School performance in primary school and psychosocial problems in young adulthood among care leavers from long term foster care

We used data from Swedish national registers for ten entire birth year cohorts (1972-1981) to examine psychosocial outcomes in young adulthood for youth that left long term foster care after age 17, comparing them with majority population peers, national adoptees and peers who had received in-home interventions before age 13. The population was followed in the registers from age 16 to 2005. Data were analyzed in Cox regression models.Youth who left long term foster care had six-to eleven fold sex and birth year adjusted excess risks for suicide attempts, substance abuse and serious criminality from age 20, and for public welfare dependency at age 25. Overrisks were considerably lower for the in-home intervention group and the national adoptees. Adjusting results for poor school performance in the final year in primary school (ages 15-16) reduced overrisks by 38-52% for care leavers from long term foster care.Irrespective of issues of causality, poor school performance seems to be a major risk factor for future psychosocial problems among youth who age out of long term foster care. The results suggest that promoting foster children's school performance should be given high priority by agencies.     

Alcohol and drug abuse among young adults who grew up in substitute care — Findings from a Swedish national cohort study

To what extent substitute long term care modifies intergenerational transmission of substance abuse has rarely been investigated. Using register data, we followed a national cohort born 1973–1985 consisting of 1012 national adoptees, 2408 former children from long term foster care, 348/846 environmental siblings of adoptees/foster children, and 952,935 majority population peers, from their 15th birthday to age 27–35. Using Cox regression, we calculated hazard ratios (HR) for hospital care and criminality associated with illicit drug/alcohol abuse, with adjustments for socio-demographic indicators of caring families, and substance abuse in caring and birth parents.     

Parental substance abuse and the development of children in family foster care

To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided.     

Crisis nursery effects on child placement after foster care

The results of a study of the relationship between receiving crisis nursery services and the placement outcomes for young children leaving the child welfare system in Illinois are reported in this paper. The placement outcomes for children leaving foster care whose families received crisis nursery support prior to the children's placement in foster care is compared to the placement outcomes for children whose families received only foster care services. The children in two samples were identified by matching crisis nursery children's data from FY 2006 with children's data in the Illinois Child Abuse and Neglect Tracking System and Children Youth and Services Information System databases. After children served by crisis nursery and foster care services were identified, a comparison group of children with like-characteristics whose families received only foster care services was identified using propensity score matching. The children were followed until their out-of-home placement was terminated or until June 30, 2009. The placement outcomes and the length of stay were compared for the two groups. Using logistical regression analysis the results showed that children whose families received crisis nursery services prior to foster care placement were twice as likely to be reunited with their biological families (birth or extended family members) when compared to children whose families received only foster care services. The difference in the length-of-stay in foster care was not statistically significant when the two groups were compared. This preliminary study using administrative data shows that receiving crisis nursery services may have positive effects on the children's ultimate placement outcome after foster care. Additional research is needed to further explore the relationship between placement outcome and crisis nursery services.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

Substance use in youth adopted from foster care: Developmental mechanisms of risk

Children who enter foster care are at unique risk for developing substance abuse due to experiencing early life stressors. A large body of research has revealed robust effects of various stressors on later substance use, implicating the role of early neurobiological changes that create chronic internalizing problems. However, less literature has investigated externalizing behavior as a mechanism underlying this relationship. Moreover, few studies have examined these mechanisms through a model of cumulative risk. The present study examined whether the prospective association between cumulative pre-adoptive risk (e.g., maltreatment, age at placement, foster placement instability, ever having lived with birth parent) and adolescent/young-adult substance use was mediated by childhood internalizing and externalizing problems in youth adopted from foster care. Participants included 82 adoptees, most with histories of prenatal substance exposure (72%). We tested parent-rated internalizing and externalizing problems across 5 years in childhood as simultaneous mediators of cumulative risk and level of substance use 11–15 years later. Bootstrapping mediation procedures, controlling for age, prenatal substance exposure, adolescent/young adult mental health symptomatology, and youth participation in follow-up, revealed a significant indirect effect of cumulative risk on substance use through childhood internalizing problems, but not externalizing problems. These results underline the importance of mitigating early risk for children in the child welfare system and call for targeting childhood emotion dysregulation to reduce likelihood of substance abuse among previously high-risk adoptees. Nevertheless, low rates of substance use overall in the present sample underscore the positive impact of adoptive placement on mitigating risk for substance abuse among foster youth.     

What are the factors associated with educational achievement for children in kinship or foster care: A systematic review

Children in care lag behind their peers on a number of outcome measures, including education. Interventions have been developed to help them close the gap with their peers but these have had limited success to date. One possible reason for this may stem from our lack of understanding about underlying processes and mechanisms.This paper presents the findings of a systematic review of the factors associated with educational outcomes for children in foster and kinship care. It aims to inform the literature on risk and protective factors and inform the development of future interventions.Eight major databases and websites were searched between 1990 and 2016 using a combination of mesh terms. Studies were included if they tested the statistical association between any variable and educational outcomes for school age children in foster or kinship care in high-income countries. Children in other placement types were excluded. Titles and abstracts were screened for 7135 studies identified through searches. Full texts were obtained for 298 and 39 were retained for inclusion.Over 70 factors were identified. For the purposes of the narrative synthesis, factors were categorised into spheres of influence adapted from Bronfennbrenner's (1979) ecological framework. The findings reveal significant heterogeneity. Male gender, ethnic minority status and special educational needs were consistent predictors of poor educational outcomes, while carers' and young people's aspirations appeared to predict greater success. The findings are discussed with implications for future research and practice.     

Health outcomes for adults in family foster care as children: An analysis by ethnicity

Studies have linked the experience of child abuse or adversity to health problems in adulthood, and researchers have long documented health problems affecting children in foster care. Yet, the adult health outcomes of maltreated children placed in foster care have not been sufficiently isolated. Although information on transitioning youth and young adults is now beginning to emerge, the impact of ethnicity on adult health outcomes has been largely ignored. Given the overrepresentation of ethnic minority children in foster care and the national disparities in the health of ethnic minorities, this study examined the relationship between ethnicity and physical health outcomes for African American, Hispanic, and White adults who experienced family foster care as children. Logistic regression models indicated that ethnicity was not a significant predictor of physical health (p > .05). However, gender and age were associated significantly with their physical health outcomes.     

Placement Instability and Risky Behaviors of Youth Aging Out of Foster Care

Youth who age out of foster care are at risk of poor outcomes and risky behaviors in young adulthood. Yet, little is known about what child welfare workers can do to decrease these risks. The effect of foster care placement instability on substance use and risky sexual behaviors is examined using data from 114 young adults who aged out of care. When controlling for variables commonly associated with these behaviors, a history of foster care placement instability increased the young adults’ likelihood to use substances. Child welfare practitioners could potentially reduce the vulnerability of this population by providing them greater stability during adolescence.     

Conceptions of Family and Adoption Among Older Adoptees

ABSTRACT

Research on older child adoptions that incorporates the adoptee's perspective is noticeably absent from the literature. Drawing on the theoretical, clinical and empirical literature on children's understanding of family and adoption, this paper reports a study that examined older adoptees' conceptions of family and adoption relative to nonadopted peers. Interviews with 15 children adopted between ages 8 and 11 and a sample of 15 demographically matched nonadopted children (47% male; 84% Caucasian, 13% African American, 3% Biracial Asian/American) provided data that were analyzed for differences in children's understanding and elaboration of family and adoption concepts. Although no group differences were found in children's basic understanding of family or adoption, differences emerged in children's ratings of the acceptability and typicality of family constellations, as well as in the nature of concept elaboration. Older adoptees were more likely to accept and view as typical nontraditional family constellations. Whereas nonadopted children relied more on biological themes, older adoptees' concept elaboration was qualitatively richer, reflecting their varied birth family and foster care experiences. Within-group comparisons among older adoptees revealed differences: Children with more experience in foster care and children who lived in the adoptive home longer displayed higher levels of family understanding and a more realistic perspective of the permanence of the placement. Implications for future research and adoption service delivery are discussed.     

Enhancing the validity of foster care follow-up studies through multiple alumni location strategies

While family-based placement prevention services, family reunification programs, subsidized guardianship, and aggressive adoption programs are reducing the numbers of children spending long periods of time in substitute care, a significant number of America's children will come of age in foster care. Agencies and policymakers should use research and evaluation to assess the effectiveness of foster care in nurturing healthy adults and to explore ways to improve services. Outcome studies that have focused on locating and interviewing young or middle-aged adults emancipated from foster care have been hampered by modest response rates, limiting the field's ability to evaluate the efficacy of foster care programs. This article describes a set of strategies that were used to achieve higher response rates in two recent follow-up studies.     

Achieving Permanence in Foster Care for Young Children: A Comparison of Kinship and Non-Kinship Placements

ABSTRACT

A number of child welfare policies have reinforced the use of kinship care as the most preferred placement for foster children, reflecting the philosophy that maintaining children within their own extended family system contributes to their stability and well-being. Given the growing utilization and legislative emphasis on kinship care along with the push for an immediate implementation of permanency plans for children in foster care, this study examines how the permanency goal under the 1997 Adoption and Safe Families Act (ASFA) is being implemented and achieved. The reunification and permanency placement (adoption or legal guardianship) outcomes of children in relative and non-relative care are analyzed, focusing on the experiences of young children. Based on public child welfare agency data from 2000 to 2003, child, case, and placement variables are explored to identify which set of factors best explains case outcomes. The present study identifies the total length of foster placement (kinship and non-kinship), the length of family maintenance services, and the number of placement changes as the most important variables in determining family reunification and permanent placement (legal guardianship and adoption) outcomes for young children.     

Reunification of foster children: Factors associated with reunification outcomes in Flanders and the Netherlands

Although a significant number of foster children eventually return to their birth parents, evidence-based models for permanency planning are scarce, and there is a lack of clear decision-making criteria for reunification. This study aimed to establish further knowledge about reunification. Both reunification pace and factors which are associated with reunification were examined. The focus was on factors related to the foster child, the birth parents, the foster parents and the foster placement, and reasons for removal. Case file analysis was performed for 580 Flemish and Dutch foster children ages 0–18. Cox regression analyses showed contact with birth parents to be most strongly associated with reunification. Moreover, particularly placement related factors (e.g., legal framework, additional support services, contact with birth parents) increased the likelihood of reunification. Furthermore, over a period of six years approximately 15% of foster placements led to reunification notably during the first 2.5 years of placement. Policy makers and foster care professionals are therefore encouraged to timely aim for permanency planning. Reunification efforts should be planned from the start of the foster placement. If subsequently reunification proves not feasible, permanency should be secured within the foster family.     

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.     

Placement stability in non-kinship foster care: variables associated with placement disruption

In Spain research has been conducted into the outcomes of foster care, although there is a need for further analysis, especially as regards the variables associated with placement disruption. In 2008 (T1) was collated information on all foster placements that were registered in three Spanish provinces. In 2014 (T2), data were gathered by reviewing the children's case notes and through interviews with the social worker responsible for each case. The resulting sample comprised 104 non-kinship foster children in long-term foster care who were being fostered in 86 families. The results obtained at T2 showed that the percentage of children who were still living with the same family (68.3%) was greater than the proportion of children whose circumstances had changed (31.7%). The social workers considered that placement disruption had occurred in 27 of the 33 cases. One of the main finding was placement disruption was associated with the older age at the time of being fostered and the emotional relationship quality between children and foster carers. A regression analysis showed that low levels of warmth and communication in the relationship between child and foster carers were shown to be a predictor of placement breakdown. Implications for practice are discussed.     

Children in out-of-home care as young adults: A systematic review of outcomes in the Nordic countries

BackgroundInternationally, the Nordic countries occupy top positions in child well-being. We investigated literature on the overall outcomes of young adults from the most vulnerable backgrounds in the Nordic countries, namely young adults who were placed in statutory out-of-home care (OoHC, i.e. foster care) during childhood in the Nordic countries for the protection of their safety and welfare.MethodsWe followed PRISMA guidelines and conducted literature searches manually, as well as electronically, via EBSCO's Psychology/Sociology databases and ProQuest's Social and Behavioral Sciences databases in February 2016 for quantitative studies that compared outcomes at age 18 or later between young adults placed in OoHC as children and those never placed in OoHC. Because of the heterogeneity and small number of eligible studies on each outcome, we conducted no meta-analysis but did formulate a narrative synthesis.ResultsOf 333 studies identified, 20 met the inclusion criteria. All of these studies were cohort studies that employed social and health register data. OoHC placement was studied with nine outcome categories: self-supporting problems, educational challenges, mental health problems, criminality, teenage parenthood, mortality, suicidal behavior, alcohol and drug use, and disability pension. In each of these categories, young adults with a history in OoHC faced higher risks compared with the general population, even after adjusting for various birth parents' socio-economic, demographic, and mental health–related factors.ConclusionAlthough the Nordic countries are among the world's leading nations in promoting child well-being, the Nordic welfare model has partly failed in preventing the inequality of families with children. As young adults, children placed in OoHC in the Nordic countries face an elevated risk of experiencing adversity.     

Transitioning youth: Policies and outcomes

The primary policies and outcome studies regarding youth transitioning from foster care and young adults who have aged out of foster care over the past quarter of a century are reviewed. Although several policies have increased services and funding for this population, overall, their outcomes have not significantly improved. In terms of educational achievement, employment, and well-being, many continue to fare poorly in young adulthood. Further policies and practice improvements may need to be implemented. The population of youth transitioning has far outpaced the funding available, state and program eligibility requirements may be eliminating the most vulnerable from services, in many states there is an inadequate provision of basic needs such as housing and healthcare, the expectations of self-sufficiency for this population now exceed societal norms, and the restrictions and placement instability associated with many older adolescents in care may be in contrast to their developmental needs. In order to more fully address the needs of youth transitioning from foster care, child welfare policies and practices may need to focus more attention on the relational and social development of youth while in foster care. Furthermore, during young adulthood, policies and practices may need to provide greater safety nets and resources to this population.     

Foster care,geographic neighborhood change,and the risk of delinquency

Background and purposePrevious studies report that foster care placement is associated with an increased risk of delinquency. Yet it remains unclear which aspects of the placement experience increase the risk of delinquency. The current study addresses this knowledge gap. This study investigates the relationship between geographic neighborhood change and the risk of delinquency for adolescents in foster care settings. Based on findings from the neighborhood effects literatures, we hypothesize that moving to a neighborhood characterized by concentrated disadvantage and residential instability is associated with increased risk of delinquency.MethodsThe design for the current study is longitudinal. The sample is comprised of 145 foster youth from two birth cohorts, one born in 1983 and one in 1984, in Chicago, Illinois. The sample was 92% African American and 52% male. Overall, 11% had an official juvenile arrest. We used data from multiple sources, including the 1990 census data and administrative data from the Illinois Department of Children and Family Services and the Cook County Juvenile Court. To measure neighborhood change, we calculated a difference between children's home and placement neighborhoods on ten census variables: percentages of households in a given neighborhood that were below the poverty line, neighborhood households on public assistance, female-headed households, unemployed population, and persons < 18 years old, African American, Latino, foreign-born, residents living in the same house as five years earlier, and owner-occupied homes, all of which are commonly used in neighborhood studies. We identified two factors within the neighborhood variables—concentrated disadvantage and residential instability,—and used the two-factor scores in the following analysis. We conducted a Cox regression to model time to first arrest.ResultsThe results indicate that moving to a neighborhood with high residential instability significantly increases an individual's risk of juvenile delinquency. In addition, two subgroups—male foster youth; and all foster youth with an experience of neglect—are significantly more likely to be associated with a formal delinquency petition.Conclusions and implicationsThe current study is unique and builds the knowledge base with regard to the placement of children and adolescents in substitute care settings. The findings indicate that the neighborhoods in which children are placed do matter in terms of their outcomes, and thus they should be considered in the placement decision process. This finding is consistent with the “person-in-environment” concept advanced by social work professionals.     

Studies of the maintenance of subsidized foster placements in the Casey Family Program

The Casey Family Program provides a planned, long-term approach to subsidized foster care for the underachievers of the child welfare system. Its concept is a marriage of what foster care professionals know about effectively helping children and what managers know about effectively running organizations. The purpose of our studies of The Casey Family Program was to determine whether the outcomes of its foster placements were predictable from factors that could be known, at least in principle, at the time the placements were made. We built statistical models of placement maintenance based upon characteristics of (a) the foster child; (b) his or her biological family; and (c) the foster family. We used two main sources of data to construct models: archival material on the child and his or her biological family, and caseworker ratings of various aspects of the child and his or her foster family. Information was derived from a sample of 51 children served by the Montana Division of The Casey Family Program to build the models, which in general provided accurate predictions of placement outcomes. The models were then cross-validated with a sample of 55 children from the Idaho Division. There was a substantial amount of shrinkage in the variance accounted for in the cross-validation sample, but outcomes remained largely predictable. To determine whether predictions of placement outcomes could be based upon brief assessments of factors that could be evaluated at the time placements were made, a third study was undertaken. The results of that study implied that ratings of salient characteristics of foster children and foster families based upon as little as a single day's observation could be used to effectively predict placement outcomes. Several aspects of these studies deserve special emphasis. First, the research confirmed that the children served by the Montana and Idaho divisions of TCFP were among the underachievers of the child welfare system whom Jim Casey desired to reach. It also confirmed that the Montana and Idaho divisions were doing an effective job of serving those children. Their placements were generally stable and both foster children and foster families were rated as functioning at levels that ranged from acceptable to good.(ABSTRACT TRUNCATED AT 400 WORDS)