Who returns home? Study on placement outcomes of Flemish foster children

Until recently, Flemish family foster care was a temporary measure with as its most important goal, the reunification of the foster child with the birth parents. To date, nothing is known on the number of reunifications, nor has any study been undertaken into the factors (child, parent, foster parent and foster care process) associated with reunification. Case files of 127 foster children who exited foster care in 2007 were analysed. Dependent variables were type of foster care placement outcome (reunification, successful placement without reunification or breakdown) and place of residence after placement ending (with birth parents, extended family, foster family, residential care or living independently). After placement ending, only 40% of foster children went living with their parents, including foster children who were reunified (26%) and foster children who moved to their parents after a placement breakdown (14%). Characteristics of the foster children, and in particular absence of problem behaviour, were associated mainly with a return home. This may indicate that too much attention is paid to the functioning of the foster child and too little to improving the competencies of the parents and the (future) home environment.     

Community Integration of the Elderly in Foster Family Care

Currently the care of the elderly is part of a nationwide trend of deinstitutionalization. However, community placement of formerly institutionalized clients, particularly through the mental hygiene system, has in some instances met with negative community response. Extent of resident participation in the community and degree of community acceptance were studied through interviews with caretakers ir) 100 foster homes, housing one to four clients over 60. More than 3/4 of the residents were reported as having met neighbors. One-third of the residents take walks in the neighborhood, with an additional 2/5 visiting in the neighborhood. One-third participate in activities such as senior centers or church groups. Contrary to expectation, those homes associated with the mental hygiene system reported greater participation in community activities than did those sponsored by the social services system. Negative response from the community occurred in only about 10% of homes. Thus, foster family care appears to show promise both for community integration of the elderly and for community acceptance of the deinstitutionalized.     

The Role of Family Care and Living Arrangements in Acute Care Discharge Recommendations

This study examined placement recommendations of elderly acute care patients who are identified by hospital discharge planners as vulnerable to institutionalization. The purpose of the research was to determine the role of available family care and living arrangements prior to hospitalization in the placement recommendations made by discharge planners. Results indicated that elderly who lived with family compared to those who lived alone were in poorer mental, physical and functional health but had considerably more available family care and fewer service needs that could not be met in the community. Additionally, available family care was found to be significantly related to nursing home recommendations, even with living arrangements controlled. Analysis of placement recommendations by prior living arrangements indicated that family care may be especially important in mitigating the consequences of deficient activity of daily living skills and mental complications. Implications of this research to the role of family care in placement decisions are discussed.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

Adverse Selection,Bequests, Crowding Out,and Private Demand for Insurance: Evidence from the Long-term Care Insurance Market

Adverse selection, moral hazard, and crowding out by public insurance have all been proposed as theoretical reasons for why the market for private long-term care insurance has been slow to evolve in the U.S. Using national samples of the elderly and near elderly, this study investigates which is most important. The data contain direct measures of risk aversion, expectations of future nursing home use and living to old age, and the bequest motive. For both groups, we find evidence of adverse selection, and, for the elderly, crowding out of private long-term care insurance by Medicaid. However, we do not find that demand for such insurance is motivated either by bequest or exchange motives.     

Foster care placement breakdown in the Netherlands and Flanders: Prevalence,precursors, and associated factors

Family foster care is the option of choice for children in need of out‐of‐home care in Flanders and the Netherlands. Foster care is however a vulnerable intervention, and questions can be raised as to its efficacy. Although the literature on placement breakdown has made significant progress during the last years, empirical knowledge regarding breakdown in Flanders and the Netherlands remains scant. Consequently, this study aimed at investigating prevalence and precursors of breakdowns in long‐term foster care, the duration of placement before breakdown, and the association of child and placement characteristics with breakdown. Case files of 271 Dutch and 309 Flemish foster children were analysed with a coding scheme designed for this study. After 6 years, 398 placements had terminated: 169 placements broke down and 229 placements ended positively. Placements broke down mainly because of behavioural problems of the foster child, foster parents' parenting problems, and conflicts between birth and foster parents. Foster children with behavioural problems, older foster children, foster children denied treatment, and foster children in care because of sexual abuse were more at risk of breakdown. Assessing these factors is important when evaluating the appropriateness of a family foster care placement.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

Intergenerational pathways leading to foster care placement of foster care alumni's children

This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between poorer father's functioning to greater alumni depression, which was in turn associated with negative social support, and then a greater likelihood of child out‐of‐home placement. Other parent to alumni paths were that poorer father functioning was associated with alumni anxiety and post‐traumatic stress disorder (PTSD), and poorer mother's mental health was associated with PTSD; however, anxiety and PTSD were not implicated as precursors of foster care placement of the child. Findings support the need for increased practice and policy support to address the mental health needs of parents of children in or at risk of foster care, as well as the children themselves, as family history may have a lasting influence on quality of life, even when children are raised apart from biological parents.     

Carers and Professionals' Perspectives on Foster Care Outcomes: The Role of Contact

This study investigates the association between the contact of children or young people in care with their family, and the foster care placement evaluation (positive or negative) in Portugal. According to the perspectives of foster carers and service professionals' perceptions regarding children and young people's reactions, during and after the visits, are measured. Utilizing a quantitative approach, two fostering services teams and 140 foster carers completed questionnaires, which had 212 children in common. Results indicated that despite the importance of continued contact, especially for children and their parents, it was not determined to be essential to long-term placement. On one hand, there was the perception that a high percentage of children expressed positive reactions during and after the visit, while on the other hand, this didn't influence the perception of placement success. This study also showed significant differences between foster carers' and the professionals' perceptions on several dimensions of foster care, especially the children's reactions during visits. These differences need to be further analyzed in future research and the outcomes used to help improve contact management.     

Placement breakdowns in long‐term foster care – a regional Swedish study

We used a regional sample of children in long‐term foster care to investigate the prevalence of placement breakdown in adolescence, and to assess risk factors/risk markers for placement disruption. The sample consisted of all 136 foster children in the region, born 1980–1992, who on their 12th birthday had been in the same foster family for at least 4 years. They were followed in case files until date of disruption or their 18th birthday. Data on conditions before and during placement were retrieved from case files, and analysed in bi‐ and multivariate models. Results showed that one in four placements broke down in adolescence. The median child who experienced a breakdown was 14 years old, and had been in the same foster home for more than 10 years. Prominent risk factors were (i) being placed after age 2 and (ii) having a birth sibling in the same foster home. We also uncovered strong risk markers that can be viewed as precursors of placement disruption. When the child or the foster parents repeatedly over time expressed dissatisfaction with the placement, this ended with a placement breakdown in 60% of cases. Implications for practice are discussed.     

Secure Attachment to Family and Community

ABSTRACT

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services. A placement prevention model, outlined as an alternative “mentalising social system” approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Breakdown of teenage placements in Swedish foster and residential care

This article deals with the problem of breakdown in different types of out‐of‐home care (foster care/residential care) for Swedish teenagers. How often are such placements prematurely terminated against the wishes and intentions of child welfare authorities? Which factors appear to increase or decrease the risk of placement breakdown? The sample consists of a national cohort of 776 youths who started 922 placements during 1991. Every placement was followed in municipal case files for a maximum period of five years. Between 30 and 37% of all placements were prematurely terminated, the exact figure depending on whether a narrow or wide definition of breakdown was applied. The lowest rates of breakdown were found in kinship care and secure units, the highest in non‐kinship foster homes. Teenagers who display antisocial behaviour and/or have mental health problems constitute a high‐risk category for most types of out‐of‐home care, but especially in non‐kinship foster homes. Risk factors in relation to breakdown were analysed in the four main forms of Swedish out‐of‐home care separately (foster homes, privately/publicly run residential care and secure units). The analysis pointed out that risk factors are not the same in all types of care, but antisocial behaviour at time of placement increased the risk in most forms of care. Prior research indicates that placement breakdown is a major problem of child welfare in other countries, and this study found that Sweden is no exception.     

The Relationship Between Homebound Older People and Their Home Care Workers,or "The Pas de Deux" of Home Care

The multiple components in the provision of home care services, as distinct from home health care, are examined in this paper. Specifically addressed are the unique aspects of the setting, the particular characteristics of the elderly in need of care, the challenges to the care provider, and the dynamics of the relationship between the recipient and provider of care. Data were obtained from a sample (n = 200) of inner-city hospital clinic patients, aged 65+, of which 34% (n = 68) were home care clients. Practitioners can best design successful home care programs if consideration is given not only to a person's physical needs but also to their individual characteristics and those of the home care provider.     

The concept of family: Perspectives of Spanish young people in foster care

This article employs concepts from family sociology to explore how ‘family’ is conceptualised in 14 life narratives of young people in foster care in Spain. The article draws on a multi-method approach with young people who are in long-term non-kinship foster care. Seven girls and seven boys aged 10 to 22 took part in the study. The empirical material reveals an interplay between biological preference and foster family affective practices in young people's narratives, illuminating a struggle to make sense of the concept of family in foster care. Most of the participants understand family as shared affective practices sustained through love, commitment, consistent care and reciprocity rather than blood ties. Some show a preference for biological connectivity, while others describe family as determined by rituals and family displays. The key practice implications highlight the importance helping young people positioning themselves in birth family relationships, and supporting their sense of family belonging.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

The Reaction of the Family to the Institutionalization of an Elderly Member: Factors Influencing Adjustment and Suggestions for Easing the Transition to a New Life Phase

The institutionalization of an elderly person is a crisis for the family. Using case illustrations, this article presents three major factors affecting family reactions and adjustment (the expectations of society, family roles and expectations, and the impact of the move upon daily family life), suggests that nursing home placement be viewed as a step in the normal family life cycle, and discusses ways in which rituals could be used to ease the tradition to the post-placement phase of the family.     

Kin Visiting and the Biological Attachment of Long-Term Foster Children

This study examines the relationship between visiting by extended family members and biological family attachment for 92 long-term foster children. Correlation and regression analyses revealed that kin visiting has a significant association with family attachment. The effect kin visiting has on the foster children's family attachment is independent of the influences foster family attachment, parental visiting and age at placement have on the relationship. The findings highlight the importance of biological family involvement for children in placement.     

We care about care: advice by children in care for children in care,foster parents and child welfare workers about the transition into foster care

Twenty children in foster care, ages 8 to 15 years, provided advice to children in care, foster parents and child welfare workers about ways to assist service delivery during the transition into foster care. The children discussed the importance of tending to experiences such as foster home expectations, the importance of time and information, the new foster/parent–child relationship, coping with stress, the ability to be engaged in decision‐making, the benefits of foster care and the need to build a trusting and personal relationship between children in care and their caregivers. The importance of listening to children's experiences of the transition into foster care and incorporating their advice into future research, policy and practice will be discussed.