Predictors of foster care exits to permanency: A competing risks analysis of reunification, guardianship, and adoption

Although foster care is intended to be temporary, and policy explicitly requires permanency outcomes, many children experience lengthy stays and exit foster care without a permanent family. This study sought to identify which child and placement characteristics were important predictors of exit to three types of permanency outcomes: reunification, guardianship, and adoption. A sample of 3351 children who entered foster care in 2006 was observed for 30 to 42 months. Permanency outcomes were analyzed using competing risks survival analysis. Children exited foster care to different types of permanency at different rates and frequencies. Reunification occurred most quickly and frequently. Guardianship was second in terms of median duration but third in frequency. Adoption was the second most common exit but had the longest median duration. One in four children remained in foster care or exited without permanency. While patterns varied by type of permanency, three major categories of important predictors were identified: 1) demographic characteristics of age at entry and race, 2) clinical needs related to children's disabilities and mental health problems, and 3) continuity and connections represented by kin placements, sibling placements, early stability, and absence of runaway events. Implications for practice, policy, and research are discussed.     

Opting Out (Without Kids): Understanding Non‐Mothers' Workplace Exit in Popular Autobiographies

Since the term appeared in 2003, popular media and academics have been interested in the phenomenon of ‘opting out’ — elite women choosing to leave their jobs to stay at home with their children. Although it is unclear whether the opt‐out revolution actually exists, this conversation has resulted in a wealth of scholarship on women leaving successful jobs to care for their children, particularly how maternity might be a graceful time to exit gendered organizations. However, there is not scholarship considering women without children who opt out of the dominant career model. In this study, I look at three popular autobiographies of women who left successful careers to pursue alternative work (farming, baking). I found that the women sought meaning in their work, control over their labour process, and a new definition of success. These narratives provide broader insight into the constraints of the dominant career model and gendered organizations as well as the particular difficulties for non‐mothers to opt out.     

Community Case Management Intervention for Hard-to-Place Homeless Families Leaving Emergency Shelter

Abstract

The Community Case Management Intervention was designed to fill a gap in services for hard to place homeless families who leave emergency shelters. There were 51 adults and 78 children who participated in the research. Families who met the criteria and volunteered for the study were randomly assigned to an intervention or comparison condition. Intensive case management was provided to families in the intervention condition upon their exit from the shelter. Services included referral, advocacy, support, and assistance with family problem-solving and decision-making. Comparison families did not receive similar services. Results of the study are encouraging and show that families in the intervention felt greater levels of social support and greater family unity.     

WORKING TO EXIT POVERTY WHILE CARING FOR CHILDREN'S HEALTH AND DEVELOPMENT IN VIETNAM

Since the implementation of economic reforms in 1986, levels of urbanization, industrialization, and women's labour force participation have increased in Vietnam. This article focuses on the experiences of parents in Vietnam and how labour and social conditions affect their ability to work and exit poverty while caring for their children's health and development. We interviewed a sample of 147 parents in Ho Chi Minh City using in-depth, semi-structured questionnaires. Sixty-three percent of parents had faced loss of income or promotions or had difficulty retaining jobs because they had to care for children. Fifty-eight percent of parents lost income while caring for their sick children because they had to take unpaid leave from work to care for their children or because they had to decrease productivity if they were able to continue working. Fifty percent of parents with school-age children experienced barriers to helping with homework, to attending meetings, or to participating in other aspects of their children's education. The aftermath of the Vietnamese – American War affected parents through loss of extended family members, limiting access to a major traditional source of support. The war had affected other parents by preventing them from completing their education, which left them with job choices that offer little or no work benefits. Although Vietnam has made significant progress in providing early childhood care and education and legislating labour laws, working families’ experiences demonstrate the need to ensure that paid leave and work flexibility policies are available and implemented in all work sectors and to expand affordable, quality child care in order to help low-income working parents in Vietnam meet work demands and exit poverty while meeting their children's needs.     

Broadening Our View

Summary

The growth in child welfare caseloads and the increasing use of kinship foster care has raised new questions about effective permanency planning. The majority of children in kinship foster care are children of color and have been less likely to exit the custody of the child welfare system than children placed in traditional foster care. Permanency planning which ensures the long-term protection and well-being of children from diverse cultural backgrounds requires a broad view of family, ongoing striving for cultural competence, collaboration between the formal child welfare system and the kinship systems of children in state custody, and a long-term view of permanency planning and child-rearing that builds on the case-management capacities of kinship networks to support permanent plans, looks beyond the child's exit from state custody, and helps families and larger kinship systems make long-term plans for the protection, permanence, and well-being of children.     

Punishing Children for Caring: The Hidden Cost of Young Carers

SUMMARY. This paper examines the lives, experiences and needs of children who care - those children under the age of 18 who provide primary care for a sick, disabled or elderly adult in the home. It presents data from a recent study into the lives of these children, their responsibilities, their commitments, their pain and their fears. It paints a picture of neglect both by professionals paid to care as well as by other family members. It suggests that child carers are effectively punished for caring. The paper goes on to examine the implications for child carers of the Community Care Act, finally implemented on 1 April 1993, to raise a number of critical questions about the rights of children who care, and to suggest a number of innovative ways forward, based upon the expressed needs of young carers.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Medical Utilization and Health Expenditure of the Elderly in Taiwan

The present analysis, based upon data from the 1989 Taiwan Labor Force Survey, includes two parts. First, the determinants of physician visits and hospitalization by the elderly are analyzed according to the behavioral systems approach, and, second, variation in health expenditures among the elderly are examined using the Tobit model with sample selection. Findings show that elderly with good or poor health conditions are less likely to use medical services than the frail elderly and that married elders are less likely than the non-married to use medical care. The higher the educational level, the lower the probability of using formal medical services, and elderly who have health insurance are more likely to use formal health care than those who have no health insurance. The elderly who live with their children are less likely to use formal medical services than those who do not live with their children. Finally, among the elderly who have used formal health care, individual health expenditures are influenced primarily by three factors: health condition, health insurance, and residential location. Implications for Taiwan's relatively newly established national health insurance program (effective April 1, 1995) are discussed based upon the findings of this research.     

Parenting Under Pressure: Experiences of Parenting While Aging Out of Foster Care

Youth “aging out” of foster care experience higher rates of adolescent parenting than their peers who have not been in care. Due to their history of maltreatment, high adolescent pregnancy rates, and poor psychosocial outcomes, youth aging out who are parents are a vulnerable at-risk group. This study examines the parenting experiences of 33 youth aging out (21 mothers and 12 fathers) using data from a larger ethnography. Field notes of observation and transcribed interviews of youth aging out who are parents were analyzed using open coding strategies. Findings show parents encountered challenges while aging out and parenting, yet they found joy in their children and strived to be good parents despite having limited parenting skills, few resources, and little support. Desiring a better life for their children and fearing their children would enter foster care, parents were motivated to improve their lives for their children. Implications are discussed.     

Caregiver perceptions of children in their care and motivations for the care work in children's homes in Ghana: Children of God or children of white men?

The perceptions and motivations that workers have in their work and work environment are important determinants of the quality of work they do. For people who work in residential institutions where children who have lost the care of their parents receive care, these perceptions and motivations become a crucial part in determining the quality of services or care the children are given. This study set out to explore the perceptions and motivations of caregivers in the institutional context in Ghana. Adopting a qualitative, phenomenological approach, data were collected from 35 caregivers in two children's homes in Ghana through participant observations, focus group discussions and in-depth interviews. It emerged that caregivers perceived the children in their care first as children of God and then as children of white men and were predominantly motivated by their religious convictions to keep doing ‘the work of God’. Other motivations included personal life situations and economic aspects of the job. Implications for the workers and children in this environment are discussed.     

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.     

Prevalence,experiences, and characteristics of children and youth who enter foster care through voluntary placement agreements

A voluntary foster care placement (sometimes referred to as a voluntary placement agreement) is an agreement, entered into without court involvement, between a state or county child welfare agency and a child's parents to place a child into out-of-home placement. When a child enters foster care through this type of placement, state and federal programs that cover children who enter child welfare due to a court order become the custodians of the voluntarily-placed-child's placement, care, and supervision. In this cross-sectional, exploratory study, data from the Adoption and Foster Care Reporting System (AFCARS) was used to examine the characteristics and experiences of children who enter foster care through a voluntary foster care agreement, and to compare them with those of children who enter foster care through a court order. Findings indicate that children who are placed through a voluntary placement agreement differ from children who enter through a court order in their personal characteristics, as well as in their placement settings, length of placement, and manner of discharge from foster care. This study provides a baseline for future research into this area of child welfare practice.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

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.     

Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

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.     

The transition from in-home services to out-of-home care: A Danish register-based study

Objective

This register-based study describes the transition from in home-based care to placements in out-of-home care. It also describes whether children who enter care directly differ from children who enter care after episodes of in home-based care.

Method

The study includes all children who entered the child protection system of a larger regional social service system in Denmark from 1993 to 2006 (N = 9961). Graphs of cumulative incidences were used to describe transitions into out-of-home care within two years after in home-based care started. Cox regression models are used to estimate the impacts of child and parental characteristics. In addition, Chi² tests are used to identify differences between children who enter care directly and children who receive in home-based care.

Results

Results indicate that the majority of children do not enter out-of-home care but that risks differ among age groups. Covariates did not predict transitions into out-of-home care for those who entered in-home care after becoming teenagers. Especially for those who entered in-home care before entering their teens, the psychiatric histories of the mothers and the children predicted the transitions into out-of-home care. Immigration background was a protective factor for those who entered in-home care as pre-scholars. Depending on the age group, low birth weight, children's fathers' and mothers' psychiatric histories, and single parentship were all characteristics more likely to be associated with children who entered care directly. Children who entered care directly differed from children who entered care within two years after an in home-based service had been initiated on covariates that described psychiatric history.     

Kinship care of the abused child: the New Zealand experience.

The concept of continuity--keeping children within their own kinship, community, and cultural networks--has found international favor in contemporary child welfare practice. This principle is reflected in the 1989 New Zealand Children, Young Persons, and Their Families Act. The Act represents a significant shift--from the state to the family--in responsibility for children in need of care. The increasing use of the Family Group Conference process allows families to make decisions about the future of kin children and reflects the belief that, although most abuse is intrafamilial, the family will also be the most committed to keeping the child safe. Other countries have adapted this model to suit their own cultural child welfare needs. The international trend toward formal use of kinship care for children who have suffered abuse or neglect is likely to continue as foster care resources shrink. Drawing on qualitative research, this article describes the experiences of caregivers and their kin children who have been the subject of a care and protection order.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.