Effects of a book gifting programme on literacy outcomes for foster children: A randomised controlled trial evaluation of the Letterbox Club in Northern Ireland

The poor educational outcomes of children in care are a significant concern internationally. Whilst there have been many interventions developed to address this problem, very few of these have been rigorously evaluated. This article presents the findings of a randomised controlled trial that sought to measure the effectiveness of a book gifting programme (the Letterbox Club) that aims to improve literacy skills amongst children aged 7–11 years in foster care. The programme involves children receiving six parcels of books sent through the post over a six-month period. The trial, which ran between April 2013 and June 2014, involved a sample of 116 children in Northern Ireland (56 randomly allocated to the intervention group and 60 to a waiting list control group). Outcome measures focused on reading skills (reading accuracy, comprehension and rate) and attitudes to reading and school. The trial found no evidence that the book-gifting programme had any effect on any of the outcomes measured. Drawing upon some of the emergent themes from the accompanying qualitative process evaluation that sought to determine foster carer/child attitude towards and engagement with the parcels, it is suggested that one plausible reason for the ineffectiveness of the Letterbox Club, as intimated by carers and children (rather than explicitly explored with them), is the lack of support provided to the carers/children in relation to the packs received. Reflective of an ecological model of children's development, it is recommended that for book-gifting programmes to be effective they need to include a focus on encouraging the direct involvement of foster carers in shared literacy activities with the children using the books that are gifted.     

Agency and its Constraints among Biological Children of Foster Carers

There is currently limited understanding of biological children of foster carers and their experiences of foster care placements. This article presents findings from focus groups with biological children that shed light on their perspectives and experiences. Findings indicate biological children are competent social actors who contribute to, and seek to influence, the care environment in their homes. However, due to a lack of recognition, information, and support, biological children’s agency is constrained and their challenges exacerbated. This article argues for increased recognition, information and support for biological children, advocating for a “whole-of-family” approach to foster care practice and policy.     

Permanence for disabled children and young people through foster care and adoption: A selective review of international literature

Children who have been removed from their parents need stability and permanence; this is as true for disabled children as it is for others. Yet many children are subject to extended periods of uncertainty and instability. Growing attention has been paid to the need to achieve permanence within a timescale which meets children's needs. As disabled children are over-represented in looked after (in care) populations it is especially important that their needs are considered when formulating policy and practice in this area.This review of literature covers international material related to stability and permanence for disabled children, in particular permanence achieved through fostering and adoption. A scoping method was used to identify and analyse a broad range of material. Ninety texts were included in the review, including material from the US, the UK, Canada, Australia, China and the Netherlands. Empirical research included quantitative, mixed methods and qualitative studies. Other sources included literature reviews and a small number of research-based ‘think pieces’ and briefings.Disabled children often have permanence outcomes and experiences which differ from those of other children; most often they are disadvantaged by systematic features of services and by the latent disablism of decision-makers, professionals, carers and potential carers. The findings also show that disabled children are not a homogenous group and that characteristics such as age, gender, ethnicity and impairment type show complex relationships with permanence through adoption and foster care.Important gaps in current knowledge are identified, including disabled children's views and experiences in relation to achieving permanence. Several areas of policy and practice are highlighted where effort to improve permanence needs to be made. These range from tackling negative professional attitudes about the prospects of placing disabled children to further development of non-traditional approaches to the recruitment of foster carers and adopters.     

Enhancing Service Evaluability: Lessons from a Programme for Disaffected Young People

The effectiveness of children's services is often limited by a series of problems that also impede meaningful evaluation. This article describes and assesses research strategies to enhance the evaluability of a programme for disaffected young people, arguing that they have the potential to improve services more widely. It explores methods for developing a logic model, setting target group criteria, tightening programme components, identifying sufficient suitable candidates and selecting appropriate measures. Examples of other preparatory work aimed at helping the evaluation are given, including firming‐up the programme and evaluation ethics and dealing with the politics of a fairly complex evaluation (a randomised controlled trial) that involves numerous stakeholders.     

The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.     

Effects of a school readiness intervention for children in foster care on oppositional and aggressive behaviors in kindergarten

One hundred ninety-two children in foster care participated in a randomized efficacy trial of a school readiness intervention, the Kids In Transition to School (KITS) Program, designed to increase literacy, social, and self-regulation skills in children before kindergarten entry. One hundred two children were randomly assigned to the KITS intervention and 90 were randomly assigned to the foster care services as usual comparison group. At the end of the kindergarten year, teachers were asked to report on the children's oppositional and aggressive behaviors in the classroom. Controlling for gender, baseline levels of parent-reported oppositional and aggressive behaviors, and level of disruptiveness in the classroom, children who had received the intervention had significantly lower levels of oppositional and aggressive behaviors in the classroom. Findings suggest that an intervention designed to increase school readiness in children in foster care can have positive effects on kindergarten classroom behavior.     

The Reunification Partnership: Engaging Birth Parents and Foster Carers as Collaborators in Restoration Casework

Collaboration is recognised as a key factor influencing the success of efforts to reunite children with their family following a protective intervention and a period in out-of-home care. Until now, little research has explored the possibilities of collaboration in this context, especially between parents and foster carers. This qualitative, interpretive study asked child protection caseworkers involved in restoration cases about their perceptions, perspectives, and experiences of collaboration between parents and carers. In-depth interviews were conducted with six caseworkers from five locations in New South Wales. The study found that caseworkers identified factors that influence the development of collaboration. These factors include trust, motivation and willingness, knowledge, and agreement. They also described strategies for promoting these factors in their casework. The research highlighted that a collaborative relationship between parents and carers can be facilitated through casework practice that considers certain factors and that strategically addresses the barriers to collaboration.     

We Live Here Too: Birth Children's Perspectives on Fostering Someone with Learning Disabilities

SUMMARY. This paper reports some results from a study of foster care of young people with severe learning disabilities. It focuses upon the views and experiences of the birth children in foster families. The findings demonstrate how fostering involves everyone in the family, not just the adult carers; and highlight some of the rewards and difficulties of fostering from the birth children's point of view.     

Decreasing risk factors for later alcohol use and antisocial behaviors in children in foster care by increasing early promotive factors

Children in foster care are at high risk for poor psychosocial outcomes, including school failure, alcohol and other substance abuse, and criminal behaviors. Promoting healthy development by increasing broad-impact positive skills may help reduce some of the risk factors for longer-term negative outcomes. School readiness has been linked to a number of positive outcomes across childhood, adolescence, and adulthood, and may also boost intermediary positive skills such as self-competence. This paper presents findings from a longitudinal study involving 192 children in foster care who were 5 years old at the start of the study. They participated in a randomized controlled trial of a school readiness program to prepare them for kindergarten. Outcomes were assessed at third grade (9 years old) on variables associated with risk for later involvement in substance use and delinquency. These included positive attitudes towards alcohol use, positive attitudes towards antisocial behaviors, and involvement with deviant peers. Results showed that the intervention decreased positive attitudes towards alcohol use and antisocial behaviors. Further, the mediating role of children's self-competence was tested. The intervention positively influenced children's third-grade self-competence, which in turn, decreased their involvement with deviant peers. Findings suggest that promoting school readiness in children in foster care can have far-reaching, positive effects and that increased self-competence may be a mechanism for reducing risk.     

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.     

Levels of burden and satisfaction among Spanish foster carers

The aim of this study was to analyse the levels of burden and satisfaction among foster families in Spain, as well as the relationships between these variables and characteristics of the foster children and their carers. Participants were 86 foster families (comprising 71 foster fathers and 86 foster mothers) and the 104 children who they were fostering (56 boys and 48 girls). The instruments used were the Zarit Burden Interview and a questionnaire on foster carers' satisfaction with the preparation and support they had received. The results revealed low levels of burden among the families. Levels of burden were directly correlated with the amount of time the children had spent in residential care and with the age of foster fathers, and inversely correlated with how long the child had been with the current foster family. Higher levels of burden were reported by carers whose foster child was academically delayed. Regarding satisfaction, the highest ratings corresponded to items referring to the work of professionals, while the lowest were given for items concerning the information that foster families had received about the child's personality and the material and financial support available to them. The implications of the findings for professional practice are discussed.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Carer perspectives of factors affecting placement trajectories of children in out-of-home care

Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.     

Foster carer stress and satisfaction: An investigation of organisational,psychological and placement factors

The unique demands of the foster carer role are associated with high levels of self-reported stress among foster carers. The current study examines the amount of carer stress that can be attributed to certain role specific challenges and how stress from these challenges varies between carers and placements. As a secondary aim the study examines carer perceptions on current organisational support and training. Participants were sourced from a national fostering agency with branches in the local area. Carers were eligible to participate in the study if they were caring full time for at least one foster child. Eligible carers completed an identical online or paper survey including measures of general stress and parenting stress as well as study specific measures regarding satisfaction with organisational training and support. Results demonstrated that challenging behaviours are the most stressful unique role demand for foster carers and the largest predictor of carer stress levels. Overwhelmingly carers reported a desire for additional training in order to support them in their role. The results support previous research outlining the difficulties faced by foster carers and the need to improve support and training to ensure good placement outcomes including placement stability and reduced carer attrition.     

“It's really overwhelming”: Parent and service provider perspectives of parents aging out of foster care

Rates of pregnancy and parenthood among current and former foster youth are two to three times higher than non-foster youth peers. Repeat pregnancies among young mothers aging out of foster care also occur at higher rates than peers not involved with the child welfare system. Furthermore, mothers aging out of foster care demonstrate high levels of parenting stress and risk for child maltreatment. Indeed, this population is in significant need of help; however, beyond anecdotal evidence, little is known about the needs and day-to day experiences of this population. In order to tailor interventions to meet the needs of parents aging out, the perspectives of stakeholders must be taken into account. Using qualitative data gathered from separate small group interviews with parents aging out and service providers, this study examined participants' perceptions of parents' daily experiences, strengths, and needs. Findings indicated that parents aging out face overwhelming adversity and stress with little outside financial, emotional, or parenting support from family or friends. Yet, parents also expressed motivation to be good parents, resilience, and the desire to gain effective parenting skills. Although similar themes arose among parent and provider interviews, perceptions differed. Parents expressed hope and optimism in providing for their children while providers expressed systemic failure in preparing parents for independent living. Based on these findings, we conclude that parenting interventions specific to parents aging out may need to address three fundamental and key components: basic needs, social support, and effective parenting techniques.     

Foster family acceptance: Understanding the role of foster family acceptance in the lives of LGBTQ youth

LGBTQ youth in the child welfare system have historically received very little attention. The limited research available suggests that they encounter a number of disparities and double standards when compared to straight youth. The current study examines the role that foster family acceptance plays in the lives of LGBTQ youth as they navigate the child welfare system. The experiences of LGBTQ foster care alumni who had accepting foster family experiences are compared to those who had rejecting experiences. Findings suggest that foster family acceptance plays a pivotal role in creating an affirming and inclusive environment for LGBTQ youth. Similarly, findings provide further evidence for the need to educate, train, and recruit affirming and accepting foster families.     

Foster fathers performing gender: the negotiation and reproduction of parenting roles in families who foster

ABSTRACT

Foster care research and social work practice tend to focus on how women look after children living in foster care. This focus has limited our understanding of what it is that men do within foster caring families and they are automatically assigned secondary or breadwinning roles. Families who foster involve some form of renegotiation of roles to care for children they foster. While foster caring arrangements are internationally diverse, foster carers often work with social workers. It would therefore seem important for social workers to understand how foster carers negotiate their parenting roles. This paper reports findings from seven main caring foster-fathers who took part in a wider study involving twentythree foster-fathers. The evidence provided by these foster-fathers demonstrate they are highly motivated to care for children and, alongside delivering traditional parenting roles, they negotiate new, non-traditional parenting roles as foster-fathers. These new roles, taken on by foster-fathers, often challenge stereotyped masculinity while they also concurrently enact parenting norms. This study applied Judith Butler’s work on performing gender to foster caring families to theorise on the process whereby foster-fathers negotiate diverse masculinities and continue to reproduce gendered relations in foster caring families.     

Promoting a sense of ‘secure base’ for children in foster care – Exploring the potential contribution of foster fathers

The role and impact of male foster carers in the lives of foster children is under-explored.This article reviews relevant research evidence (based on searches of Web of Science and PubMed and other sources) in relation to the particular contribution men as foster carers can make to a sense of ‘secure base’ for children in their family's care. It also includes attention to how men as foster carers may play a special role in helping to cultivate valuable social capital for the young person in their care.     

Joining formative evaluation with translational science to assess an EBI in foster care: Examining social–emotional well-being and placement stability

This study examined measures of placement stability and social–emotional well-being for a federally-funded demonstration project of inhome Parent Management Training-Oregon model (PMTO) for children in foster care with serious emotional disturbance (SED). Following a cultural exchange framework for translational research and a tollgate approach to evaluation, this formative study tested these measures prior to further investment in summative evaluation. The research aim was to observe whether measures of social–emotional well-being and placement stability performed as expected. Using a pretest–posttest randomized consent trial, children identified as SED within six months of entering foster care were randomly assigned to PMTO or to a services-as-usual comparison group (N = 121). A multi-group structural equation model was tested to observe the relationship of baseline social–emotional wellbeing and placement stability on post-test social–emotional well-being. Results showed that post-test well-being was significantly predicted by baseline well-being for both groups and, importantly, only the intervention group demonstrated significant effects of placement stability on post-test well-being. For the intervention group, as placement stability increased, post-test social skills significantly improved, demonstrating an association between well-being and placement stability that was not evident in the comparison group. Overall, wellbeing measures performed as expected and detected relationships between variables and variation as hypothesized. Additionally, placement stability may have been mediated by the PMTO intervention. In conclusion, by using a real world example of the translational research concept of cultural exchange between university-based researchers and agency-based practitioners, this study shows that formative evaluation offers an important opportunity to test ad hoc research questions inspired by the process of implementation itself.     

Evidence-based Medicine and Child Mental Health Services

There is increased focus on using research evidence to guide clinical practice in the provision of child mental health services, to allocate resources and to make policy decisions. Emphasis has been placed on randomised controlled trials, which are clearly vital. However, given the complexity of children's lives and the multiple systems relevant to their care, it is important to consider alternative research designs and to think creatively about outcomes. In the context of difficulties with random allocation a number of quasi-experimental designs are described that may more closely reflect actual clinical work. In the context of ecological theory, the importance of taking a systems level approach to evaluation is highlighted, with examples from the US. Finally, the ways in which qualitative outcomes measures can be used to sensitively describe the effects of treatment are outlined, and their potential for giving voice to children and families as consumers of mental health services. These suggestions aim to lessen the tension between the requirements of the scientific investigations of treatment effectiveness and the realities of clinicians' daily experiences.