Placement Stability Research Articles

How does kinship and foster care differ on caregiver-child relationship quality and child and caregiver mental health?

Internationally, there is an increasing preference to place children in kinship versus foster care. While research suggests that kinship care might promote better child mental health and placement stability than foster care, less is known about how these placement types compare on other factors of significance to family wellbeing in out-of-home care, including caregiver-child relationship quality and caregiver strain. We aimed to examine potential group differences on these outcomes in a sample of 101 kinship (N = 30), foster (N = 35), and birth (N = 36) caregivers of 7- to 16-year-olds in Australia. Caregivers completed measures on child mental health (behavioral and emotional adjustment, affect regulation), caregiver-child attachment, and caregiver strain, and a Five-Minute Speech Sample interview regarding their relational schemas (e.g., attitudes and feelings) about their child. Results showed that kinship and foster care families fared similarly on levels of child mental health, caregiver relational schemas, caregiver-child attachment, and caregiver strain. However, both groups displayed significantly more challenges in these domains than the birth family comparison sample. Sixty one percent of children in kinship and foster care experienced clinically significant mental health problems, yet many families–particularly kinship care families–had not received adequate professional supports for these challenges. Our findings suggest that families in kinship and foster care experience similar relational and mental health challenges, though they may require services tailored to their unique circumstances.

Patterns of substance use among adolescents in and out of foster care: An analysis of linked health and child welfare administrative data

BackgroundYoung adults with a history of foster care have higher risk for substance use disorders. Social systems can deliver substance use prevention to youth; however, the timing of intervention delivery and how needs differ for youth in foster care are unclear. ObjectiveTo compare initiation and rates of substance use among adolescents in foster care to demographically similar adolescents never in foster care as identified by the healthcare system, and identify factors associated with increased substance use. Participants and settingYouth in foster care (n = 2787, ages 10–20, inclusive) and demographically matched youth never in foster care (n = 2787) were identified using linked child welfare and electronic health records from a single pediatric children's hospital and county over a five-year period (2012–2017). MethodsAll healthcare encounters were reviewed and coded for substance use by type (alcohol, tobacco, cannabis, other). Age of first reported or documented substance use was also captured. Demographic and child welfare information was extracted from administrative records. Survival and logistic regression models were estimated. ResultsIn adjusted models, youth in foster care initiated substance use at earlier ages (HR = 2.50, p < .01) and had higher odds of engaging in use (AOR = 1.54; p < .01) than youth never in care. By age 12, substance use initiation was more likely while youth were in foster care than when they were not in foster care (HR = 1.42, p < .01). Placement stability and family care settings reduced odds of lifetime substance use. ConclusionsFoster care placement is associated with substance use. Screening may be important for prevention.

A qualitative exploration of the drivers for the transfer of foster children in Gauteng, South Africa

BackgroundMany children in South Africa are orphaned or subjected to maltreatment, leaving them in need of care and protection. Foster care is one form of alternative care for such children. Retention of foster parents, or foster care placement stability, is one of the many challenges related to foster care, globally and in South Africa. This instability can have an adverse impact on children, and although some research speaks to the problem, the experiences of South African role players regarding this problem have not been documented, to date. To improve foster care retention in South Africa, local, contextualized studies exploring the drivers of foster care placement instability are required. AimThe aim of this qualitative study was thus to explore designated social workers' (DSWs) and foster parents' experiences about the reasons prompting foster care transfers. Participants and settingA purposively selected sample of ten foster parents and ten DSWs in the Gauteng province of South Africa took part in the study. MethodsA descriptive qualitative study was adopted as basis for this study, which entailed thematic analysis of 20 semi-structured interviews. ResultsIt was found that children's behavioural problems, a shortage of resources, a lack of parenting skills, problematic relationships between foster parents and foster children, and previous traumatic events, led to most foster care transfers. A key finding from this study, which appears not to be evident in previous studies, centres on the critical role played by money, or rather its absence, in contributing to foster care placement instability. ConclusionsWhen considered in conjunction with findings emerging from previous studies, our findings underscore the importance of obtaining a contextualized understanding of local, cultural factors at play in foster care delivery. To improve foster care retention in South Africa, which is fraught with challenges not yet reported elsewhere, it is recommended that screening procedures for foster parents be revised, and that allocation of resources to DSWs be prioritized.

Outcomes for children and young people growing up in kinship care in Scotland: A population-level data linkage study

ObjectivesThe number of children and young people living in kinship care (living separately from their parents with a family friend/relative) in Scotland has increased consistently since 2010. This study aims to explore outcomes for children and young people in kinship care in terms of their health, education, and care journeys.&#x0D; MethodsThis population-wide data linkage study will utilise data on all children and young people who have been placed in formal kinship care from 2008 onwards. The datasets linked for this study are:&#x0D; &#x0D; Looked After Children&#x0D; Child Protection&#x0D; Health Visiting&#x0D; Educational attainment, attendances, absences and exclusion&#x0D; Children’s Hearings data&#x0D; &#x0D; Through descriptive analysis the study will provide insight into the experiences and outcomes of children and young people in kinship care. Where appropriate, comparisons will be drawn with the wider care population and the general population of children and young people in Scotland.&#x0D; ResultsData will be presented which highlight:&#x0D; &#x0D; Levels of kinship care usage in Scotland, and how this varies regionally and over time.&#x0D; The routes into kinship care in terms of child protection concerns and legal reasons data.&#x0D; How children fare while in kinship care – specifically in terms of their childhood development, placement stability and educational attainment/engagement.&#x0D; The pathways out of formal kinship care, and whether these differ over time.&#x0D; &#x0D; Full results will be available for publication at the 2023 ADR UK conference.&#x0D; Conclusion This is the first population-wide study on outcomes for children and young people living in kinship care within Scotland. It is hoped that insight arising from this work will aid local authorities, government and others in meeting the needs of the steadily increasing number of children living in formal kinship care.

The impact of the Covid-19 pandemic restrictions on children entering and leaving care in Scotland

ObjectivesThe Covid-19 pandemic caused huge upheaval across the world, and the Scottish children’s social care sector was not exempt from this. This study explored the extent to which the Covid-19 pandemic restrictions impacted on the rate at which children and young people were entering and leaving care in Scotland.&#x0D; MethodsAnalysis was conducted on the Scottish Government’s ‘Longitudinal Looked After Children’ dataset which contains information on the care journeys of all children who were ‘looked after’ in Scotland between April 2008 and July 2021. Through a descriptive analysis, the study determined how the pandemic restrictions impacted the rates of children entering care, the rates of children leaving care, and the stability and duration of care placements at this time.&#x0D; ResultsDuring the initial year of the pandemic, there was a marked reduction in the number of children both entering (38%) and leaving (22%) care when compared to the year prior. The reduction in entries to care were less notable for infants under the age of 1 than it was for older age groups. Fewer children entered care under compulsory measures, with an increased proportion entering through ‘voluntary’ Section 25 measures. The impact on entries to care and exits from care varied substantially across local authorities in Scotland. The stability and duration of children’s placements were also impacted, with children moving placements less and staying in care for longer periods of time.&#x0D; ConclusionThe pandemic restrictions had a substantial impact on the interactions of children and young people with the ‘care system’. At a time where there is great focus on improving the experience of young people in care within Scotland, it is important that lessons are learned and implemented for future disruptive events.

Returning to the child welfare system: Understanding the wellbeing, health, education, and placement of children who return

AbstractUsing longitudinal archival Child Welfare System (CWS) data, this study describes child health and wellbeing at their initial entrance into the CWS and subsequent returns. Associations between child wellbeing, health, placement stability, and frequency of returning to the system were also investigated. Results indicated most children were healthy and developmentally on target. In addition, emotional distress, behavioral concerns, and number of placements in the CWS were significantly correlated with placement stability. Future work should utilize the use of developmental assessments to systematically and reliably document the concerns for children in the system, and investigate factors contributing to stable placements.

Trajectories for children and young people who experience out of home care: Examining the influences of pre-care characteristics on later wellbeing and placement stability

BackgroundInterplay of risk and protective factors influence longer-term outcomes for children in out-of-home care. Participants and settingPathways of Care Longitudinal Study (POCLS) data were used to explore how child and birth family factors interact to influence wellbeing and placement stability over time. MethodsCluster analysis identified three groups of children differentiated on demographic characteristics on entry in care. Latent growth curve modelling was used to compare changes in children's cognitive functioning, socio-emotional wellbeing, and health over time. ResultsThere were cluster differences in trajectories for cognitive and socio-emotional outcomes, but not for health. Children who were older at entry to care (mean 7.6 years) showed the poorest socio-emotional and cognitive functioning at Wave 2, and despite improvements by Wave 4, the poor starting point may explain why their cognitive functioning scores never catch up to children entering care younger (mean 1.5 years). Younger on entry children who also tended to come from less socio-economically disadvantaged backgrounds showed the most positive cognitive and socio-emotional functioning over study waves, and cognitive functioning for these children improved at a steeper rate than the other clusters. Children with multiple characteristics associated with risk of poorer outcomes showed little improvement in cognitive functioning over time, and the poorest socio-emotional wellbeing by Wave 4. Placement changes between waves were lowest for children who entered care younger. ConclusionsThis study explicates the role of early risk and protective factors on subsequent trajectories for children in care. Understanding how early risk and protective factors impact longer term wellbeing may help to better target placement and support for cohorts of children with different presentations at entry to care.

Supraspinous ligament arc tangent guided freehand thoracic pedicle screw insertion technique: high parallelism between screws and upper endplate.

To propose a technique for placing pedicle screws in the thoracic spine using the Supraspinous ligament Arc Tangent (SLAT) as a guide to increase the safety and stability of screw placement. A retrospective analysis of postoperative anteroposterior and lateral x-ray images was performed for 118 patients with thoracic spine diseases who received conventional freehand technique from January 2016 to May 2020 and SLAT-guided technique since June 2020 to present. The diagnoses included thoracic spinal stenosis, deformity, fractures, infections, and tumors. The angle between the screw and the upper endplate was categorized as grade 1 (0°-5°), grade 2 (5°-10°), and grade 3 (>10°). Three surgeons with more than 10 years of experience in spinal surgery measured the angle between the screw and the upper endplate in the lateral view. Chi-square test was used for statistical analysis, and p < 0.05 was considered statistically significant. A total of 1315 pedicle screws were placed from T1 to T12 in all patients. In the conventional freehand technique group, 549 screws were grade 1, 35 screws were grade 2, and 23 screws were grade 3. In the SLAT-guided freehand technique group, 685 screws were grade 1, 15 screws were grade 2, and 8 screws were grade 3. The data of each group was p < 0.05 by Chi-squared test, which was statistically significant, indicating that the SLAT-guided freehand technique resulted in a higher rate of parallelism between the screws and the upper endplate. All patients underwent intraoperative neurophysiological monitoring, immediate postoperative neurological examination, postoperative x-ray examination, and assess the eventual recovery. The screws were safe and stable, and no complications related to pedicle screw placement were found. The SLAT-guided freehand technique for placing pedicle screws in the thoracic spine can achieve a higher rate of screw-upper endplate parallelism, making screw placement safer and more accurate. Our method provides a convenient and reliable technique for most spinal surgeons, allowing for increased accuracy and safety with less fluoroscopic guidance.

Evaluation of Grid-Forming Inverters' Impact on Transient Stability and Proposal of Effective Inverter Placement in Power System and Operation Method

Evaluation of Grid-Forming Inverters' Impact on Transient Stability and Proposal of Effective Inverter Placement in Power System and Operation Method

The longitudinal outcomes of mental health for Flemish care leavers

Young people leaving foster- and residential care more often indicate having mental health problems than their peers from the general population. International research has extensively studied these mental health outcomes of care leavers. However, in Flanders (the Dutch speaking part of Belgium), no previous quantitative studies are known. This longitudinal study explores outcomes of depression, anxiety, sleep and general mental health of care leavers in Flanders and investigates if these outcomes improve in the years after leaving care. Associations with placement factors are explored to support recommendations to the clinical field. The current study involves 175 care-leavers. The participants of the study are between 18 and 27 years old at the start of the study and have all left care. Data was collected using a self-reporting questionnaire touching multiple domains. On all domains, no significant differences between foster- and residential care leavers are found. Residential care leavers more often indicate depressive symptoms than their peers from the general population. Foster care leavers more often indicate sleeping problems. Regarding anxiety, no differences are found. In all conducted analyses, the number of years in care, the age of starting and leaving care, the different types of support during care and whether aftercare was offered were included. However, none of these factors provide a sufficient explanation for the outcomes found. On all scales, the effect of gender, the number of placements and the reason of placement do recur. This indicates the importance of these factors. Policy makers should focus on improving placement stability and extra support for children who were placed due to own emotional or behavioral problems or maltreatment.

Step-down service improves placement stability

Step-down service improves placement stability

The Importance of Sibling Relationships for Children in Foster Care.

There are approximately 500,000 children in the foster care system in the United States of America. With exposure to chronic and cumulative trauma, they constitute a population with an increased risk of developing mental health concerns and adverse outcomes in later life, including contact with the forensic system. Legislative frameworks that have been developed to facilitate improved outcomes are outlined, although these vary between states, and the focus is often on the parental relationship. Several studies have emphasized the importance of sibling relationships and that placing siblings in the same foster home is associated with higher rates of placement stability, reunification, adoption and guardianship, and fostering positive sibling relations. The multifaceted role of the clinician in promoting recovery from trauma, enhancing resiliency, and thoughtfully prescribing and advocating for familial relationships is discussed.

Child Welfare System-Level Factors Associated with All-Cause Mortality Among Children in Foster Care in the United States, 2009-2018.

Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1year: IRR = 1.06, 95% CI [1.02, 1.11]; 5-9years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts.

For-profit outsourcing and its effects on placement stability and locality for children in care in England, 2011–2022: A longitudinal ecological analysis

BackgroundThe responsibility of local authorities in England to provide children in care with stable, local placements has become increasingly difficult due to the rising number of children in need of care and a shortage of available placements. It is unclear if the trend of outsourcing children's social care to private companies has exacerbated this challenge. This paper examines how the outsourcing of children's social care to the private market has influenced placement locality and long-term stability over time. MethodsWe created a novel dataset of multiple administrative data sources on the outsourcing, placement locality and stability, and characteristics of children in care between 2011 and 2022. We conducted time-series fixed-effects regression analysis of the impact of for-profit outsourcing on placement locality and stability from 2011 to 2022. ResultsOur fully adjusted models demonstrate that for-profit outsourcing is consistently associated with more children being placed outside their home local authority and greater placement instability. We found that an increase of 1 % point of for-profit outsourcing was associated with an average increase of 0.10 % points (95 % CI 0.02–0.17; p = 0.01) more children experiencing placement disruption, and 0.23 % points (95 % CI 0.15–0.30; p < 0.001) more children being placed outside their home local authority. We estimate that an additional 17,001 (95 % CI 9015–24,987) out-of-area placements can be attributed to increases in for-profit provision. DiscussionOur analyses show that placement stability and distance have deteriorated or stagnated over the last decade, and that the local authorities that rely most on outsourcing have the highest rates of placement disruptions and out-of-area placements.

Family, mental health, and placement outcomes of a low-cost preventive intervention for youth in foster care

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16–17) but not younger youth (ages 13–15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting’s driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Mental Health Diagnoses, Health Care Utilization, and Placement Stability on Antipsychotic Prescribing Among Foster Care Youth.

This study sought to examine how mental health diagnoses, health care utilization and foster care placement instability affect antipsychotic prescribing and how these factors may contribute to disproportionate antipsychotic prescribing among youth in foster care. This retrospective cohort study utilized EHR data that were linked to administrative child welfare data. Two outcome variables were analyzed: 1) any antipsychotic prescription documented and 2) number of antipsychotic prescriptions documented. Predictor variables included foster care status, number of unique mental health diagnoses, counts of health care encounters over the study period, and counts of foster care placements. Covariates included gender, persons of color, and age in years. Models were estimated using logistic regression for the dichotomous outcome and Poisson regression for the count outcome. Increased antipsychotic prescribing among children in foster care persists even after accounting for mental health diagnoses and health care utilization. However, the number of placements modified the effect of foster care involvement on antipsychotic prescribing such that after 2 placement changes, the odds of being prescribed an antipsychotic surpassed the effect of foster care involvement. More mental health diagnoses, more inpatient and emergency health care encounters, and more foster care placements were associated with an increased odds of being prescribed an antipsychotic and an increased count of antipsychotic prescriptions. Decreased primary care encounters were associated with increased odds of antipsychotic prescriptions, and decreased specialty encounters were associated with higher counts of antipsychotic prescriptions. Placement instability is associated with disproportionate antipsychotic prescribing among youth in foster care.

Influence of placement stability on developmental outcomes of children and young people in out-of-home care: Findings from the Pathways of Care Longitudinal Study

BackgroundPlacement stability is an important indicator of the functioning of an out-of-home care system. Previous research suggests that frequent placement changes have a negative impact on the outcomes for children and young people in out-of-home care. ObjectiveThis paper examines the association between placement stability in out-of-home care and children's socio-emotional, cognitive and physical health outcomes. Participant and settingThe Pathways of Care Longitudinal Study (POCLS) is the first large-scale prospective longitudinal study of children in out-of-home care in Australia. The sample consists of any study child who participated in any of the first three waves of the POCLS interview. MethodsUnweighted data from the first three waves of the POCLS interview and administrative data was used. A measure of placement stability was developed that accounted for both number of placements and length of time in care. Mixed effect modelling was used to examine the link between placement stability and children's developmental outcomes. ResultsPlacement stability was found to have a significant association with socio-emotional, cognitive (non-verbal) and physical health (gross and fine motor skill) development. A number of other factors were also found to be associated with positive development. ConclusionsThe findings support the existing evidence that placement stability is an important factor for children's development. Other factors including placement type, carer wellbeing and carer support are also important for positive development. Appropriate policy and practice intervention to support children and families to improve placement stability is fundamental to achieving positive developmental outcomes for children in out-of-home care.

Is human bone matrix a sufficient augmentation method revising loosened pedicle screws in osteoporotic bone? – A biomechanical evaluation of primary stability

IntroductionDespite good screw anchorage and safe screw trajectory, screw loosening occurs in several cases, especially in osteoporotic individuals. The aim of this biomechanical analysis was to evaluate the primary stability of revision screw placement in individuals with reduced bone quality. Therefore, revision via enlarged diameter screws was compared to the use of human bone matrix as augmentation to improve the bone stock and screw coverage. Methods11 lumbar vertebral bodies from cadaveric specimens with a mean age of 85.7 years (± 12.0 years) at death were used. 6.5 mm diameter pedicle screws were inserted in both pedicles and hereafter loosened using a fatigue protocol. Screws were revised inserting a larger diameter screw (8.5 mm) in one pedicle and a same diameter screw with human bone matrix augmentation in the other pedicle. The previous loosening protocol was then reapplied, comparing maximum load and cycles to failure between both revision techniques. Insertional torque was continuously measured during insertion of both revision screws. FindingsThe number of cycles and the maximum load until failure were significantly greater in enlarged diameter screws than in augmented screws. The enlarged screws' insertional torque was also significantly higher than of the augmented screws. InterpretationHuman bone matrix augmentation does not reach the same ad-hoc fixation strength as enlarging the screw's diameter by 2 mm and is therefore biomechanically inferior. Regarding the immediate stability, a thicker screw should therefore be prioritised.

Connecticut university establishes Innovations Institute

The University of Connecticut School of Social Work (UConn SSW) announced last month the arrival of its Innovations Institute. The institute extends the UConn's commitment to social, racial, and economic justice and the improvement of human well‐being nationwide, the campus news website, UConn Today, reported on Dec. 8. To fulfill its mission, the UConn SSW has deep and long‐standing partnerships with Connecticut state agencies that serve children, youth, and their families, including the departments of social services, children and families, mental health and addiction services, and the Connecticut Office of Early Childhood. Through these robust partnerships, UConn provides research, implementation, and evaluation of evidence‐based programs and policies that serve children, youth, and families across the state, officials stated. The Innovations Institute is comprised of 41 faculty and staff and six national centers that are formerly affiliated with the University of Maryland. These centers include the Peer TA Network; the National SOGIE Center; the National Wraparound Implementation Center; the National Quality Improvement Center on Family‐Centered Reunification; the National Quality Improvement Center on Tailored Services, Placement Stability, and Permanency for Lesbian, Gay, Bisexual, Transgender, Questioning and Two‐Spirit Children and Youth in Foster Care; and the Center of Excellence on LGBTQ+ Behavioral Health Equity, the online campus news site, UCONN Today reported on Dec. 8. Innovations Institute builds research‐based, inclusive, culturally responsive, and transformative child‐, youth‐ and family‐serving systems and services, and develops the capacity of the workforce within these systems. They are currently partnering with state and local governments, health care providers, youths and their families, and community‐based organizations in 42 states across the U.S.

Planning Irregular Object Packing via Hierarchical Reinforcement Learning

Object packing by autonomous robots is an important challenge in warehouses and logistics industry. Most conventional data-driven packing planning approaches focus on regular cuboid packing, which are usually heuristic and limit the practical use in realistic applications with everyday objects. In this paper, we propose a deep hierarchical reinforcement learning approach to simultaneously plan packing sequence and placement for irregular object packing. Specifically, the top manager network infers packing sequence from six principal view heightmaps of all objects, and then the bottom worker network receives heightmaps of the next object to predict the placement position and orientation. The two networks are trained hierarchically in a self-supervised Q-Learning framework, where the rewards are provided by the packing results based on the top height, object volume and placement stability in the box. The framework repeats sequence and placement planning iteratively until all objects have been packed into the box or no space is remained for unpacked items. We compare our approach with existing robotic packing methods for irregular objects in a physics simulator. Experiments show that our approach can pack more objects with less time cost than the state-of-the-art packing methods of irregular objects. We also implement our packing plan with a robotic manipulator to show the generalization ability in the real world.