Children in Foster Care and the Development of Favorable Outcomes

Young foster children have invariably faced a variety of risks that are strongly linked to long-term deficits in functioning across multiple developmental domains. Despite these risks, however, some children demonstrate more favorable outcomes and exhibit adaptation and the development of assets. In the present study, the relationship of early childhood factors (e.g., maltreatment history, placement history, parenting practices, environmental stress, developmental status, and attachment behavior) to the development of favorable outcomes in middle childhood was examined in a sample of foster children who had been in foster care in preschool (N = 35). Favorable outcomes were defined as demonstrations of emotion regulation and school adjustment during middle childhood. Developmental status (particularly attention and executive functioning) and a lack of environmental stress during early childhood foster care experiences had a significant positive relationship with the development of emotion regulation and school adjustment in middle childhood.     

Infant Nutrition and 12 and 18 Months Secure Base Behavior: An Exploratory Study

A notable omission in studies of developmental links to early nutritional deficiencies is infant attachment. In those few studies investigating associations between infant nutrition and attachment, nutrition was defined solely by physical growth, and infants had moderate–severe growth retardation. In this study, we utilized multiple markers of infant nutrition. Our sample consisted of 172 12‐month‐old Peruvian infants and their mothers from low‐income families, with a follow‐up assessment on 77 infants at 18 months. Infants were not severely malnourished, but did have micronutrient deficiencies. Anthropometry, dietary intake, and iron status were used as measures of infant nutrition. Based on infant behavior in a structured laboratory situation, Q‐sort techniques were used to rate three attachment markers: infant secure base behavior, interaction quality, and negative emotionality with mother. At 12 months, infant weight was positively related to interaction quality. At 18 months, infant iron status was positively related to secure base behavior. This pattern of findings remained even after statistically controlling for family socioeconomic status and maternal education. Our findings indicate that infant nutritional status is associated with markers of infant attachment and these associations are not restricted just to severely malnourished infants.     

Comparing the health status of low-income children in and out of foster care

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Environmental Correlates of Cognition and Behavior in Children with Fetal Alcohol Spectrum Disorders

ABSTRACT

The physical, cognitive, and behavioral correlates of Fetal Alcohol Spectrum Disorders (FASD) have been well-researched. However, there is minimal investigation of the non-biological correlates of cognition and behavior in this population. The association between foster care placement history and cognitive and behavioral functioning was explored using archival data from 136 children with FASD. Significant cognitive and behavioral abnormalities were found in the overall sample. Children with one foster care placement performed significantly better on measures of verbal intelligence, mathematics achievement, and impulse control and endorsed fewer symptoms of internalizing disorders compared to children who were never removed from their biological home. Children with multiple foster home placements generally fell between the other two groups on assessment measures. It may be important to consider placement history of children with FASD when attempting to understand their cognitive and behavioral abnormalities.     

An Overview of Problematic Eating and Food-Related Behavior Among Foster Children: Definitions, Etiology, and Intervention

Although several studies have identified problematic eating and food-related behaviors (e.g., Bulimia Nervosa, hoarding, obesity) as significant concerns among children in foster care, there is little evidence-based guidance on how practitioners may appropriately identify and treat children with these concerns. The current review describes the scope of eating and food-related difficulties among foster children, discusses potential etiological factors associated with these behaviors, reviews prevention and intervention strategies, and highlights implications for future research. All of these topics are aimed toward child welfare workers who are likely to encounter these eating patterns in practice. In addition to addressing problematic behaviors, this review also incorporates strategies for the promotion of healthy nutrition among families in the welfare system.     

Effectiveness of a group-based academic tutoring program for children in foster care: A randomized controlled trial

The consistently poor educational achievement of children in foster care has been associated with many negative outcomes including long term poor adult adjustment (e.g., higher rates of suicide, criminality, and substance abuse). The current study was undertaken to improve foster children's academic skills through academic remediation. Across this two year randomized study, 91 children in out of home foster or kinship care, between grades 1 and 8 inclusive, completed the study. One-half were randomly assigned to the 30-week direct-instruction small group tutoring condition, while the other half served as wait-list controls. A statistically significant increase in standard scores was found on reading decoding, spelling and mathematic skills for the children who received tutoring, but no differences were obtained on sentence comprehension. Significant effect sizes, in the small to moderate range, were also found in support of the tutoring condition across these three domains. The implications of these positive findings as they relate to improving educational achievement among children in foster care are discussed.     

Developmental Outcomes of Vulnerable Youth in the Child Welfare System

Abstract

Adolescent development of youth in foster care holds great interest for society. This article examines a random sample of 200 adolescents currently placed in foster care on developmental outcomes. Using face-to-face interviews, the present study found that a majority of foster youth have biological families experiencing multiple problems and experience many developmental difficulties. A large percentage of the sample youth experience mental illness, school failure, substance abuse, and other antisocial behaviors. This paper considers implications from the study findings for policy and interventions designed to foster better developmental outcomes among youth in the child welfare system.     

Developmentalism and the Rhetoric of Best Interests of the Child

Abstract

The foster care system in Australia has recently recognised the importance of encouraging lesbians and gay men to become foster carers. Whilst this may be seen as an important step towards overcoming social stereotypes that position lesbians and gay men as unfit parents, I propose that foster care public policy in Australia is shaped by a number of key assumptions that effectively exclude lesbian and gay foster parents. In particular, I focus on how the logic of developmentalism [where children are assumed to follow a (hetero)normative developmental pathway] and the rhetoric of best interests of the child (within which a particular moral framework is employed to judge who can and who cannot protect children) work to recenter a normative understanding of families and parenting that encourages lesbians and gay parents to adopt a heterosexual model of parenting.     

Neglect and Abuse Associated with Undernutrition in Long-Term Care in North America: Causes and Solutions

ABSTRACT

Protein-calorie undernutrition in institutional long-term care is a significant cause of morbidity, mortality, increased health care costs, and poor quality of life. Failure to provide adequate nutrition constitutes neglect, and certain practices associated with feeding the dependent elder or adult with developmental disabilities can be abusive. The causes are multifactorial. They are related to conditions common to these persons; multiple medication use, difficulty in swallowing, gastrointestinal dysfunction, poor oral health and oral care, sensory changes with aging, and lack of education and training in the proper protocols required to provide adequate food and liquid to persons with cognitive and physical impairments. Solutions which are simple, cost-effective, easy to apply and cross national, ethnic, and cultural boundaries are described.     

Foster Parents' Understanding of Children's Problematic Attachment Strategies

ABSTRACT

Foster mothers and biological mothers were interviewed regarding their understanding of children's insecure attachment strategies and their knowledge of foster care issues. In addition, parent sensitivity was assessed and case workers in the foster care system reported on foster mothers' effectiveness. As expected, foster mothers reported significantly more attachment-related difficulties with their foster children than biological mothers reported with their natural children. Foster mothers were not significantly different from biological mothers in their understanding of attachment strategies, knowledge about foster care issues, or sensitivity. Case workers' reports of foster parent effectiveness were significantly related to foster parents' knowledge about foster care issues but were not significantly related to parents' understanding of attachment strategies. We discuss the importance of sensitivity to attachment issues among foster parents.     

Directions for developmental screening in child welfare based on the ages and stages questionnaires

Many young children investigated for maltreatment have developmental problems qualifying them for early intervention services, yet only a portion of these children receive such services. To address this gap, all children ages 0-3 with child welfare (CW) substantiated maltreatment in Pennsylvania are screened for developmental and socioemotional problems using the Ages and Stages Questionnaires (ASQ). This study views screening results for over 500 children to address whether children's substantiation status, living situation, and administering worker as CW or early intervention (EI) predicts screening rates. Bivariate and logistic regression analyses were used. Results showed that 22% of children scored in the problem-range of at least one developmental area and 18% scored in the problem-range of social-emotional concerns warranting EI referral. Results of bivariate analyses showed that children who spent time in the NICU were more likely to have developmental concerns. Socioemotional concerns were related to child race, foster care living situation, child as the subject of the referral, and physical neglect. Older children and children whose referral involved lacking basic needs showed both developmental and socioemotional concerns. There were no significant differences in screening results of children with substantiated versus unsubstantiated maltreatment. Children whose screening was conducted by EI were more than three times as likely to show developmental concerns compared with those screened by CW. Child welfare workers need more support when conducting developmental screening, and policies that limit screening to children with substantiated maltreatment or to children in out-of-home care should be reconsidered.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

Crisis nursery services and foster care prevention: An exploratory study

ObjectiveTo examine whether receiving crisis nursery services reduces the chances of subsequent placement of children into foster care.MethodThe study includes a sample of 322 children from the administrative data from a crisis nursery in Ohio. Generalized estimating equations analysis was conducted to assess the relationship between crisis nursery services (case management and parenting education) and subsequent foster care placement.ResultsThe generalized estimating equations analyses indicated that case management and parenting education provided from the crisis nursery were associated with reduced likelihood of subsequent foster care for children who were placed in the crisis nursery. Foster care placement during the previous 12 months and Caucasian race were also associated with higher odds of subsequent foster care placement.ConclusionsCrisis nursery services delivered with case management and parenting education may be an effecive intervention to reduce children's subsequent foster care placement.     

The Placement History Chart: A Tool for Understanding the Longitudinal Pattern of Foster Children's Placements

Despite growing concerns about foster placement instability, little information is available regarding the longitudinal patterns of placement histories among foster children. The purpose of the present study was to develop a charting system using child welfare records to facilitate a better understanding of longitudinal patterns of placement history for 117 foster children. The resulting Placement History Chart included all placements that occurred during the observed time period and accounted for various dimensions: number, length, type, and sequence of placements; timing of transitions; and total time in out-of-home care. The Placement History Chart is an effective tool for placing foster care experiences within a broader developmental context. As such, the Placement History Chart can be a valuable research tool for understanding various dimensions and variations of placement transitions among foster children by capturing sequences and cumulative risks over time. Furthermore, this chart can facilitate the development of intervention programs that are developmentally sensitive and effectively address particularly vulnerable subpopulations of foster children.     

Compliance and Internalization in Preschool Foster Children

Child compliance and internalization are socio-cognitive developmental processes which are critical for children's social outcomes in multiple arenas. These developmental processes are found to be compromised in maltreated children. The current study was designed to add to the extremely limited literature on compliance and internalization in maltreated children in foster care. Compliance and internalization tasks were administered to preschool foster children, videotaped and later coded. Through parent-report questionnaires completed by the foster parents and observations of the foster home, the relation of compliance/internalization to child behavior problems, foster care experiences, and the foster home environment was examined. Findings revealed that most children showed committed compliance, but over 50% of children exhibited “deviation” behaviors in the internalization task. HOME acceptance scores (via observation of parent and child in home setting) significantly contributed to children's compliance levels but did not significantly contribute to their internalization. Internalization was related to children's externalizing behavior problems. These findings are considered in the context of future research and practice with respect to young children in foster care.     

Early care and education arrangements and young children's risk of foster placement: Findings from a National Child Welfare Sample

A primary goal of the U.S. child welfare system (CWS) is to maintain children investigated for maltreatment in their parents' homes whenever safely possible. This study explores the possibility that early care and education (ECE) services (e.g., child care, preschool, day care) can help the CWS achieve this goal by using a nationally representative sample of children referred to CWS for suspected maltreatment to measure the relationship between ECE receipt and the likelihood that 0–5 year olds in the CWS will be placed in foster care approximately 18 months later. Specifically, logistic regression analyses explore the relationship between: (1) regular ECE participation (yes/no), and (2) type of ECE arrangement (Head Start, other center- or home-based ECE, family/friend/relative ECE, other ECE, and multiple types of ECE) and foster placement risk. After controlling for multiple socio-demographic characteristics and foster placement risk factors, children who received ECE (yes/no) were no less likely to be placed in foster care than children who received no ECE. However, when exploring type of ECE arrangement, children who received Head Start were 93% less likely to be placed in foster care than children with no ECE. Children who participated in multiple types of ECE were almost seven times more likely to be placed in foster care than children with no ECE. These results suggest that Head Start may help maltreated children avoid foster placement and that experiencing multiple types of ECE is a risk factor for foster placement. It is recommended that caseworkers routinely assess the ECE service history and needs of families with young children who come in contact with the CWS, paying attention to the type and number of ECE services used.     

Medical complexity and placement outcomes for children in foster care

ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ² tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes.