Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

Child Protection Workers’ Perceptions of Foster Carers and the Foster Care System: A Study in Queensland

Abstract

Child protection workers are key players in the statutory system for the protection of children and young people. For this reason, their perceptions of the operation of the system are important. This study, conducted in Queensland, Australia, explored the views of child protection workers regarding foster carers and the foster care system. The present study revealed the difficulties the child protection workers encountered in engaging with foster carers. These difficulties were due to the structure of the child protection system and the conflicts experienced by workers in balancing the needs of children and young people, their primary clients and the carers of those children and young people. Several recommendations for policy and practice are made.     

Evidence-based practice for youth in supervised out-of-home care: a framework for development, definition, and evaluation

Adolescents comprise more than half of the children in child welfare supervised out-of-home care. This article considers the evidence-base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.     

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.     

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.     

Facing Time Limits

Abstract

With reauthorization of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the horizon, policy makers need to have a sound understanding of the act's consequences for children and families. In contrast to earlier studies, the present study quantifies the impact of a 24-month state imposed welfare time limit on foster care placements. It also examines the impact of a “hardship” provision that temporarily excuses select families from meeting a two-year time limit on foster care placements in Nevada. In order to determine how these factors, in conjunction with other relevant welfare experiences and personal factors, affect parent-child separation, a multivariate logit model was tested. Key findings reveal that families who have more months counted toward their time limits also are more likely to have at least one child removed and placed in foster care. On the other hand, hardship families are not more likely to have their children placed in foster care than non-hardship families. The findings lend support to the notion of providing family-centered casework services to those identified to be at risk of approaching their welfare time limits. The findings also lend support to inter-agency collaboration between TANF and child welfare systems.     

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

BackgroundU.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas.Data and methodsWe assembled a unique, longitudinal, state-level panel dataset (1990–2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes.FindingsState foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, > 50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates.ConclusionsDespite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services.     

EDITORIAL

ABSTRACT

Many states are implementing concurrent planning as a means to expedite permanency planning for children in foster care; however, the parameters for this strategy vary significantly and the research regarding outcomes is sparse. This qualitative study sought to examine the experiences of child welfare experts, parents, foster parents and caseworkers regarding concurrent planning in New York State. The findings indicate that although concurrent planning is generally understood, training, services and supports are lacking for parents, foster parents, and caseworkers in the implementation of concurrent planning. In addition, although all parties see concurrent planning as an effective strategy, crafting and maintaining working relationships between key parties is challenging. Clearer communication with parents, joint training of caseworkers and foster parents, improved information disclosure, and fuller involvement of foster parents in the planning process are among the recommendations for improving practice.     

Examining risk,strengths, and functioning of foster families: Implications for strengths-based practice

ABSTRACT

Foster families provide safe and stable homes for children and youth who are removed from their homes due to maltreatment. Despite the stressors associated with bringing children in and out of a family’s home, many maintain healthy family functioning and continue fostering for many years serving an essential function in the child welfare system. This study sought to understand the factors that explained higher levels of family functioning within foster families. Collaborating with one statewide public child welfare agency, 681 licensed foster parents participated in an online survey that examined the association between family functioning with family strengths and risk factors. Findings from this study can inform strengths-based practice including training, assessment, and interventions for new and existing foster families to strengthen families and improve the well-being of children and youth in their care.     

The Value of Adoption

ABSTRACT

Recent work shows that the governmental cost of adoption is about half the cost of long-term foster care for children whose birth parents' rights have been terminated. Because adoption is also associated with greater accumulation of human and social capital, the total savings to government in areas such as special education and criminal justice is of the same magnitude as the child welfare savings. The private benefit to adopted children in terms of additional income earned over their working lives is similarly large. In all, a dollar spent on the adoption of a child from foster care yields about three dollars in benefits.     

Intergenerational Programming for Foster-Adoptive Families

Abstract

Generations of Hope serves foster and adoptive children, their adoptive families and older adults through an innovative program that is breaking new ground in the development of caring intergenerational communities. It was created in 1993 as a non-profit social service agency designed to improve the service delivery and policies of the child welfare system; it ended up helping not only foster and adopted children but senior citizens as well. This paper examines critical social issues facing both foster children and senior citizens in the United States and how this program created a neighborhood that combines several generations of kin-like support to meet the needs of these vulnerable groups. We describe how the Generations of Hope model brings together in tangible ways critical shifts in perspective regarding foster care and gerontology. The lessons we have learned speak to research, policy making and practice.     

Completing the Circle

Abstract

The four themes of the Circle of Courage, a Native American medicine wheel that focuses on child socialization, connect with and add to key ideas from Western theories of human development. These themes are belonging, mastery, independence, and generosity. The purpose of this paper is to present a framework developed from the integration of the Circle of Courage with theories of human development. A key feature of the framework is the role of adults in providing guidance, modeling, and affirmation. Assessment guidelines to promote the resilience of children and youth in out-of-home care are developed from the framework. The long term goal of the framework is to “complete the circle”; that is to foster the resilience of young people in care so that they can in turn provide to guidance, modeling, and affirmation.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Kinship Care and Public Child Welfare: Challenges and Opportunities for Social Work Education

Abstract

The growing practice of arranging and financing “foster placement” of abused and neglected children with relatives provides an opportunity to redefine relationships between extended families and the child welfare system. The dilemmas and possibilities presented by kinship care as a child welfare service challenge schools of social work to provide intellectual leadership and to prepare social workers for changing child welfare practice. The author's ideas concerning responses to this challenge focus on key mandates of the Council on Social Work Education's Curriculum Policy Statement and on five principal curriculum areas in social work education.     

Preparing and Partnering with Families to Support the Adoption of Children from Foster Care

ABSTRACT

This investigation evaluated the effectiveness of a pre-placement education and preparation curriculum (PREP) for prospective foster/adoptive parents in improving attitudes toward children with prenatal substance exposure and their substance-using birth parent and increasing willingness to adopt these children. Participants included 1,836 prospective parents seeking adoption through foster care who received three 3-hour sessions of PREP. Prospective parents completed questionnaires assessing their knowledge about important issues involved in adopting a child from foster care, attitudes, and willingness to adopt children with a variety of characteristics. Changes from pre- to post-intervention were examined. Results indicated significant increases in self-reported knowledge; significantly more positive attitudes toward substance-abusing parents and children with prenatal substance exposure; and significantly increased willingness to adopt children with a variety of potential difficulties, including children with serious behavior problems, attention deficit hyperactivity disorder, and a biological history of mental illness. In sum, findings suggest that prospective adoptive parents who attended the PREP sessions felt better prepared by the end of training with regard to issues related to adoption of high-risk foster children with special needs, particularly those with prenatal substance exposure.     

Special foster care for exceptional children:: A review of programs and policies

This article reviews programs and policies regarding alternative home care for exceptional and special-needs foster children. While some focus is placed on program evaluation and efficacy of these specialized foster homes, the major thrust of the review is to identify major procedural underpinnings of successful programs for special needs foster children. These include: (a) appropriate selection of qualified therapeutic parents; (b) preservice training of parents; (c) matching of child to abilities of parents; (d) high-intensity and high-frequency casework and consultation; and (e) professional status for the specialized foster parents. Special foster care programs which have been evaluated offer generally high levels of success and goal attainment at much lower per diem rates than institutional care. Summary policies and recommendations are forwarded.     

Displacement,caregiving, and the ecological system of youth in foster care: a theoretical perspective

Children involved in the child welfare (i.e., foster care) system are at a greater risk for numerous negative outcomes in adolescence and adulthood (e.g., lower educational attainment, higher risk for a criminal record). For children in foster care who experience placement disruption (i.e., removed from a foster home and placed in another nonpermanent placement), the risks significantly increase. Informed by the ecological systems model, the authors propose a theoretical perspective to explain the unique aspects of a foster child’s development and discuss how this framework informs child welfare practice and intervention for foster children at risk for placement disruption. This perspective has the potential to provide a framework that has implications for foster caregivers and child welfare professionals and to inform future policies.     

Interactive Media for Child Care and Counselling: New Resources,New Opportunities

SUMMARY

A familiar children's story in the UK–Bruce's Story, about the adventures of a puppy moving into the unknown world as he grows up–is converted into a multimedia program designed to help children in out of home care talk (or write) about their own experiences coming into the child welfare system and into foster and adoptive families.     

Kinship foster parenting; gender,class and labour-force participation

Objective: Knowledge about gender, class and labour-force participation of kinship foster parents in European countries is scarce. This study examines the gendered structure and generational pattern of kinship foster parenting in Norway and compares class components and labour-force participation of kinship foster mothers to the larger female population and to non-kinship foster mothers.

Method: The analysis is based on survey data on relationships between foster parents and child, social demographics and placement characteristics from 123 kinship and 88 non-kinship foster mothers of children in state custody. Labour Force Survey and Education Statistics from Statistics Norway were used to compare the kinship sample to the average female population.

Findings: Kinship foster care in Norway is gendered, in that it is women who assume the responsibility for relatives' children. Kinship foster care reflects class differences in that the educational level of kinship foster mothers and their household income are lower than the average female population and of non-kinship foster mothers in Norway. The labour-force participation of kinship foster mothers in Norway is comparable to that of the country's female population in general, except for women aged 35–55 with children under seven, among whom labour-force participation is lower than for the female population.     

Descriptive Analysis of Foster Care Adoptions in New South Wales,Australia

This paper describes the population of children in care in New South Wales, Australia, who were adopted by their foster families (N?=?372) from 2003 to 2014. Data pertaining to 370 of these adoptees were available and obtained from administrative records accompanying adoption applications. Most of these children had been placed with their subsequent adoptive family during infancy. However, adoption orders occurred much later in their lives. According to the available information at the time of adoption, these children did not suffer the high levels of mental health problems typically identified in populations of children in foster care. Though the data do not include follow-up to determine if the contact agreed upon at the time of adoption orders translated into practice, the most frequently postadoption arrangement recorded was face-to-face contact, four times a year with mother and siblings. The high levels of openness and face-to-face contact in Australian adoptions from care are a significant point of difference with other adoption models, and presents a need for research in the area.

IMPLICATIONS

• Following the change of legislation in New South Wales, Australia, that prioritises open adoption over foster care, social workers in the field of child protection are well placed to assist in this process.

• Social workers can assess children entering care to identify those who will benefit from adoption in a timely manner; undertake casework and administrative aspects of the adoption process; work closely with the child, and birth and adoptive families by delivering pre- and post-adoption supports; and conduct longitudinal research on the outcomes for children adopted from care.