An intervention to improve sibling relationship quality among youth in foster care: Results of a randomized clinical trial

Sibling programming is an important part of a prevention framework, particularly for youth in foster care. After children are removed from their families and placed into foster care in the aftermath of maltreatment, the sibling relationship is often the most viable ongoing relationship available to the child, and may be critical to a youth’s sense of connection, emotional support, and continuity. The promise of dyadic sibling programming in particular rests on the ability of interventions to enhance the quality of sibling relationships; yet little research exists that suggests that sibling interventions can improve relationship quality among foster youth. The primary aim of the current study was to examine the effects of a specific dyadic sibling-focused intervention for older and younger siblings on sibling relationship quality. One hundred sixty four dyads (328 youth) participated in the study, with each dyad consisting of an older sibling between 11 and 15 years of age at baseline and a younger sibling separated in age by less than 4 years. Hierarchical linear models were applied to self-reported, observer-reported and observational data over the 18-month study period. Findings suggest that the sibling intervention holds promise for improving sibling relationship quality among youth in foster care. Implications and future directions for research are discussed.     

Developing a tailored substance use intervention for youth exiting foster care

Youth who are aging out of the foster care system face significant barriers to accessing substance use treatment. Mobile interventions have shown efficacy for several mental and physical health issues and may be helpful in overcoming barriers facing foster youth with substance use problems. A program (iHeLP) for substance use reduction was developed that used a computerized screening and brief intervention (SBI) followed by six months of dynamically-tailored text messages. The program was shown to focus groups of youth (N = 24) ages 18–19 who recently left foster care and had moderate to severe substance use risk. Focus group feedback was used to modify iHeLP prior to delivery in an open trial (N = 16). Both study phases included assessments of feasibility and acceptability; the open trial also included assessments of substance use outcomes at 3 and 6 months. Focus groups indicated a high level of acceptability for the proposed intervention components. Of those screened for the open trial, 43% were eligible and 74% of those eligible enrolled, indicating good feasibility. Retention through the final follow-up was 59%, and drop out was associated with involvement in the criminal justice system. Participant ratings for liking, ease of working with, interest in and respectfulness of the SBI were high. Satisfaction ratings for the texting component were also high. A computerized brief screening intervention for substance use risk reduction together with tailored text messaging is both feasible and highly acceptable among youth who have recently aged-out of foster care.     

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.     

Homelessness in the child welfare system: A randomized controlled trial to assess the impact of housing subsidies on foster care placements and costs

Inadequate housing and homelessness among families represent a substantial challenge for child and adolescent well-being. Child welfare services confront housing that threatens placement into foster care with little resources and evidence to guide practice. The present study provides the first rigorous test of the Family Unification Program (FUP) – a federal program that offers housing subsidies for inadequately housed families under investigation for child maltreatment. A randomized controlled trial assesses program impact on foster care placement and costs.The experiment referred intact child welfare-involved families whose inadequate housing threatened foster placement in Chicago, IL to FUP plus housing advocacy (n = 89 families with 257 children) or housing advocacy alone (n = 89 families with 257 children). Families were referred from 2011 to 2013, and administrative data recorded dates and costs of foster placements over a 3-year follow-up. Intent-to-treat analyses suggested families randomly assigned for FUP exhibited slower increases in rates of foster placement following housing intervention compared with families referred for housing advocacy alone. The program generates average savings of nearly $500 per family per year to the foster care system. Housing subsidies provide the foster care system small but significant benefits for keeping homeless families together. Findings inform the design of a coordinated child welfare response to housing insecurity.     

Summer school effects in a randomized field trial

This field-based randomized trial examined the effect of assignment to and participation in summer school for two moderately at-risk samples of struggling readers. Application of multiple regression models to difference scores capturing the change in summer reading fluency revealed that kindergarten students randomly assigned to summer school outperformed their control group peers by .60 of a standard deviation in an intent-to-treat analysis. For the first grade sample, the intent-to-treat estimate was over three quarters of a standard deviation. The contrast in performance was greater when the comparison was focused more specifically on the change in literacy between treatment participants (i.e., randomly assigned students who actually attended summer school) and students randomly assigned to the control group and in analyses that explicitly adjusted for non-compliance with treatment assignment. These results support the experiential intuition of school district personnel regarding the benefits of summer school and suggest that targeted summer instruction can be a useful strategy to support student learning over the summer months.     

Engaging foster parents in treatment: A randomized trial of supplementing Trauma-focused Cognitive Behavioral Therapy with evidence-based engagement strategies

The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.     

Abuse of children in foster and residential care

OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.     

Children's participation in foster care hearings

Purpose

Empirical research regarding potential risks and benefits of children's participation in the legal system generally, and in the child dependency legal system in particular, is sparse and mostly characterized by small studies without comparison groups. The current study was designed to address the following questions regarding children's participation in dependency court hearings: (1) Is attending court harmful to children? (2) Is attending court beneficial to children? (3) Is judicial behavior with the child in the courtroom related to potential harms or benefits? and (4) Are there age differences in children's reactions?

Method

The authors measured children's reactions to attending dependency review hearings (n = 43) and compared them to a sample of children who did not attend their hearings (n = 50). One to 2 weeks following review hearings, both groups of children were interviewed about their reactions to the court process.

Results

Children who attended their hearings reported more positive feelings about the dependency process (e.g., trust in judge, perceived fairness, and more comfort with their guardians ad litem and caseworkers). For children who attended, there was no evidence of high distress immediately preceding or following their hearings. Court observations revealed that more active engagement by judges was related to positive responses from the children. Most children, including both children who attended hearings and those who did not, believed that all children should be able to attend their hearings.

Conclusion

Overall, the findings suggest that policies encouraging children's attendance at dependency hearings are viewed positively by and not harmful to children.     

Dimensions of maltreatment and academic outcomes for youth in foster care

Childhood maltreatment is often associated with youth’s ability to successfully function in school. Youth with a history of maltreatment often receive lower grades and scores on tests of academic achievement, as well as demonstrate more negative behaviors in school, as compared to non-maltreated youth. However, there are many inconsistencies in previous studies examining the association between maltreatment and academic outcomes in youth. One potential reason for mixed findings within the literature could be a result of how maltreatment is measured and operationalized. The current study examined if the methods used to define and describe maltreatment contribute to the association between maltreatment and academic functioning in youth. Youth in foster care (N = 490, M_age = 13.13[3.09]) were recruited and information on their maltreatment history and academic functioning was obtained from official agencies, school records, and self-reported measures. Using a SEM framework when examining each dimension separately in the same model, results suggested that frequency maltreatment was more predictive of academic behavior, as compared to type and severity. No dimensions were associated with grades and significant findings were only observed for models using self-report data. However, when examined using a measurement model approach, maltreatment as a whole was associated with school behavior, which was found for both self-report and case file measurement models. The findings suggest a need for research on academic functioning to take a comprehensive approach when measuring and defining maltreatment as this may be a more robust and accurate predictor of academic functioning.     

Identifying effective interventions for promoting parent engagement and family reunification for children in out-of-home care: A series of meta-analyses

BackgroundAn important obstacle for family reunification following child placement in residential care and other temporary out-of-home care services is the lack of engagement among parents.ObjectiveThe aim of this meta-analysis is to identify the most effective interventions to promote parental engagement and family reunification.Method and participantsEight studies, for a total of 2996 families, were used to conduct two series of meta-analyses. Each study examined the effectiveness of a goal-oriented parental engagement intervention, relative to a control group made up of parents who received standard services. Six moderators were analyzed: type of clinical modality, number of clinical strategies, sources of motivation for intervention, focus on the child care staff-parent relationship, child care staff training, and strategies to promote access to intervention.ResultsResults indicate that parents exposed to goal-oriented engagement interventions showed greater engagement (effect size d = 0.71, CI: 0.35–1.07, p < 0.001) and likelihood of reunification (effect size OR = 2.49, CI: 1.22–5.10, p < 0.05) than parents who received standard services. In particular, moderator analysis showed that parents who specifically participated in a family-focused intervention showed the highest engagement in comparison to parents involved in other types of interventions or who received standard services (effect size d = 1.08, CI: 0.58–1.59, p < 0.001). No moderators significantly explained heterogeneity of studies on family reunification.ConclusionOverall, the results underline the effectiveness of family-focused interventions to promote parental engagement. Nevertheless, greater knowledge on the mechanisms by which interventions can increase parents’ engagement and family reunification is still needed.     

Intrinsic instructional goal adoption increases autonomy-supportive teaching: A randomized control trial and intervention

Goal contents theory (GCT) stresses the benefits of intrinsic goal pursuit. To extend this research to teachers, the present investigation conducted two experiments to apply GCT's principles to the classroom to test for the causal, facilitating effect of teachers' intrinsic instructional goals on the new benefit of autonomy-supportive teaching. Study 1 was a laboratory study with 156 college students randomly assigned into one of three conditions: intrinsic instructional goal-personal growth, intrinsic instructional goal-relationship growth, or no-goal. Planned comparisons showed that teachers who pursued an intrinsic instructional goal showed more autonomy-supportive teaching than did teachers in the no-goal condition. Study 2 was a classroom-based intervention with 26 experienced K-12 teachers and their 538 students. Teachers were randomly assigned into either an intrinsic instructional goal intervention or a no-intervention control condition. Repeated-measures ANCOVAs showed that intrinsic instructional goals were malleable and led to significantly greater autonomy-supportive teaching, according to trained raters and teachers but not their students. Teachers in the intervention condition also reported greater need satisfaction and teaching efficacy. These findings confirm the teacher benefits of adopting intrinsic instructional goals and therefore open up a new and promising area for future research.     

Attachment representations and socio-emotional difficulties in alternative care: A comparison between residential,foster and family based children in Chile

Attachment has been assessed in children living in alternative care (AC) settings, such as Residential Homes (RC) and Foster Care (FC). However, no study has been conducted to compare attachment styles in residential, foster and parental care conducted as usual in the same country at the same point in time. There is also a lack of studies conducted in less developed countries. Therefore, the aim of this study was to compare outcomes for children living in three different types of care in Chile. Three groups of children (N = 77), living in (RC), (FC) and with biological parents (PC) were compared. Attachment styles, Indiscriminate Friendliness (IF) and socio-emotional/behavioral difficulties were assessed.Higher rates of secure attachment were observed in the RC group (36.1%) when compared to studies in RC in other countries (mean 18%). However, children in both types of AC were significantly more likely to have insecure and/or disorganized attachment styles than PC children. Higher rates of socio-emotional and behavioral problems were observed in RC (55.6%) and FC (50%) compared to PC (10%). Within type of AC, no significant differences were found, for attachment styles or for socio-emotional/behavioral difficulties, the only difference were the levels of IF, with children in RC having higher levels. As a conclusion, impact of placement in AC can vary between different countries, other factors, rather than only type of AC could better explain differences in attachment security for children. Implications for research and practices are discussed.     

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.     

The socioemotional development of orphans in orphanages and traditional foster care in Iraqi Kurdistan

In order to investigate orphans' situation and development in Iraqi Kurdistan, samples from the two available orphan care systems, the traditional foster care and the modern orphanages, are examined at an index test and at 1-year follow-up regarding competency scores and behavioral problems at both test occasions, and post-traumatic stress reactions at a 1-year follow-up. Achenbach Child Behavior Check List (CBCL) and two instruments regarding post-traumatic stress disorder (PTSD) were used. While competency scores showed an improvement in both samples at the follow-up test, the problem scores increased in the orphanage sample and decreased among the foster care subjects. Moreover, the orphanage sample reported higher frequency of post-traumatic stress disorder (PTSD) than the foster care children. The results are discussed with regard to the value of the Kurdish society's own traditions in taking care of orphans.     

Weight changes in children in foster care for 1 year

Objective

The aims of this study of predominately racial/ethnic minority children in foster care (N = 360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥95 percentile) and overweight/obese (≥85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement.

Methods

Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fisher's exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal.

Results

The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2.

Conclusion

Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.     

Heuristic decision-making in foster care matching: Evidence from a think-aloud study

Complex decisions are often based on heuristics, which are shortcuts or simple ‘rules of thumb’. Since the matching decision in family foster care is often made in a less-than-ideal setting and riddled with uncertainty, heuristics are expected to be applied in that field of child and youth care on a daily basis. However, the use of heuristics in the matching decision has not been studied empirically until now. This research explores how decision-making heuristics are used by practitioners to determine which foster family is the best fit for a child. A number of 20 matching practitioners from the Netherlands were interviewed using vignettes and a ‘think-aloud’ methodology to generate an understanding of their reasoning. Two types of vignettes were created: hypothetical children and hypothetical foster families. The interviews were analyzed using a qualitative deductive content analysis focusing on key indicators of three classes of heuristics: recognition heuristics, one-reason heuristics, and trade-off heuristics. The results show that recognition heuristics did not play a decisive role in the matching process; practitioners considered more than one family before making a final decision. The findings for the one-reason heuristics reveal conjunctive decision-making rules; families were rejected based on one negative premise. The analysis of the trade-off heuristics demonstrates that the number of positive premises and the ratio between positive and negative premises predicted the matching decision. However, the total number of premises also predicted the matching decision, which might indicate confirmation bias.     

A small-scale randomized efficacy trial of Carescapes: Enhancing children’s social development in child care homes

The quality of the child care environment and caregiver practices can potentially have significant, lasting impact on children’s social development. This study involves the development and a small-scale efficacy trial of the Carescapes program, a video-based training program that focuses on promoting positive social development in young children attending family child care. Fifty-seven caregivers who provided child care in their homes were randomly assigned to immediate intervention or waitlist control groups. Random coefficients analyses showed significant increased use of effective behavior management practices and decreased overall children’s problem behavior for the intervention group. A mediation model demonstrated that increases in effective behavior management practices were associated with decreases in problem behavior. A medium intervention effect was found for caregiver’s monitoring and a small effect for use of positive attention. These effects declined 5 months following the intervention. Implications for future efficacy and effectiveness studies in family child care settings that involve strategies to facilitate maintenance are discussed.     

Coping styles in youth exposed to maltreatment: Longitudinal patterns reported by youth in foster care

Coping styles in youth living in foster care with a history of maltreatment were examined to determine the nature and stability of self-reported coping behavior over time. Participants included 542 (time 1), 377 (time 2), and 299 (time 3) youth ages 8–22 years (M = 13.28 years, SD = 3.04). Using the Behavioral Inventory of Strategic Control, a dimensional, continuous measure of coping, across four possible coping styles endorsed in reference to specific potentially stressful situations, the results indicated that direct action coping was the most frequently endorsed or preferred style for more than 50% of the sample at each time point. A number of youth endorsed using more than one coping style, indicating some flexibility in the approach to coping when problems occur. Although most youth endorsed a preferred style, coping style endorsed did vary somewhat over time. The coping style endorsed also varied depending on the type of problem referenced, but no statistically significant differences were noted across situations, including social, academic, general, and foster-specific situations. Effects for age were also examined and the results indicated no significant differences across the age range for type of coping most commonly endorsed. The present study is the first large-scale, longitudinal assessment of coping styles in youth in foster care and the results suggest that coping is not a simple, categorical-only construct and the implications for the endorsement of the direct approach for youth in foster care along with the other findings are discussed.