Placement Of Children Research Articles

The Evolution of Alternative Care in Pakistan over the Last Decade and Way Forward

This research article explores the situation of children in alternative or institutional care in Pakistan, aiming to shed light on the challenges they face, interventions implemented to address their needs, and the associated laws and policy implications. Drawing on the existing literature, empirical studies and reports from reputable organisations, this research article examines the factors contributing to the placement of children in alternative care, highlights the impact of institutionalisation on their development and assesses the effectiveness of interventions and policies aimed at improving their well-being. The findings emphasise the importance of family-based care alternatives, comprehensive support systems and evidence-informed policies to ensure the holistic development of children in Pakistan’s alternative care system.

Foster care in Portugal: outcomes, needs, and challenges for deinstitutionalization

This paper assesses evidence of and challenges to the development of the foster care system in Portugal. It describes the evolution of the social policy adopted in the Portu­guese child placement system, highlighting family placement in foster care, followed by an overview of the main institutional actors in the protection system and the supports provided to family carers. Then, based on available research developed in Portugal, a portrait of the experiences lived by foster families and children placed in foster care is presented, reveal­ing children and carers’ opinions about well-being and personal development, education and leaving care process, foster care and residential care, and participation in decision-making. The analysis adopted identify the intensity and singularity of relationships in foster care, and the impact it has on children’s and foster families life’s. They reveal an intense, unique experi­ence that is unmatched by other educational and affective relationships established between adults and children. The article discusses implications for policies and practices, by consid­ering the need for a shift from residential to family care to achieve a better balance in the system and move closer to international statements of good practices.

Variation in cumulative childhood risks of parental imprisonment and foster care removal by state and race/ethnicity

The racialized nature of state intervention into family life has increasingly called attention to the impact of parental incarceration and foster care placement on the wellbeing of children across the United States. Yet little is known about how these interventions collectively operate at a macro-level in the lives of children. This study estimates the cumulative childhood risks of experiencing parental imprisonment or foster care placement for White, Black, and Hispanic children across fourteen states. Drawing on policy regime theory, I identify subnational family intervention regimes based on the relative risks of ‘right’ prison-driven and ‘left’ welfare-driven intervention, examining how these regimes vary across both states and racial/ethnic subgroups. In documenting variation in family intervention regimes across states and race/ethnicity, this study offers three key findings. First, I find evidence of foster care’s unique position within policy regime thought, with most intervention regimes misaligning with the traditional linear understandings of a punitive-protective continuum. Second, where regimes do align with policy regime theory, I document a clear racial divergence in that operation, with White children exclusively facing welfare-driven risks while Black and Hispanic children exclusively facing prison-driven risks of family intervention. Finally, I present evidence that Black children consistently and uniquely face high risks of intervention that go unshared with their resident peers, further underscoring the deeply racialized nature of state intervention in the United States.

Service dogs for autistic children and family system functioning: a constant comparative analysis.

Service dog placements for autistic children are growing in popularity, yet findings to date are mixed. Moreover, no study to date has examined these placements through the lens of a recognized theoretical model. The purpose of this study is twofold: to explore experiences reported by caretakers of autistic children involved in a service dog program, and to contextualize findings within an established theoretical framework. A total of n = 50 caretakers of autistic children (n = 38 with and n = 12 without a service dog) were recruited through the national non-profit service dog provider Canine Companions. Participants completed an online survey through Qualtrics which asked open-ended questions about their experiences, both negative and positive. Constant comparative analysis identified two high level themes, nested within a family systems approach framework: (1) Enhancing social functioning of the family system unit and (2) Fostering stability and strength within family system subunits. These themes interacted holistically to foster and reinforce family system resilience. Placements led to greater social inclusion for children and their families, acted as a highly individualized intervention, and decreased experiences of judgement and stigma. Perceived as members of the family, service dogs may coregulate with the autistic child and family members and can be a source of joyful connection within the family. Results highlighted the service dog's influence on the entire family (beyond the autistic child). Implications for service dog organizations suggest it may be helpful to account for family-wide impacts throughout the placement process. High standards on the part of provider organizations may minimize negatives, optimizing outcomes for both humans and canines. Ultimately, findings enrich our understanding of service dog interventions for autistic children.

CHOOSING INCLUSIVE OR SPECIAL SCHOOLS FOR CHILDREN WITH DISABILITY IN INDONESIA: EDUCATIONAL PLACEMENT AND ANALYSIS OF RELATED FACTORS

Access to education remains a challenge for children with disability. In Indonesia, families can choose to send children with disability to either inclusive or specialized schools. This study aimed to identify the factors associated with the choice of sending children with disability to inclusive or special schools and factors linked to school dropout. Caregivers of children with disability in Java, Indonesia were interviewed to collect data on enrolment in school, sex and age of the children with disability, type of disability, parents’ age and education, and independence of children with disability. The characteristics of children with disability studying in inclusive and special schools were compared. Logistic multivariate linear regression was done to analyze factors related to the choice of school. Data from 281 children with disability were analyzed: 175 (62.3%) of the school-aged children with disability were actively studying at school, with 84.57% studying in inclusive schools and 15.43% in special schools. Children’s age, independence in daily activities, and ability to learn and play are factors that affect parents’ choice of educational placement for children with disability. Children’s age and mothers’ age are variables influencing children with disability to drop out.

DEVELOPMENT AND VALIDATION OF PROFESSIONAL ENHANCEMENT PROGRAM ON INCLUSIVE EDUCATION FOR ELEMENTARY TEACHERS OF ALAMINOS DISTRICT

The success of inclusion or organized placement of children with disabilities in mainstream classrooms largely depends on teachers’ attitudes towards students with special educational needs (SEN) and their knowledge on how to properly educate them. This study dealt with teachers’ assessment on attitudes, self-efficacy and concerns towards inclusive education, teachers’ perception on the extent of the use of inclusive practices, the relationship of teachers’ attitude, self-efficacy and concerns on their perception on the extent of the use of inclusive practices and the development and evaluation of the Professional Enhancement Program on Inclusive Education. The study employed descriptive and correlational analysis methods. The participants were 139 public elementary teachers in Alaminos District and four (4) experts. Data analysis utilized frequency counts, percentage, weighted mean, and Pearson-r correlation. Findings revealed that teachers’ attitudes towards inclusive education were moderately favourable, self-efficacy was high, and concern was moderate. Inclusive practices were perceived to be frequently used by the teachers. Teachers’ attitude, self-efficacy and concerns have significant relationship with the teacher’s perception on the extent of the use of inclusive practices. As assessed by the experts, the developed Professional Enhancement program on Inclusive education was rated as “Excellent”. It is highly recommended that the developed Professional Enhancement program be used by the schools offering inclusive education.

International legal regulation of social protection of homeless and neglected children in conditions of war

The article examines the current state of state policy in the field of social protection of homeless and neglected children in wartime conditions. The special relevance of this topic is due to the increase in the number of homeless and neglected children due to the full-scale invasion of the russian federation.
 Attention is focused on the fact that orphan hood is a social phenomenon that is caused by the existence in society of children whose parents have died, or children who have been left without parental care due to the deprivation of parental rights, being recognized as disabled, missing, etc. Because of the war in Ukraine, thousands of children remain orphans, lose contact with their relatives and find themselves in difficult life circumstances.
 The main normative legal acts regulating the protection of children's rights are analyzed - the Universal Declaration of Geneva, the Universal Declaration of Human Rights, the Convention on the Protection of Human Rights and Fundamental Freedoms, the Declaration on the Rights of the Child, the Declaration on the Protection of Women and Children in Extraordinary Circumstances and During Armed Conflicts, Convention on the Rights of the Child, Optional Protocol on the Participation of Children in Armed Conflicts.
 Among the main national normative legal acts that regulate the issue of social protection of children are the laws of Ukraine "On ensuring the rights and freedoms of citizens and the legal regime in the temporarily occupied territory of Ukraine", "On amending some laws of Ukraine aimed at strengthening the social protection of children and support families with children", "On the protection of childhood", resolutions of the Cabinet of Ministers of Ukraine "On approval of the Procedure for granting the status of a child who suffered as a result of hostilities and armed conflicts", "On amendments to some resolutions of the Cabinet of Ministers of Ukraine on the protection of children's rights during the period of emergency or war state".
 The number of injured children in Ukraine as a result of the armed aggression of the Russian Federation was analyzed, attention was paid to the issue of ensuring the child's right to safety, legislative regulation of ensuring the child's right to education, as well as problematic aspects that arise during the realization of this right. Peculiarities of placement of children who were left without parental care as a result of the invasion of the Russian Federation on the territory of Ukraine in family-type orphanages and foster families were studied.

The Impact of Proactive Gastrostomy Tube Placement on Treatment-related Outcomes in Young Children With High-grade Central Nervous System Tumors.

Young children undergoing treatment with intensive chemotherapy for high-grade central nervous system (CNS) tumors are at risk for malnutrition, yet no guidelines exist for the placement of enteral tubes. Prior studies evaluated the impact of proactive gastrostomy tube (GT) placement with a narrow scope of outcomes, such as weight. To examine the impact of proactive GT on comprehensive treatment outcomes, we performed a single-center, retrospective study of children younger than 60 months of age with high-grade CNS tumors treated per CCG99703 or ACNS0334 between 2015 and 2022. Of 26 patients included, 9 (35%) underwent proactive GT, 8 (30%) had rescue GT, and 9 (35%) had a nasogastric tube (NGT). Clinically significant weight loss occurred in 47% of patients with NGT during induction compared with 22% with proactive GT ( P = 0.274); however, between cohorts, there was no significant difference in antibiotic or parenteral nutrition utilization, weight loss at therapy completion, and duration of hospitalization. Therefore, proactive GT placement was modestly effective at preventing significant weight loss during induction, however, there was no clear benefit for hospitalization duration, antibiotic, or parental nutrition requirements compared with NGT. We recommend an individualized approach to GT placement for young children with CNS malignancies undergoing intensive chemotherapy.

The multifaceted nature of risk behaviour among adolescents-A document analysis of patient and aftercare service providers' records.

The aim of this study was to describe the forms and the prevalence of risk behaviour among adolescents in aftercare services, as well as identify the associated factors and use of services by adolescents. Adolescents in aftercare services represent a vulnerable group that struggles with several aspects of life. The challenges they face are known to accumulate in certain individuals, and the problems that are relevant for this group tend to have an intergenerational nature. The research applied retrospective document analysis, with the analysed data comprising information on 698 adolescents in aftercare services in one large Finnish city from the fall of 2020. The data were analysed using descriptive statistics and multivariate methods. Risk behaviour was identified among 616 of the studied adolescents (88.3%), and manifested as substance abuse, reckless sexual behaviour and/or use of money, nicotine use, self-destructive behaviour, delinquency and functional dependencies. Regarding the associations between risk behaviour and background variables, an adolescents' child's clientship in child protection or the child's placement in foster care, adolescent's need for support in parenting, problems with daily rhythm and problems with studying were found to influence the prevalence of risk behaviour. Forms of risk behaviour were also found to be associated with each other. Adolescents displaying risk behaviour commonly did not use the social counsellor, psychiatric outpatient care and study counselling services, even if they would have needed them. The interconnections between different forms of risk behaviour mean that this issue should be prioritized when developing aftercare services. This is the first time that risk behaviour among adolescents in aftercare services has been comprehensively examined. Understanding this phenomenon is key to identifying future research topics, guiding decision-making and helping stakeholders truly understand the needs of these adolescents. No patient or public contribution as the study was based on a document analysis.

A preliminary review of the parenting assessment and skill development service: A 10‐day residential service for families at risk of child maltreatment

AbstractTweddle's Parenting Assessment and Skill Development Service (PASDS) is a 10‐day residential programme for families at risk of child maltreatment. The service aims to conduct a comprehensive parenting capacity assessment to inform case management and improve parenting practices. The aims of the study were to (1) describe the psychosocial functioning of parents taking part in PASDS, (2) describe the key parenting assessment outcomes, and (3) explore parents' experiences of participation in PASDS including (a) perceived barriers and enablers of participation and (b) perceived outcomes for their family. Participants were 18 parents who participated in Tweddle's PASDS in Melbourne, Australia. A mixed methods study comprising a case file review and qualitative interviews was conducted. Parents accessing PASDS had experienced adverse childhood events, and many were experiencing mental health difficulties. Interviews with parents revealed perceived benefits of PASDS in improving parenting knowledge and skills, family relationships, and parenting confidence. At the time of discharge, 33% of families were assessed as unable to provide independent care for their child. The current findings have important implications for the further evaluation of evidenced‐based services which can improve the accuracy of parenting capacity assessments, aiding in child protection decision‐making related to child placement and safety.

On Causal Inference and the Limits of Disproportionality as a Construct: The Case of Foster Care Placement

The unwarranted disparities in our foster care system are the result of historical and structural causes. If we hope to correct these disparities by addressing their root causes, we must measure them carefully. In this article, I ask whether our usual measures of Black child/White child placement differences tell us what we need to know to act on those disparities with greater certainty. I specifically examine the limits of disproportionality as a measure. As a way to observe over- and underrepresentation, disproportionality is useful. When the discussion turns to the causes of differential treatment of Black children (or any other children) within the child protection system, there are more useful ways to measure those differences. I demonstrate this point in technical terms, and then I suggest alternative approaches to the measurement problems. Other approaches, I argue, offer a more vivid picture of the problem social workers are trying to solve.

Tailored Nurse Support Program Promoting Positive Parenting and Family Preservation.

Public health nurse home visiting is a promising approach for addressing the complex needs of families at risk of child maltreatment. The Colorado Nurse Support Program advances service provision by using evidence-based practices to provide tailored assessment and intervention to low-income, primiparous, and multiparous families with children under 18 years of age identified as high risk by county human service systems. This study aimed to test the effects of the Nurse Support Program on child protective services case characteristics between Nurse Support Program families and a demographically comparable reference group of families and evaluate changes in parenting outcomes from pre- to postprogram involvement for Nurse Support Program families. We used a matched comparison group quasi-experimental design in which families in the Nurse Support Program ( n = 48) were compared to families ( n = 150) who were identified using administrative data from Colorado's Comprehensive Child Welfare Information System. Outcomes were child protective case characteristics (child protection referrals, open assessments, founded assessments, open cases, and children's placement in out-of-home care) and parenting outcomes. Nurse Support Program families were less likely to have a child protection case opened or have their child placed in out-of-home care. There were no significant between-group differences in child protection referrals, open assessments, or founded assessments. Families in the Nurse Support Program showed improvements in parenting outcomes over time. Findings suggest that the Nurse Support Program is a successful public health nurse home-visiting approach to promote positive parenting and family preservation among families with complex needs. Implementing tailored public health nurse home-visiting programs, such as the Nurse Support Program, should continue to be evaluated and supported to mitigate the public health risk of child maltreatment.

Parents’ and child welfare workers’ understandings of consent to emergency placements

ABSTRACT Emergency placements of children are often made in haste and experienced as dramatic. This article is based on interviews with 9 parents who have consented to emergency placements and their caseworkers. We explore parents’ reasons for giving their consent to placement and the child welfare workers’ understanding of these consents. This leads to a discussion of what constitutes valid consent from parents in emergency cases. Relational autonomy is applied as a perspective to understand the context and influencing factors of parental consent. The results, derived by thematic analysis, show three main themes regarding parents’ reasons for their consent: (1) The child wanted to move out, (2) the parents couldn’t manage the situation, and (3) parents felt the child welfare service (CWS) gave them no choice. Parents experience a high degree of pressure in the context of giving their consent, either from their child or the CWS. Asymmetrical power dynamics between the CWS and parents were highly present and relevant in parents’ reasons for consent, especially when the CWS communicated that the alternative to consent is coercive placement. Furthermore, it is often unclear to the parents what consent entails. This is especially evident through CWS’s regulation of child-parent contact. In the discussion, we emphasize a high degree of awareness on the part of CW workers with regards to understanding how contextual and relational factors influence parent’s choice to consent; when consent is valid; how far consent extends, and the potential weakening of parents’ legal security when a voluntary placement is conducted.

Transracial adoption: art therapists’ views on facilitating children's racial and adoptive identity

ABSTRACT Background There is an absence of research on working with transracially adopted children in the UK. This suggests the need to provide insight into how art psychotherapy practice can be used to explore the transracially adopted child's lived experience of navigating their racial and adoptive identity. The theory of intersectionality highlights the importance of recognising marginalised categories of identity. Without such, these children may only integrate partial knowledge of themselves, which inevitably undermines their voice and ability to hold power in a racialised and oppressive socio-political system. Aims The study aimed to explore: how art therapists work with transracially adopted children to help them find a coherent sense of self; what therapists themselves consider the benefits and limitations of the art psychotherapy practice; intersectional thinking as a way to avoid examining identity differences in silos. Methods This study used semi-structured interviews to gather the views of four art psychotherapists. Thematic analysis was then used to analyse the data collected. Results Evolved as three themes: the containing role of art psychotherapists, primary caregivers and wider care system; a child-led approach; the challenge of integrating cultural humility into the art psychotherapy profession. Conclusion Findings highlighted a systemic approach to processing trauma, including the use of shared, joined-up and non-verbal language could be key in helping transracial adoptees explore their identity using culturally relevant approaches in art psychotherapy. Implications for practice and future research The researcher recommends that access to cultural humility training is formalised for art psychotherapists in order to establish anti-oppressive frameworks. Plain-language summary This article outlines a research project, which examined how art psychotherapy can be used to explore the identity of children and young people who have been adopted transracially. Within this context, it sought to gain a better understanding of how art psychotherapists currently use artmaking and creativity in the therapeutic relationship with these children. It is recognised that for a transracially adopted child's placement to be successful their sense of identity and belonging needs to be supported. In some areas of the UK, post-adoption support exists, which includes access to art psychotherapy. For this research project, four qualified UK based art psychotherapists were interviewed in the hope of revealing what these participants considered to be the benefits and the limitations of art psychotherapy practice when working with this client group. Additionally, the researcher examined the art psychotherapists’ motivations for engaging in this specific subject area. Participants were further asked if any personal challenges, such as their own racial background and/or unconscious biases arose when navigating a transracially adopted child's racial and adoptive identity. From the findings, the researcher provided recommendations that recognise the need for the formal integration of cultural humility for both trainee and qualified art psychotherapists. This small study highlighted three themes: the containing role of art psychotherapists, primary caregivers and the wider care system; a child-led approach; and the challenge of integrating cultural humility into the art psychotherapy profession.

Transformation of Out-of-Home Services for Children in North Macedonia: Towards Individualized and Child Tailored Care

Abstract Republic of North Macedonia in the last several years undergoes comprehensive social protection reform. The reform processes have been focused on furthering the processes of deinstitutionalization, decentralization and pluralization of social services delivery. The transformation of social protection institutions has been one of the key priorities in this period, specifically out-of-family services for children. In this respect, alternative care services for children without parents and parental care has been strengthened and promoted. Foster care as a traditional form of protection has been given particular attention and has undergone considerable changes. This article will review key reform processes in the domain of social protection in the country, with focus on social services for children without parents and parental care. To do this, results from recent empirical research will be presented. Mixed methodology research findings target current conditions in respect to foster care, small group homes and supported living as services used for placement of children without parents and parental care as well as professional approaches used to provide for individualized and child-tailored care. Cross-cutting issues relate to human rights, basic human needs and social integration of children.

State protection of family rights of internally displaced persons

The protracted war in Ukraine and the full-scale invasion led to an increase in the number of refugees from Ukraine and internally displaced persons in the middle of the country, actualizing the issue of protecting their rights. That is why this article analyzes the mechanism of state protection of family rights of internally displaced persons. It is clarified how the mechanism of state protection of the family functions during the war. It is substantiated that the basis of the mechanism of state protection of family rights is the principle of state protection of the family. The provisions of international acts, the Constitution of Ukraine, the Law of Ukraine "On Ensuring the Rights and Freedoms of Internally Displaced Persons", as well as norms of family legislation, were studied.
 The differences between the concepts of "protection" and "protection" are analyzed. It is emphasized that the mechanism of state protection of the family rights of internally displaced persons includes legal norms that provide for various tools for ensuring and protecting rights, as well as positive obligations of the state. The approach of the Constitutional Court of Ukraine, formed during the war, regarding the understanding of social protection and protection of the family, childhood and motherhood (parenthood) is clarified.
 It was noted that the number of orphans and children abandoned by their parents increased during the war, therefore the system of legal guarantees for the placement of such children in such forms, which are closest to family ones, is of great importance.
 It is proved that the mechanism of state protection of family rights of internally displaced persons is based on the general principle of state protection of the family and includes legal, institutional, procedural, financial and informational tools. It is substantiated that the project of the State Policy Strategy on Internal Displacement for the period until 2025 contains a limited approach to guaranteeing the family rights of IDPs. First of all, the principles must be supplemented with the principle of the best interests of the child, and the list of measures must guarantee the right of every family member who is an IDP to information about missing relatives.

Nosocomial influenza in a pediatric general ward: Effects of isolation and cohort placement of children with influenza.

Many studies have described nosocomial outbreaks of influenza in specialized wards. We evaluated nosocomial transmission of influenza in a pediatric general ward. Retrospective observational study. Single secondary hospital. The study included 814 hospitalized children with influenza between September 2015 and August 2020. The medical records of the included children were retrospectively reviewed, and clinical characteristics of children with community-acquired (CA) influenza and hospital-acquired (HA) influenza were determined. The room of each included child during hospitalization was traced to identify the children exposed to them. CA influenza and HA influenza were diagnosed in 789 (96.9%) and 25 (3.1%) children, respectively. Among children with CA influenza, 691 (87.6%) were isolated or place in a cohort on admission. In total, 98 children (12.4%) admitted to multibed rooms exposed 307 children with noninfluenza diseases to influenza during 772 patient days; 3 exposed children (1.0%) were diagnosed with HA influenza. Including these 3 children, 25 children (19 without definite in-hospital exposure to influenza and 3 exposed to other children with HA influenza) were diagnosed with HA influenza, and 11 (44.0%) exposed 31 children with noninfluenza diseases to influenza for 85 patient days. Also, 3 exposed children (9.7%) were diagnosed with HA influenza, a significantly higher rate than that for CA influenza (P = .005). The clinical characteristics were comparable between children with HA influenza and those with CA influenza. Cohort placement of children with influenza in a pediatric general ward can be effective in controlling nosocomial transmission of influenza. However, control measures for children with HA influenza should be emphasized.

Parenting during a child's placement: A systemic perspective on parental commitment

AbstractObjectiveThis study aims to document birth parents' commitment from a systemic perspective. Characteristics of birth parent's mental health (depressive symptoms), placement characteristics (family reunification, parent–child contact), and systemic characteristics (parent's perception of the foster parent's opinion on parent–child contact) are examined.BackgroundFoster placement creates a highly vulnerable situation within families of origin. Moreover, birth parents are liable to have been exposed to multiple risk factors. Foster placement comes with many challenges that are not without consequences on the parenting experience, including loss of parenting responsibilities and redefinition of the parenting role.MethodParents (n = 59) participated for 70 parent–child dyads in 90‐minute home visits where data on sociodemographic characteristics, mental health status, experience of the placement measure and parent–child contact, as well as level of parental commitment were gathered.ResultsThree‐step hierarchical regression models were used to examine the independent contribution of the parent's perception of the foster parent's opinion on contact on parental commitment after accounting for the birth parent's mental health and placement characteristics. Results suggest that parent–child contact and parent's perception of foster parent's opinion on contact have a significant contribution to parental commitment.ConclusionThese findings underscore the importance of addressing parenthood in placement situations and the relevance of examining parental commitment from a systemic perspective.ImplicationsA deeper understanding of this vulnerable population would require reflecting on the psychosocial practices in Child Protective Services while accounting for the needs of birth parents in the placement system.

Documentary analysis of the legal and policy framework of transracial adoption in South Africa

AbstractTransracial adoption was legalized in South Africa through legislative reform as South Africa moved into a post‐apartheid era of non‐racialism. Transracial adoption offers one option of placement for Black children in need of alternative care. However, adoption continues to face obstacles to implementation, including cultural obstacles which impact on placement of Black African children. This paper reports on adoption statistics on national adoption in the period 2013–2021 and a documentary analysis of the current legal and policy framework governing transracial adoption. We cover international instruments, local laws, including the Children's Act of 2005, and relevant policy documents designed to facilitate the implementation of adoption. We show that the law is supportive of transracial adoption, but that policy documents offer a somewhat contradictory stance to the practice. The lack of success of transracial adoption as a child protection strategy does not lie within the legal framework but may lie in the difficulties in interpreting and implementing the range of different policies by those implementing these policies. More research into the implementation practice of these bureaucrats is required to understand the underutilization of transracial adoption as a placement option for Black children in South Africa.

Home First: Stability and Opportunity in Out-of-Home Care

In this report, the concept of “Home First” is introduced for those children who require long-term, non-kin placements. The term “Home First” connotes a placement engendering stability and continuity; this concept is introduced in conjunction with an evaluation of the historical, theoretical, and empirical evidence surrounding different forms of out-of-home placement, including group-care placements and foster family care. In light of these observations and studies, this report will argue that stability is a major factor, perhaps a necessary if not a sufficient condition, in successful child development. It will argue for the initiation of a new focus on the creation of long-term positive and stable residential placements within the out-of-home care system and show that such placements can and have contributed to the development of healthy, happy, and successful adulthoods. This report offers a bio-psycho-social perspective on child development in out-of-home care. It provides a brief overview of the multiple bio-psycho-social theoretical perspectives that inform us on the necessary role of stability in growth and development and the contribution of instability to dysfunction. This report considers stability in out-of-home care in relation to its associated outcomes and those factors believed to enhance or detract from these outcomes. It reviews the history of substitutive care provision for children and youth and the role of the “stability objective” in that history. Finally, it looks at how child welfare system priorities have influenced stability, and it offers some suggestions for ensuring more stable growth and development in child placement provision.