Placement Stability Research Articles

Teetering on the edge of care: the role of intensive attachment-based play therapies

The number of children and young people who are being adopted is increasing, with moves to place more children for adoption as quickly as possible currently high on the UK Government's agenda. The House of Lords Select Committee on Legislation proposed, in March 2013, that adoptive parents should have a legal right to support, on the basis that support services are ‘critical in ensuring placement stability and in achieving the happy outcomes which adoption is designed to deliver’ (Butler-Sloss, cited by Burns, 2013 ). This article demonstrates how an adoptive family experiencing significant difficulties relating to their child's attachment benefited from an intensive piece of attachment play-based intervention, offered by a Looked After Children's Child and Adolescent Mental Health Service. The work included both the adoptive parents and the child in treatment. The authors advocate that in order to support families looking after children with complex attachment difficulties, a high level of therapeutic support is required from agencies for an extended period of time.

Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention

This study reports on child welfare outcomes of a community based, randomized control trial of Promoting First Relationships® (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008), a 10-week relationship-based home visiting program, on stability of children's placements and permanency status two years after enrollment into the study. Toddlers 10–24months (N=210) with a recent placement disruption were randomized, along with their birth or foster/kin parents, to PFR (n=105) or a comparison condition (n=105). A stable placement had no interruptions or disruptions. A permanent placement was a stable placement ending with a legal discharge to the study caregiver. Logistic regression models predicting the dichotomous stability and permanency variables, controlling for caregiver type, child welfare variables, and caregiver commitment, were conducted. There was no difference by intervention group on stability or permanency, but there was a significant interaction between caregiver type (birth parent vs. foster/kin) and intervention group. More foster/kin caregivers who received the PFR intervention provided stable, uninterrupted care and eventually adopted or became the legal guardians of the toddlers in their care, compared to foster/kin caregivers randomized to the comparison condition.

Sibling Foster Care, Placement Stability, and Well-Being: A Theoretical and Conceptual Framework

Sibling relationships are an important, yet underinvestigated dimension of foster care research. Despite the fact that a majority of children in care have brothers or sisters, only recently have child welfare researchers begun to explore the complex and dynamic nature of sibling relationships in substitute care settings. Although cross-sectional and longitudinal studies suggest differences in stability and permanency outcomes for siblings placed together versus those placed separately, exactly how and under what conditions do sibling relationships positively influence placement stability, permanency, and well-being in foster care settings remains unknown. This article provides a substantive review of the research on sibling foster care, placement stability, and well-being; identifies two theoretical frameworks that may be particularly useful to help explain the intersection of these constructs; and proposes a multilevel conceptual model for advancing research and practice with siblings in foster care.

Neighbor to Family: Supporting Sibling Groups in Foster Care

Neighbor To Family (NTF) is a foster care program that prepares sibling groups for permanency and the future through the use of professional caregivers; extensive training and support for caregivers; a team-based approach which includes family, kin, and caregivers as equal partners; and intentional and aggressive outreach to biological parents and extended family. This article reports on the first controlled study, using a propensity analysis, that compares outcomes for 417 children receiving the NTF service with a matched group of 417 children receiving traditional foster care services. Matching demonstrated significant improvement in placement within county, placement with siblings, stability of placement, time to permanent placement, and cost of care for the children receiving NTF services compared to the children who received other forms of foster care. The studies are discussed in terms of their implications for foster care practice and the use of propensity matching to expand research opportunities.

The stability of child protection placements in Québec, Canada

This is the first Canadian longitudinal study to use province-wide clinical-administrative data to explore the factors most associated with changing out of home placements. Clinical-administrative child protection data were merged with Canadian Census data for the province of Québec and the final dataset included 29,040 children admitted to out-of-home care for the first time between April 1, 2002 and March 31, 2011. Cox proportional hazard results indicate that older youth, specifically those aged 10 to 13years at initial placement, have the highest risk to experience the most placement changes over time. The increased risk of placement changes for older youth was statistically explained by a combination of male gender, behavioral problems, school truancy and school neglect, residential or group care at initial placement, request for youth criminal justice services, number of investigations, and neighborhood area socioeconomic disadvantages. Neighborhood area socioeconomic disadvantages were only considered a statistically significant predictor of older youth changing placements at least three times, but not for younger children, or for youth experiencing fewer placement changes.

Children in foster care: What behaviours do carers find challenging?

BackgroundChildren placed in care because of abuse or neglect can display a range of challenging behaviours that can be difficult for foster carers to manage. While much is known about the prevalence of behavioural disorders among children in care, little quantitative information exists about which behaviours are problematic for carers.MethodTwo hundred and one foster carers of children aged 4–12 were asked to rate a range of potentially problematic behaviours via online survey. Items were drawn from existing clinical measures, a review of the practice literature, and focus group consultation.ResultsPrincipal component analysis yielded four distinct profiles of behaviours that carers identified as problematic. The first component reflected cognitive difficulties (e.g., executive functioning, language, and memory problems). Component 2 comprised sexual or otherwise risky behaviours (e.g., drug or alcohol use). Component 3 contained behaviours of an aggressive, controlling, and violent nature (e.g., enjoying upsetting others). Component 4 contained anxiety‐based behaviours (e.g., obsessive compulsive behaviour). Collectively, these four factors accounted for almost 60% of the variance.ConclusionsFour discrete profiles of problem behaviours were identified. These distinct groups of behaviour serve as a focus for targeting supports that may ultimately help enhance foster placement stability.

Trauma, Abuse and Foster Placement and the Development of ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopment disorder with a multifactorial basis that is derived from the dynamic interplay that exists between genetic and environmental determinants. ADHD childhood symptoms include pronounced hyperactivity, impulsivity and/or a relative lack of ageappropriate executive function. Depression, Obsessive Compulsive Disorder, Bipolar Disorder, Oppositional Defiant Disorder, Conduct Disorder and substance abuse are common comorbid conditions found in ADHD patients. Trauma, abuse and placement stability may contribute to the development course of ADHD. Inadequate sleep hygiene compounded by sleep deprivation may exacerbate the symptoms of ADHD in children, namely, attention difficulties and restless behavior. Instability in foster care placement is often accompanied with childhood disturbances in sleep.

Esthetic Outcomes and Tissue Stability of Implant Placement in Compromised Sockets Following Immediate Dentoalveolar Restoration: Results of a Prospective Case Series at 58 Months Follow-up

The aim of this prospective case series was to evaluate the stability of esthetic treatment after single tooth replacement in compromised sockets using the immediate dentoalveolar restoration (IDR) concept. Eighteen patients underwent immediate implant placement and IDR of bone defects. Clinical photographs were used to evaluate the gingival contour and papillae. The mean soft tissue dimensions at baseline and final follow-up were 12.85 ± 2.33 mm and 12.79 ± 2.48 mm, respectively, revealing no recession. The mean mesial and distal papillary heights increased slightly over time. Stable periimplant soft tissues and satisfactory esthetic outcomes were achieved.

What explains instability in foster care? Comparison of a matched sample of children with stable and unstable placements

This study investigates what characteristics explain placement instability for children in foster care. Using a matched sample of children experiencing stable and unstable placements, bivariate and logistic regression analyses were conducted to identify factors for placement instability. The study also examines specific reasons for placement changes for a group of children who experienced multiple placements. Findings from this study highlight the following three components that contribute to placement stability for children in foster care: a) a caregiver's commitment to a child's legal permanence; b) the absence of a child's mental health diagnosis; and c) placements with a relative caregiver. The findings of the study also illustrate that while system- or policy-related reasons explain the largest proportion of placement changes for children's earlier stay in foster care, a majority of placement changes are attributed to either foster family-related or child behavior-related reasons over time. Implications of these findings are discussed.

Educational outcomes for adults formerly in foster care: The role of ethnicity

Abstract Focusing on Hispanics and using data from the Casey National Foster Care Alumni Study, this paper examines the impact of ethnicity and other predictors on educational outcomes of adults placed in family foster care as children/youth. Though 88% of the alumni completed high school with a diploma or a GED, less than 10% obtained bachelor's degrees or higher. Regression models indicated that ethnicity did not predict outcomes. Physical/learning disabilities, placement in care due to child maltreatment, younger age at entrance into child welfare, less time in care, instability in care, less preparation for leaving care, and younger age at the time of the study interview predicted lower educational outcomes. Findings are interpreted and the importance of stability of placement, continuity of services, and transition-to-independence services are discussed.

Foster Children With Autism Spectrum Disorder: Prevalence, Length of Stay, and Placement Patterns

The goals of this study are to identify the prevalence of children with autism spectrum disorder (ASD) entering out-of-home care and to focus attention on length of stay and placement stability. To achieve these goals, this study links Illinois administrative data with Medicaid records. Overall, 2.4% of the sample has a diagnosis of ASD. The median length of stay for children with ASD is 1.6 times longer than children without ASD. A latent class analysis identifies three distinct profiles of movement: escalating, de-escalating, and continuous. Study findings are discussed in the context of service needs of children with ASD.

Long-term Stability of Early Implant Placement with Contour Augmentation

In this prospective case series study, 20 patients with an implant-borne single crown following early implant placement with simultaneous contour augmentation were followed for 6 years. Clinical, radiologic, and esthetic parameters were assessed. In addition, cone beam computed tomography (CBCT) was used at 6 years to examine the facial bone wall. During the study period, all 20 implants were successfully integrated, and the clinical parameters remained stable over time. Pleasing esthetic outcomes were noted, as assessed by the pink esthetic scores. None of the implants developed mucosal recession of 1 mm or more. The periapical radiographs yielded stable peri-implant bone levels, with a mean DIB of 0.44 mm at 6 years. The CBCT scans showed that all 20 implants had a detectable facial bone wall at 6 years, with a mean thickness of around 1.9 mm. In summary, this prospective case series study demonstrated stable peri-implant hard and soft tissues for all 20 implants, and pleasing esthetic outcomes overall. The follow-up of 6 years confirmed that the risk for mucosal recession is low with early implant placement. In addition, contour augmentation with guided bone regeneration (GBR) was able to establish and maintain a facial bone wall in all 20 patients.

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

BackgroundU.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. Data and methodsWe assembled a unique, longitudinal, state-level panel dataset (1990–2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. FindingsState foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2year-olds, 58% for 9year-olds, and 65% for 16year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, >50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates. ConclusionsDespite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services.

Three-Year Follow-Up of a Single Immediate Implant Placed in an Infected Area: A New Approach for Harvesting Autogenous Symphysis Graft

Three-Year Follow-Up of a Single Immediate Implant Placed in an Infected Area: A New Approach for Harvesting Autogenous Symphysis Graft

Physical Health Status as a Predictor of Treatment Outcomes Among Youth in Residential Care

In addition to complex behavioral and emotional issues, youth presenting to residential care tend to have higher rates of physical health conditions than those in the general population. Although a strong body of research has found a relationship between physical and mental health, the influence of health status on youth residential care outcomes has not been explored. This study examined the impact of poor physical health on mental health treatment outcomes in a sample of 1,735 youth entering residential care from 2000 to 2010. At intake, youth received medical evaluations identifying physical health conditions, medication prescriptions, and anthropometric measurements. Residential care outcomes were measured by changes in 1-year National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children–IV mental health diagnoses and discharge setting. Rates of school dropout and placement stability were also examined 6 months after discharge. Results suggest that factors related to poor physical health, specifically nonpsychotropic medication prescriptions, are associated with suboptimal mental health outcomes at 1 year, discharge, and follow-up from residential care. These findings indicate that physical health issues adversely impact residential care outcomes, suggesting these youth may require specialized services, such as integrated treatment planning, to achieve optimal treatment outcomes.

Understanding Foster Placement Instability for Looked After Children: A Systematic Review and Narrative Synthesis of Quantitative and Qualitative Evidence

Ensuring the stability of foster placements for looked after children is a priority for social services. Many previous studies have highlighted the negative psychological, social and academic consequences of placement breakdown for foster children, but less is known about how services can effectively promote placement stability. A systematic review and narrative synthesis of research examining correlates of placement moves and breakdown were undertaken in order to inform practice in this area. Qualitative studies were included alongside quantitative research, providing additional insights into the processes that facilitate and impede placement stability. Correlates of increased placement instability with the strongest evidence included older age of children, externalising behaviour, longer total time in care, residential care as first placement setting, separation from siblings, foster-care versus kinship care and experience of multiple social workers. Key protective factors included placements with siblings, placements with older foster-carers, more experienced foster-carers with strong parenting skills, and placements where foster-carers provide opportunities for children to develop intellectually. Following from these findings, a conceptual framework is proposed that distinguishes vulnerability and protective factors as well as background and immediate factors. Implications for front line social work practice, including the development of manualised tools, are discussed.

Patterns of out-of-home placement decision-making in child welfare

Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state's child welfare system by comparing two models of placement decision-making: a multidisciplinary team decision-making model and a clinically based decision support algorithm. Based on records of 7816 placement decisions representing 6096 children over a 4-year period, hierarchical log-linear modeling characterized concordance or agreement, and discordance or disagreement when comparing the two models and accounting for age-appropriate placement options. Children aged below 16 had an overall concordance rate of 55.7%, most apparent in the least restrictive (20.4%) and the most restrictive placement (18.4%). Older youth showed greater discordant distributions (62.9%). Log-linear analysis confirmed the overall robustness of concordance (odd ratios [ORs] range: 2.9–442.0), though discordance was most evident from small deviations from the decision support algorithm, such as one-level under-placement in group home (OR=5.3) and one-level over-placement in residential treatment center (OR=4.8). Concordance should be further explored using child-level clinical and placement stability outcomes. Discordance might be explained by dynamic factors such as availability of placements, caregiver preferences, or policy changes and could be justified by positive child-level outcomes. Empirical placement decision-making is critical to a child's journey in child welfare and should be continuously improved to effect positive child welfare outcomes.

SU-E-T-294: Biological Effect of Motion On Fractionated Dose Delivery: Statistical Analysis and Simulation

Purpose: To analyze and validate with simulation with radiobiological effect of motion on dose delivery. To reveal the impact of motion pattern, dose modulation level and fractionation pattern on this effect. Methods: Cell survival fraction was modeled according to the LQ. We derived the contribution from instantaneously received dose caused by movement by tracking the trajectory of each cell subvolume, and utilized a first order perturbation approach to analyze its integral effect. The local instantaneous dose was modeled as a nonstandard Gaussian process by taking interfraction setup as fractionwise constant and intrafractional motion to be normally distributed. The analysis was performed as a function of spatial location to account for variations in radiobiological property and dose pattern. We derived the expected value to the biological effect and revealed the factors and their impact on the motion‐induced discrepancy from expected biological effect. Numerical simulation was performed to verify the analysis. Results: The discrepancy between the motion‐affected and expected radiobiological effect (in terms of biological effective dose) was revealed to scale quadratically with the local dose gradient, the standard deviation of the intra‐fraction motion. The interfraction motion contributes to such discrepancy via both a linear bias and a quadratic noncentrality, indicting a persistent effect even if daily setup were random and averaged out in first order in physical dose. Late responding tissues with a small alpha/beta ratio are affected more significantly than early responding tissues. Simulation results verified these observations. Conclusion: This analysis suggests that motion‐induced discrepancy in biological effect (from expectation at planning) is most significant for late responding tissues located in the neighborhood of high dose gradient, when treated with a small number of fractions. This may explain the relatively high toxicity for treatment with SBRT and rationalizes the importance of localization accuracy and placement stability for such treatment. funded in part by AACR and TRDRP.

Achieving Placement Stability

Placement stability as an outcome goal in child welfare performance measurement is grounded in the importance of providing stability for children as they are developing attachments and relationships to caregivers. Research shows that many children are vulnerable to placement instability, especially those who have been in long term foster care. This literature review provides an overview of the federal placement stability measure. It then summarizes the diverse set of factors has been found to be associated with placement instability, including characteristics of the child and family of origin, placement type and quality, and the child welfare system and services. Promising practices aimed at promoting placement stability are summarized, followed by questions designed to foster discussion about the relationship of the evidence to child welfare practice.

Interest from Tertiary Educated Persons in Fostering Children with Higher Care Needs under a Professional (Paid) Model Compared with General Foster Care

The number of Australian children requiring foster care due to abuse and neglect is increasing, with more children presenting with high care needs, creating a challenge for the recruitment and retention of foster carers. Carers with higher education recruited as professional foster carers may improve placement stability and outcomes for higher needs children. An e-survey was conducted to explore the level of interest of tertiary students in a professional model of fostering children with higher needs. An online survey covering demographic information, knowledge of and attitudes to foster care was completed by 644 university undergraduate and postgraduate students within the faculties of health, education, arts, and the social sciences. Twelve per cent (n = 77) of respondents said “yes” they would be interested in professional foster care; and 16% (n = 105) an interest in general foster care of which 5% (n = 32) said “yes” to both professional foster care and general foster care. Thus, 23% of respondents expressed an interested in some form of foster care. Psychology students were more likely than other students to be interested in professional foster care (27% of respondents). Results give merit to further enquiry into the application of a professional foster care model for higher care needs children requiring out-of-home care.