Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

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.     

Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.     

Aggression and depression among abused and non-abused children in foster care

This study compared the aggressive coping behaviors and depressive reactions among 30 physically abused and 30 non-abused children in foster care. Multiple regression analysis identified experiencing abusive parenting, affective mood depressive themes, and school performance as accounting for 63 percent of the variance in overt aggressive behavior within the sample. The abused children connected the reasons for placement with their own behavior; the non-abused children, with a crisis event. The findings support the need for differential foster care programming for children placed in care.     

Parent-child interaction therapy: application of an empirically supported treatment to maltreated children in foster care

One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.     

Therapy Outcome with Children in Foster Care: A Longitudinal Study

The present paper describes a naturalistic study of therapy with children in foster care. The goal was to attempt to begin to understand what happens to children in foster care while they are in therapy. The functioning of all children referred for therapy in a foster care agency was assessed as rated by different informants at different points in time over an 18-month period. These children present with low-level behavior problems but the level and type of problem they present with depends on the person rating the child and the child’s gender and age. Two thirds of the children improve and do so within the early stages of therapy. One third of the children do not improve. The distinguishing feature of this group appears to be the high level of aggressive behaviors reported at intake. Results suggest that improvement depends on the eye of the beholder. These findings are discussed and recommendations for therapeutic and systemic practice are made. The importance of using multiple informants when evaluating the treatment needs of children in care is pointed out as is the need to rethink therapeutic strategies with children that present with high levels of aggressive behavior at intake and show no improvement after the first 6 months of therapy.     

Temporal effects of distressed housing on early childhood risk factors and kindergarten readiness

Poor housing quality and housing crises have been linked to adverse outcomes for children. However, few studies have focused on the early childhood period or been able to pinpoint how the timing and duration of housing problems contributes to early educational success. This longitudinal study draws on linked administrative records from housing, education, social service and health agencies to examine the influence of exposure to housing neighborhood conditions since birth on school readiness of all children entering kindergarten over a four-year period in a big city school system. Using marginal structural models that properly account for dynamic housing and neighborhood selection, we find that children exposed to problematic housing and disadvantaged neighborhoods have lower kindergarten readiness scores after accounting for other factors. The negative effects of housing problems on kindergarten readiness are partially mediated by child maltreatment incidences, residential instability, and elevated blood lead levels. Communities are advised to pay more attention to distressed housing as a cause of disparities in early child development and school readiness.     

School readiness of low-income children at risk for school failure

The goal of this research project was to gain information about the readiness skills of kindergarten children in 11 inner city schools with the highest poverty rates in the Salt Lake City School District. Kindergarten teachers and principals in these schools were interviewed regarding their perceptions of the readiness skills needed for these children to be successful in their schools. A summary of the readiness skills of the kindergarten children was derived from a state mandated Pre-Kindergarten Assessment. Most principals stressed children's social and emotional development as a priority in school readiness. The majority of teachers emphasized literacy as a prerequisite for school success. Yet, the Pre-Kindergarten Assessment revealed that one fourth of the children could not identify the front of a book and two thirds of the children did not know where to start or which direction to go when reading. Half of the parents of these children reported that they rarely read to their children and that they had only visited a library once or not at all. The gap between the readiness skills educators think these children need and the skills children enter school with presents a serious problem for educators and policy makers. Multiple intervention strategies are recommended including providing education and home activities to enhance children's readiness skills, coordinating access to early childhood programs, and educating parents on available community resources.     

Academic engagement and performance: Estimating the impact of out-of-home care for maltreated children

Using data from the National Survey of Child and Adolescent Well-being II, the authors examined whether being placed in foster care was associated with school engagement and performance. The authors used propensity score matching to compare children who had similar demographic characteristics, maltreatment histories, and prior levels of school engagement. Children who were in foster care at wave 2 were found to have higher levels of cognitive engagement in school compared to children who were maltreated but never removed from their homes. It is recommended that children who are maltreated but remain in their familial home receive additional intervention related to their educational engagement.     

Aggressive behaviors among Korean children in out-of-home care: The role of placement characteristics

Using data from the Korean Panel Study on Children in Out-of-Home Care, this study examined the impact of placement characteristics on aggressive behaviors among children in out-of-home care by placement type. The sample was divided into three groups based on placement type: institutional care (n = 118), group homes (n = 95), and foster care (n = 212). Results from hierarchical multiple regression analyses indicated that the length of stay in out-of-home care significantly influenced aggressive behaviors amongst children in institutional care, such that increased duration of out-of-home care decreased the level of aggressive behaviors. Perceptions of stigma/discrimination also significantly influenced aggressive behaviors displayed by children in institutional and foster care. Children with a higher perception of stigma/discrimination were more likely to exhibit severe aggressive behaviors than were their counterparts. On the other hand, placement characteristics had no significant influence on aggressive behaviors of children in group homes. The study findings suggest that children's mental health problems and disabilities should be considered during the placement procedure and interventions focusing on decreasing stigmatization should be developed and provided for children in out-of-home care.     

Administrative case reviews: Improving outcomes for children in out-of-home care

For nearly three decades foster care review has been required and practiced in the United States. It is well established that foster care review was designed with the intent to reduce the time children spend in foster care and increase permanent placements for children. This article presents that foster care review, as practiced in Colorado, is a social work intervention and quantitative results of this study demonstrate that as an intervention, timely administrative case review is an effective social work intervention related to improving child welfare outcomes for the children and families served in Colorado. The major findings show that timely administrative case review and increased levels of review attendance (mother, father, Guardian ad litem's, and foster parents) are predictors of the child welfare outcomes of permanency and length of time in out-of-home care. Bivariate results indicate a median length of stay approximately 10.76 months longer for children who do not consistently receive timely case reviews. Additionally, the results show that timely care review moderates the underlying casework process related to caseworker contacts, demonstrating that a child's length of stay differs depending on the level of timely case review. In essence, the administrative case review process in Colorado is effectively achieving its goal and is an effective intervention for improving the lives of children in foster care.     

Foster parent and teacher assessments of youth in kinship and non-kinship foster care placements: are behaviors perceived differently across settings?

With a growing number of children living in kinship foster care, it is important to understand how youths are faring in kinship care compared to youths in non-kinship care. In the present study, we first evaluate teacher ratings of problem behaviors exhibited in school by youths in kinship and non-kinship foster care. We then examine whether correspondences between parent and teacher ratings of problem behaviors across home and school settings differ by kinship status. The youths in the study represent an ethnically diverse sample (N = 185), with significantly more children of color in kinship placements. Across the majority of problem behavior scales on the Teacher's Report Form (TRF: Achenbach, 1991), teacher perceptions of youth behavior did not differ significantly according to kinship or non-kinship care placement. Furthermore, the youths in this study had elevated scores relative to general population norms on only a few TRF problem behavior scales. A sub-sample (N = 122) with foster parent assessments on the Child Behavior Checklist (CBCL: Achenbach, 1991) permitted comparison of perceptions of youth behavior across the home and school settings for youths in kinship and non-kinship placements. Correlations between the TRF and CBCL composite scale scores (internalizing, externalizing, and total problem behaviors) indicated slightly higher agreement between teacher and foster parent ratings for kinship placements. The non-kinship foster parents reported higher levels of problem behavior at home relative to school. The paper interprets these results and suggests implications for practice and future research directions.     

An exploratory study of self-esteem and quality of care of 100 children in foster care

This small-scale research study examined children's perceptions of themselves, their situation, career aspirations and hopes for the future. One hundred San Francisco children in foster care were interviewed and filled out a questionnaire. 50 of the children lived in foster family care; 50 in group homes. The Department of Social Services in San Francisco cooperated in executing this study. Children ranged in ages from 8–18. Both male and female children participated. The questionnaire contained two standarized tests, Coopersmith Self-Esteem Inventory and Parks Career Role Inventory. A section was written by the authors to examine how children in care spend their time, and how they feel about where they live and their foster care status. The last part, an open-ended section asks them which foster care setting they liked best, why, and what they would suggest to improve the foster care system. An additional question “Why do you think you are in foster care?” was designed to elicit the children's understanding of why they lived in foster care rather than their biological home.     

Understanding contextual effects on externalizing behaviors in children in out-of-home care: Influence of workers and foster families

The expression of externalizing behaviors of children in-care can be influenced by a multitude of factors. The current study examined the simultaneous levels of influence of workers and foster families on children's externalizing behaviors in those receiving out-of-home care. A cross-classified multilevel model was used to partition variance in children in-care's externalizing scores into worker, foster family and child-specific levels of influence. The extent to which processes are explained by worker and foster-family level predictors was examined. Assessment and Action Record (AAR) data from the Ontario Looking after Children (OnLAC) project were analyzed. The sample included data from 1063 children between 10 and 17 years of age (M age = 13 years, 6 months, SD = 2.08 years). While individual differences in children's externalizing behaviors were primarily attributable to child-specific effects (72%), 10% and 18% of the variance can be explained by worker and foster family influences respectively. Worker education accounted for substantial differences seen between workers where more difficult children were monitored by workers with less educational attainment. Furthermore, foster-family level predictors also explained variance in children's externalizing behaviors. Relative to children in foster care, those in kinship care displayed significantly lower levels of problem behaviors while children in group care displayed significantly higher levels. Higher levels of parental negativity within the foster family and the experience of more differential parental negativity relative to siblings were significantly associated with more externalizing behaviors. Lastly, children who were more satisfied with their placement displayed significantly lower levels of problematic behaviors. These results suggest that children in-care can be conceptualized within a multilevel framework.     

Parent Management Training, Relationships with Agency Staff, and Child Mental Health: Urban Foster Parents' Perspectives

Many foster parents are ill prepared to meet the behavioral needs of children placed in their homes. Research suggests they lack training in evidence-based behavioral interventions and feel unsupported by child welfare professionals. Given the complex needs of foster children and increased rates of placement disruption for foster children with behavior problems, implementation of effective interventions is essential. However, little is known about foster parents' receptivity to these types of interventions. In this qualitative study, we examine urban foster parents' perceptions of the specific elements of parent management training (PMT), an evidence-based treatment for disruptive behaviors that teaches parents to improve desired behaviors and decrease oppositional behaviors by rewarding positive behaviors (positive reinforcement) and responding to negative behaviors with mild, consistent punishments such as timeout or a privilege removal. We present data from four focus groups (N = 38). While the questions focused on parent's perceptions of PMT, responses often related to parent interactions with agency staff. Four strong themes emerged from the data. First, foster parents discussed a need for more support and training in how to address children's behaviors, but also had concerns that some PMT discipline techniques would be ineffective based on their past experiences with foster children. Second, they described how staff communication skills and allegations of child abuse could affect parents' motivation to continue fostering. Third, they expressed a need for more detailed information about children's histories and visits with biological families as the lack of information contributed to difficulty in meeting foster children's needs. They suggested that joint training of foster parents and staff in the intervention could improve their ability to work together to support the child's positive behaviors. Finally, parents reported little involvement in child mental health services and doubted the effectiveness of the mental health services their foster children received.     

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.     

Academic Performance of Subsequent Schools and Impacts of Early Interventions: Evidence from a Randomized Controlled Trial in Head Start Settings

The role of subsequent school contexts in the long-term effects of early childhood interventions has received increasing attention, but has been understudied in the literature. Using data from the Chicago School Readiness Project (CSRP), a cluster-randomized controlled trial conducted in Head Start programs, we investigate whether the intervention had differential effects on academic and behavioral outcomes in kindergarten if children attended high- or low-performing schools subsequent to the preschool intervention year. To address the issue of selection bias, we adopt an innovative method, principal score matching, and control for a set of child, mother, and classroom covariates. We find that exposure to the CSRP intervention in the Head Start year had significant effects on academic and behavioral outcomes in kindergarten for children who subsequently attended high-performing schools, but no significant effects on children attending low-performing schools. Policy implications of the findings are discussed.     

Psychiatric Rehospitalization of Children and Adolescents: Implications for Social Work Intervention

This study explored factors associated with the psychiatric rehospitalization of children and adolescents. A retrospective archival review was conducted on 403 children and adolescents admitted into an inpatient psychiatric hospital. Results indicated that 16% were readmitted in the same year. Children and adolescents who had a prior history of psychiatric rehospitalization, lived in a residential treatment facility, and had a diagnosis of oppositional/defiant or conduct disorder were more likely to be rehospitalized. Psychosocial factors must be considered in predicting and preventing psychiatric rehospitalization. Clinical social workers should include therapeutic foster care as an option for aftercare placements of youth exhibiting externalizing behaviors and/or with a history of multiple restrictive care placements.     

Early Child Care and the School Readiness of Children from Mexican Immigrant Families1

Combining conceptual models from immigration and educational research, this study investigated whether a normative antecedent to the transition to formal schooling in the contemporary U.S. – early child care – links Mexican immigrant status to various aspects of school readiness. Regression models with nationally representative data revealed that children from Mexican immigrant families were overrepresented in parental care and underrepresented in center‐based care compared to their native peers from other race/ethnic populations, which helped to explain a significant but small portion of their generally lower rates of both math achievement and externalizing symptoms in kindergarten. This mediating role of early child care, however, paled in comparison to family socioeconomic circumstances.     

Use of a Parent Management Training Intervention with Urban Foster Parents: A Pilot Study

The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (ages 4-12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.