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.     

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.     

Multilevel correlates of behavioral resilience among children in child welfare

Resilience, defined as positive adaptation and functioning following exposure to significant adversity, is an important topic of investigation in child welfare. The current study used data from the Ontario Looking After Children (OnLAC) project to estimate the prevalence of behavioral resilience (i.e., lower frequency of conduct and emotional problems, higher frequency of prosocial behavior) in 531 5–9 year olds living in out-of-home care, and to determine how behaviorally-resilient children are functioning in other domains (i.e., peer relationships and academic performance). Furthermore, hierarchical linear modeling was used to examine the contribution of four levels of analysis (i.e., child, family, child welfare worker, and child welfare agency) on behaviors and to identify the contribution of predictor variables within each of these levels. Findings indicated that 50–70% of children exhibited resilience on one behavioral outcome while approximately 30% showed resilience on at least two of the outcomes. Also, 8.4–9.6% exhibited resilience on one of the behavioral outcomes in addition to peer relationships and academic performance. The child level accounted for the highest proportion of total explained variance in behavioral outcomes, followed by the family-, child welfare worker-, and child welfare agency-levels. A number of child and foster family variables predicted behavioral functioning. Findings indicate that it is important to inquire about children's functioning across multiple domains to obtain a comprehensive developmental assessment. Also, child and foster family characteristics appear to play considerable roles in the promotion of behavioral resilience.     

Do Stability of Care and Teacher–Child Interaction Quality Predict Child Outcomes in Early Head Start?

Research Findings: This study examined whether children’s outcomes at age 3 were predicted by their experiences in Early Head Start (EHS), focusing on 2 key features of infant and toddler care: (a) stability of care and (b) teacher–child interactions. This study further explored potential interaction effects between stability of care and teacher–child interactions in predicting child outcomes. Three main results were found from secondary analyses of the recently released EHS longitudinal data set the EHS Family and Child Experiences Study (Vogel & Boller, 2009–2012). First, children who had stability of care (no teacher change) were rated as having fewer behavior problems and higher social competence. Second, children were rated as demonstrating better orientation/engagement and emotional regulation when they were in EHS classrooms observed to have higher emotional and behavioral support. Third, teacher–child interactions that are emotionally and behaviorally supportive may mitigate the potential drawbacks of experiencing instability of care on early social-emotional development. Study implications are discussed. Practice or Policy: Both stability and quality teacher–child interactions are important in center-based infant and toddler care, and ensuring quality teacher–child interactions is particularly important for children who experience teacher changes during their infant and toddler years.     

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.     

SUPPORTING STUDENTS IN FOSTER CARE

Students living in foster care are at risk for experiencing many challenges in school, spanning domains of social–emotional, behavioral, and academic functioning. They are twice as likely to be absent from school and to have received and out‐of‐school suspension and up to three and a half times more likely to receive special education services. Therefore, it is important for schools to recognize and respond to the unique needs of students in foster care to provide the necessary resources for school success. When working with students in foster care, school psychologists should be equipped to support the success of these students by determining what the needs of students in foster care are, and how to meet identified needs. The current paper will discuss the education‐related vulnerabilities and presenting problems for children in foster care and outline social–emotional, behavioral, and academic supports that school psychologists can offer.     

Prognosis of children admitted to institutional care during infancy

The present study has investigated the prognosis of infants admitted to institutional care. The follow-up was made after five and ten years. Three groups of children were studied: those who were in adoptive homes, foster homes and biological homes, respectively, at the time of the investigation. Approximately 50% of the total population was treated in hospital after the neonatal period. More children in foster and biological homes were hospitalized because of trauma. At 4 years of age the psychomotor development was considered normal in 77% of the adopted children compared to approximately 55% in the other two groups. Furthermore, the children in foster and biological homes demonstrated a higher rate of psychological or behavioral disturbances. The children who were in foster homes had experienced more separations and 39% of them had been subjected to 6 or more placements. The experiences of institutional care per se in infancy do not predispose the child to health and behavioral problems. The determining factor for optimal development seems to be permanency of care and parenting capability.     

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.     

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.     

Behavior problems of children in foster care: Associations with foster mothers’ representations,commitment, and the quality of mother–child interaction

This study investigated different environmental and contextual factors associated with maltreated children's adjustment in foster care. Participants included 83 children (52 boys), ages 1–7 years, and their foster caregivers. Quality of interaction with the foster caregiver was assessed from direct observation of a free-play situation; foster caregiver attachment state of mind and commitment toward the child were assessed using two interviews; disruptive behavior symptoms were reported by foster caregivers. Results showed that quality of interaction between foster caregivers and children were associated with behavior problems, such that higher-quality interactions were related to fewer externalizing and internalizing problems. Foster caregivers’ state of mind and commitment were interrelated but not directly associated with behavior problems of foster children. Type of placement moderated the association between foster caregiver commitment and foster child behavior problems. Whereas greater foster caregiver commitment was associated with higher levels of adjustment for children in foster families (kin and non-kin), this was not the case in foster-to-adopt families. Finally, the associations between foster child behavior problems and history of maltreatment and placement related-risk conditions fell below significance after considering child age and quality of interaction with the foster caregiver. Findings underscore the crucial contribution of the foster caregiver–child relationship to fostering child adjustment and, thereby, have important implications for clinical services offered to this population.     

Disentangling the effect of out-of-home care on child mental health

BackgroundChildren in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care.ObjectiveThis research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care.Participants and SettingThe sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).MethodsThe mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.ResultsThe odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).ConclusionsThese findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.     

Working towards better education for children in care: longitudinal analysis of the educational outcomes of a cohort of children in care in Australia

ABSTRACT

Internationally, reviews of educational outcomes of children in care reveal consistent findings highlighting the need for considerable policy attention to be paid to their education to ensure they achieve optimal economic and psychosocial life outcomes. Important to enhancing the educational achievement of children in care are support, stability of environment, teaching resources and the recognition by all stakeholders – birth parents, foster carers, social workers and statutory authorities — that education is paramount to a child’s future well-being. This paper highlights the perspectives of carers, teachers and children on the fostering experience with particular focus on educational outcomes drawing on a prospective longitudinal study of children in long-term care. Using a multimethod, repeated measures multi-informant design, children were assessed by carers and teachers using the Achenbach Child Behaviour Checklist and its companion, the Teacher Report. The findings indicate demonstrated gains in terms of improved scores and adaptive functioning at subsequent assessments following two years of stable care. Discussion of the findings and implications for practice will focus on the need for a coordinated strategy to improve placement continuity and focused professional and organisational support with respect to the emotional and educational needs of children in care.     

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.     

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.     

The medical and psychosocial needs of children entering foster care

The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population, require significant amounts of medical sub-specialty care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.     

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

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

Teachers’ Emotional and Behavioral Support and Preschoolers’ Self-Regulation: Relations With Social and Emotional Skills During Play

Research Findings: Drawing from a Dutch sample of 113 Dutch children (M age = 37 months, SD = 3.5) from 37 early care and education classrooms (19 child care centers and 18 preschools), this study examined whether the relation between classroom emotional and behavioral support and children’s observed social integration and positive mood in a play situation depends on children’s observed behavioral self-regulation. Multilevel analyses revealed a positive association between emotional and behavioral support and children’s social integration for children low on behavioral self-regulation, but there was no such association for children high on behavioral self-regulation. Contrary to our expectations, children low on behavioral self-regulation showed more integration in the case of relatively highly supportive classrooms but not less integration in classrooms that were low in support. For children’s positive mood, a positive association with emotional and behavioral support was found, and no association was found with behavioral self-regulation. Practice or Policy: This study’s findings highlight the importance of emotionally and behaviorally supportive classroom experiences for young children’s social and emotional skills. Moreover, results hint that experts should perhaps not see children low in behavioral self-regulation as always at risk for poorer social outcomes.     

Shared care: establishing a balance between home and child care settings

The onset of regular nonparental care for infants and toddlers has complex psychobiological and behavioral effects on their functioning both at home and in child care centers. Maladaptive behavior on the part of children who spend many hours in child care may reflect not the direct effects of nonparental care but the inability of parents to buffer the enhanced levels of stress experienced in child care. Successful adaptation demands careful equilibration of the contrasting limitations and benefits of the two environments, with parental care characterized by stress reduction and emotional regulation and providers' care characterized by emphasis on cognitive stimulation and behavioral regulation.