Age and other risk factors related to reentry to care from kin guardian homes

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (N = 18,831). Specifying time-dependent Cox relative risk models, children’s age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and children’s development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13–15 years (HR = 1.63, p < .001), and late adolescents, age 16–17 years (HR = 1.93, p < .001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HR = 2.18, p < .001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.     

Continuity for children after guardianship versus adoption with kin: Approximating the right counterfactual

Over the past two decades there has been a rapid increase in the number of children and youth living in guardianship and adoptive homes who were previously in foster care. Further, previous studies compared outcomes for children in guardianship homes to those for children in adoptive homes, despite the fact that many factors likely affect the selection of foster youth into different types of permanent placements. This study examined two counterfactuals for guardianship as a permanent placement type: adoption only and adoption or long-term-fostercare (A + LTFC). Longitudinal outcomes were tracked for children who exited foster care with relatives through guardianship (N = 4,884) or adoption (N = 12,163), as well as children in long-term foster care with relatives (N = 4,840). Propensity scores were used to match children on key indicators. In the matched sample of guardianship versus adoption cases only, children who exited to guardianship were more likely to experience discontinuity than children who exited through adoption, 11% vs. 6% respectively. However, when guardianship was compared to the combination of adoption or long-term foster care, children in guardianship experienced the same proportion of discontinuity, 11% vs. 11% respectively. These results suggest that simply matching guardianship to adoption without taking into account LTFC may be the wrong way to estimate the “what if” counterfactual if children were not discharged to guardianship. Findings also support the use of guardianship as a potential solution for children in LTFC whose caregivers are not planning to adopt.     

The efficacy of family reunification practices: reentry rates and correlates of reentry for abused and neglected children reunited with their families

OBJECTIVE: Since the 1980s Child Protective Services has increasingly relied on family reunification for abused/neglected children rather than long term foster care or adoption. While family reunification practices are controversial, little research is available to inform the debate. This research explores the efficacy of these practices. METHODS: This study utilizes two CPS data sources and both quantitative and qualitative methodologies to identify reentry rates and correlates of reentry for abused and neglected children returned to their families by CPS. RESULTS: System reentry due to additional maltreatment is considerable. Thirty-seven percent of the children reunited with their families reenter the system within 3 1/2 years. Correlates of reentry are identified as; abuse type, CPS history, parental competency, race, criminal history, substance abuse, and social support. Notably, assessments of risk made by caseworkers are found to be unrelated to reentry. CONCLUSIONS: The high reentry rate and the limitations of current risk assessment procedures suggest that CPS family reunification practices have not been entirely successful. The identification of specific risks of reentry, such as those revealed in this study, will be helpful in assessing risk on cases. In addition, future studies should explore the systemic deficiencies that contribute to the additional maltreatment that occurs for a sizable proportion of the children served by the system.     

An empirical examination of the Indian Child Welfare Act and its impact on cultural and familial preservation for American Indian children

OBJECTIVE: Cultural and familial ties are crucial for the overall well-being of children. Extant research and permanency planning practices support the reunification of children with their families when possible. In 1978, the Indian Child Welfare Act (ICWA) was enacted to promote cultural and familial preservation for Indian children, but sparse empirical research has examined the implementation and outcomes associated with this landmark legislation. This article examines the relationship between compliance with ICWA in one Southwestern state and the rate of reunification of Indian children with family or tribal members following out-of-home placement. METHOD: Public child protection records were reviewed for 49 ICWA-eligible children who were placed in alternate care. Data were collected on compliance with placement type, use of qualified expert witnesses, and incorporation of Indian culture and resources. Additionally, 78 state caseworkers and 16 tribal workers were surveyed regarding knowledge and attitudes about three areas of compliance. RESULTS: Case record reviews indicated that the majority (83%) of Indian children were placed according to preferences outlined by ICWA. Almost all cases included a court finding that active efforts were applied to prevent family breakup. While state workers reported limited understanding of many ICWA's requirements, both state and tribal workers reported a high level of state-tribal cooperation in working with Indian families and children. CONCLUSIONS: Results of this study point to two major patterns of findings: (1) individual case record reviews suggest compliance with ICWA; and (2) differences exist in knowledge and perceptions of ICWA by state and tribal workers. Furthermore, state child protection systems should follow the American Indian lead in further emphasizing cultural and familial ties for children. Highlighting such ties acknowledges the importance of reunification and cultural and familial preservation to enable children to have a clear sense of tradition and belonging. Evidence indicates that compliance with ICWA promotes better outcomes through reunification.     

Relationship between out-of-home care placement history characteristics and educational achievement: A population level linked data study

Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children’s out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children’s educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N = 235,045 children, including 2160 children with a history of out-of-home care). Children’s educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR = 1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child’s care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification.     

Can the actions of child welfare case managers predict case outcomes?

This study examined the effect of efforts made by child welfare case managers to involve parents in case processes on two divergent case outcomes: reunification and the termination of parental rights (TPR). The sample was comprised of a cohort of children who received child protection services while in out-of-home care during fiscal year 2009–2010 and were randomly selected by the Florida Department of Children and Families (DCF) for their case management quality of practice reviews. Findings revealed that when child welfare case managers made efforts to encourage and support parents in participating in child-related decisions and activities, there were increased chances for timely reunification. However, these same efforts were only associated with a lower risk of TPR for mothers and not for fathers. Implications of these findings are discussed.     

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers’ reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.     

Permanency planning for children and youth: out-of-home placement decisions

This article advocates the extension of "permanency planning" in out-of-home placements to include those children and youth with developmental disabilities. It discusses permanency planning and notes its promise in improving the opportunities of all children and youth to grow up in a stable family environment. There is a need for major initiatives in this area: 78% of children and youth with developmental disabilities who are placed in long-term care have no such protections. Though some states currently operate programs according to the principles of permanency planning, significant changes in existing federal policy are recommended to require permanency planning in federally supported out-of-home care for all children, including those with severe disabilities.     

The adoption of children from out-of-home care: The understandings of key decision makers in Victoria,Australia

Adoption is one of a range of options that can provide children in out-of-home care with permanency when they are unable to be reunified with their birth parents. This paper reports on how the adoption of children from out-of-home care is understood by professionals involved in making decisions about the permanent placement of children in out-of-home care in Victoria, Australia, where adoption is rarely used. Data were collected through a single, face-to-face semi-structured interview with 21 professionals; eight child welfare specialists, eight adoption and permanent care specialists and five judicial officers. The adoption of children from out-of-home care was primarily understood as a child-centered practice that can afford children stability and a sense of belonging. Adoption was largely viewed as a voluntary process dependent upon the consent of a child’s birth parents. Adoption and permanent care specialists were the only group to refer to the dispensation of parental consent as a means of obtaining an adoption order. Most decision makers understood that contact between children and their birth parents is possible following adoption, but this was not understood by all judicial officers or all child welfare specialists. Children’s connection to their cultural heritage was viewed as important to the consideration of adoption for children in out-of-home care. This research provides insight into the foundations upon which decision makers may appraise adoption, within a hierarchy of options, as a potential outcome for children in need of permanency.     

Maltreatment following reunification: Predictors of subsequent Child Protective Services contact after children return home

ObjectivesThis study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment.MethodA longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment.ResultsChildren in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification.ConclusionsSupports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports.Practice implicationsThis study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.     

Improving outcomes for babies and toddlers in child welfare: A model for infant mental health intervention and collaboration

Children under three comprise a sizable and growing proportion of foster care placements. Very young children who enter the child welfare system experience disruptions of critical attachments that are essential to this formative stage of brain development, as well as other traumatic events, leaving them at great risk for lifelong impairments. To reverse these concerning outcomes, babies who have been removed from their homes require intensive, relationship-based interventions that promote secure attachment to a primary caregiver and holistic attention the child's developmental needs. Child welfare decision-makers must be informed of infant brain development and knowledgeable about the particular needs and circumstances of each child. This article describes a model with these features that has been developed and tested in the Bronx, New York, one of the nation's poorest urban counties with high rates of foster care. The Project utilizes evidence-based Child-Parent Psychotherapy (CPP) as its core intervention, and emphasizes collaboration and information sharing– driven by the CPP clinician– with judges, child welfare workers, attorneys and other social service and mental health providers, thereby encouraging developmentally and relationally informed case planning and permanency decisions. The model is evaluated using pre and post treatment psychosocial measures and program outcome data. Results indicate improvement in parenting interactions, positive child welfare outcomes (including increased rates of reunification, fewer returns to foster care), and improved safety and wellbeing. Results highlight the need for child welfare practices to be more closely aligned with the current science of infant brain development, and to incorporate a specialized approach to address the unique needs of infants.     

Adopted and permanently placed children in education: from rainbows to reality

Children who leave care into adoption and special guardianship are often considered by schools and local authorities to have found their “happy ending.” Yet there is growing evidence that the impact of prenatal and early trauma, abuse and neglect does not disappear upon placement in a permanent family. Rates of social, emotional and mental health difficulties remain high, and the group has pronounced educational needs. Whilst having high levels of involvement with education and health services, families report significant difficulties in mobilising understanding, support and provision. In the context of growing numbers of children in England finding permanence through adoption and special guardianship, and the Department for Education’s increasing focus on addressing the needs of this group, this paper highlights the key role of Educational Psychology Services in supporting adopted and other permanently placed children by providing training, consultation, assessment, intervention and research for children and their families, their schools, and the local authorities.     

The impacts of family treatment drug court on child welfare core outcomes: A meta-analysis

BackgroundSubstance abuse has been prevalent among caregivers involved in child welfare and is a major barrier to their achieving favorable outcomes. Family Treatment Drug Courts (FTDCs) have been viewed as one of the most promising interventions but research has reported mixed effects on child welfare outcomes. No meta-analysis was conducted to synthesize the findings to reach a more generalizable conclusion.ObjectiveThe meta-analysis synthesized findings from existing evaluations to examine whether and to what extent FTDC participants achieved better reunification and safety outcomes than non-participants.Participants and SettingAmong 17 identified studies dated from 2004 to 2018, the pooled sample subjects in the intervention and comparison groups were 3402 and 3683 for the 16 studies on reunification outcomes, and 842 and 632 for the eight studies on child safety outcomes.MethodsWe first estimated the FTDCs’ pooled effects on child reunification and safety outcomes. Furthermore, we conducted a series of subgroup meta-analysis to compare FTDCs’ effects across study and program characteristics.ResultsSubjects participating in FTDCs were substantially more likely to achieve reunification (OR = 1.75, 95% CI = 1.38, 2.22) without increasing the risk of subsequent foster care reentry or maltreatment re-report. Subgroup meta-analysis suggests factors such as research design, FTDC model, observation length, publication type and period may contribute to FTDCs’ disparities on reunification outcomes.ConclusionsThe synthesized findings strengthen evidence for the implementation and expansion of FTDCs for serving substance abusing caregivers in the child welfare system.     

Contextual and individual-level predictors of abused children's reentry into out-of-home care: a multilevel mixture survival analysis

Objectives

This study examined the effects of individual and contextual factors on reentry into out-of-home care among children who were discharged from child protective services in fiscal year 2004-2005. The objectives were to: (1) examine individual and contextual factors associated with reentry, (2) explore whether there are meaningful groups of youth who differ in terms of risk for reentry, and (3) determine whether relatively homogeneous clusters of child welfare agencies, based on contextual characteristics, differ significantly in terms of the reentry rates of the children whom they serve.

Method

The study design involved a multilevel longitudinal analysis of administrative data based on an exit cohort. Two Cox proportional hazards multilevel mixture models were tested. The first model included multiple individual level predictors and no agency level predictors. The second model included both levels of predictors.

Results

The results of multilevel Cox regression mixture modeling indicated that at the individual level, younger age, being placed in out-of-home care because of neglect and having physical, health problems corresponded to a decreased likelihood for reentry. At the agency level, lower average expenditures per child and contracting out case management services were associated with faster reentry into out-of-home care.

Conclusions

This study demonstrates that children who reenter out-of-home care appear to be a homogeneous population and that reentry is associated with both contextual factors and individual characteristics.

Practice implications

The most important implication that can be drawn from the study findings is that reentry may be most effectively prevented by focusing on such factors at the organizational level as contracting out case management services and funding allocation. Child welfare agencies that are responsible for an array of services and decide to contract out case management should consider the use of performance-based contracts and emphasize and strengthen quality assurance approaches for contracted services. In addition, to compensate for lower funding allocated for children served in out-of-home care, child welfare workers should become more familiar with community resources and help connect families to these supports.     

Child welfare outcomes for youth in care as a result of parental death or parental incarceration

Every day, in the United States, children are removed from their homes and placed into state supervised out-of-home care because of concerns around their safety. These children enter care as a result of child abuse, child neglect, abandonment or some other reasons. Lost in most discussions of out-of-home care is the role that parental incarceration and parental death have on the trajectory of children through the child welfare system. In order to address this gap in the literature, the present study aims to compare youth in foster care as a result of parental death or youth in foster care as a result of parental incarceration with youth in care because of child maltreatment in terms of the length of time to achieve permanency. Holding all other variables constant, entering care as a result of parental death more than doubled the average time to exit (HR = 2.32, SE = 0.22), and these youth were significantly less likely to exit to permanency when compared to children entering care for other maltreatment reasons (OR = 0.35, SE = 0.24). Entering care as a result of parental incarceration led to a 24% longer time to exit (HR = 1.24, SE = 0.09) compared to children entering care for other maltreatment reasons. Findings suggest that a one-size-fits-all approach to policy and practice may not be useful to identifying permanent placements for children entering care as a result of parental death or incarceration.     

The profile and progress of neglected and abused children in long-term foster care

ObjectivesThis study compared the profile of neglected and abused children in the Australian foster care system as well as differences between maltreatment types in relation to parental contact, reunification and psychosocial progress in care.MethodThe case files of 235 children entering foster care were examined and their social workers were administered standardised questionnaires at the point of intake. All measures were repeated for those remaining in care 1 year and then again 2 years later.ResultsNeglected children were younger than non-neglected children, more likely to have a physical or mental disability, more likely to experience multiple forms of maltreatment and less likely to pose conduct problems for carers. Neglected children were more likely than non-neglected children to experience a decline in parental contact over time, and were less likely to be reunified with their families of origin. There was minimal difference between neglected and non-neglected in their psychosocial progress while in care. Aboriginal children were more likely to be reunified than non-Aboriginal children when neglect was attributable to transient factors (parental incapacity) but the reverse was true for non-neglected children.ConclusionsThe fact that neglected children more often require a second form of maltreatment before being removed from home suggests that children's services workers are less inclined to remove children for neglect than for other forms of maltreatment. As a consequence, those neglected children who are in care tend to come from more dysfunctional families than non-neglected children do, as evidenced by the relatively poorer parental contact and reunification results of neglected children.Practice implicationsNeglected children differ systematically from non-neglected children and suffer relative disadvantage in relation to multiple forms of maltreatment, parental contact, and reunification. The fact that declines in parental contact among neglected children in care occurred only when indirect contact was provided suggests that, wherever possible, care plans should include face-to-face visits and overnight stays rather than being restricted to less direct forms of contact. The difference in the success of reunification according to type of neglect (chronic or transient) also suggests that parental intervention programs need to focus their efforts on chronic factors rather than transient parental factors.     

Type of child care and children’s development at 54 months

The types of non-maternal child care received by more than 1000 U.S. children were examined from birth to 54 months and related to family selection factors and to child outcomes. Individual children tended to experience a variety of different types of care and not to fit into clear patterns of either stable care types or progressive patterns of movement from less structured to more highly structured care settings. Across the entire sample, however, hours in center care were higher in the preschool period than earlier, whereas hours in relative care remained stable and hours in child care homes decreased. Mothers who were single, those with more education and less traditional beliefs about child rearing, and families with higher incomes and fewer children in the household were more likely to use more hours of center care than other families; single mothers and those with fewer children also used more hours of care in child care homes. Minority families, those with low incomes, and mothers with less education and fewer children used more hours of relative care. With family selection factors and quality of child care controlled, only hours in center care across the time period from 3 to 54 months were related to child outcomes. Children who experienced more center care were reported by caregivers at 54 months to have somewhat higher externalizing behavior problem scores than other children, although these scores were not in the clinical or at-risk range. Center care hours were also related to cognitive and language outcomes, with more hours in infancy associated with lower preacademic test scores and more hours in the toddler period with higher language scores.     

Children leaving foster care: Outcomes of permanency planning

Foster care, created to overcome some of the disadvantages and abuses of institutional care of children, can present its own problems. One problem is overt abuse, but there are other, more subtle, deficiencies and concerns about foster care. In response, the concept of permanency planning has been introduced as a philosophy, a policy, and a technique. It is designed to return every child who enters care to the stability of a family as quickly as possible. This paper presents findings of a longitudinal study of the outcomes of permanency planning. Results show that over half the children returned to their biological parents, that adoptions were more common for Caucasian than black children, that 78% of the children were still in their permanent placements 12-16 months later, that most children were functioning well, and that there was a marked need for services for the families. In addition to the results of the study, the discussion focuses on implications for foster care practice and child welfare policy, including the importance of relatives, the impact of foster care placements, the needs of biological families, and the provision of services and supports for reunified families.     

Children in care in education: Who is entered for exams and who reaches critical thresholds of success at age 16?

Being entered for exams and reaching key educational thresholds, for example 5 A* to C grades (including English and Mathematics) at GCSE, are important markers of participation and success in secondary education. However, little is known about the prevalence and make-up of children in care reaching these thresholds. Using secondary data analysis, we compared the proportions of children in care, children ‘in need’ and children in the general population who achieved four key thresholds, including exam entry and 5 A* to C grades, including English and Mathematics. We then focused on children in care and examined factors that predicted exam entry and achieving 5 A* to C grades, including English and Mathematics. Children receiving social care interventions were less likely than children in the general population to be entered for exams or to reach important educational thresholds. For children in care, several socio-demographic, care and educational factors predicted their likelihood of success. No children with an autistic spectrum disorder or who had ever been permanently excluded were recorded to have achieved 5 A* to C grades, including English and Mathematics. Children with poor attainment at Key Stage 2 were also at significant risk of not achieving this threshold. Practitioners and policymakers should consider the modifiable risk factors for poor educational performance and be aware of groups of children in care who are at significant risk of not achieving a minimum standard which could open doors for their future.     

The impact of a statewide trauma-informed child welfare initiative on children’s permanency and maltreatment outcomes

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children’s Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project’s implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.