Do children in foster care receive appropriate treatment for asthma?

Asthma is the most common childhood chronic disease, and children in foster care have the highest rates of chronic conditions of any studied child population. The purpose of this study is to determine whether there are disparities in asthma management and health care utilization between children in foster care and other children covered by Medicaid in the state of Illinois. We use performance measures developed by the state child welfare system as well as those developed by the National Committee on Quality Assurance and used throughout the country. The study sample was drawn from linked administrative data on children in foster care and paid Medicaid claims. In order to determine the influence of living arrangement setting within the child welfare system, children in foster care were further grouped according to whether they lived in a stable home setting, a stable congregate care setting, or other living arrangement. We found that children living in home settings performed better on most performance measures than income-eligible Medicaid children. In contrast, children with asthma living in congregate care were particularly vulnerable as reflected in poor asthma care measurements and high utilization of hospitalizations despite positive performance on indicators of medication use. This population presents a significant challenge to the child welfare and health care delivery systems.     

Kinship care for children in the UK: messages from research,lessons for policy and practice1

This article presents a comprehensive overview of kinship care, or as it is also known, family and friends care, paying particular attention to the UK child welfare, legal, policy/practice contexts. The aim of the article is to raise awareness, and provide information, about a hitherto largely invisible, yet expanding placement option being widely used in child welfare systems in the UK, in Europe and elsewhere. The article places kinship care within a UK and European child welfare legal context, including the European Convention on Human Rights 1998 [Articles 8 and 14] and European kinship care developments are also highlighted. It contains the main findings of a kinship care research study conducted by the author, based on interviews with children and young people living with kinship carers, as well as with the kinship carers. Following an examination of theoretical and policy issues, the article examines ways forward for developing and supporting kinship care. In the final section, and based on the research findings and literature review, a new paradigm for child welfare is introduced. It is argued that this new paradigm is necessary in order for kinship care practice and policy to develop within a supported and sustainable family support framework.     

Child resilience in out-of-home care: Child welfare worker perspectives

The study of resilience and its associated factors is highly applicable to the child welfare population as children living in out-of-home care have often experienced much adversity and are particularly vulnerable to the development of problems in numerous domains of functioning. The use of qualitative research in this area is scarce, and the majority of such studies have been based on the U.K. or U.S. child welfare systems. Therefore, the goal of the current study was to gain child welfare workers' perspectives on resilience and to explore the factors that they believe might influence resilience. Semi-structured interviews were conducted with 11 child welfare workers from Ontario (Canada) to accomplish this goal. The interview was developed using an ecological perspective that inquired about possible sources of resilience from within children themselves, their family, their community, and the child welfare worker and agency. The workers identified a number of factors associated with resilience (e.g., child intelligence, worker communication skills); however, the critical importance of a child's relationships and social support from others underpinned all factors discussed. The findings highlight the importance of including the perspectives of all those involved in the child welfare system in assessing the well-being of children in out-of-home care. In addition, the dynamic interrelationships between the various levels of the ecological model and how these can impact on how a child is doing in out-of-home care were highlighted.     

Bureaucratic Neglect and Oppression in Child Welfare: Historical Precedent and Implications for Current Practice

Historically, child maltreatment has been seen as an issue warranting the involvement of the American government. However, over time, the definition of child maltreatment has changed; typically, maltreatment is often understood as a violation of the parental right to care for and protect a child. Consequently, the government, through systems such as child protective services is expected to be the acceptable parental alternative. As illustrated by the numerous negative outcomes experienced, it is clear that the system is not meeting the needs of abused and neglected children. This bureaucratic neglect is allowed to occur because of population primarily served by the child welfare system, the poor and families of color. In this way, dynamics of power and privilege manifest in the differing expectations of appropriate care between biological parents and the foster care system.     

Pathways to permanence in England and Norway: A critical analysis of documents and data

The English language term ‘permanence’ is increasingly used in high income countries as a ‘short-hand’ translation for a complex set of aims around providing stability and family membership for children who need child welfare services and out-of-home care. From a scrutiny of legislative provisions, court judgments, government documents and a public opinion survey on child placement options, the paper draws out similarities and differences in understandings of the place of ‘permanence’ within the child welfare discourse in Norway and England. The main differences are that in England the components of permanence are explicitly set out in legislation, statutory guidance and advisory documents whilst in Norway the terms ‘stability’ and ‘continuity’ are used in a more limited number of policy documents in the context of a wide array of services available for children and families. The paper then draws on these sources, and on administrative data on children in care, to tease out possible explanations for the similarities and differences identified. We hypothesise that both long-standing policies and recent changes can be explained by differences in public and political understandings of child welfare and the balance between universal services and those targeted on parents and children identified as vulnerable and in need of specialist services.     

Every Child Matters? A critical review of child welfare reforms in the context of minority ethnic children and families

This paper critically reviews some key government papers that together largely provide the foundation for the relevant child welfare reforms in England and Wales. The context of this review was to evaluate whether these papers and documents made sufficient reference to improving policies and practices for minority ethnic children and families involved in child welfare matters, given the research evidence from the early 1990s suggesting that such families may experience particular disadvantages or discriminations within the UK child welfare system. The research evidence cited draws upon studies that have considered the experiences of different minority ethnic groups from the point of referrals through to long term services, including those children who have been looked after in local authority care and those families that have been subject to care proceedings. This paper concludes that more is needed under the Every Child Matters agenda to both acknowledge and address the specific needs of minority ethnic children and their families, as identified in the range of studies published post Children Act 1989. Copyright © 2008 John Wiley & Sons, Ltd.     

Teaching Note—CASA Volunteerism: Preparing MSW Students for Public Child Welfare Practice

In an effort to reform public child welfare systems across the nation, Title IV-E child welfare training programs were established over 2 decades ago. Participating students typically engage in a customized educational experience as part of their MSW program that prepares them to work in the field of child welfare upon graduation. This article describes an initiative taking place in one MSW program where students are encouraged to serve as a Court Appointed Special Advocate (CASA), paired with an individual child or youth in foster care. The purpose is to offer students a deeper understanding of the lived experiences of children in care. Information relating to program design and student perspectives on the experience are presented.     

Broadening Our View

Summary

The growth in child welfare caseloads and the increasing use of kinship foster care has raised new questions about effective permanency planning. The majority of children in kinship foster care are children of color and have been less likely to exit the custody of the child welfare system than children placed in traditional foster care. Permanency planning which ensures the long-term protection and well-being of children from diverse cultural backgrounds requires a broad view of family, ongoing striving for cultural competence, collaboration between the formal child welfare system and the kinship systems of children in state custody, and a long-term view of permanency planning and child-rearing that builds on the case-management capacities of kinship networks to support permanent plans, looks beyond the child's exit from state custody, and helps families and larger kinship systems make long-term plans for the protection, permanence, and well-being of children.     

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.     

Aboriginal child placement principle and family group conferences

Throughout the twentieth century, Aboriginal children have been removed from their family and cultural networks under a range of government policies that have professed to be ‘in their best interests’. This article outlines the historical context to the development of the Aboriginal Child Placement Principle, which is currently the operating principle for all States and Territories in Australia when child welfare services have engaged with Aboriginal families and there is likelihood that a child may be removed. Because of problems with the implementation of the Principle, the option of family group conferences is suggested as a way of ensuring the objectives of the Principle are still met. Family Group Conferences originated in New Zealand initially as a response to the over-representation of Maori children in the substitute care system, and have since been part of child welfare legislation in that country for both Maori and non-Maori families since 1989. The application of the New Zealand model to working with Indigenous Australians will be discussed, along with a recommendation for this form of empowering practice to be considered more comprehensively as a family decision-making strategy within the field of child protection.     

On the margin? Residential child care in Scotland and Finland

Situated on the margins of Europe, Scotland and Finland are small countries which share similar demographic and economic profiles. In many European countries, residential child care can also be considered to be ‘on the margin’ of child care provision; there is ambivalence about residential care and a view that it should be used as a last resort. This paper examines systems and practices of residential care in Scotland and Finland, locating these in the context of wider child welfare policy in both countries. The underpinning principles of child welfare provision in both countries are similar—based on children's rights and primarily family-focused. In both countries there are also similar concerns about the fragmentation of child care provision and the cost of residential services. However, there are also important differences relating to child welfare provision and the use of residential care. In Finland, overall numbers of children in residential care are much greater than in Scotland; the age profile of these children and young people is very different; and the two countries vary markedly in the use of secure accommodation and custody. This comparative analysis suggests new ways of understanding the similarities and difference in the use of residential care in the two countries. It highlights the continuing challenge to develop residential care as a positive and integral part of a continuum of care services.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

The shift toward private sector service delivery: Restructuring child welfare systems in the name of children

This article reviews the current condition of some of the worst child welfare systems in the country, focusing on several of the reforms these systems have adopted in order to meet compliance standards enforced by consent decrees and lawsuits. Section I covers the historical background of government intervention in social welfare systems and the funding of these systems. Section II profiles top media cases involving abused children, and addresses the implications of lawsuits and decrees. Section III discusses the implications of privatization, observing both the purported benefits and the disadvantages. Section IV introduces the concept of managed care.     

Child abuse and the bureaucratisation of social work

Child abuse became a public issue in the early 1970s. The alleged failure of social workers and welfare agencies to prevent children being killed by their parents and caretakers led to changes in the practice and organisation in child abuse work. The way public inquiries and government departments framed the problem of child abuse produced solutions which were essentially legalistic and bureaucratic. No longer was the aim to rehabilitate poorly functioning families, but to protect children from dangerous parents. But in order to achieve this aim, it was first necessary to identify the factors that would allow child protection agencies to recognise which families were dangerous and which were not. Once these factors were identified, it was possible to develop administrative systems that would facilitate the collection and analysis of information obtained during the investigation of suspected families. These systems allowed welfare agencies to identify ‘high risk’ cases. During the translation of the problem of child abuse into a set of judicial and bureaucratic procedures, therapeutically orientated professional practices found themselves out-manoeuvered. The translation witnessed the production of social workers as ‘passive agents’, a new cognitive perspective on the problem of child abuse, and a contribution to the bureaucratisation of child care practice.     

Expanding the conceptualization of re-entry: The inter-play between child welfare and juvenile services

Re-entry in child welfare is traditionally viewed as a child exiting to permanency and then reentering the child welfare system. Using this approach is effective for understanding child welfare practice from a single-system lens, but gives an incomplete picture of how children may move between related child serving systems. The present study expands the definition of re-entry by examining re-entry for 2259 children who either return to the child welfare system or move into the juvenile justice system after reunification from foster care. When measuring a broader concept of re-entry (into either system) the rate of re-entry went from 18% to 25% - a 33% increase. Regression analyses further suggested that many of the risk and protective factors associated with standard child welfare reentry were also predictive of multisystem re-entry such as having previous child welfare experience (OR = 1.79, p < 0.000), and child behavior as a factor at removal (OR = 1.75, p < 0.000). Findings of this study support the need to continue increasing the conceptualization of re-entry to be more inclusive of related systems as well as continuing to focus research efforts on understanding effective practices within child serving systems so that re-entry into either system is mitigated.     

Displacement,caregiving, and the ecological system of youth in foster care: a theoretical perspective

Children involved in the child welfare (i.e., foster care) system are at a greater risk for numerous negative outcomes in adolescence and adulthood (e.g., lower educational attainment, higher risk for a criminal record). For children in foster care who experience placement disruption (i.e., removed from a foster home and placed in another nonpermanent placement), the risks significantly increase. Informed by the ecological systems model, the authors propose a theoretical perspective to explain the unique aspects of a foster child’s development and discuss how this framework informs child welfare practice and intervention for foster children at risk for placement disruption. This perspective has the potential to provide a framework that has implications for foster caregivers and child welfare professionals and to inform future policies.     

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.     

The role of licensing in child placement and protection

Regulation of child residential care facilities requires licensors who have professional experience in child welfare. Licensing requirements must be applied within a context of professional knowledge and experience, particularly in regard to child placement and child protective services. The licensing of facilities for out-of-home care of vulnerable children generally has not been viewed as a mainstream social service or child welfare function. Although licensing differs from placement services and protective services in that licensing is basically a nonservice approach to protection each of the three elements forms a triangle of comprehensive protection for vulnerable children. Recognition of both the similarities and the distinguishing characteristics of the three elements reduces individual and organizational role conflict and, furthermore, holds promise for mature and effective coalitions in achieving the common goal of protection for vulnerable children in out-of-home care. The strength of a statewide licensing program is founded in centralized organizational and supervisory structure. Licensing must fulfill its partnership role in coordination with child placement and child protective services to achieve genuine community protection for vulnerable children.     

Prevalence,experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements

A voluntary foster care placement (sometimes referred to as a voluntary placement agreement) is an agreement, entered into without court involvement, between a state or county child welfare agency and a child's parents to place a child into out-of-home placement. When a child enters foster care through this type of placement, state and federal programs that cover children who enter child welfare due to a court order become the custodians of the voluntarily-placed-child's placement, care, and supervision. In this cross-sectional, exploratory study, data from the Adoption and Foster Care Reporting System (AFCARS) was used to examine the characteristics and experiences of children who enter foster care through a voluntary foster care agreement, and to compare them with those of children who enter foster care through a court order. Findings indicate that children who are placed through a voluntary placement agreement differ from children who enter through a court order in their personal characteristics, as well as in their placement settings, length of placement, and manner of discharge from foster care. This study provides a baseline for future research into this area of child welfare practice.     

Effects of kinship care on behavioral problems by child age: A propensity score analysis

When a child must be removed from the family home, placement with a relative is often sought because kinship care is the least restrictive and most family-like out-of-home placement. Although kinship care has become a preferred option in most U.S. child welfare systems, this preference is often based on “soft evidence” rather than rigorous evaluation of the risks and benefits of kinship care. Therefore, an evaluation of the impact of kinship care on child behavioral problems is needed to guide child welfare practice and policy. In addition, given that children of different ages and in different developmental stages are likely to have varying placement experiences, the evaluation of kinship care should explore the effect of kinship care on child behavioral problems across age groups. To fill these knowledge gaps, we compare the behavioral problems of 584 children in kinship care with those of 470 children in non-kinship care. Moreover, we examine the impact of kinship care on behavioral problems in 2 age groups: younger children (0 to 5 years) and older children (6 to 17.5 years). The analysis uses data from Waves 1 and 2 of the National Survey of Child and Adolescent Wellbeing, and applies propensity score methods to account for selection bias. Results show that older children in kinship care had significant lower levels of externalizing, internalizing, and total behavior problems. However, for younger children, the effects of kinship care on child behavioral problems did not reach statistical significance. The implications for practice, research and policy are discussed.