Profile of children placed in out-of-home care: Association with permanency outcomes

The goals of this study were to explore characteristics and profiles of children who received out-of-home care services and to examine the relationship between their profiles and permanency outcomes. Results of latent class analysis suggest that there are three distinct subgroups of children served in out-of-home care (N = 33,092): Children with Complex Needs (6%), Children in Families with Complex Needs (64%), and Older Abused Children (30%). Of the three identified subgroups Children with Complex Needs consisted of youth who were at greater risk for adverse outcomes. These children were less likely to experience timely adoption, had the longest length of stay in out-of-home care, and were least likely to experience timely reunification. Although permanency outcomes for Older Abused Children are somewhat better than for Children with Complex Needs, they represent a vulnerable population of youth in out-of-home care who have a very low chance of being adopted. Overall, this study suggests that service provision by itself may not improve permanency outcomes for children unless both prevention and intervention efforts address co-occurring family needs and are tailored to specific characteristics of the children being served.     

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.     

Behaviorally impaired children in out-of-home care.

This study was undertaken to determine the nature of the out-of-home care placement experience for 131 behaviorally impaired children entering care over the course of a year in Nebraska. Variables analyzed included behavioral impairment, age at entry, age at termination, gender, race/ethnicity, family violence, geographical area before and at termination, closeness to home of most recent placement, and length of time in care. Multiple regression analysis showed that behavioral impairment was the strongest predictor of length of time in care, accounting for 2.4% of the variability.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

The impact of income on reunification among families with children in out-of-home care

Income appears to be associated with faster time to family reunification. The observed connection between income and reunification, however, may be causal in nature or the relationship may be an issue of selection, in that other underlying factors explain both income and family safety and stability. We examine the causal role that the source of income plays in reunification. We use administrative data on primary caregivers of children placed in out-of-home care in Washington State from 2000 through 2007 (N = 15,159) matched with public economic support and employment data linked by the Washington State Department of Social and Health Services (DSHS) Integrated Client Database (ICDB). Using instrumental variable analysis, we estimated the effect of the amount of earnings and the amount of cash benefits on reunification. We used county unemployment rates and county food stamp participation rates as instruments. We find modest and inconsistent results that suggest higher earnings are associated with lower likelihood of reunification. We find no consistent evidence linking cash assistance to reunification.     

Perceived discrimination and early substance abuse among American Indian children

This study investigated internalizing and externalizing symptoms as potential mediators of the relationship between perceived discrimination and early substance abuse among 195 American Indian 5 through 8 graders from three reservations that share a common culture (e.g., language, spiritual beliefs, and traditional practices) in the upper Midwest. The findings indicated that, although perceived discrimination contributed significantly to internalizing symptoms among the adolescents, internalizing symptoms were unrelated to early substance abuse. Rather, the effects of perceived discrimination on early substance abuse were mediated by adolescent anger and delinquent behaviors. The results are discussed in terms of the consequences of perceived discrimination on the development of American Indian early adolescents.     

Outreach to birthfathers of children in out-of-home care

This article presents findings from a study of casework outreach to birthparents of children in out-of-home care. The study explored whether the birthfather was being ignored as a resource for discharge planning. It examined the outreach and interventions of caseworkers in three New York City out-of-home care agencies. Casework activity levels were found to be higher for birthmothers than for birthfathers, and a complex relationship among the variables of gender, outreach, and response was revealed. The nature and value of more specific outreach toward birthfathers of children in care and the risk of ignoring men in the birthfamily system are discussed.     

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.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

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.     

Characteristics of effective, harm-free environments for children in out-of-home care.

The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.     

Children placed in out-of-home care: risk factors for involvement with the juvenile justice system

In previous research, child maltreatment has been associated with several negative outcomes, including delinquency. This study uses administrative data to examine risk factors, including the severity and chronicity of maltreatment, for juvenile justice involvement among children, ages 7 to 17, who were placed in out-of-home care in Florida (N = 13,212). The results of multivariate Cox regression analysis indicated that among specific types of maltreatment, sexual abuse was associated with the risk of faster placement only in a detention center. Additionally, findings from this study suggest that maltreatment chronicity but not maltreatment severity increases the chances of earlier involvement with the juvenile justice system among children who were placed in an out-of-home care. Implications of these findings are discussed.     

Junior life skills: an innovation for latency-age children in out-of-home care.

Children age seven to 13 in out-of-home care should be given instruction in basic life skills, just as their older counterparts are prepared for independent living. One program that provides such instruction is detailed here.     

Negotiating case decisions in substance abuse managed care

In substance abuse managed care, the number of treatment sessions that a provider can deliver is constrained by the policies and procedures of the specialized managed care organizations (MCOs) that typically administer the substance abuse portions of healthcare plans. Managed care organizations commonly are alleged to control treatment providers through rules, but they also might rely on a particular patterned authorization of discretion, whereby they determine when and how frequently to respond to providers' appeals of rule-based decisions. The current paper uses data from a national random sample of managed care contracts between MCOs and substance abuse providers to test the hypotheses that (1) managed care organizations' "logics" about the types of provider discretion to allow affect the rate to which they concede to appeals, and (2) the rate of conceding to appeals, in turn, affects the providers' duration of substance abuse treatment. Results from generalized linear estimation models support the hypotheses and suggest that many MCOs pattern discretion to balance strict rules with concern about the quality or cost of care. The results more generally suggest that MCOs use discretion in planned ways, and thus that the patterns of control are more complex and sophisticated than commonly described in the literatures on managed care, transaction cost economics, or other perspectives.     

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.     

Placement stability for children in out-of-home care: a longitudinal analysis

This study examines the number of placement moves experienced over an eight-year period by 5,557 children in one state who first entered out-of-home care between birth and age six. This group comprised 28% of all young children who entered care during this period. Nearly 30% of children in kinship care and 52% of children in nonrelative care experienced placement instability (defined as three or more moves after the first year in care). Children in kinship care, regardless of age, had fewer placement moves than those in nonkinship care. A multivariate analysis found that children who had more than one placement move during their first year of care were more likely to experience placement instability in long-term out-of-home care than if they did not move or were moved only once during their first year in care.     

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.     

When staff members sexually abuse children in residential care.

When an agency staff member is accused of sexually abusing a client, the administration is faced with the Solomonic task of balancing the necessity of protecting the child, supporting the staff, and maintaining the integrity and reputation of the agency. This article presents practical suggestions for managing the agency through such a crisis.     

Adoption of evidence-based practices among substance abuse treatment providers

This research was conducted at a Substance Abuse Forum designed to address local community needs by focusing on Evidence-Based Practices (EBPs) in addiction treatment. The purpose of the study was to assess substance abuse treatment professionals' readiness to adopt EBPs, experience with EBPs, and attitudes toward EBPs, as well as agency support for EBPs. A total of 119 addiction treatment providers completed pre-test measures, and 82% completed a post-test. Eighty-three percent of participants reported using some EBPs in the past year, and 75% reported currently using EBPs. Participants who were currently licensed or certified in addictions had less negative attitudes toward EBPs than those without credentials. While respondents reported agency support for EBPs, most expressed interest in further training. This study underscores the movement toward EBPs in addiction treatment and the need for effective dissemination and training in this area.