Residential Child Research Articles

Outsourcing and children's social care: A longitudinal analysis of inspection outcomes among English children's homes and local authorities

Most residential children's social care services in England, including children's homes, are operated by for-profit companies, but the implications of this development are not well understood. This paper aims to address this gap by undertaking the first longitudinal and comprehensive evaluation of the associations between for-profit outsourcing and quality of service provision among English local authorities and children's homes. To enable investigation of the implications of outsourcing children's residential social care services, we create and analyse a novel and longitudinal dataset covering more than 13,000 children's home inspections by Ofsted (the independent regulator of children's social care in England) over a period of 7 years (2014–2021). We also investigate the association between Ofsted local authority (LA) ratings and the reliance of LAs on for-profit and third sector outsourcing of children in care placements. Our analysis shows that for-profit providers are statistically significantly more likely to be rated of lower quality than both public and third sector services. For-profit children's homes also violate a greater number of requirements and receive more recommendations compared to other ownership types. These findings are robust to model specification and consistent over the full analysed period. At LA level, we find provisional evidence that LA Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that LAs which outsource a greater amount of their children in care placements perform less well than those which do not. These findings are of significant concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit provision cannot be replaced without substantial coordination and long-term planning.

Stress, cognitive appraisal, and burnout in social workers of residential child care

Stress and burnout are global epidemics that may cause negative consequences for workers and organizations. Social workers of residential child care are especially at risk, due to the inherent characteristics of their work. Subsequently, this study aimed to analyse these professional’s stress, cognitive appraisal, and burnout. The sample included 92 social workers (90.2% female and 9.8% male) with ages between 25 and 64 years old (M = 38.08; SD = 7.91). The evaluation protocol included a sociodemographic questionnaire, the Stress Questionnaire for Health Professionals, the Primary and Secondary Cognitive Appraisal Scale, and the Shirom-Melamed Burnout Measure. Results indicated that 58% of professionals assumed high levels of general stress, and that physical fatigue and cognitive weariness were the burnout dimensions with higher values. The combination of sociodemographic variables, stress factors and cognitive appraisal were important to explain the burnout experience and can contribute to design interventions directed to these professionals.

Water quality evaluation and ecological-health risk assessment on trace elements in surface water of the northeastern Qinghai-Tibet Plateau

The Qinghai-Tibet Plateau is a unique area with water sources for approximately 40 % of the population in the world. Water resources and water quality are closely associated with ecological security and human health. Fifty-one trace elements in surface water samples (n = 40) were measured, and water quality, health and ecological risks were assessed. Trace elements showed significant variations in different surface water bodies in the study area. Concentrations of minor elements were relatively high in saline and salt lakes while those of REEs varied from 0.05 to 33.62 μg/L with an average value of 3.80 μg/L. The Nemerow pollution index (NP) values of trace elements ranged from 0.08 to 3.48, with an average value of 0.36 in rivers, fresh lakes and reservoir water samples; The heavy metal pollution index (HPI) values ranged from 3.70 to 21.18, indicating that most samples were within the critical limit; The heavy metal evaluation index (HEI) values and degree of contamination (DC) values indicated a free pollution status. The water quality index (WQI) values showed that 96 % of the samples belonged to excellent status in rivers, fresh lakes and reservoir water samples. More attention should be given to the Cr, Zn and Hg in the study area according to potential ecological risk assessment. Hazard quotients for residential children in 30 sites exceed 1.0 with maximal value of 10.97, suggesting the high non-carcinogenic risks for children in the study area. U, Zr and Cr for the ingestion pathway, Cr and U for the dermal pathway were primary contributors to the total health risk. Carcinogenic risk values of trace elements for residential and recreational receptors were in the range of 3.20 × 10−5-7.38 × 10−3 and 8.62 × 10−6-3.63 × 10−3, respectively. The carcinogenic risk values of Cr in surface water were higher than the target risk of 1 × 10−4, while the carcinogenic risk values of As were below the target risk. The results of this study provided information on trace elements for human health protection and water management in the northeastern Qinghai-Tibet Plateau.

Flexible placement practice

Danny Wilson, head of children's residential at Bedspace, sets out why commissioners need a wider range of care placement options

Tevredenheidsvragenlijsten bij residentiële geestelijke gezondheidszorg voor minderjarigen: systematische review

Satisfaction questionnaires for residential care in child psychiatry: a systematic review Background. The measurement of patient satisfaction in child psychiatry is used for evaluation, quality projects and scientific research. It is recommended to use instruments with sufficient validity and reliability. Methodology. The goal of this systematic review is to make an overview of the questionnaires that are currently used in residential child psychiatric care, and to evaluate the quality of those instruments. A search was performed in the databases Medline and Cochrane Library. Studies with patients aged below 18 years or their parents, who have used residential psychiatric care, were included. The studies were published in peer-reviewed magazines in Dutch, French or English. The quality of the instruments was evaluated based upon their psychometric properties (using the COSMIN (‘Consensus-based Standards for the Selection of Health Measurement Instruments’) criteria) and descriptive features were compared. Results. In 50 relevant articles, 44 questionnaires were found. For 31 questionnaires, psychometric properties were mentioned. Validity was determined more frequently than reliability (30 versus 2 questionnaires). Conclusion. Questionnaires YSS (Youth Services Survey) and YSSF (Youth Services Survey for Families) are recommended to use because of their good content validity and internal consistency.

Prevalence and 10-Year Stability of Personality Disorders From Adolescence to Young Adulthood in a High-Risk Sample.

BackgroundWith the implementation of the 11th edition of the International Classification of Diseases (ICD-11) in early 2022, there will be a radical change in the framework and process for diagnosing personality disorders (PDs), indicating a transition from the categorical to the dimensional model. Despite increasing evidence that PDs are not as stable as previously assumed, the long-term stability of PDs remains under major debate. The aim of the current paper was to investigate the categorical and dimensional mean-level and rank-order stability of PDs from adolescence into young adulthood in a high-risk sample.MethodsIn total, 115 young adults with a history of residential child welfare and juvenile-justice placements in Switzerland were included in the current study. PDs were assessed at baseline and at a 10-year follow-up. On a categorical level, mean-level stability was assessed through the proportion of enduring cases from baseline to follow-up. Rank-order stability was assessed through Cohen’s κ and tetrachoric correlation coefficients. On a dimensional level, the magnitude of change between the PD trait scores at baseline and at follow-up was measured by Cohen’s d. Rank-order stability was assessed through Spearman’s ρ.ResultsThe prevalence rate for any PD was 20.0% at baseline and 30.4% at follow-up. The most frequently diagnosed disorders were antisocial, borderline, and obsessive-compulsive PDs, both at baseline and at follow-up. On a categorical level, the mean-level stability of any PD was only moderate, and the mean-level stability of specific PDs was low, except of schizoid PD. Likewise, the rank-order stability of any PD category was moderate, while ranging from low to high for individual PD diagnoses. On a dimensional level, scores increased significantly for most PDs, except for histrionic traits, which decreased significantly from baseline to follow-up. Effect sizes were generally low. The rank-order stability for dimensional scores ranged from low to moderate.ConclusionThe findings indicate low to moderate stability of Pds and Pd traits from adolescence to adulthood, which supports the growing evidence that categorical diagnoses of Pds are quite unstable. This in turn, emphasizes the use of the upcoming ICD-11 that Acknowledgments Pds to be only “relatively” stable.

Urinary cystatin C: pediatric reference intervals and comparative assessment as a biomarker of renal injury among children in the regions with high burden of CKDu in Sri Lanka.

Cystatin C (Cys-C) is an emerging biomarker of renal diseases and its clinical use, particularly for screening the communities affected by chronic kidney disease of unknown etiology (CKDu), is hindered due to the lack of reference intervals (RIs) for diverse ethnic and age groups. The present study aimed to define RIs for urinary Cys-C (uCys-C) for a healthy pediatric population in Sri Lanka and in turn compare the renal function of the residential children in CKDu endemic and non-endemic regions in Sri Lanka. A cross-sectional study was conducted with 850 healthy children (10-17years) from selected locations for reference interval establishment, while a total of 892 children were recruited for the comparative study. Urine samples were collected and analyzed for Cys-C, creatinine (Cr) and albumin. Cr-adjusted uCys-C levels were partitioned by age, and RIs were determined with quantile regression (2.5th, 50th and 97.5th quantiles) at 90% confidence interval. The range of median RIs for uCys-C in healthy children was 45.94-64.44ng/mg Cr for boys and 53.58-69.97ng/mg Cr for girls. The median (interquartile range) uCys-C levels of children in the CKDu endemic and non-endemic regions were 58.18 (21.8-141.9) and 58.31 (23.9-155.3) ng/mg Cr with no significant difference (P = 0.781). A significant variation of uCys-C was noted in the children across age. Notably high uCys-C levels were observed in children with elevated proteinuria. Thus, uCys-C could be a potential biomarker in identifying communities at high risk of CKDu susceptibility.

Assessing Independent Life Skills of Youth in Child Protection: A MultiInformant Approach

Background: This study aimed to adapt and validate a staff version of the PLANEA Independent Life Skills Assessment tools, which were then used to explore the convergence between self-reported and staff views of independent living skills of young people in residential child care in Spain.Method: A sample of 422 care-experienced young people was evaluated by their residential or care workers (n = 219) using the staff version of PLANEA instruments. Psychometric analyses were carried out to study dimensionality and measuring properties of the instruments, while t-tests, Pearson correlations and Fisher’s z were used to study convergence between informants.Results: The results show that the internal structure of the instruments was confirmed for the staff versions (three first-order factors and one second-order factor model for PLANEA-S, unidimensional model for PLANEA-9-S, and two-factor correlated model for PLANEA-T-S). The instruments showed excellent reliability (ω = .80-.97) and discriminative capacity. Staff showed less optimistic views than young people about their independent living skills but not their autonomy to perform everyday life tasks. This was mediated by the role of the adult respondent towards the young person evaluated.Conclusions: As conclusions we can say that the validated staff version of the PLANEA Independent Life Skills Assessment tools expands the scope for assessing this construct in young people in care from a multi-informant perspective. This is key for child protection services to address young people’s individual needs and inform decision-making regarding the provision of support services that will promote a successful transition from care to adulthood for them.

The Perceptions of Educators Relating to the Promotion of the Psychological Well-Being of Abandoned Children

Promoting the psychological well-being of abandoned children raises specific issues. These children have no choices but to live in residential child care institutions. They are called to take part in society, to become autonomous and competent adults. However, these children present difficulties that result in impairment of self-esteem and are identified by negative feelings, as well as failures in their relationship with others. Researchers point out that the satisfaction of the three basic psychological needs: the need for autonomy, the need for social affiliation and the need for competence, is essential to the growth of the individual’s integrity and well-being. Our ultimate interest is to contribute through this work, to the development of educational practices and the quality of care in the child care institutions. From this perspective, this qualitative research aims to explore the educators’ perceptions of psychological well-being of abandoned children, actions they take and the contributions of professional services to promote it. Semi-structured individual interviews were conducted with educators (N=10) in a residential child care institution. The results show that the educator’s perceptions of psychological well-being go in the same direction as the definitions of psychological well-being in the scientific literature. The majority of their actions tend towards satisfaction of the three fundamental psychological needs, which are essential to the development of psychological well-being. They also underlined the important role of professional services, material and human resources in this direction. This research allowed identifying five specific ways to promote the psychological well-being of abandoned children in the residential child care institutions.

Characterization of groups of siblings in residential child care in Spain

AbstractInternational guidelines recommend that groups of siblings remain together when protective measures are taken. Although this is a deeply rooted practice in most countries, research has found no conclusive evidence of the benefits of this practice, so further knowledge in this field is required. This work aims to describe the characterization of groups of siblings in residential child care. The sample consists of 281 children and adolescents who were in residential care, of which 42% were composed of groups of siblings. Case files were analysed, and the main results indicate that those who are cared for with their siblings are younger, have longer stays and have been subjected to neglect to a greater extent than those who are alone and reunification with their family is more complicated than for the rest. These results are discussed with regard to the scientific literature in this field and conclude with the need to carry out preventive actions and to make decision‐making criteria about groups of siblings more flexible.

Residential care

Latest figures show a growth in the number of residential children's care homes, but local authorities continue to report problems in finding sufficient care placements to meet the needs of young people

Promoting a relational approach to residential child care through an organizational program model: Impacts of CARE implementation on staff outcomes

We evaluated the impact of Children and Residential Experiences (CARE), an organization-wide program model implemented in 13 residential child care agencies in one Southeastern state. CARE implementation lasted three years and involved the application of six evidence-informed principles throughout the organization in order to create more therapeutic environments and improve the quality of care for children.A wait-list design was used with one cohort of agencies starting CARE immediately and a second cohort waiting 12 months before starting, allowing them to serve as a comparison group. Agency staff completed annual surveys assessing curricular knowledge, their beliefs about and their use of practices that reflect a relational approach to care. Using linear mixed models that accounted for clustering within agencies and several important covariates, results showed significant increases in all staff outcomes. CARE effects on knowledge and beliefs emerged in Year 1 and CARE effects on practice emerged in Year 3. Exploratory analyses showed that the CARE effects were evident across all staff demographic and agency subgroups, with evidence of more pronounced effects for some subgroups. Results contribute to an emerging pattern of evidence that CARE implementation improves the capacity of agencies to provide effective therapeutic care for children.

Subjective Well-Being of Young People in Therapeutic Residential Care from a Gender Perspective

A growing body of research focus on subjective well-being (SWB) in adolescence; however there are few studies focus specifically on the residential care population and even fewer on differences by type of residential facility separately for males and females. This study aims to analyze SWB in therapeutic residential care (a residential program created to address youths with severe emotional and behavioral problems) in relation to young people in other kinds of residential child care (RCC). 567 adolescents aged 14-18 from Therapeutic Residential Care (TRC) (n=256) and RCC (n=311) participated in the study. Results showed few significant differences concerning the residential program factor. Satisfaction with their own family was greater for young people in TRC and satisfaction, both with the groups they belong to and with their own residential facility, rated higher among the RCC group. Regarding differences by sex, females reported less SWB in all the domains including overall life satisfaction. The effect of the interaction between sex and type of residential program showed that females in TRC reported SWB, particularly low. The main implications for research and intervention will be discussed.

Psychological Distress, Burden of Care, and the Role of Coping Strategies Among Childminders in Residential Children's Homes.

This study aimed to identify the prevalence of psychological distress and its association with sociodemographic characteristics, burden of care, and the coping strategies used by childminders in residential homes. A total of 151 childminders (median age = 39; 64.7% female) participated in the study. The prevalence of psychological distress was 59.4%, and 74.0% recorded mild to moderate burden. Multivariate analyses showed that caregiver burden (adjusted beta = 0.464, P = .01), lesser application of problem-focused coping (adjusted beta = -0.292, P = .012), lower salary (adjusted beta = -0.196, P = .040), and lower educational qualification (adjusted beta = -0.212, P = .038) predicted higher psychological distress. Regular screening of psychological distress and burden of care is recommended among this population.

Are residential care homes really bad for children? Voices of alumni of residential child and youth care in Trinidad and Tobago

Social workers have advocated closing large youth care institutions and moving to adoption, foster care and group homes. However, these approaches have proven to be costly and often disruptive of children’s lives. This study of 24 alumni of orphanages and large group homes in Trinidad and Tobago shows that the children experienced stability and happiness, with siblings kept together and almost universal secondary school graduation. Problems occurred in the transition from the homes to the community. With attention to gender in discharge policies, large group care may be beneficial and cost effective, especially for low-resource developing countries.

Residential Child and Youth Care in a Developing World: Volume 4 – African Perspectives, edited by Tuhinul Islam and Leon Fulcher

Residential Child and Youth Care in a Developing World: Volume 4 – African Perspectives, edited by Tuhinul Islam and Leon Fulcher

Stronger together: Workplace social support among residential child welfare professionals

BackgroundResidential childcare workers (RCWs) in child welfare and youth-justice settings are at risk of secondary traumatic stress, burnout, and moral distress. Workplace support has been shown to be protective against work-related harms for some helping professionals and a lack of workplace support has been cited as a contributing factor toward workforce instability; however, little is known about what types or sources of support are effective for RCWs. Participants and setting81 RCWs from 11 residential units in 11 of the 16 territorial service centers across the province of Québec, Canada. MethodsThis interpretive description study analyzed data extracted from transcripts of individual interviews guided by the Secure Base Interview protocol (Schofield & Beek, 2018). Responses to a single item were read for meaning, compared, contrasted, and then coded using the thematic analysis technique. The sources of support identified by participants as helpful were aggregated to reveal a common support system pattern. ResultsMultiple sources of social support were described; the majority were interpersonal interactions with peers, unit managers, and various interdisciplinary team members. Informal individual supports without role overlap and teams with a common vision were most often cited, even when formal supports were available. ConclusionsImplications of these findings include the need to conceptualize effective workplace social support for RCWs and to rethink the place of mutual-aid among trauma-exposed professionals in residential child welfare and youth-justice settings.

Bringt das überhaupt was? – Selbstevaluation präventiver Bemühungen in pädagogischen Einrichtungen mithilfe des Instruments IPSE

The vagueness of the term “Schutzkonzept” (protection concept) discussed in the first section of this article includes, among other things, the inability to operationalize the preventive success of educational institutions. In a research project funded by the Federal Ministry of Education and Science (BMBF), a set of methods was developed to enable educational institutions (especially residential child and youth welfare) to systematically review their efforts to prevent violence. In the first phase of this project, five central dimensions were identified in an elaborate empirical study, which are likely to be of decisive importance for the success of a sustainable implementation of preventive concepts in educational institutions (sense of development; differences / identity; internal-external relationships; empowerment - disempowerment; claim and reality). On the basis of these findings, the “Instrument for Participatory Self-Evaluation (IPSE)” was developed, which is presented in this article.

Mental disorders among adults formerly in out-of-home care: a systematic review and meta-analysis of longitudinal studies

While children and adolescents placed in child welfare or juvenile justice out-of-home care show higher prevalence rates of mental disorders compared to the general population, it remains unclear whether this pattern persists into adulthood. A quantitative synthesis of existing studies is lacking. The aim of this meta-analysis was to estimate the prevalence rates for mental disorders among adults with a foster or residential child welfare or juvenile justice care history, comparing them where possible to rates among the general population. PubMed, PsycInfo, EMBASE, and Web of Science were systematically searched for epidemiological studies published up to 28 October 2020. Nineteen studies, totaling 604,257 participants, met our inclusion criteria. Random-effects models were used for prevalence rates and odds ratios (OR) of mental disorders, and study quality was rated. A prevalence rate of 30% [95% CI (23.36, 37.36)] for any mental disorder in adults with a child welfare care history was found (3–17% for specific disorders). A prevalence rate of 45% [95% CI (42.38, 47.38)] for any mental disorder was found in adults with a juvenile justice care history (6–66% for specific disorders). For out-of-home placement history, adult mental disorders were significantly higher than in the general population (OR = 1.33–2.76). Studies differed in terms of methodology and the disorder groups considered, so heterogeneity between effect sizes ranged from low to high. Our findings suggest that the high risk that mental health issues will persist in adults with an out-of-home placement history needs to be taken seriously in the transition from adolescence to adulthood. The care systems involved need to collaborate and to be aware of these risks.

Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019)

Objective To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019). Methods A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval. Results From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing. Conclusion The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.