress, parent mental health, parent reflective function and mind-mindedness, parent/child relations, child attachment representations, and placement breakdown. In order to explore implementation fidelity as well as practitioner experiences, we will administer questionnaires designed for this study and conduct qualitative research exploring the practice of the MBT therapists.DiscussionThis trial is the first experimental study of a family therapeutic intervention based on attachment theory for foster families within the Scandinavian context. This project will contribute with novel knowledge on attachment representations in foster children and the effects of an attachment-based intervention on essential outcomes for foster families and children.Trial registration ClinicalTrials.gov NCT05196724. Registered on January 19, 2022.

The 10-year trajectory of aggressive behaviours in autistic individuals.

Aggressive behaviours are common in people with neurodevelopmental conditions, contributing to poorer quality of life and placement breakdown. However, there is limited empirical research documenting the prevalence and persistence of aggressive behaviours in autism. In this longitudinal study, aggressive behaviours were investigated in a sample of autistic individuals over 10 years. Caregivers of autistic individuals, both with and without intellectual disability, completed questionnaires relating to the presence of aggressive behaviours at T1 [N=229, mean age in years 11.8, standard deviation (SD) 5.9], T2 (T1+3years, N=81, mean age in years 15.1, SD 5.9) and T3 (T1+10years, N=54, mean age in years 24.5, SD 8.1). Analyses examined the presence and persistence of aggressive behaviours and the predictive value of established correlates of aggression. Aggressive behaviours were common at baseline (61.6%) but only persistent in 30% of the sample over 10years. Higher composite scores of overactivity and impulsivity at T1 were significantly associated with the persistence of aggressive behaviours at T2 (P=0.027) and T3 (P=0.012) with medium effect size. Aggressive behaviours are common in autism, but reduce with age. Behavioural correlates of attention deficit hyperactivity disorder (ADHD)predict the presence and persistence of aggressive behaviour and as such may be useful clinical indicators to direct proactive intervention resources to ameliorate aggressive behaviours.

Foster children's perspectives on participation in child welfare processes: A meta-synthesis of qualitative studies.

The objective of this meta-synthesis was to systematically synthesise qualitative research that explores foster children's perspectives on participation in child welfare processes. Searches were conducted in Medline (OVID), Embase, PsycINFO, and Social Science Citation Index. Children in non-kinship foster care in any setting (high-income, middle-income, low-income countries) who self-reported their experiences of care (removal from home, foster family processes, placement breakdown) were eligible for inclusion. Selected studies took place in 11 high-income countries. A total of 8436 citations were identified and 25 articles were included in this meta-synthesis. Studies summarized the views of 376 children. Children had been in foster care between two weeks and 17 years. Findings synthesize 'facets' of children's participation (e.g., being asked vs making decisions), as well as children's perceived barriers and facilitators to participation. A main priority for children was the quality of their relationships, especially in terms of values (e.g., fairness, honesty, inclusivity). No one way of participating in child welfare processes is better than another, as some children more clearly expressed a desire for passive listening roles and others indicated a desire for active roles in decision-making. However, meaningful adults in foster children's lives have a responsibility to act in a way that strengthens the emphasis on children's needs and voices.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Positive parenting in foster care: A video-feedback intervention to promote positive parenting – theory and practice

Foster children are known to be at high risk for developing attachment problems. Moreover, their associated behavioural problems can be a burden for the foster family and increase the risk of placement breakdown. A sensitive parenting style promotes a secure attachment which, in turn, can reduce the chance of difficulties arising and protect against placement disruption. Interventions using video-feedback of parent–child interactions offer a method of increasing parental sensitivity and improving the quality of the parent–child attachment. The intervention discussed in this article was part of a wider initiative, Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), fashioned to promote sensitive parenting, secure attachment and a reduction in children’s behavioural problems. Its effectiveness has been shown for a variety of target groups. A variant of the approach was developed specifically for foster and adopted children, Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline – Foster Care/Adoption (VIPP-FC/A). This article discusses the design and delivery of the intervention and illustrates these with case material.

The development and evaluation of an integrated intensive support service

PurposeThis paper aims to describe the development and evaluation of integrated intensive support service (ISS) for adults with learning disabilities who have complex needs and are at risk of admission to an inpatient unit.Design/methodology/approachExisting services were remodelled. The service explored external service models and established an integrated ISS comprising intensive community support and intensive support beds.FindingsData indicates that the majority of people referred to the service avoid both admission to an inpatient unit and placement breakdown. Most people admitted to the inpatient unit are not known to community services. Length of stay has significantly reduced.Practical implicationsOther services can use the information to remodel how to provide intensive support and avoid admission to an inpatient unit.Originality/valueIt demonstrates how remodelling can drive improvements to reduce placement breakdown and risk of admission.

Prevalence and associated factors of placement breakdown of unaccompanied children in Flemish family foster care. A follow-up study

This study examines the prevalence of placement breakdown in family foster care for unaccompanied refugee minors (URM). Furthermore, it investigates which foster child, foster family and case characteristics are associated with breakdown. Case files of 107 URM who were placed in 2016 in Flemish family foster care (Dutch speaking part of Belgium) were analyzed. In a research window of 2.5 years, 62 placements (57.9%) had terminated: 32 placements broke down (29.9%) and 30 placements ended positively (28.0%). An ongoing asylum procedure and lying or cheating were associated with an increased likelihood of breakdown. Contacts with birth parents, on the other hand, was a protective factor for placement disruption. Therefore, legal authorities should limit the term of asylum procedures, foster care services and guardians must facilitate contacts between the URM and their parents, and the building of trust between youngsters and foster carers should be a central theme in the support process.

Developing trauma-informed care: using psychodynamic concepts to help staff respond to the attachment needs of survivors of trauma

PurposeMany referrals to our mental health of learning disability service focus on concerns about behaviours that present risks to the referred person and to those around them, including support workers. If the referred person has good verbal ability, psychological therapy may be requested and offered, but the person may find it too difficult to engage for a number of reasons. Even when they do engage in therapy, the authors recognise the importance of helping staff better understand their attachment needs. This paper aims to demonstrate an innovative approach to helping staff provide Trauma-Informed Care (TIC).Design/methodology/approachThe authors developed a training programme for support workers using psychodynamic concepts, such as splitting, transference and counter-transference, to help them develop insight into the processes that get enacted during their work. In this paper the authors have generally used the term “care staff”, recognising that an important aspect of the role of those staff is to provide care within an attachment framework; as well as support to maximise independence.FindingsThe feedback from staff who have attended has been very positive, both at the time and later. Staff who have attended have talked to multidisciplinary colleagues about the impact their learning has had on their ability to work with service users who present great challenges, in the context of their trauma histories.Originality/valueThe importance of providing TIC is gaining traction across varied settings. The authors are in the process of developing both qualitative and quantitative research programmes to evaluate this approach to increasing TIC for adults with learning disabilities, reducing staff burn out and placement breakdown.

Perspectives of unaccompanied refugee children, their foster carers and guardians on placement success: Which factors predict multi-informant discrepancies?

This study examined multi-informant discrepancies (between child, carer, and guardian perspectives) regarding placement success of 39 foster placements, as well as possible factors associated with these discrepancies. We also examined whether these discrepancies in placement success at baseline measurement (T0) are related to placement breakdown at second measurement (T1). The results showed that when placements are rated with a high average placement success score (looking at child-carer and child-guardian dyads), the child and carer, as well as the child and guardian generally agree on the success of the foster placement, showing low discrepancy. In contrast, placements with a low average score on placement success show large discrepancies between the perspectives, which may also lead to breakdown. Results of the multilevel analyses showed that discrepancies regarding placement success were mainly associated with differences in perspectives regarding fostering factors (i.e., quality of the caregiving environment, child-carer and child-guardian relationship) and child factors (i.e., conduct problems, emotional problems). The results indicate that children and their carers or guardians disagree more on the success of the placement if they disagree on the quality of the caregiving environment, the child's conduct and emotional problems, and the quality of the child-carer and child-guardian relationship. The outcomes of our study might be especially helpful for guardians in shaping their guidance practices.

Untangling the relationship between early adversity, placement breakdowns, and obesity in a secure adolescent developmental disorder service: A cross-sectional study

BackgroundObesity is a growing global health concern, and those with a developmental disorder are at particular risk. Elevated levels of childhood trauma, placement breakdowns and obesity have been documented in the developmental disorder population, yet their relative associations remain unclear. ObjectiveA previous study (Morris et al., 2020) highlighted a high prevalence of adverse childhood experiences (ACEs) and obesity in adolescents with developmental disorders residing in a secure inpatient setting. The current cross-sectional study sought to further explore the prevalence of placement breakdowns and its relationship with Body Mass Index (BMI) in this sample. MethodsSecondary analysis was conducted on existing data for 34 adolescents, aged 10–17 years at admission, held in a secure mental health hospital developmental disorder service in the United Kingdom (UK) under the Mental Health Act. ResultsAlmost half of participants had experienced a placement breakdown (47.1%), the majority of whom typically experienced multiple breakdowns (M = 3.94, SD = 2.14). Placement breakdowns significantly predicted BMI and had a predictive effect that was independent to and above that of ACEs. ConclusionsPlacement breakdowns significantly contribute to risk for obesity, above that explained by early adversity. Those who have experienced placement breakdowns have a greater risk for obesity, irrespective of their level of exposure to ACEs. A history of previous placement breakdowns may act as a red flag for obesity.

The evolving use of Mentalization informed thinking with the ‘Care Team’ in the Irish statutory child protection system

ABSTRACT This article articulates the development of a novel form of service provision in Ireland directed at supporting Foster placements and Social Work practice with the aim of adverting placement breakdown. Within The Attachment & Mentalization Service model emphasis is placed on supporting the Care Team (i.e. Social Workers, Foster Parents) around children in care in Ireland with the ultimate aim of providing a depth of understanding that is commensurate with the level of relational difficulty experienced by children in care. The service model is underpinned by evidenced informed thinking relating to the knowledge bases of Mentalization, Reflective Functioning, and Alan Schore’s articulation of Co-regulation. Privilege of space is provided to the illumination of the theory of Mentalization and Reflective Functioning with Co-regulation and psychoanalytical concepts of projection and containment also be highlighted. To aid the reader’s digestion of the material a simple, everyday case example is provided.

The incredible years parenting program for foster carers and biological parents of children in foster care: A mixed methods study

Trauma-related social, emotional and behavioral difficulties (SEBD) are common among children in foster care and are the primary reason for placement breakdown. SEBD in foster children – and especially in the context of unstable and troubled relationships with both foster and biological parents - affects the child’s future functioning and has substantial cost implications in terms of public service utilization. The aim of this study was to assess the utility and perceived effectiveness of the 18-week Incredible Years parenting program (IYPP) which was delivered, on an exploratory basis, to both biological and foster parents (including kinship and non-relative care) of 23 foster children (aged 3–10 years). Biological and foster parent pairs (n = 46) were assessed at pre-intervention and at 6-month follow up, using measures of child SEBD, parenting stress, competencies, and quality of child-parent/carer relationships. One-to-one interviews and a focus group were also undertaken with a subset of biological parents (n = 12), foster carers (n = 11) and Social Work clinicians (n = 5) who delivered the program; the findings were analyzed using grounded theory. Both biological and foster parents reported statistically significant improvements in child SEBD, parent–child relationships, and in parenting stress and competencies. The qualitative findings highlighted further benefits for families, such as an increased number of access visits between biological parents and children and improved relationships with Social Work clinicians. Several factors were identified as important when implementing the IYPP with foster children, including: potential difficulties in engaging both foster and biological parents within the Social Work infrastructure; making appropriate adaptations to program principles, and integrating delivery with a trauma-informed approach. These findings contribute to the growing body of evidence that the IYPP could add value to the standard training and supports for foster parents, children and biological parents.

The use of Intensive Interaction within a Positive Behavioural Support framework

Accessible summary Intensive Interaction is an approach that supports the development of essential communication skills, and social and emotional relationships. Positive Behavioural Support (PBS) is a framework for developing the quality of life for people who use challenging behaviour. Intensive Interaction may be used in all the phases within a PBS framework. No previous articles on the use of Intensive Interaction within PBS could be found. The use of Intensive Interaction in PBS is described for three people. AbstractBackgroundPositive Behavioural Support (PBS) provides an overarching framework for supporting quality‐of‐life improvements for people who use challenging behaviour. Rapport, or the lack of it, is well understood as a setting factor for some challenging behaviours. Intensive Interaction is an approach that, among other possible outcomes, can develop rapport and feelings of safety, security and connection.MethodWithin an NHS Trust, the Intensive Interaction Service works in partnership with the Intensive Support Team. We present case descriptions of people who used challenging behaviour and received Intensive Interaction support. Changes are described using staff and family interview data. The Intensive Interaction techniques that helped develop rapport at each PBS phase are described.ResultsIntensive Interaction was used in all PBS phases. It played a role in preventing placement breakdown for one individual.ConclusionIntensive Interaction should be considered at initial assessment within PBS so that immediate and important improvements can be made to the person's social and communication experience. It is hoped that Intensive Support Services and all PBS practitioners will use it.

COVID-19 and people with intellectual disability: impacts of a pandemic.

The impacts of the COVID-19 pandemic affect all groups in society. People with intellectual disability (ID) are especially vulnerable to the physical, mental and social effects of the pandemic. Cognitive impairments can limit understanding of information to protect them relying on carers to be vigilant on their behalf during quarantine. Restrictions on usual activities are likely to induce mental stress especially among those who are autistic leading to an escalation in challenging behaviours, risk of placement breakdown and increased the use of psychotropic medication. People with ID are vulnerable to exploitation by others where the usual community supports no longer function to protect them. In future pandemics, it is important that lessons are learned from the impacts COVID-19 have on people with ID. Collecting the evidence through a rigorous approach should help to empower people with ID and their carers to face future outbreaks of infectious diseases.

PROTOCOL: Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

This is the protocol for a Campbell review. The objectives are as follows: 1.To assess the efficacy of attachment-based interventions on measures of favourable parent/child outcomes (attachment security, dyadic interaction, parent/child psychosocial adjustment, behavioural and mental health problems and placement breakdown) within foster and adoptive families with children aged between 0 and 17 years.2.To identify factors that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (for example, age of the child at placement and at intervention start, programme duration, programme focus).