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

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

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.     

‘If the Social Worker had Called at Least it Would Show they Cared’. Young Care Leaver’s Perspectives on the Importance of Care

Young people leaving local authority care are frequently discussed in terms of being socially excluded and having ‘poor life outcomes’. In terms of educational achievement, employment and involvement in the criminal justice system, those with an experience of the care system fare the worst. Within the context of these poor outcomes, the Government Green Paper ‘Care Matters’ has emerged. However, the Green Paper’s outcomes framework for looked after children’s well‐being risks simplifying the complex nature of children’s experiences and needs. It is children’s experiences of care, both before entering the care system and whilst growing up within the care system that shapes their well‐being and their life outcomes. The basis of improving children’s outcomes should include listening to and understanding what children need from the care system. This knowledge helps to develop an understanding of how failings within the care system are experienced by children in care and how these experiences are subsequently translated into negative outcomes for young care leavers. Drawing upon qualitative, empirical data, this study aims to explore young care leavers’ experiences of care. Through this, the extent to which feelings of care shape self esteem and a sense of self will be explored. Finally, this study will outline themes of trust and stability in the provision of care services and how these can shape positive outcomes for care leavers.     

Parenting groups for parents whose children are in care

Excluding very severe child abuse cases, biological parents are usually encouraged to maintain contact with their children in care. Parent‐child contact is often considered important because it can maintain the child's psychological identity and well‐being. It can also maintain parent‐child attachment and in some cases facilitate reunification. Improving parenting skills is viewed as an important method by which contact between children and their biological parents can be enhanced. However, mainstream parenting groups are often unsuitable for parents whose children are in care for a number of reasons. There is stigma involved with having children in care, such parents have very complex lives and there are reduced opportunities to practise skills learnt with their children. Groups designed specifically for parents whose children are in care appear to be a promising approach to improving the quality of contact between these parents and their children. This paper will review group‐based approaches to working with biological parents whose pre‐school‐aged children have been placed in care. The paper will also report the findings of a research project designed to identify key facilitators and barriers to parental involvement in a group‐based programme which includes contact between parents and their children who have been placed in care. Copyright © 2009 John Wiley & Sons, Ltd.     

Social images of residential care: How children,youth and residential care institutions are portrayed?

The literature suggests that residential care for children and youth is associated with a negative social image harmful to their wellbeing. However, the social images of children and youth in residential care and of the residential care institutions have received no systematic study. The current study seeks to examine the social images associated with children and youth in residential care and the respective care institutions in Portugal. The sample of 176 participants in the present study was comprised of individuals with and without professional contact with children and youth in residential care. Participants responded to an open-ended questionnaire requesting attributes and characteristics of children and youth living in residential care as well as attributes associated with residential care institutions. The data collected were analysed through Discriminant Analyses, Z Tests and Multiple Correspondence Analyses. Results show that children and youth are primarily described with negative attributes (e.g., sad, rebellious, deprived, lonely) while residential care institutions are mainly described with positive attributes (e.g., cosy, secure, affectionate, comfortable). Results also show that the social images of children and youth in care and the respective care institutions are heterogeneous and present different profiles. Finally, there will be a discussion of the implications of these results for practice, namely the importance of raising awareness about existing biased social images and how to deconstruct them.     

Care for vulnerable and disadvantaged children in the Czech Republic

The problematic issue of care for vulnerable and disadvantaged children in the Czech Republic, highlighted in this article, stems from the large number of children in institutional care. Workers from the Department for Social and Legal Child Protection (OSPOD) may get involved if there are factors in the family jeopardising the child's healthy development that cannot be improved, and institutional care may be recommended. This article discusses factors that influence and many times complicate the worker's job and are often the reason for an adversely high number of children living without a family. Attempts to reunite children with their biological families are complicated by the fact that the family situation rarely improves. Therefore children returning to live with their own families face the same conditions they were previously removed from. A more positive option for some children placed in institutional care is adoption or long-term foster care. However, many children continue to spend their whole childhood in a care home. The authors describe the care system in the Czech Republic and point out its weaknesses and some controversial facts. They also discuss and evaluate the ‘National Action Plan’, a government policy document, which articulates aspirations and obligations for all government departments and organisations involved in the Czech childcare system.     

Kin and non-kin foster care—findings from a National Survey

This article uses national data to look at the differences between children in kinship and non-kinship care arrangements. Three groups are compared: children in non-kin foster care, children in kinship foster care, and children in “voluntary” kinship care. Children in voluntary kinship care have come to the attention of child welfare services, are placed with kin, but unlike those in kinship foster care, these children are not in state custody. Findings suggest that children in the kin arrangements faced greater hardships than those in non-kin care. They more often lived in poor families and experienced food insecurity. They were more likely to live with a non-married caregiver who was not working and did not have a high school degree. And fewer kin than expected received services to overcome these hardships. In addition, nearly 300,000 children lived in voluntary kinship care arrangements; these children are of particular concern because they are not in state custody and therefore may or may not be monitored by a child welfare agency.     

The abuse of children in out of home care

SUMMARY: One of the major paradoxes in child protective services in the United States is that children removed from their homes on protective orders and placed in foster and group care face continued abuse. These children are reported at two to three times the rates of children living with their families. Investigations are performed by the very system that marks placements. In the US, some recommend resolving these problems by withdrawing from the active protection of children in care. Others hold that because children are in the care and custody of the state, and demand a higher standard of care, specialised prevention, identification. reporting and investigation initiatives are necessary to ensure their safety. This has important implications for other countries, especially the United Kingdom with its recent spate of inquiries into abuse in residential care.     

Children in Need in the South of Italy: Features and Distortions in the Deinstitutionalisation of Care

Despite the shift in emphasis from institutional to foster family care, in the south of Italy children in need are mainly looked after by residential services. These are required to provide family‐style care and to place children on a short‐term basis. Using data from research on a 100% sample of day units, residential services and children in care in the Calabria region, this article investigates the functioning of the system of care for vulnerable children at the sub‐national level, describes looked‐after children’s characteristics and life conditions and questions the extent to which a real deinstitutionalisation process has occurred in this area. Finally, some deinstitutionalisation recommendations are given.     

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.     

Interjurisdictional placement of children in foster care

As the population of children in foster care has increased and more children are freed for adoption, foster and adoptive families are needed in ever increasing numbers. One avenue for expanding the pool of families is through placement of children with families in other counties and states. This article considers the policy and practice implications of interjurisdictional placement in the context of foster care, adoption, and kinship care and suggests directions for interjurisdictional adoption practice and policy.     

Children residing with no parent present

Although foster care and Temporary Assistance for Needy Families “child-only” caseloads have fallen from heights in the 1990s, detailed household relationship data from panels of the Survey of Income and Program Participation (SIPP) establish that the share of children residing with no parent present (NoPP) has been rising for decades. Characteristics of NoPP children and the composition and poverty rates of their households are traced over time. Most NoPP spells are found to last 2 years or more. Special attention is paid to “informal care” children, the majority of NoPP children not in contact with foster care or income support programs designed to assist children with no parent present and provide access to health care. By several measures of well-being, informal care children occupy a margin between all children and other NoPP children. Children residing with only one parent are at higher risk of entering NoPP status than those with both parents present.     

Pflege der Eltern – Ein europäischer Vergleich*

Elderly people are predominantly cared for by family members. However, not every parent in need is cared for by a child, and not all family members are involved in care. Which factors influence the provision of care? Do European countries differ in regard to intergenerational care, and what are the reasons for these differences? The empirical analyses, based on the Survey of Health, Ageing and Retirement in Europe (Austria, Belgium, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and Switzerland), show that various factors influence care by children: individual characteristics of parents and children, family structures and cultural-contextual factors, including welfare institutions. Intergenerational help occurs more often in Southern and Central European countries, where children are legally obliged to support parents in need. At the same time, in Europe professional home care services enable adult children to pursue their personal plans beyond care obligations.     

Foster care and Medicaid managed care

Children in the foster care system are often dependent on Medicaid for health care. These children, however, have more complex health care needs than the typical child receiving Medicaid. States are implementing Medicaid managed care programs as a way to control escalating costs while providing necessary services. This article reviews the issues surrounding delivery of managed health care services to children in foster care and describes several solutions.     

Parental substance abuse and the development of children in family foster care

To determine the impact of parental substance abuse on children, the cognitive skills and behavior ratings of 268 school-age children placed in family foster care were examined. As a group, the children in family foster care presented with low average cognitive skills and made significant improvement in cognitive functioning during placement. The children with prenatal exposure to drugs scored significantly lower in cognitive skills at the beginning of placement but made significantly more progress than the other children during placement. Behavior ratings by the foster parents and teachers revealed that 29% of the children had scores in the significant range, and the children exposed prenatally to drugs had a higher incidence of behavior problems at school compared to family foster care peers. Recommendations for further study of these factors and for enhancing outcomes for children in care are provided.     

Intergenerational transfers in long term care

How are parental inter-vivos transfers to their children and children’s informal care of parents influenced by personal characteristics, family conditions and state specific long term care policies? AHEAD data from 1993 and 1995 and a two-party choice model are used to guide the estimation of OLS and binary logit models of the amount and likelihood of inter-vivos transfers to children and informal care of parents. Results suggest that both parents’ characteristics and their offspring’s characteristics affect parental gifts to children and children’s time assistance to their parents, highlighting the interdependent nature of these decisions. Furthermore, though state policies did not consistently affect parental gift giving, the availability of state respite care support -short-term “breaks” for informal family caregivers- (1 % significance level) and adult day care centers (5 % significance level) were positively related to the amount and likelihood of children’s time assistance to their parents. These findings highlight the importance of some state programs such as respite care support in encouraging intra-family support for the elderly. Support for programs that reduce the caregiving burden may encourage more children to care for their elderly parents.     

Care-leavers and their children placed for adoption

Young people in and leaving state care are more likely than the general population to become parents at a young age. Relatively little is known about the experiences and progress of care leaver parents and their children, but emerging evidence suggests an increased risk of intergenerational state intervention. Drawing on data from the Wales Adoption Study, this paper examines the prevalence and profiles of care leavers amongst birth parents whose children were placed for adoption. Findings showed that more than a quarter (27%) of birth mothers and a fifth (19%) of birth fathers with children placed for adoption were themselves care leavers. There were no significant differences between care leaver and non-care leaver birth parents in terms of involvement in crime or substance misuse, but carer leaver birth parents were distinguishable from other birth parents by their own experiences of abuse and neglect. Care leaver birth mothers were also more likely than their non-care leaver counterparts to have diagnosed mental health problems and were less likely to appeal the adoption plan. The profiles of children placed for adoption between care leaver and non-care leaver birth parents were similar. The findings presented in this paper strengthen the moral imperative to address the over-representation of care leavers amongst birth parents whose children are placed for adoption. There is an urgent need to revise how children and young people in state care are prepared for parenthood and supported as parents.     

Effects of kinship care on behavioral problems by child age: A propensity score analysis

When a child must be removed from the family home, placement with a relative is often sought because kinship care is the least restrictive and most family-like out-of-home placement. Although kinship care has become a preferred option in most U.S. child welfare systems, this preference is often based on “soft evidence” rather than rigorous evaluation of the risks and benefits of kinship care. Therefore, an evaluation of the impact of kinship care on child behavioral problems is needed to guide child welfare practice and policy. In addition, given that children of different ages and in different developmental stages are likely to have varying placement experiences, the evaluation of kinship care should explore the effect of kinship care on child behavioral problems across age groups. To fill these knowledge gaps, we compare the behavioral problems of 584 children in kinship care with those of 470 children in non-kinship care. Moreover, we examine the impact of kinship care on behavioral problems in 2 age groups: younger children (0 to 5 years) and older children (6 to 17.5 years). The analysis uses data from Waves 1 and 2 of the National Survey of Child and Adolescent Wellbeing, and applies propensity score methods to account for selection bias. Results show that older children in kinship care had significant lower levels of externalizing, internalizing, and total behavior problems. However, for younger children, the effects of kinship care on child behavioral problems did not reach statistical significance. The implications for practice, research and policy are discussed.     

The role of child care in supporting the emotion regulatory needs of maltreated infants and toddlers

Infants and toddlers who experience physical abuse and/or neglect are at a severe risk for disruptions to emotion regulation. Recent prevention and treatment efforts have highlighted center-based child care as an important setting for providing support to the needs of these children, as child care centers are already an existing point of entry for reaching high-risk families. Guided by ecological theory, this review draws on the maltreatment and child care literatures to consider the opportunity for child care centers, specifically teacher-child interactions within the classroom, to support the unique regulatory needs of maltreated infants and toddlers. Existing research on the effects of child care for children facing other types of risk, as well as research with maltreated preschool children, provides a foundation for considering the role child care may play for infants and toddlers, whose emotion regulation skills are just emerging. More research is needed regarding teachers' roles in facilitating effective emotional experiences in the classroom that meet the unique needs of maltreated children. Additionally, early childhood teacher training that focuses on infant/toddler mental health and a trauma-informed perspective of care, as well as structuring child care centers as communities of support for high risk families, all may aid child care centers in better serving this vulnerable population.