Foster care assessment: A study of the placement decision process in Flanders

Family foster care placement decision-making has a weak scientific underpinning. Mostly a ‘variable-oriented approach’ is taken, which requires a lot of information that is not always available. The identification of clusters of foster children with similar characteristics may be a more viable decision strategy. In this study we investigated if foster children could indeed be clustered, which problems were identified at the time of placement, and the influence of placement history. It proved possible to group foster children into two clusters: (1) young children with familial problems and few behavioral problems, and (2) older children with prominent child problems and behavioral problems. For foster children with and without placement history, problems associated with placement proved identical. Considering that a foster care placement did not result in fundamental change in the problems present at time of placement, the importance is stressed of approaching foster care assessment as part of a decision making process which looks back as well as forward. Placement decisions should be based on an appraisal of the appropriateness of foster placement as a solution for the child. In conjunction with this appraisal a decision is required on how parents can be supported toward reunification. Or – if this is not an option – whether long term foster care is the best option for the child and if so, what conditions need to be met.     

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.     

Reasons for placement decisions in a case of suspected child abuse: The role of reasoning,work experience and attitudes in decision-making

Child welfare and child protection workers regularly make placement decisions in child abuse cases, but how they reach these decisions is not well understood. This study focuses on workers’ rationales. The aim was to investigate the kinds of arguments provided in placement decisions and whether these arguments were predictors for the decision, in addition to the decision-makers’ risk assessment, work experience and attitudes towards placement. The sample consisted of 214 professionals and 381 students from the Netherlands. The participants were presented with a vignette describing a case of alleged child abuse and were asked to determine whether the abuse was substantiated, to assess risks and to recommend an intervention. The participants’ placement attitudes were assessed using a structured questionnaire. We found that the participants provided a wide range of arguments, but that core arguments – such as the suspected abuse, parenting and parent-child interaction – were often missing. Regression analyses showed that the higher the perceived danger to the child and the more positive the participants’ attitudes towards placement, the more likely the participants would be to propose placing the child in care. Arguments related to the severity of the problems (i.e., suspected abuse, parenting and the child’s development) as well as the parents’ perceived cooperation also influenced placement decisions. The findings indicate trends in the decision-making process, in the sense that participants who decided to place the child out-of-home emphasized different arguments and had different attitudes towards out-of-home placement than those who did not. We discuss the implications of our findings.     

Predicting re-involvement for children adopted out of a public child welfare system

Some of the approximately 400,000 children currently placed out-of-home in a public child welfare system will not reunify with their family of origin. They may instead be adopted into a new family. Adoption placements can be characterized by poor adjustment for children; some such placements even result in disruption or dissolution. We conducted a stratified Cox regression of 4,016 children from the Colorado public child welfare system. All of the children had a finalized adoption during the years 2002 through 2006. The two outcomes analyzed were new child protection and youth-in-conflict referrals and assessments for these previously adopted children. New child welfare referrals and assessments may be early indicators of poor adjustment for adopted children within the adoptive family. Study results indicate that older children and Hispanic children had higher rates of referral and assessment. Children with a pre-adoption history including longer time out-of-home or a larger number of out-of-home placements also experienced higher referral and assessment rates. Additional factors which predicted subsequent system re-involvement included presence of paid adoption assistance, adoption by a non-relative foster parent and younger adoptive parent age. Several study results were moderated by the presence or absence of an ethnic match between the child and the adoptive parents. We provide an overview of the statistical model used for analysis and we discuss implications of the study results for child welfare practice.     

In and out of home care decisions: The influence of confirmation bias in developing decision supportive reasoning

The aims of this study were to identify the themes Social Workers regard as important in supporting decisions to remove children from, or return them to, the care of their parents. To further elicit underlying hypotheses that are discernible in interpretation of evidence. A case study, comprising a two-part vignette with a questionnaire, recorded demographic information, child welfare attitudes and risk assessments, using scales derived from standardised instruments, was completed by 202 Social Workers in Northern Ireland. There were two manipulated variables, mother's attitude to removal and child's attitude to reunification 2 years later. In this paper we use data derived from respondents’ qualitative comments explaining their reasoning for in and out of home care decisions. Some 60.9% of respondent's chose the parental care option at part one, with 94% choosing to have the child remain in foster care at part two. The manipulated variables were found to have no significant statistical effect. However, three underlying hypotheses were found to underpin decisions; (a) child rescue, (b) kinship defence and (c) a hedged position on calculation of risk subject to further assessment. Reasoning strategies utilised by social workers to support their decision making suggest that they tend to selectively interpret information either positively or negatively to support pre-existing underlying hypotheses. This finding is in keeping with the literature on ‘confirmation bias.’ The research further draws attention to the need to incorporate open questions in quantitative studies, to help guard against surface reading of data, which often does not ‘speak for itself.’     

Neglected children with severe obesity have a right to health: Is foster home an alternative?—A qualitative study

ObjectiveTo explore key person’s perspectives of foster home placement or notification of risk of harm to Social Services of children with severe obesity.MethodsThis case study research was performed in the southwest of Sweden and based on interviews with nine informants: a foster home youth, two foster parents, a social worker, two hospital social workers, a pediatric physician, a pediatric nurse, and a psychologist. Content analysis was used for narrative evaluations, within- and cross case analyses and displays.ResultsPositive health outcomes of the foster home placement were described as a healthy and normalized weight status, a physically and socially active life, and an optimistic outlook on the future. The foster parents made no major changes in their family routines, but applied an authoritative parenting style regarding limit setting about sweets and food portions and supporting physical activity. The professionals described children with severe obesity as having suffered parental as well as societal neglect. Their biological parents lacked the ability to undertake necessary lifestyle changes. Neglected investigations into learning disabilities and neuropsychiatric disorders were seen in the school and healthcare sector, and better collaboration with the Social Services after a report of harm might be a potential for future improvements. Rival discourses were underlying the (in) decision regarding foster home placement.ConclusionA child’s right to health was a strong discourse for acting when a child was at risk for harm, but parental rights are strong when relocation to a foster home is judged to be necessary.     

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.     

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.     

Clout or doubt? Perspectives on an infant mental health service for young children placed in foster care due to abuse and neglect

Despite knowledge about the profound effects of child abuse and neglect, we know little about how best to assess whether maltreated children should return home. The effectiveness of the New Orleans Intervention Model (NIM) is being tested in a randomized controlled trial where the comparison is social work ‘services as usual.’ The future trial results will tell us which approach produces the best outcomes for children; meanwhile qualitative process evaluation is generating intriguing findings about the perceived impact of NIM on decision-making about childrens’ futures. Interviews and focus groups were conducted with social workers, foster carers, legal decision-makers and the NIM team (n = 63). Data were analysed thematically. Findings suggest that NIM is seen as bringing greater influence (‘clout’) to decision-making due to its depth of focus, provision of treatment for the family, health professional input and perceived objectivity. Simultaneously, the NIM approach and the detailed information it produces potentially throws judgments into doubt in the legal system. Clout/doubt perceptions permeate opinions about NIM and are inter-related with a historical discourse about ‘health versus social’ models of information gathering, with implications for assessment of child abuse and neglect that extend beyond the study context. The juxtaposition of ‘clout versus doubt’ both highlights and is strengthened by an intense focus among social workers and legal professionals on how evidence will be regarded within legal fora when making decisions about children. There is continuing uncertainty in the child welfare system about the best ways of assessing maltreated children, underscoring a continued need for the trial.     

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.     

A study to define and assess severity of institutional abuse/neglect

The purpose of this paper is to examine results of an empirical study of judgments about the seriousness of situations of institutional child maltreatment. This study furthers the development of operational definitions of institutional abuse and neglect by examining the following issues: What is the relative seriousness of institutional child maltreatment events? Are judgments of seriousness made on the basis of caregiver behavior or negative consequences to the child? Are incidents of child maltreatment which occur in institutions judged differently than similar incidents which occur in an intrafamilial context? This paper presents data gathered on judgments made by 630 respondents regarding 24 situations of child maltreatment. Respondents in the study represented: children in care, direct caregivers, managers in institutions, public child welfare workers, facility board members, and foster parents. Respondents judged the situations to be harmful more readily than they judged them to be abuse/neglect. For the majority of events in this survey, the setting (out-of-home care vs. intrafamilial) did not appear to significantly affect the judgments of respondents in their assessment of harm or judgment as abuse/neglect. The presentation of a negative consequence for the child significantly (p < .05) increased the respondents' assessment of harm in 12 out of 24 events. The presentation of a consequence for the child significantly (p < .05) increased the respondents' assessment of harm in 12 out of 20 events. The presentation of a consequence for the child significantly (p < .05) increased the judgment of abuse/neglect in 8 out of 24 events.     

A longitudinal analysis of the impact of child custody loss on drug use and crime among a sample of African American mothers

This study examines the influence of child custody loss on drug use and crime among a sample of African American mothers. Two types of custody loss are examined: informal custody loss (child living apart from mother but courts not involved), and official loss (child removed from mother’s care by authorities).MethodsUsing data from 339 African American women, longitudinal random coefficient models analyzed the effects of each type of custody loss on subsequent drug use and crime.Resultsindicated that both informal and official custody loss predicted increased drug use, and informal loss predicted increased criminal involvement. Findings demonstrate that child custody loss has negative health implications for African American mothers, potentially reducing their likelihood of regaining or retaining custody of their children.ConclusionsThis study highlights the need to integrate drug treatment and other types of assistance into family case plans to improve reunification rates and outcomes among mothers, children, and families. Additionally, the finding that informal loss predicts increased drug use suggests that community-based efforts within the mother’s social network could be implemented to intervene before child welfare system involvement becomes necessary.     

Development of an instrument to understand the child protective services decision-making process,with a focus on placement decisions

When children come to the attention of the child welfare system, they become involved in a decision-making process in which decisions are made that have a significant effect on their future and well-being. The decision to remove children from their families is particularly complex; yet surprisingly little is understood about this decision-making process. This paper presents the results of a study to develop an instrument to explore, at the caseworker level, the context of the removal decision, with the objective of understanding the influence of the individual and organizational factors on this decision, drawing from the Decision Making Ecology as the underlying rationale for obtaining the measures. The instrument was based on the development of decision-making scales used in prior decision-making studies and administered to child protection caseworkers in several states. Analyses included reliability analyses, principal components analyses, and inter-correlations among the resulting scales. For one scale regarding removal decisions, a principal components analysis resulted in the extraction of two components, jointly identified as caseworkers’ decision-making orientation, described as (1) an internal reference to decision-making and (2) an external reference to decision-making. Reliability analyses demonstrated acceptable to high internal consistency for 9 of the 11 scales. Full details of the reliability analyses, principal components analyses, and inter-correlations among the seven scales are discussed, along with implications for practice and the utility of this instrument to support the understanding of decision-making in child welfare.     

Child strengths and placement stability among racial/ethnic minority youth in the child welfare system

While all children deserve a stable living environment, national data illustrate that many states struggle to achieve placement stability for youth in the child welfare system as a significant number of children in foster care continue to experience multiple placements while in state custody. Prior research has not considered the impact of youth protective factors or strengths on the frequency of placement changes that youth experience while in the child welfare system. This study examined the association between strengths measured at multiple levels (i.e., individual, family, and community) and placement stability among 4022 minority youth (aged 10–18) using administrative and clinical data from the Illinois child welfare system. Negative binomial regressions at the family level revealed that youth with at least one loving and supportive family member experienced 16% fewer placement changes than youth without family strengths. At the community level, youth attending schools that work to create an environment that meets its students’ needs experienced 13% fewer placement changes than youth without educational supports. These findings can inform the quality of treatment and services provided to minority youth in the child welfare system.     

The work–family support roles of child care providers across settings

This paper presents a qualitative investigation of the work–family support roles of a sample of 29 child care providers serving low-income families in the Chicago area (16 family, friend, and neighbor providers (FFN), 7 licensed family child care providers (FCC), and 6 center-based teachers). Providers report offering low-income parents substantial logistical (flexible hours, help with routines) and economic help (flexible fees, help with subsidies) managing work and family, in addition to their care of children. For FFN providers, support was often provided in the context of significant stress and burden. FCC providers and center-based teachers were often constrained in their help-giving by ambivalence regarding professional guidelines and institutional constraints. Findings from this study may inform future research on the effects of child care on children and parents, and models of child care quality.     

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.     

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.     

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.     

Assessing parental understanding of sexualized behavior in children and adolescents

The current study assessed parents’ ability to identify normal, concerning and harmful sexualized behaviors in children and adolescents, as well as the parents’ ability to identify and select an appropriate level of intervention. The influence of a parent’s relationship with the victim or the perpetrator on the level of action taken was also examined. A cross-sectional survey incorporating a randomized experimental vignette condition determined that parents (N = 244) were not able to consistently identify sexualized behaviors accurately, and they provided lower-than-recommended levels of intervention responses. Parents were best able to identify and respond to behaviors considered normal and age-appropriate, but had greater difficulty with behaviors considered concerning or harmful. Parents were significantly less able to accurately identify and respond to behaviors exhibited by very young children (in the 0–4 year-old age-bracket). In three vignette comparisons, no significant difference in the level of intervention responses was found between parents who viewed the victim as their own child and parents who viewed the perpetrator as their child; while parents who viewed both the victim and perpetrator as being their children (siblings) reported lower intervention response levels. Because a lack of accurate knowledge around risks and indicators of child sexual abuse negatively affects the ability to prevent and detect abuse, the results have implications for a shift from a forensic model of child protection towards a public health model, which emphasizes parent and community education.