Kinship care and service utilization: A review of predisposing,enabling, and need factors

Research has shown that relative caregivers are less likely to use formal supports and services than non-relative foster parents. However, less is known about factors influencing kinship caregivers' help-seeking behaviors and service use. This systematic review identified research studies examining factors associated with service use among kinship caregivers using key search terms in five computerized bibliographic databases and four journals. The search identified 337 potentially relevant studies. After screening and study eligibility assessments, a final sample of 13 studies was reviewed. Findings suggested that although children and their kinship caregivers were clearly in need of services, service use was low. Results suggested a need for more rigorous research designs and that the following factors may influence service use: child behavioral problems, caregiver mental health status, resources, provider characteristics, caregiver perceived need, and social support. More research examining help-seeking behaviors, perceptions of formal services, and effectiveness of kinship caregiver services in relation to child outcomes is needed to improve the wellbeing of kinship families in the child welfare system.     

Evaluating Services for Kinship Care Families: A Systematic Review

Despite their needs, kinship care families receive less support and fewer resources than other foster care families. This study systematically reviews thirteen studies that evaluated services and programs for kinship caregivers and children. Studies evaluating the effectiveness of the Kinship Navigator Program, financial assistance, support services, and training/educational programs were identified and reviewed. The Levels of Evidence-Based Intervention Effectiveness (LEBIE) scale was used to evaluate the research designs. The findings indicate that although positive results are shown for enhanced well-being and permanency outcomes of children and kinship caregivers, the rigor of the research designs are low, making it difficult to draw any firm conclusions about the effectiveness of these programs. Recommendations for child welfare practice and future research include the need to develop services for informal caregivers and particular racial/ethnic groups. In addition, more rigorous research designs and qualitative research should be conducted to support the effectiveness or social validity of the services and to inform evidence-based practice.     

Kinship Care Providers: Designing an Array of Supportive Services

Kinship care, the placement of children with their relatives, has become an integral part of the child welfare system in the United States. It is also becoming a more established way of meeting the needs of children in care in other western countries (Greeff, 1999). However, kinship care did not emerge as a child welfare issue until the late 1980s, and only recently has it become a part of the formalized system for out-of-home care (Hegar & Scannapieco, 1995). Since that time, many states have come to rely more heavily on placements with relatives to meet the needs of children removed from parental custody. For example, California has placed approximately 51% of the foster care population in kinship care, while Illinois has placed 55% (GAO, 1999).Discussion about the reasons for the increases in kinship care has been widespread (Brooks & Barth, 1998; Gleeson, 1999; Harvey, 1999; Hegar & Scannapieco, 2000). Regardless of the impetus behind the increased use of kinship care, states must now incorporate kinship foster care into the traditional foster care system in order to qualify them for federal funding (O'Laughlin, 1998). The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 amended federal law to require that states give priority to relatives when deciding with whom to place children who are in the foster care system (GAO, 1999).The apparent paradigm shift from traditional foster parents to kinship care parents (Hegar, 1999) requires that agencies use both different approaches to assessment (Scannapieco & Hegar, 1996) and provide different types of intervention and services. Adapting placement services to the needs of kinship care providers is the focus of this article.     

Relative foster parents of HIV-affected children

The HIV epidemic is one of the reasons for an increase in relative foster care. Most children of HIV-infected parents are not infected, but both the children and their caregivers are affected by the parent's illness. Twenty-eight caregivers participated in an exploratory, qualitative study of the permanency planning needs of HIV-affected relative foster parents. Of the caregivers, 17 disclosed that the foster child's parent was HIV-infected; 11 caregivers did not report HIV infection in the immediate family. HIV-affected caregivers' greatest need was a more adequate response from social workers and therapy services for the children; nonaffected caregivers needed financial assistance most. More HIV-affected caregivers were considering permanency than nonaffected caregivers. Child welfare workers and relative foster parents need training on HIV's effect on the families so that appropriate services can be accessed as early as possible.     

Foster Care to Kinship Adoption: The Road Less Traveled

ABSTRACT

Although a rather extensive literature concerning informal kinship care and kinship foster care has emerged over the past 30 years, much less is known about the children and families involved in kinship adoption. This article pays particular attention to recent research that investigates placement decisions and outcomes for former foster children adopted by relatives. This review suggests conclusions similar to broader reviews, in that kinship placement tends to show some consistently favorable outcomes across a range of study populations and methods. Financial need may be the greatest concern for relatives who adopt. The Fostering Connections to Success and Increasing Adoptions Act of 2008 expands adoption subsidies and provides states with the option of providing ongoing subsidies to certain relatives who take guardianship of family members from the foster care system. However, relative caregivers often are not well informed about financial supports afforded them by federal and state policies. Specialized programs for kinship adoptive families are still limited. Much of the growth of kinship placement has been due to the absence of other placement options for many children and value-based decision making that places a premium on kinship, rather than on evidence of the advantages of kinship adoption.     

Post-adoption service need and access: Differences between international,kinship and non-kinship foster care

Post-adoption services are important to bolster a family's commitment to their adopted children, thus avoiding potential problems following adoption finalization. It is vitally important to assess post-adoption services in an effort to ensure families are provided with effective supports for successful family functioning. Few investigators have assessed service needs and access according to adoptive family type. This study focuses on international, foster care kin and foster care non-kin adoption types. Utilizing the National Survey of Adoptive Parents, this research investigated twelve post-adoption services. Two comparisons were made with respect to whether, according to the adoptive parents, post-adoption services were received or not received: 1) international and foster care non-kin adoptive families; and 2) foster care kin and foster non-kin adoptive families. International non-kin families were more likely to indicate they discussed post-adoption services than foster care non-kin families, particularly among those who were white, had adopted boys, had no other children in the home, and whose socio-economic background was lower. When comparing foster care non-kin families with kinship families, non-kin families tended to receive more desired services than kinship families, with kinship families indicating less need for services. Policy efforts and program design need to focus on reaching out to families and developing effective post-adoption services based on the expressed needs of families.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.     

Training and services for kinship and nonkinship foster families

Researchers have raised concerns about the adequacy of the training and services for foster families in general and kinship families in particular. This study examines the training and services received by kinship and nonkinship family foster caregivers. The article compares kinship and nonkinship caregivers in terms of an array of training and services. The authors examine the demographic characteristics of these two groups and the problems of the foster children placed with them to better understand their needs. Consistent with previous research, levels of training and services received were inadequate for both groups. Contrary to previous research, few differences between kinship and nonkinship caregivers were found in training or services, in demographic characteristics, or in foster children's problems.     

Kinship Caregiver Perception of a State-Supervised Kinship Navigator Program

This study evaluated a state-administered Kinship Navigator (KN) program providing information and support to grandparents and other relatives caring for children who are not in child welfare custody. Caregivers’ perceptions of types of services, impact, satisfaction, and areas for improvement were examined. Caregivers (N = 92) reported feeling supported, gaining knowledge about services, and feeling highly satisfied with the program. Caregivers expressed needs for additional financial assistance and more time with their KN. Findings suggest that the KN program may meet key service needs of informal kinship caregivers, but additional staff time and financial resource advocacy would improve the program.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Parenting stress of grandparents and other kin as informal kinship caregivers: A mixed methods study

Informal kinship caregivers provide the majority of out of home care to children who can no longer safely stay with their biological parent. Yet their parenting challenges are understudied since they are often left out from child welfare and other service systems. This mixed methods study, using a survey and focus groups of grandparent and other kin, examined predictors and sources of parenting stress. Quantitative findings suggested that the kinship family's needs and the caregiver's health and emotional well-being adversely affected parenting stress. Grandparent caregivers experienced an elevated level of parenting stress compared to other kin caregivers. Qualitative findings suggested that financial strains, concerns over children's behavior, navigating service systems and difficult relationships with birth parents contributed to their stress. It appeared that grandparent caregivers faced special challenges due to generational gaps, guilt and concerns over birth parents.     

Kin and non-kin foster care—findings from a National Survey

This article uses national data to look at the differences between children in kinship and non-kinship care arrangements. Three groups are compared: children in non-kin foster care, children in kinship foster care, and children in “voluntary” kinship care. Children in voluntary kinship care have come to the attention of child welfare services, are placed with kin, but unlike those in kinship foster care, these children are not in state custody. Findings suggest that children in the kin arrangements faced greater hardships than those in non-kin care. They more often lived in poor families and experienced food insecurity. They were more likely to live with a non-married caregiver who was not working and did not have a high school degree. And fewer kin than expected received services to overcome these hardships. In addition, nearly 300,000 children lived in voluntary kinship care arrangements; these children are of particular concern because they are not in state custody and therefore may or may not be monitored by a child welfare agency.     

The gift of kinship foster care

This study examines kinship foster care as a gift relationship. Reunification rates and replacement rates into non-related foster care are analyzed within the statistical framework of competing risks to examine the effects of reciprocity, payment, empathy, and duty on the dynamics of kinship foster care. The study makes use of a unique set of survey data on 983 kinship foster children in Cook County, Illinois. Survey responses are linked to computerized administrative records from the Illinois Department of Children and Family Services to create a 5-year longitudinal file on placement changes from June 30, 1994 to June 30, 1999. Children whose parents were reported as regularly visiting and working toward regaining custody (reciprocity) were more likely to be reunified and less likely to be replaced than children whose parents were reported as non-cooperative with visitation and service plans. Controlling for reciprocity, children were also less likely to be replaced if caregivers retained the full foster care subsidy (payment), reported a good relationship with the child (empathy), and grew-up in the American South and attended church regularly (duty). The sensitivity of these findings to alternative specifications of the competing risks of foster care replacement and kinship transfers is reported.     

Connective complexity: African American adolescents and the relational context of kinship foster care

Attempts to address racial disproportionality in child welfare must include a focus on the benefits and challenges facing children in kinship care. African American children not only are overrepresented in the child welfare system, but also are placed disproportionately in kinship foster care. Using a sample of 18 African American adolescents ages 11 to 14, this article explores how the relational context of care experienced by adolescents in kinship foster care differs from that of adolescents in nonkinship foster family placements. Findings are presented regarding the stability of relationships as well as complex role dilemmas experienced by kinship youth as they relate to caregivers and birthparents in the child welfare context. Implications are given for practice with kinship families.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

Replication of the KEEP foster and kinship parent training program for youth with externalizing behaviors

This article presents findings from Maryland KEEP, a replication of KEEP (Keeping Foster and Kinship Parents Trained and Supported), a foster and kinship parent training intervention. We examined child behavior change, changes in caregiver parenting style, and permanency and placement stability at baseline and then after the KEEP intervention. The KEEP intervention was provided to 65 foster and kinship parents providing care for children ages 4–12. Children who participated in the study were referred due to behavior problems, as reported by foster parents: they all scored in the clinical range for externalizing behavior on the Child Behavior Checklist (CBCL). Baseline and posttest analyses assessed for child behavior and parenting style changes. Permanency data, including placement moves and exits from child welfare were examined. Overall, foster and kinship parents reported significantly fewer child behavior problems at posttest; severity levels on the CBCL and scores on the Parent Daily Report decreased. However, there were not any changes in parenting styles from baseline to posttest. Placement stability significantly increased between baseline and post-KEEP intervention. The results provide support for the effectiveness of KEEP for a child welfare population with a high level of behavior problems and for the effectiveness of KEEP as a training program for foster and kinship parents.     

The impact of state TANF policy decisions on kinship care providers

Based on a survey of public assistance and child welfare agency staff, this article examines how state Temporary Assistance for Needy Families (TANF) policy decisions have affected kinship care providers. Findings indicate that most states have continued using TANF to provide income support to kinship caregivers, and some have used TANF to find related support services. These payments, however, are much lower than rates for licensed providers, and many kinship caregivers are subject to work, training requirements, and time limits.     

Kinship liaisons: A peer-to-peer approach to supporting kinship caregivers

Relative caregivers are invaluable to the child welfare system. Although most states have a preference for relative placement, the support and assistance provided to relatives during and beyond the initial child placement period are inadequate. Through a U.S. Children's Bureau System of Care Demonstration project, a peer-to-peer approach (based in social cognitive theory) which paired a new relative caregiver (n = 74) with a full-time, paid kinship liaison (a current or former relative caregiver) was studied. Findings show that kinship liaisons are extremely helpful to caregivers and reveal 27 support categories that caregivers find most useful. One of the most significant services (i.e., information and referral) provided by the liaisons increased caregivers' knowledge of accessing available services and the permanency process. Data results show significant increases in caregivers' coping abilities and willingness to become a permanent resource for the children in their care. Policy and practice insights are provided.     

A first look at the need for enhanced support services for kinship caregivers

This article describes findings from a series of focus groups conducted with formal kinship caregivers in Maryland. The findings reveal that kinship caregivers are committed to providing safety and stability for the children placed with them. The findings also suggest that caregiving can be a significant adjustment for many kinship caregivers and that expanded support services are needed to enhance their relationship with the child welfare agency.