Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

What can agencies do to increase foster carer satisfaction?

Stable, long‐term foster care homes are critical to ensuring a safe and nurturing childhood for many children worldwide. Greater foster carer satisfaction is associated with increased carer retention and is therefore critical in securing such stable homes for children. The purpose of this study is to determine which factors associated with foster care agencies contribute to higher levels of foster carer satisfaction. Results from a longitudinal study of 137 foster carers indicate that perceived adequacy of agency support, preplacement training, money to cover placement expenses, and a good match between the carer and the child are predictive of higher foster carer satisfaction. A mediation model further points to the provision of preplacement training as key to ensuring higher levels of satisfaction. Results offer new insights into factors related to foster carer retention and provide guidance to foster care agencies about actions that they can take to maximize the retention of foster carers.     

A Kind of Loving: A Model of Effective Foster Care

Correspondence to Professor Kate Wilson, Centre of Social Work, University Park, Nottingham, NG7 2RD. E-mail: kate.wilson{at}nottingham.ac.uk Summary The article builds on a companion statistical paper, which drewon the findings of a large sample of foster placements and analysedfactors leading to a successful placement and the avoidanceof disruption. A model of successful foster care was developedwhich suggested that outcomes depend on three aspects of thefoster placement, those that relate to the child, the fostercarer and the interaction between the two. Here, a concreteexample in the form of a case study drawn from interviews undertakenas part of the study is used to illustrate the relevance ofthe model to practice. The qualities that make up the interactionbetween the carer and the child are elaborated through the conceptof ‘responsive parenting’. The analysis is takenfurther by identifying the processes involved in a way thatis detailed and precise and has relevance to theory. The paperargues that the case study provides material that could informboth training and the theories that underpin practice.     

How do placements in kinship care compare with those in non‐kin foster care: placement patterns,progress and outcomes?

As the use of kinship care is set to rise in England, it is important that policy and practice developments are based on firm evidence about kin placement outcomes and how these compare with those in stranger foster care. The research reported in this paper was based on case file reviews of 270 children, half in kin placements and half in stranger foster care, and on interviews with a sub-sample of 32 kin carers, social workers, children and parents. Kin carers were found to be significantly more disadvantaged than stranger foster carers: more kin carers were lone carers, with health problems, living in overcrowded conditions and had financial difficulties. The children, in contrast, were remarkably similar in the two kinds of placement. The main differences between the children in the two settings are examined in the paper. The children's progress and outcomes in terms of placement quality and disruption were very similar in the two settings, but kin placements lasted longer, mainly because fewer were planned as interim placements. However, because kin carers persisted with very challenging children and yet received fewer services than stranger foster carers, they were more often under strain. The implications for policy and practice are examined.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

Responding to child sexual abuse: an evaluation of social work by children and their carers

This paper presents the views and perceptions of 35 children and their current carers regarding the social work response to child sexual abuse. Interviews with the children and carers, including foster carers and residential carers, were carried out 2–4 years following disclosure, thus the nature of social work support in the longer term, as well as the initial response, is assessed and described. Three evaluations of social work support are presented: the child-ren's evaluations of social workers known since disclosure, and two evaluations from the carers, one focusing on the child's needs, and one focusing on their own as carers. All three evaluations perceived the majority of social workers as having helped. Aspects of social work considered essential included providing emotional support and reassurance, providing information and explanation and arrang-ing and coordinating services, including counselling or therapy.
  Carers of children who were abused by someone outside the family were less likely to receive social work support. The frustra-tion and disappointment expressed by some of these carers reaffirms the importance of assessing needs even when the child is considered protected from further abuse. The findings of this study support the need to refocus responses to abused children and their families.     

An investigation of the needs of grandparents who are raising grandchildren

Evidence suggests that children in out‐of‐home care function better when placed in kinship compared with foster care. Less is known about the functioning of children in the unique form of kinship care where grandparents are caring full‐time for their grandchildren in informal care arrangements. As grandparent carers are increasingly taking on this role, it is timely to investigate the functioning of the children in this form of care and the characteristics of the grandparents themselves. We compared the functioning of children in the two types of care. We also investigated carer characteristics, including the relationship between child functioning, social support and daily hassles on carer stress. One hundred fourteen cares and 180 children were assessed on a range of demographic and clinical measures. Children in grandparent care were displaying better behavioural and adaptive functioning than children living with foster carers. Grandparent carers reported higher levels of distress in the carer role. Predictors of carer stress included severity of child behaviour problems and daily hassles. Both group of carers and the children in their care would benefit from increased support from treatment services.     

Carers and Professionals' Perspectives on Foster Care Outcomes: The Role of Contact

This study investigates the association between the contact of children or young people in care with their family, and the foster care placement evaluation (positive or negative) in Portugal. According to the perspectives of foster carers and service professionals' perceptions regarding children and young people's reactions, during and after the visits, are measured. Utilizing a quantitative approach, two fostering services teams and 140 foster carers completed questionnaires, which had 212 children in common. Results indicated that despite the importance of continued contact, especially for children and their parents, it was not determined to be essential to long-term placement. On one hand, there was the perception that a high percentage of children expressed positive reactions during and after the visit, while on the other hand, this didn't influence the perception of placement success. This study also showed significant differences between foster carers' and the professionals' perceptions on several dimensions of foster care, especially the children's reactions during visits. These differences need to be further analyzed in future research and the outcomes used to help improve contact management.     

Which Children are Registered at Case Conferences?

Correspondence to Terry Fisher, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary A postal questionnaire to social workers was used to describethe characteristics of situations where children were the subjectsof child protection case conferences, to identify factors distinguishingthose registered from those not registered and to describe theaccounts given by social workers of the reasons for registration.The paper reports and analyses this information and raises somebasic issues about the relative importance in registration decisionsof evidence of physical or sexual abuse, characteristics ofthe adults involved, and a child's feelings and emotional state.     

Parenting fostered adolescents: skills and strategies

This paper discusses findings from a recently completed study of adolescent foster care, which included a detailed assessment of the parenting approaches and strategies used by the foster carers of adolescents in long‐term placements. Sixty‐eight foster carers were interviewed at two points in time. The first interview was conducted two months after the start of a new adolescent placement and the second after the placement had been continuing for a year, or at the point of disruption if this occurred earlier. The interview schedules were designed specifically for this study and were based upon well‐established techniques developed in other studies of parenting. They enabled the researchers to make summary ratings for each carer on established dimensions of parenting such as control and discipline, responsiveness and the level of engagement with the child. The researchers assessed how these strategies changed and developed in relation to the young person's behaviour and whether these approaches influenced either the likelihood of placement disruption or the quality of the placement for the child. This paper describes the parenting strategies used by the foster carers, highlighting the areas of parenting that significantly affected the placement outcomes and the corresponding implications for policy and practice.     

A four factor model predicting likelihood of foster carer retention

This study used a self‐report method to test a conceptual model for predicting the likelihood of retention of foster carers for children requiring out‐of‐home care. It was hypothesized that satisfaction levels of foster carers would be determined by locus of control and social support, and that the decision to stay or leave fostering within the next 18 months would be influenced by foster carer satisfaction, and commitment to a child/ren in care. Participants were 185 Queensland foster carers. Results supported the proposed model. Logistic regression analysis revealed that an increase in either satisfaction or commitment would result in foster carers being more likely to decide to stay in fostering. Multiple regression analysis found that both locus of control and social support made a significant contribution to the prediction of carer satisfaction. The findings were further supported by qualitative data. Implications of the findings are discussed.     

The trouble with foster care: the impact of stressful 'events' on foster carers

Summary The article draws on the first stages of a large-scale longitudinalstudy into foster care with 'looked after' children. It usesdata supplied by 950 foster carers in response to a postal questionnairedesigned to document the proportions who had experienced oneor more of six potentially stressful 'events': breakdowns ordisruptions, allegations, relationship with birth parents, familytensions, 'tug of love' cases, and other disagreements withsocial services. The article uses carers' comments to describetheir reaction to the 'events'. It then examines the relationshipbetween the 'events' and measures of carer stress, satisfactionwith fostering, and intentions to continue fostering. Overall,two-thirds of the sample had experienced one or more of these'events' and these were associated with a measure of mentalill-health and with attitudes towards continuing fostering.     

Training foster carers in challenging behaviour: a case study in disappointment?

This paper sets out key features of a semi‐experimental investigation conducted between March 1999 and April 2001 into the impact of training foster carers in techniques to manage challenging behaviour. We identified a sample of children (n = 103) in foster care in four authorities in South Wales who were selected by a checklist as showing behaviours that could be defined as challenging. From this search procedure we identified their foster carers (n = 106) and created a training intervention group for 53 carers looking after 49 children and a non‐intervention comparison group of 53 carers looking after 54 children. Both groups of carers were interviewed using a range of measures before and after the delivery of the training in order to identify any changes they perceived in the conduct of children and changes they perceived in their own capacities as carers. The training was delivered in small groups and evaluative feedback was gathered from carers and from training officers in those agencies that participated in the study. The results suggested that training, as designed and delivered in this study, had limited impact on child conduct and carer capacity. The reasons for this are discussed in light of selected findings. We spend some time on describing our methods in order to expose our approach to the critical scrutiny of readers, whose views would be welcome as we make our future research plans in this field.     

Foster carers' experiences of a paired reading literacy intervention with looked‐after children

Previous studies have shown that paired reading, a structured literacy intervention, is a promising method for improving looked‐after children's literacy skills. The aim of this study was to explore variations in foster carers' experiences of conducting the intervention. Interviews were carried out with 15 Swedish foster carers with varying experiences in programme compliance and of practicing the method. Findings suggest that the intervention process starts with getting carers involved, which seems to be dependent on a positive carer attitude. Integrating the reading training in the everyday life is another important aspect, which evolves around motivating the child and prioritizing the reading sessions. Furthermore, the results emphasize the need of having a flexible approach when delivering the intervention. The results suggest that it is possible to engage foster carers in literacy training for looked‐after children and that paired reading can provide a model for competent reading and also result in improved child/carer relations. However, participants need support, and in some cases adjustments in the day‐to‐day delivery of the intervention are required.     

“She was accused of colluding with the mother”; the training and support needs of parent‐and‐child foster carers: A qualitative study

Parent‐and‐child foster placements are used to accommodate parents with their children, either when the mother is a looked‐after child or as a setting for a parenting assessment. Despite this being a specialized role with significant potential for affecting outcomes for disadvantaged families, there is currently a lack of accessible learning opportunities for foster carers on the physical and mental well‐being of women with complex needs such as a history of domestic abuse, substance abuse, perinatal mental ill‐health, or having a learning disability. Parent‐and‐child carers experience some unique stresses and value the support of others with similar experiences; this kind of peer support is currently largely absent. This qualitative study has used ten focus groups with foster carers, eight interviews with mothers, and nine interviews with supervising social workers, to inform the development of an online learning resource and a social media‐based peer support network for parent‐and‐child foster carers.     

The Limits of Support in Foster Care

Correspondence to Stephen Nixon, School of Continuing Studies, The University of Birmingham, Edgbaston, Birmingham B15 2TT; E-mail: Continuing-Studies{at}bham.ac.uk Summary This study was designed to explore the support provided forfoster carers during crises. A sample of sixty-seven fostercarers who had experienced an allegation of abuse against amember of their immediate family were questioned, with a specificfocus on their support needs and experiences during the periodof investigation and its aftermath. Data were also gatheredfrom a smaller sample of twenty family placement social workerswho worked with a sub-sample of these foster carers in orderto establish their perceptions of the issues. Shock, anger,bitterness and a sense of isolation were the prevailing emotionsexperienced by foster carers. It was found that the formal supportoffered by the child-care agencies was not used by 76 per centof foster carers. For most carers there was a lack of congruencebetween the type of support they needed and the support providedby the child-care agency. A number of other useful findingsemerged which are discussed in relation to crises in fostercare. The implications for foster care practice are substantial andrelate to the optimum provision of support for foster carersin such crises. It is suggested that the key role of socialworkers is to encourage and enable foster carers to establishtheir own close network of personal support in anticipationof such events.     

An Outcomes Focus in Carer Assessment and Review: Value and Challenge

Correspondence to Elinor Nicholas, Research Fellow, Social Policy Research Unit, University of York, Heslington, York YO10 5DD, UK. E-mail: en2{at}york.ac.uk Summary A focus on outcomes and a desire to improve assessment and supportto carers are central to government policy, crystallized inthe 2000 Carers and Disabled Children Act. This paper exploresthe benefits and challenges of implementing an outcomes approachto carer assessment and review, highlighted by a research anddevelopment project, undertaken in partnership with one localauthority. The project developed and tested research-based practicetools which aimed to promote carer-centred practice, togetherwith clarity in communication and recording of outcomes intendedand achieved. Findings indicated that practice could be enhancedwith the help of a clear conceptual framework and tools, flexiblyand sensitively used to assist discussion and decision-makingwith carers about outcomes. Information about outcomes, aggregatedfrom individual records, was perceived as potentially usefulfor informing service development. Some significant obstaclesand challenges also emerged; not least, the subtle but significantculture shift required, and the additional time needed to effectivelyidentify and address outcomes with carers. A number of factorswere highlighted as important in introducing such an approach:collaboration with, and between, all stakeholders; trainingand support for practitioners to include practice in recordingoutcomes, and opportunities for continuing discussion and reflectionduring implementation.     

Contact visits between foster children and their birth family: the views of foster children,foster parents and social workers

It has been argued that contact visits between foster children and birth parents can help maintain attachment bonds and support the child's development. However, some research suggests that such visits can be detrimental. This study analyses the characteristics of contact visits and examines children's perceptions of the emotional relationship they have with foster carers and their biological parents. Participants were 104 non‐kinship foster children and their respective foster carers and social workers. Fifty‐six of these foster children had contact visits with their birth parents. Foster children rated the quality of their relationship with foster carers and birth parents using the Affect Scale. Foster children, foster carers and social workers all completed the Evaluation of Contact Visits Questionnaire. Results showed that (i) a high proportion of children had no contact visits; (ii) the contact agreement was often not fulfilled; (iii) many visits were rated as poor quality; (iv) foster carers' evaluation of visits was more negative than that of both foster children and social workers; and (v) children who experienced poor‐quality visits and perceived less warmth and more criticism/rejection from their parents. These results highlight the need to improve contact visits by developing intervention strategies targeted at all those involved.     

Broken circles to a different identity: an exploration of identity for children in out–of-home care in Queensland, Australia

Child protection manuals and literature emphasize that developing a sense of identity is one of the most important elements in achieving good outcomes for children in out-of-home care. Yet, the very issue of identity raises questions that many child protection workers are ill-equipped to answer. In practice, life story book work based on developmental theories has been utilized by child protection workers and foster carers as a response to a sense of 'lost identity' for children in out-of-home care. However, Indigenous and psychological concepts of identity may have little in common.
Current theories of identity development in children lack evidence from the children and young people themselves in informing these notions, which have been criticized as adult-centric. Developmental theories may also be problematic for children from non-Western cultural groups. This research was undertaken in a regional area of Queensland, Australia where the majority of children in the child protection system who are identified as Indigenous, come from two or more cultural backgrounds. The research presented in this paper firstly explores identity issues for children and young people in foster care from their own perspective using narrative art therapy. Secondly, the research views identity from the perspective of professionals working in child protection and out-of-home care.     

Could I do something like that? Recruiting and training foster carers for teenagers “at risk” of or experiencing child sexual exploitation

Child sexual exploitation (CSE) is a category of child abuse that was historically created to recognize the victimhood of children and young people, illuminating the ways that their evolving capacity to consent to sex is manipulated and undermined. Using evidence from the evaluation of specialist foster care provision and a CSE training course for foster carers, this paper considers how training might be used to widen the pool of potential foster carers for children affected by CSE and identifies qualities displayed by effective carers. It argues that improving the recruitment of foster carers can create safer home environments for teenagers at risk of or experiencing sexual exploitation and reduce the risk of further harm and that informed and effective foster care provision is crucial to prevent both the sexual exploitation of looked‐after teenagers and placement breakdowns that can ultimately increase risk.