Age-specific risk factors associated with placement instability among foster children

Placement instability places foster children at an increased risk of negative developmental outcomes. Previous research has yielded inconsistent results on risk factors for placement instability. Therefore, we investigated two research questions: (1) Which child attributes and case histories are associated with placement disruptions (moves indicative of child, agency or caregiver dissatisfaction with the existing placement)?; and (2) How do associations of child attributes and case histories with placement disruptions vary by developmental stage --early childhood (0–5 years), middle childhood (6–12 years), and adolescence (13 years or older)? Using a complete entry cohort of 23,765 foster children in Texas, our results demonstrated that the effects of different risk factors varied by placement end reason and across developmental stages. Of note, kinship placement, compared to non-relative foster care, and placement with all siblings were each associated with an increased risk of substandard care disruptions. Placements with females or Hispanic children were at an increased risk of child-initiated disruption, whereas placements with Black children were more likely to end due to placement mismatch or substandard care reasons. Finally, the adolescence age group was always associated with the greatest increase in risk regardless of disruption reason. These findings provide researchers, caseworkers, and policymakers important information on the risk factors for placement instability among children in foster care.     

Is higher placement stability in kinship foster care by virtue or design?

Prior research has repeatedly documented higher placement stability for children who enter kinship care rather than non-relative foster care. However, little is known about why, and under what circumstances, kinship care is more stable. This study uses longitudinal state administrative data to explore possible explanations. Results suggest that, while children in non-relative foster care are indeed at higher risk of any placement move than their peers in kinship care, this appears to be partly driven by child selection factors and policy preferences for kinship care. That is, the gap is not explained primarily by different rates of caregiver-requested moves. However, the gap was sizably smaller among select high-risk subgroups of foster children, suggesting that higher stability in kinship care may be partly explained by differences in the characteristics of children entering kinship care (versus non-relative foster care). Moreover, a large portion of the gap is explained by children in non-relative care being moved into kinship care; a move that is likely the result of policy preferences for kinship care rather than a defect in the initial placement. In sum, these results suggest that kinship care provides only a limited stability advantage, and the reasons for that advantage are not well understood.     

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.     

Placement disruption and negative placement outcomes among adolescents in long-term foster care: the role of behavior problems

OBJECTIVE: This study examined risk of placement disruption and negative placement outcomes (e.g., residential treatment and incarceration) among adolescents placed in traditional family foster care for a year or longer. A foster parent's report of externalizing behavior problems was expected to be a stronger predictor of disruption and negative outcomes than a caseworker's report. Additionally, the association between behavior problems and placement disruption was expected to be mediated by the youth's degree of belonging and integration in the foster home. METHOD: The caseworkers and foster parents of 179 randomly selected 12-13-year-old adolescents placed in traditional foster care were interviewed by telephone. Interviews included standardized measures of externalizing behavioral problems and several other variables that have been previously associated with placement movement. Disruption from the youth's foster home at the time of the interview was prospectively tracked for 5 years. RESULTS: Over half of the youth experienced a disruption of their placement. Contrary to expectations, behavior problems as reported by caseworkers, but not foster parents, were predictive of placement disruption. However, the foster parent's report of behavior problems predicted risk of negative outcome after a period of 5 years. As hypothesized, integration in the foster home was highly predictive of placement stability and mediated the association between behavior problems and risk of disruption. CONCLUSIONS: Results suggest that integration in the foster home might be an important dimension of placement adaptation that should be considered during service planning for foster youth in long-term foster care. In addition, using standardized measures of behavior with both foster parents and caseworkers might be necessary to assess both long-term risk of negative outcomes and more immediate risk of placement disruption.     

The relation between dimensions of maltreatment,placement instability,and mental health among youth in foster care

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster care’s (N = 496, M_age = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.     

Children and youth in foster care: distangling the relationship between problem behaviors and number of placements

OBJECTIVE: The purpose of this research was to provide a prospective look at the relationship between change in placement and problem behaviors over a 12-month period among a cohort of foster children. METHOD: The sample contained 415 youth, and was part of a larger cohort of children who entered foster care in San Diego, California and remained in placement for at least 5 months. The Child Behavior Check List was used to assess behavior problems. Every change of placement during the first 18 months after entry into the foster care system was abstracted from case records. RESULTS: The results suggest that volatile placement histories contribute negatively to both internalizing and externalizing behavior of foster children, and that children who experience numerous changes in placement may be at particularly high risk for these deleterious effects. Initial externalizing behaviors proved to be the strongest predictor of placement changes for the entire sample and for a sub-sample of those who initially evidenced problem behaviors on at least one broad-band CBCL scale. Our findings also suggest that children who initially score within normal ranges on the CBCL may be particularly vulnerable to the detrimental effects of placement breakdowns. CONCLUSIONS: On the basis of these findings we argue for an analytical approach that views behavior problems as both a cause and as a consequence of placement disruption. Children who do not evidence behavior problems may in fact constitute a neglected population that responds to multiple disruptions of their primary relationships with increasingly self-defeating behaviors.     

Risk behaviors in maltreated youth placed in foster care: a longitudinal study of protective and vulnerability factors

OBJECTIVE: Few studies have examined the impact of placement in foster care prospectively to determine what early responses might predict later functioning. The current study examined protective and vulnerability factors in a longitudinal study of youth placed in foster care. METHODOLOGY: A cohort of 214 ethnically-diverse youth, ages 7-12, who entered foster care between May 1990 and October 1991 were recruited for the Time 1 study if they remained in foster care for at least 5 months. For the Time 1 study, youth and their caregivers were interviewed and assessed approximately 6 months following their initial placement. Six years later, as adolescents, the youth were re-interviewed regarding their involvement in four domains of risk behavior. RESULTS: Bivariate analyses indicated that several Time 1 control variables (e.g., age, ethnicity, type of maltreatment, behavior problems) and Time 1 psychosocial predictor variables (i.e., dimensions of social support and self-perception) were related to the Time 2 risk behavior outcomes. Regression analyses with all variables accounted for between 33 and 46% of the variance, with the psychosocial predictor variables, as a group, significant over and above the control variables. CONCLUSIONS: The results suggest that there are some modifiable protective and vulnerability factors present shortly after maltreated youth are placed in foster care that predict their engagement in adolescent risk behaviors 6 years later.     

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.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

Predictors of foster parents’ stress and associations to sensitivity in the first year after placement

In Germany, almost 70 000 children are living in foster families (Statistisches Bundesamt, 2016). Many foster children show mental health problems as they were exposed to an accumulation of risk factors. Hence, foster parents are often faced with challenging parenting situations. The current study focuses on the predictors of foster parents’ stress and examines longitudinally whether parenting stress is associated with foster parents’ sensitivity. The sample consisted of 55 children (aged from 1 to 6 years) and their foster caregivers. Foster parents’ sensitivity was observed during home visits. Caregiver reports were used to assess parenting stress (Parenting Stress Index) as well as foster children’s externalizing behavior problems (Child Behavior Checklist). For main caregivers’ stress at the beginning of placement, regression analyses revealed both, foster children’s externalizing problems as well as partners’ stress as predictive. For main caregivers’ stress one year after, only initial parenting stress and partners’ stress were predictive. Foster parents’ sensitivity was correlated with their parenting stress one year after placement. Regression analyses revealed no longitudinal effects of initial parenting stress on overall sensitivity. However, supportive presence was predicted by initial supportive presence and by the interaction between parenting stress and children’s externalizing problems at placement. The findings highlight the role of the partner in experiencing parenting stress when taking care of a foster child. Furthermore, they emphasize that foster parents who care for children with behavior problems need adequate support that can buffer initial parenting stress and thereby promote sensitive caregiving.     

Factors associated with caregiver stability in permanent placements: a classification tree approach

Objective

Identify individual and environmental variables associated with caregiver stability and instability for children in diverse permanent placement types (i.e., reunification, adoption, and long-term foster care/guardianship with relatives or non-relatives), following 5 or more months in out-of-home care prior to age 4 due to substantiated maltreatment.

Methods

Participants were 285 children from the Southwestern site of Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Caregiver instability was defined as a change in primary caregiver between ages 6 and 8 years. Classification and regression tree (CART) analysis was used to identify the strongest predictors of instability from multiple variables assessed at age 6 with caregiver and child reports within the domains of neighborhood/community characteristics, caregiving environment, caregiver characteristics, and child characteristics.

Results

One out of 7, or 14% of the 285 children experienced caregiver instability in their permanent placement between ages 6 and 8. The strongest predictor of stability was whether the child had been placed in adoptive care. However, for children who were not adopted, a number of contextual factors (e.g., father involvement, expressiveness within the family) and child characteristics (e.g., intellectual functioning, externalizing problem behaviors) predicted stability and instability of permanent placements.

Conclusions

Current findings suggest that a number of factors should be considered, in addition to placement type, if we are to understand what predicts caregiver stability and find stable permanent placements for children who have entered foster care. These factors include involvement of a father figure, family functioning, and child functioning.

Practice implications

Adoption was supported as a desired permanent placement in terms of stability, but results suggest that other placement types can also lead to stability. In fact, with attention to providing biological parents, relative, and non-relative caregivers with support and resources (e.g., emotional, financial, and optimizing father involvement or providing a stable adult figure) the likelihood that a child will have a stable caregiver may be increased.     

The impact of changing neighborhoods,switching schools,and experiencing relationship disruption on children’s adjustment to a new placement in foster care

When children enter a new foster care placement they may experience several different transitions. Not only will a child move in with a new family, he or she may move to a different neighborhood, change schools, lose contact with old friends, be placed apart from one or more siblings, and have limited contact with his or her biological parents. The current study examined the impact of these transitions on foster children’s adjustment to a new placement in out-of-home care. The sample consisted of 152 youth ages 6–17.5 who participated in the second National Survey of Child and Adolescent Well-Being (NSCAW II) study and who were residing with relative or non-relative foster families at the time of the Wave I interview. During the Wave I interview, youth were asked to report on the types of transitions they experienced when they moved into their current placement. Linear and Poisson regressions were used to estimate the effect of the transitions on youths’ relationships with their new families, mental health, relationships with peers at school, and school engagement. The results showed that youth whose biological mothers contacted them more than once a month had more symptoms of mental health problems than youth who had less contact with their biological mothers. In contrast, changing schools had a positive impact on youths’ mental health, and youth who were separated from siblings were more likely to get along well with their school peers. Implications for improving youth’s adjustment to new foster care placements are discussed.     

Effect of foster care on young children's language learning

This report examines 174 young children's language outcomes in the Bucharest Early Intervention Project, the first randomized trial of foster placement after institutional care. Age of foster placement was highly correlated with language outcomes. Placement by 15 months led to similar expressive and receptive language test scores as typical age peers at 30 and 42 months. Placement from 15 to 24 months also led to dramatic language improvement. In contrast, children placed after 24 months had the same severe language delays as children in institutional care. Language samples at 42 months confirmed that placement after 24 months led to lower expressive skill.     

Variables associated with disrupted placement in a select sample of abused and neglected children

The purpose of this study was to examine the placement history of 172 abused and/or neglected children who had been placed in a residential home for maltreated children. Data were collected on the child's placement history (i.e., number of placements, time in transition, and placement rate) and also on child and family characteristics. Pearson correlation coefficients were run between child and family variables and each of the three placement history variables. In addition, t-tests were also used as a method of analysis. Results indicated that children with the following characteristics or life circumstances experienced the more disruptive experience while in foster care: children having severe behavior problems; children who were very young when first removed from their natural home; and children having drug addicted and/or alcoholic parents. Implications of these findings indicate social workers and judges need to be alert to the potential for system abuse of children in foster placement, responsible long-term planning for any child in foster care is critical, and those involved in therapeutic treatment for abused/neglected children should be attentive to the child's placement history.     

Who disrupts from placement in foster and kinship care?

OBJECTIVE: To identify reliable, inexpensive predictors of foster care placement disruption that could be used to assess risk of placement failure. METHODS: Using the Parent Daily Report Checklist (PDR), foster or kinship parents of 246 children (5-12 years old) in California were interviewed three times about whether or not their foster child engaged in any of the 30 problem behaviors during the previous 24 h. PDR was conducted during telephone contacts (5-10 min each) that occurred from 1 to 3 days apart at baseline. Disruptions were tracked for the subsequent 12 months. Other potential predictors of disruption were examined, including the child's age, gender, and ethnicity, the foster parent's ethnicity, the number of other children in the foster home, and the type of placement (kin or non-kin). RESULTS: Foster/kin parents reported an average of 5.77 child problems per day on the PDR checklist. The number of problem behaviors was linearly related to the child's risk of placement disruption during the subsequent year. The threshold for the number of problem behaviors per day that foster and kinship parents tolerated without increased risk of placement disruption for these latency-aged children was 6 or fewer. Children in non-kin placements were more likely to disrupt than those in kinship placements. There was a trend for increased risk of disruption as the number of children in the home increased. CONCLUSIONS: The PDR Checklist may be useful in predicting which placements are at most risk of future disruption, allowing for targeted services and supports.     

Plotting Careers in Aged Care: Perspectives of Medical,Nursing, Allied Health Students and New Graduates

The research reported in this article explored the impact of the undergraduate placement experience on medical, nursing, and allied health students' perceptions of careers in aged care. Data were collected from undergraduate students (48) and graduates (26) via individual (46) and group (7) interviews; data were thematically analyzed. Participants' placement experiences prompted them to characterize aged care simultaneously as “dirty work” and “rewarding work”. Participants perceived that working full-time as a newly-graduated health professional with the aged or in aged care settings would be an unattractive career. Instead, participants considered working in aged care either as a “mid career” or “blended career” option.     

Predictors of adult quality of life for foster care alumni with physical and/or psychiatric disabilities

INTRODUCTION: This study used quality of life and resilience as theoretical frameworks for evaluating predictors of outcomes for adults who received foster care services alumni of foster care and were diagnosed with a physical or psychiatric disability while in foster care. METHOD: First, outcomes for foster care alumni with and without physical and psychiatric disabilities (N=1,087) were compared according to quality of life variables. Second, using only participants with disabilities (N=578), stepwise regression analyses were performed to determine whether risk and protective factors were associated with specific outcomes. RESULTS: Alumni with disabilities had significantly lower economic (p=.020) and health (p=.001) outcomes; and reported lower educational attainment (p=.002), more difficulty paying monthly bills (p=.026), more psychiatric diagnoses (p=.006), lower self-esteem (p=.013), and worse physical health (p=.001) than those without disabilities. For alumni with disabilities, receiving special education services and experiencing sexual abuse while in foster care were significant risk factors for poor self-esteem; conversely, receiving services and resources that prepared foster care alumni for leaving foster care (e.g., protective factors) predicted better outcomes. CONCLUSIONS: By expanding the quality of life outcomes analyses to investigate the impact of risk and protective factors on outcomes of foster care alumni with disabilities, this study fills a gap in the literature by assessing outcome differences within the foster-care population. The study found protective factors were associated with more educational attainment and higher self-esteem in adulthood. Conversely, those who received special education services and experienced sexual abuse while in foster care may be at the greatest risk of poor self-esteem and therefore, could benefit from services that enhance self-esteem.     

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.     

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.