Sibling relationships and foster care placements for young children

There are a variety of ways in which the evolving knowledge base related to children's sibling relationships applies to the practice of social work with young children. This article¹ explores the implications of sibling relationships literature for the foster care placement of young children. The author discusses attachment, kinship, socialization, caretaking, and cultural diversity issues along with both intentional and unintentional sibling segregation concerns.     

Profiling of county-level foster care placements using random-effects Poisson regression models

Concern regarding the removal of African American children from their homes in McLean county and Peoria County Illinois, and placing them into Foster care have been the center of considerable debate and concern in the state of Illinois. As a result, a county-level (McLean and Peoria counties) investigation and intervention was performed. To evaluate the success of this intervention, we developed a mixed-effects Poisson regression model for the analysis of these data, and used it to obtain case-mix adjusted empirical Bayes estimates of county-specific changes (2000–2002) in Foster care placement rates in all counties in the state of Illinois. Results of the analysis revealed that four out of the 85 counties with African American residents in the state of Illinois exhibited significant decreases in Foster care placement rates relative to the change in the overall state-wide rate between 2000 and 2002. The two counties that received the intervention (McLean and Peoria) were among the four counties out of 85 counties that exhibited significant decreases in Foster care placement rates (OR = 14.7, P < 0.0001). Conceptual and statistical aspects of this type of statistical profiling are presented and discussed.     

The health-related quality of life of children and adolescents in home-based foster care

Objective To compare the health-related quality of life (HRQL) of 326 children and adolescents aged 6–17 years living in home-based foster care in metropolitan Adelaide, South Australia with the HRQL of a random sample of 3,582 children aged 6–17 years living in the community in Australia. Method In both groups, HRQL was assessed using the 50-item version of the Child Health Questionnaire (CHQ-PF50) completed by caregivers/parents, and the 87-item self-report version of the Child Health Questionnaire (CHQ-CF87) completed by 13–17 year olds. Results Young people in home-based foster care had significantly poorer HRQL in a wide range of different domains than those in the general community. Furthermore, among children in home-based foster care, those with mental health problems had significantly poorer HRQL in many domains than those without mental health problems. Demographic and placement characteristics of the children in home-based foster care were not significantly associated with differences in HRQL. Conclusion The findings highlight the importance of providing services and resources to improve the quality of life of children living in home-based foster care. All results of the analyses discussed in this paper are available upon request.     

Services and outcomes for transition-age foster care youth: Youths' perspectives

This article reports findings from a study of 96 former foster youth in one state in the United States regarding the transition-related services they received (both prior to and after age 18 years) and the outcomes achieved since age 18. At the time of the survey, approximately 60% of the sample was in the voluntary care of the state agency. Quantitative data describe the services received and outcomes achieved. Qualitative comments provide further feedback about young people's perceptions of services. Many statutory and private child-serving agencies continue efforts to develop services to meet the needs of this population. Study findings have implications for further development of these services to assist youth at the time of transition.     

Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review

Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition.     

The case for enhanced educational supports for children in public care: An integrative literature review of the educational pathway of children in care

For many years, the adult outcomes of young people who have grown up in foster care have been an object of broad concern. Numerous studies show that young adults who were former foster children lagged behind their community peers on a number of socio-economic indicators. Educational attainment is seen as a key developmental outcome and one that is highly associated with positive adult adjustment. Most young people today undertake a gradual process of becoming independent, but this emancipation process is very different and often traumatic for young people who age out of child protection care. This review considers the published literature that explores the educational and associated outcomes of children who leave the care of child protective services.     

Re-imagining language,culture, and family in foster care

Nearly half a million children in the United States are currently being served by the foster care system. Infants and toddlers represent the largest single group entering foster care. While these very young children are at the greatest peril for physical, mental health, and developmental issues and tend to spend the longest time in the foster care system, little research has been done to explore their experiences and developmental outcomes. In the family described here, birth family members and foster family members of multiple generations partner with Early Intervention services to support a toddler living within the foster care system.     

Reflection of foster parents on caring for foster and adopted children and their suggestions to teachers

In this research project we investigated the process of adoption of foster children by foster parents and the foster parents’ ideas of how to help foster children going through the process of adoption or those who have been adopted. We sent questionnaires to 200 foster parents living in the Cleveland area, but just 23 foster parents replied. Results of our research showed that 70% of foster parents chose the foster‐to‐adopt option because they wanted to adopt children, 65% of the foster parents stated that the school was helpful, and 50% informed their child’s school about the adoption at the beginning of the school year. Regretfully, the majority of the foster parents reported that they did not receive from the school any materials related to adoption. In addition, 75% of foster parents believe that teachers should schedule special lessons and events during Adoption Month.     

Physical health,mental health,and behaviour problems among early adolescents in foster care

Background Adolescents with chronic illness in the general population are at increased risk of mental health and behaviour problems. Depression is also associated with delinquency. Adolescents in foster care are more at risk for chronic illness and mental health issues. We investigated whether adolescents in long‐term foster care with chronic illness have associated higher rates of internalizing and externalizing problems and delinquency. We also investigated if depression mediates the relationship between physical health and externalizing behaviours. Methods Data are from the National Survey of Child and Adolescent Well‐Being; adolescents age 11 and older residing in long‐term foster care (n= 188). Children whose caregivers reported on the occurrence of a chronic illness were compared using anova on internalizing and externalizing subscale scores and total scores of the Youth Self Report (YSR) and Child Behavior Checklist (CBCL), and modified Self‐Report of Delinquency (MSRD) scores of delinquency and total number of delinquent acts. Bootstrapping analyses were used to test our hypothesis that depressive symptoms (Children's Depression Inventory) function as a mediator. Results Adolescents with a chronic illness reported greater internalizing (YSR: F= 7.069, P= 0.009; CBCL: F= 4.660, P= 0.032) and externalizing (YSR: F= 5.878, P= 0.016; CBCL: F= 3.546, P= 0.061) problems, a greater number of delinquent acts (6.66, F= 5.049, P= 0.026) and heightened overall delinquency (F= 5.049, P= 0.026). Depression significantly mediated the effects of overall health on delinquency (95% CI, 0.03–1.76). Conclusions It is important to consider the complex interrelationships between physical health, mental health, and behaviour for adolescents in foster care. These findings support the need for comprehensive services for these youths, including specialized assessments and collaboration between protective services and healthcare systems.     

Non-infant adoption from care: lessons for safeguarding children

Aim To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. Method A cohort of 130 children was identified for whom adoption was recommended in 1991–1996 at a mean age of 5.7 years (range 3–11). All were in local authority care for child protection reasons. Background information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent–Child Communication Scale were completed. Results All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty‐six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty‐seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional ‘phoniness’ and rejection affected closeness. At follow‐up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty‐eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. Conclusions This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional responsibilities in supporting it need to be acknowledged and adequately resourced. Dysfunctional hypothalamus‐pituitary‐adrenal axis programming may contribute to persisting difficulties. Supporting substitute care should be considered integral to safeguarding children.     

A 2-year follow-up of orphans' competence, socioemotional problems and post-traumatic stress symptoms in traditional foster care and orphanages in Iraqi Kurdistan

BACKGROUND: This paper aims to compare orphans' development in two different care systems. METHODS: Based on age, sex, psychological trauma scores, competence and psychological problem scores, two comparable samples were found representing orphans in the traditional foster care (n = 94) and the orphanages (n = 48) in a middle-large city in Iraqi Kurdistan. At an index interview, Child Behaviour Checklist (CBCL), Harvard-Uppsala Trauma Questionnaire for Children and Post-traumatic Stress Symptoms for Children (PTSS-C) were administered to the caregivers. After 1 year the CBCL, and after 2 years both the CBCL and the PTSS-C, were-re-administered, consecutively. RESULTS: Although both samples revealed significant decrease in the means of total competence and problem scores over time, the improvement in activity scale, externalizing problem scores and post-traumatic stress disorder-related symptoms proved to be more significant in the foster care than in the orphanages. While the activity scale improved in the foster care, the school competence deteriorated in both samples, particularly among the girls in the orphanages. The improvement of boys' activity scores in the foster care, and deterioration of girls' school competence in the orphanages were the most significant gender differences between samples over time. CONCLUSIONS: Even if the two orphan care systems showed more similarities than differences, the foster care revealed better outcomes over time. The results are discussed in relation to gender, age, socio-economic situation, cultural values and the characteristics of each care system.     

Reviewing the literature on the breakdown of foster care placements for young people: complexity and the social work task

Young people in long-term foster care are at risk of experiencing poor social, emotional, behavioural and educational outcomes. Moreover, these placements have a significantly greater chance of breaking down compared with those involving children. This article critically evaluates the factors associated with this particular outcome. The article was researched through a literature review conducted by a social work practitioner in one Health and Social Care Trust in Northern Ireland. The findings evidenced that, apart from overriding safety concerns, placement breakdown was not a one-off event but rather a complex process involving the interplay between a range of dynamic risk and protective factors over time, operating in the wider context of the young person's history and life experiences. The significance of these findings for social work practitioners is finally considered by identifying key theories to inform understanding and intervention.     

Health risks for older US adolescents in foster care: the significance of important others' health behaviours on youths' health and health behaviours

Background   Little research to date has examined older foster care youths' physical health and the associated health behaviours of the youth and important people in their lives (parents, peers and important non-parental adults).
Methods   Older US foster care youth ( n = 188) completed surveys on multiple indicators of self-report physical health, including number of chronic health problems, overall health and sick symptoms, as well as their own health-compromising behaviours and the health-compromising behaviours of important others.
Results   The findings suggested that boys, particularly those placed in non-kin foster homes and group homes, appeared to have poorer health than did boys in these placement settings. Girls, however, engaged in similar levels of health-compromising behaviours as boys. Furthermore, the health-compromising behaviours of peers and important non-parental adults (VIPs), but not parents, were associated with youths' health behaviours, which, in turn, were associated with the physical health status of the foster care youth.
Conclusion   Youth report high levels of health-related problems and involvement in health-compromising behaviours. Healthcare practitioners can help to improve the health and well-being of children in foster care by becoming informed about adolescent health behaviours, as well as the health behaviours of their peers and other important non-parental adults.     

Evaluation of the processes of family‐centred care for young children with intellectual disability in Western Australia

Introduction Government early intervention services for children with intellectual disability (ID) in Western Australia have adopted the model of family‐centred care. The aim of this study was to evaluate how well it was being practised, to describe the pattern of service utilization and to identify factors influencing parental perceptions of family‐centred care. Methods The study included children aged 0–6 years with ID, who were registered clients of Disability Services Commission, Western Australia. Parents completed a postal survey questionnaire about the frequency and type of services received and their perceptions of services using the Measure of Processes of Care (MPOC‐56) questionnaire. Mean scores for the five MPOC domains were compared using anova against the independent variables of child age group, child diagnostic group, service type and frequency, place of residence, family and demographic variables. Significant variables in each domain were then entered into multivariate analyses. Results Of 292 eligible families, 165 (59%) returned a completed questionnaire. While over 50% of children had contact with occupational, speech and physical therapists at least once per month, less than 20% of children had at least annual contact with either psychology or dental services. Families rated their satisfaction highest for ‘respectful and supportive care’ and lowest for ‘providing general information’. Individual item analyses indicated less satisfaction with ‘co‐ordinated and comprehensive care’. Higher means were associated with more frequent contact with occupational therapy. Conclusion Overall respondents reported early intervention services for young children with ID in Western Australia provided satisfactory family‐centred care by means of the 56‐item MPOC. The frequency of contact with allied health professionals was positively associated with parental ratings of family‐centred care. The study indicates under‐servicing in dental care and psychology services.     

出生缺陷患儿保健状况及保健需求分析

【目的】 了解出生缺陷患儿保健状况及其家长对相关儿童保健的需求。 【方法】 对2007年7月—2008年9月分娩且家长均居住在北京市海淀区的453例活产出生缺陷患儿,分娩6～8个月时通过电话调查方式询问出生缺陷患儿家长。 【结果】 315例在北京市生活的儿童接受计划免疫接种率94.00%、体检率93.40%;70.70%“到医院复诊过至少1次”,27.10%“未到医院复查”,2.20%“家长否认孩子有出生缺陷”。 【结论】 目前的医疗保健机构不能满足出生缺陷患儿医疗保健需求;建立有效的出生缺陷患儿信息登记系统对于患儿信息的长期随访至关重要;完善出生缺陷患儿诊断、治疗、转诊网络,为患儿提供更好的后续服务。     

The characteristics of children and young people in residential care in Wales

Care for children in residential settings is popularly characterised as the last resort for children who have had multiple failed placements and often high levels of need, requiring therapeutic help. It is often assumed that children will leave residential care for independent living. Using administrative data for a six-year period (2008–2014) for children “looked after” in Wales, univariate and bivariate analyses were conducted to provide a characteristic profile of the residential child care population. Of those placed in a residential setting, the vast majority of children were voluntarily placed and the most common reason for leaving residential care was going home. A similar number of children left residential care to move back to a family setting as entered residential care from a family setting, which challenges the assumption of residential care as necessarily the final destination in a troubled care history. The fact that large numbers of children are placed voluntarily in residential care might suggest some potential for preventing some of these placements and keeping children at home with support. Appropriate measures are needed to support children returning from residential care to live with birth families, as well as support for independent living.     

Citizens advice in primary care for families with young children

BACKGROUND: Citizens advice can help clients avoid the worst consequences of poverty and hence has the potential to reduce inequalities in health. Previous studies of providing citizens advice from primary care have concentrated largely on older clients. AIM: To measure the benefits obtained by families with young children from a citizens advice service in primary care. METHOD: An advice worker was placed in three practices. Eligible families had a child less than 1 year of age. Quantitative analysis of data on benefits obtained by all families using the service was performed. Qualitative analysis of interviews with five users and five non-users of the service was undertaken. RESULTS: Out of 107 families recruited, 23 used the CAB service, seeking advice on 49 different problems and obtaining benefit on 32 of these, most frequently on welfare benefits, debt management and housing. One-off financial benefits totalled pound sterlings 17 857 with annual recurring payments of pound sterlings 6480. The interviews raised five general themes: (1) the stresses surrounding the birth of a child; (2) factors associated with uptake of the service; (3) the content and value of the advice received; (4) the benefits to their health of the advice; and (5) their perception of the links between health and financial adversity. CONCLUSIONS: Citizens advice offers considerable benefits to families with young children. It may have positive effects on maternal and child health. An advice service is a useful component of primary health care for young families.     

Infant care in England: mothers' aspirations, experiences, satisfaction and caregiver relationships

This paper investigates non-maternal infant care in the first year of life, examining the relationships between child care ideals, attitudinal, sociodemographic and psychological characteristics of mothers at three months postpartum and their child care experiences at 10 months. Predictors of child care use, satisfaction with non-maternal care and confidence in the relationship and communication with caregivers are examined. Realising ideals predicted more hours of child care use, although not greater satisfaction. Those with the father or a grandparent as the caregiver were more satisfied, as were mothers with more progressive attitudes to child rearing and to maternal employment. Higher socioeconomic status mothers and those using nurseries were less satisfied. Relationships with caregivers were poorer for those who believed that maternal employment may have more negative consequences for children.