An empirical analysis of behavioral and emotional problems of foster children as related to re-placement in care

Foster care is seen as a temporary service. However, for many children, foster care involves years of long term care. Most professionals feel that if a child must remain in care, the number of foster homes or re-placements the child experiences should be minimized. Evidence suggests that this lack of stability has a detrimental effect on the child's psychosocial development. Even though the research evidence supports the negative impact of re-placement on the foster child, little empirical research has dealt with identification of factors associated with children likely to be re-placed. This article focuses on foster children with behavioral and emotional problems and analyzes the association of these problems with placement stability and continuity. The findings report that children with behavioral and emotional problems are replaced in foster care more often than those children without similar problems.     

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.     

Protocol to investigate child abuse in foster care

Hennepin County Community Services, a large urban agency in the midwestern United States, developed specific procedures for investigating complaints of abuse and neglect of children in foster care in 1980. During the period from May 1980 through November 1981, approximately 125 complaints of abuse and neglect in foster homes were investigated. This article discusses the Protocol, including the institutional abuse meeting, investigation by an independent third party, and statements of finding. Factors that appear to be significant in abusing foster parents are marital status, if the foster parents had children of their own, length of time licensed, and presence of previous complaints. Victims were slightly more likely to be male, aged 4-12. Many victims appeared to have adjusted well to the foster homes. Information is presented on how the abuse was reported. Recommendations include: investigations conducted by an objective third person, commitment of the administration, and enlistment of legal personnel and foster parents during implementation. Also included are prevention of abuse through comprehensive screening and then training of foster parents, social workers' close contact with foster parents and foster children, avoiding high risk placement, forbidding corporal punishment, and sensitizing social workers to abuse-neglect of children in foster care.     

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.     

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.     

Abused children admitted to a pediatric in-patient service in Switzerland: a ten-year experience and follow-up evaluation

In a period of 10 years (1974-1983) 82 children were admitted to our pediatric in-patient service because of child abuse or neglect. In 1984 the records of these children were examined to obtain a follow-up of 34 children who were less than 10 years of age at the time of their admission for non-accidental trauma. Thirty-eight percent of these children were less than 2 years old at the time of abuse, 30% from 2-3 years (68% less than 3 years) and 32% between 3-10 years. The lesions were as described in the literature. There was a greater proportion of children of foreign origin than would be expected from the general population of Geneva. At the time of hospital admission the majority of the parents were legally married and the majority of the children were cared for at home by a parent or relative. The perpetrator in most situations remained unknown; universal denial was the rule and therapeutic treatment of the family difficult to establish. The general policy of the protective services in Geneva is to maintain the abused child with his biological family. Over time, however, there is a tendency for abused children to be either removed from their homes and placed in foster care or to receive stricter supervision within their families. A large proportion of the study children were experiencing school difficulties and attended special classes. A relatively large number had left the country, either with or without their parents. Risk factors recorded in the literature were identified.     

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.     

Serious child mistreatment in Massachusetts: the course of 206 children through the courts.

Two hundred and six severely abused and/or neglected children brought before the Boston Juvenile Court on care and protection petitions were followed prospectively for 4 years. Two thirds of all parents were found to be poor, 84% had one or more psychiatric disorders, and 81% had been known to the Department of Social Services prior to their court appearance. The average age of children at the start of the court process was 4.2 years, and the average length of temporary foster care was 2.3 years. Judges' decisions to return children to parental custody or to order permanent removal were most strongly predicted by parental compliance with court-order services. Of the 63 cases dismissed from court and thus returned to biological parents, 18 (29%) had substantiated reports of new mistreatment over an approximately 3-year follow-up period. We concluded that children are often poorly served by the current delays in the social service/legal system, and that further clinical research would provide needed empirical data on how best to protect mistreated children.     

Children in foster care: factors influencing outpatient mental health service use

OBJECTIVE: To determine factors influencing outpatient mental health service use by children in foster care. METHOD: Detailed survey and administrative data were collected on 480 children who entered long-term foster care in San Diego County from May 1990 through October 1991. These data were linked with claims data from Medicaid and San Diego County Mental Health Services information systems. A Poisson regression model was used to determine whether the following factors influenced outpatient mental health service use: age, race/ethnicity, gender, maltreatment history, placement pattern, and behavioral problems as measured by the Achenbach Child Behavior Checklist (CBCL). RESULTS: Except for maltreatment history, all independent variables included in the multivariate regression model were statistically significant. The total number of outpatient mental health visits increased with age, male gender, and non-relative foster placements. Relative to Caucasians, visits were lower for Latinos, and Asian/Others, but comparable for African-Americans. Concerning maltreatment history, differences were only found in one category; children experiencing caretaker absence received fewer visits compared to children who did not experience caretaker absence. Children with CBCL Total Problem Scale T-scores of 60 or greater had significantly more visits than those with a score less than 60. CONCLUSIONS: Both clinical and non-clinical factors influence outpatient mental health service use by foster children. Limitations imposed by gender, race/ethnicity, and placement setting need to be addressed by child welfare policies. These finding suggest that guidelines are needed to systematically link children in foster care with behavioral problems to appropriate services.     

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.     

Do regulable features of child-care homes affect children’s development?

Data from the NICHD Study of Early Child Care were used to assess whether regulable features of child-care homes affect children’s development. Child-care homes selected were those in which there were at least two children and the care provider received payment for child care (ns=164 when the study children were 15 months old, 172 at 24 months, and 146 at 36 months). Caregivers who were better educated and had received more recent and higher levels of training provided richer learning environments and warmer and more sensitive caregiving. Caregivers who had more child-centered beliefs about how to handle children also provided higher quality caregiving and more stimulating homes. In addition, when settings were in compliance with recommended age-weighted group size cut-offs, caregivers provided more positive caregiving. Quality of care was not related to caregivers’ age, experience, professionalism, or mental health, or to the number of children enrolled in the child-care home or whether the caregivers’ children were present. Children with more educated and trained caregivers performed better on tests of cognitive and language development. Children who received higher quality care, in homes that were more stimulating, with caregivers who were more attentive, responsive, and emotionally supportive, did better on tests of language and cognitive development and also were rated as being more cooperative. These findings make a case for regulating caregivers’ education and training and for requiring that child-care homes not exceed the recommended age-weighted group size.     

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.     

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.     

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.     

Long-Term Effects of Institutional Care and Enhanced Attachment Relationships on Close Adolescent Friendships

This study examined whether early institutional rearing and attachment security influence the quality and quantity of friendships at age 16 in 138 participants, including children abandoned to institutions in Bucharest, Romania, who were randomized to care as usual (n = 45, 26 female), or foster care (n = 47, 25 female), and a never-institutionalized group (n = 46, 18 female). Adolescents in the foster care group with secure attachment to their foster mothers at 42 months were comparable to never-institutionalized adolescents in having more friends and more positive behaviors with their friend during dyadic interactions, compared to the foster care group with insecure attachment and care as usual group. Interventions targeting early child–caregiver attachment relationships may help foster the ability to build positive friendships in adolescence.     

The impact of childhood foster care and other out-of-home placement on homeless women and their children

OBJECTIVE: This study compares homeless women who had childhood histories of foster care or other out-of-home placement to those who have not. METHOD: A countywide probability sample of homeless women (n = 179) received structured interviews. RESULTS: One-third of homeless women reported being raised apart from their parents. Among women with children under age 18, most (61.5%) had children who had lived in foster care or other out-of-home placements. Variables associated with homeless mothers' children living in foster care or other out-of-home placements were: Child was school-age, mother was age 35 or older, mother had a current alcohol or drug use disorder, mother experienced childhood sexual abuse, and mother ran away from home (when under age 18). CONCLUSIONS: Parenting is difficult for homeless mothers who may need to place their children with others to facilitate school attendance. Parent-child interaction may be problematic in family shelters where privacy is rare. Thus, programs promoting family preservation for homeless mothers should provide parenting support as well as permanent housing.     

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.