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.     

Key factors and characteristics of successful resource parents who care for older youth: A systematic review of research

There is growing recognition that competent, committed resource parents are a critical component to the effective delivery of foster and adoptive services for teens placed in out-of-home-care. This study implemented a systematic review process to identify the personal characteristics, skills and abilities of successful resource families that maximize foster and adoptive parent retention and maximize placement permanency of teens placed in out of home care. Starting with an extensive search of the literature across the last two decades and outreach to locate studies, the authors systematically analyzed research that used permanency and placement stability as the primary dependent variables and personal characteristics/attributes, knowledge, skills and abilities as independent variables. Of the 838 total documents identified, 48 were original research studies that focused on one or more of these variables. Although rigorous and systematic, this research was hampered by differing definitions, samples, measures, and the type of analysis utilized among these studies. Personal characteristics that promoted permanency and placement stability included having a tolerance for rejection, flexible expectations, having a sense of humor, having a belief in a higher power, belief in self-efficacy, having higher education, having sufficient economic resources, having healthy family and marital functioning, having access to support systems, and being motivated to foster/adopt. Knowledge, skills, and abilities resources families acquired that promoted permanency and placement stability included the ability to communicate effectively, maintain attentiveness to the parent/child relationship (i.e. using routines and structure while also offering children a variety of experiences), understand the effects of trauma and teach socio-emotional health, provide culturally competent care, recognize, express and process grief, take care of oneself, valuing and participating in life -long learning, training and education, and valuing a connection to the child's birth family.     

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

ABSTRACT

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

Evaluation of a multi-site program designed to strengthen relational bonds for siblings separated by foster care

Sibling relationships in foster care settings have received increased attention in recent years. Despite growing evidence regarding the protective potential of sibling relationships for youth in care, some sibling groups continue to experience foster care related separation, and few programs exist to address the needs of these youth.This study describes and evaluates Camp To Belong, a multi-site program designed to provide short-term reunification to separated sibling groups through a week-long summer camp experience. Using a pre-test post-test survey design, this paper examines changes in youth ratings of sibling conflict and sibling support across camps located in six geographically distinct regions of the United States. The effects of youth age, number of prior camp exposures, and camp location were tested using multilevel modeling procedures.Findings suggest that participation in Camp To Belong may reduce sibling conflict, and improvements in sibling support are noted for youth who have had prior exposure to the camp’s programming. Camp-level variance in the sibling support outcome highlight the complex nature of relationships for siblings separated by foster care, and suggest the need for additional research. Lessons learned from this multi-site evaluation and future directions are discussed.     

Foster children placed with or separated from siblings: Outcomes based on a national sample

This study examines a range of outcomes for children in foster care who have siblings, using a large, national U.S. database. Three types of sibling placements are defined: split (child has no siblings in the home), splintered (at least one sibling in the home), and together (all siblings in the home). The study analyzes records (n = 1701) from the National Study of Child and Adolescent Wellbeing, including Child Protective Services (CPS) and Long-term Foster Care (LTFC) samples. It contributes to the literature in its inclusive definition of siblings, use of three categories for sibling placement status, and use of outcome measures that include the perceptions of foster children. The study reports limited significant findings. Neither foster parents' nor youths' reports of behavioral problems differ by sibling placement status. As rated by teachers, academic performance in the group placed together exceeds that in both of the other groups. For children in kinship homes, teachers also reported less problematic internalizing and externalizing behavior for the splintered and together groups than for the split group. Children in the splintered group also responded more favorably than those in the split group to questions of closeness to the primary caregiver and liking the people in the foster family.     

Joining formative evaluation with translational science to assess an EBI in foster care: Examining social–emotional well-being and placement stability

This study examined measures of placement stability and social–emotional well-being for a federally-funded demonstration project of inhome Parent Management Training-Oregon model (PMTO) for children in foster care with serious emotional disturbance (SED). Following a cultural exchange framework for translational research and a tollgate approach to evaluation, this formative study tested these measures prior to further investment in summative evaluation. The research aim was to observe whether measures of social–emotional well-being and placement stability performed as expected. Using a pretest–posttest randomized consent trial, children identified as SED within six months of entering foster care were randomly assigned to PMTO or to a services-as-usual comparison group (N = 121). A multi-group structural equation model was tested to observe the relationship of baseline social–emotional wellbeing and placement stability on post-test social–emotional well-being. Results showed that post-test well-being was significantly predicted by baseline well-being for both groups and, importantly, only the intervention group demonstrated significant effects of placement stability on post-test well-being. For the intervention group, as placement stability increased, post-test social skills significantly improved, demonstrating an association between well-being and placement stability that was not evident in the comparison group. Overall, wellbeing measures performed as expected and detected relationships between variables and variation as hypothesized. Additionally, placement stability may have been mediated by the PMTO intervention. In conclusion, by using a real world example of the translational research concept of cultural exchange between university-based researchers and agency-based practitioners, this study shows that formative evaluation offers an important opportunity to test ad hoc research questions inspired by the process of implementation itself.     

Using Attachment Theory When Placing Siblings in Foster Care

Attachment theory offers a useful model for determining if siblings removed from their birth parent's home and awaiting placement should remain together or be separated when placed in foster care. The paper draws from the attachment theory literature, social work literature, and the author's experience as an outpatient psychotherapist. Using the concept of a secure attachment environment, this paper argues that siblings can potentially contribute to, or detract from, a secure attachment environment. When siblings are supportive of each other they can contribute to it. When the sibling relationships are chronically abusive, the individual siblings within a sibling-set are precluded from achieving a secure attachment environment. In these cases the need for separation of the siblings is indicated, and must be considered.     

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.     

Perspectives: Former foster youth refining the definition of placement moves

Research has demonstrated that children who experience numerous moves in foster care are more likely to exhibit behavioral problems and less likely to achieve reunification or permanency. However, current knowledge about how placement move transitions impact children is extremely limited.This study used qualitative methods to explore how former foster youth define a placement move. Results indicated that placement moves can be defined by: 1) Time and relationships; 2) Packing and leaving; 3) Loss of property; 4) Returning home; 5) Type of placement; and 6) Decision-making process. An alternative definition of a placement move is offered and implications for child welfare policy, research and practice are provided.     

Birthfamilies as permanency resources for children in long-term foster care

Provisions of the Adoption and Safe Families Act of 1997 mandated shorter time frames for making permanency decisions and facilitating adoption. Yet for many children, foster care continued to be a significant portion of their life experiences. This project explored the potential permanency option of birthfamilies and extended kin for children who languished in foster care while being free for adoption. Eighteen children achieved permanent placement with their birthfamilies. In addition, staff found that although many families could not provide permanent placements, they could offer appropriate relationships with the children. This project team recommends viewing family relationships as an integral component where placement is one option on a continuum that includes letters, phone calls, and visits.     

Foster home licensing and risk of reentry to out-of-home care following family reunification

Family reunification without subsequent reentry is the primary permanency goal for children placed in foster care. While a number of placement-level factors have been examined for their effect on subsequent reentry to care, no study to date has considered foster care licensing. The current study uses statewide administrative data to construct a cohort of foster care youth who entered care between 2009 and 2012 and were reunified by the start of 2013 (N = 7752) to investigate the association between types of foster care and the probability of reentry to foster care up to two years following reunification. We focus specifically on the licensing status of foster homes, and employ propensity score analysis to address selection bias in placement type. A propensity-weighted cox proportional hazard model revealed that youth placed in licensed relative care (LRC) homes and licensed non-relative care (LNC) homes were more likely to reenter foster care than those youth placed in unlicensed relative care (URC) homes during their first spell of foster 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.     

Medical complexity and placement outcomes for children in foster care

ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ² tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes.     

Keeping it in the family: The impact of a Family Finding intervention on placement,permanency, and well-being outcomes

Child-centered recruitment via Family Finding has gained national attention as an approach to search, discover, and engage kin and fictive kin to support the attachment and permanency needs of children in foster care. However, despite its promise it has received scant attention in the empirical literature. The current study compared the outcomes of a front-end Family Finding intervention (n = 196) and a comparison group (n = 262) among children in foster care in Cook County Illinois between the ages of 6 and 13. Results showed that there were no differences between the intervention and comparison group on reunification rates, placement stability, or on longitudinal externalizing behavior and internalizing symptoms. However, the intervention found close to 75% more relatives than the control group, and many of these relatives were significant figures in the children's lives. The intervention was also associated with a higher proportion of relative placements to total placements for a subgroup of children with five or more placements. Further, the effect of the intervention on this proportion (relative placements to total placements) was mediated by the greater number of relatives found in the intervention. Finally, the intervention was associated with relatively better Concurrent Planning. These results suggest that Family Finding has the potential to impact proximal outcomes related to discovery, engagement and planning but is currently not impacting more distal outcomes such as permanency and well-being. Family Finding approaches should continue to innovate, possibly through integration with psychosocial interventions, to affect more distal variables such as well-being outcomes.     

Modelling the initial placement decision for children received into care

Initial placements of a cohort of 93 children received into the care of an English local authority over a 3-month period are examined. Sixty-five of the children were immediately placed in a foster home, 20 were placed in a residential home, 4 were received into care in hospital, and 4 remained home on trial. The research reported here focusses on the 85 children initially placed in either a substitute family home (a foster placement) or a residential home. Logit analysis is used to examine the pattern of initial placements. A clearly consistent pattern of placement emerges and a small number of factors explain or predict the initial placement decision. These factors include such child characterstics as age and health, family size and accommodation, and previous care experiecne of a child and his or her siblings.     

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

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

Foster care placement change: The role of family dynamics and household composition

Sibling co-placement and kinship care have each been shown to protect against the occurrence of placement change for youth in substitute care. However, little is known about the effects of different combinations of sibling placement and relative caregiver status on placement change. Nor does the field fully understand how family dynamics may differ in these households. Utilizing data from the Supporting Siblings in Foster Care study, this paper examines family dynamics across four typologies of living composition, and tests the effects of living composition membership on the odds of experiencing a placement change over an 18-month period of time. Findings suggest that across living composition typologies, children who were placed separately from their siblings in non-relative care were more likely to be older, have more extensive placement histories, and experience more placement changes both prior to and during the study than were children in other living composition groups. Family living composition was found to influence the occurrence of placement change. Specifically, children co-placed in kinship care were least likely to experience movement; however, sibling co-placement in non-relative care was also protective. Results reveal the need to conduct additional research into the experiences of children in different family living arrangements, and tailor case management services and supports to children in substitute care accordingly. Implications and future directions are discussed.     

Creative cooperation: involving biological parents in long-term foster care

There are some children in care for whom "permanency" means a long-term foster family placement. The author suggests that permanency for these children requires facing the reality of their biological parents in some form of relationship.     

Permanent Placements for Young Children Placed in Foster Care: A Proposal for a Child Welfare Services Performance Standard

Performance indicators for child welfare services for young children entering foster care should be established to help agencies determine the sufficiency of their efforts to provide permanency. Child welfare services need a technically feasible, conceptually sound, and achievable performance standard. Use of a 100% permanency standard, not including long-term foster care or non-kinship guardianship, within four calendar years of placement is forwarded. Data on the permanency planning performance of a state and four counties within it are presented to sharpen the discussion.     

Considering the best interests of infants in foster care placed separately from their siblings

This article offers a perspective on the child welfare practice of placing infants and their siblings in foster care using the theoretical frameworks of attachment and infant mental health. The authors highlight issues for child welfare workers to consider when determining if moving an infant or young child from one home to another for the purpose of placing him with his siblings would cause trauma or disruption; and also issues to consider when determining the infant or young child's best interest when separated from siblings. First, the authors summarize the literature regarding attachment relationships and attachment disruptions. Then, they review outcome studies of children residing in foster care who are placed with their siblings and of those who are placed separately. Finally, the authors conclude with specific recommendations for child welfare workers to aid in making such difficult decisions about placing infants in foster care.