Temporal stability of entries and predictors for entry into out-of-home care before the third birthday: A Danish population-based study of entries from 1981 to 2008

Objective

Placing a child in out-of-home care is one of the most radical measures a child protection system can decide to take. There is an essential interest in understanding the probability of entering care and what circumstances are related to the decision to place a child in out-of-home care. This study investigates the temporal stability of rates and predictors for entry into care.

Method

Data were obtained by linking several registration systems. The study population was defined as all children entering care before their third birthday from birth cohorts 1981–2008 (N = 11,034). Furthermore, a control population consisting of a randomly assigned quarter of the Danish child population from the same birth cohorts was used (N = 515,773). Rates of entry and Cox regression models from six periods from 1981 to 2008 were used to model co-variates associated with entry into out-of-home care.

Results

The overall likelihood for entering care is found to be decreasing over time. Furthermore, results reveal two trends: relative rates of entry are significantly decreasing for children whose mother has a psychiatric history prior to the child's birth; relative rates are significantly increasing for children whose mother or father was unemployed in the year prior to the child's birth.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.     

The relationship of placement experience to school absenteeism and changing schools in young,school-aged children in foster care

Background

Chronic school absenteeism and frequent school changes, particularly among younger children, may be antecedents for the high rates of school failure and subsequent dropout among youth in foster care. However, the relationship of foster care experience to absenteeism and school change has not been well studied.

Objective

This study examined the association of placement experience with absenteeism and changing schools among 209 urban children in foster care enrolled in public elementary schools.

Methods

A cohort of children aged 5 to 8 years who entered non-relative or kinship foster care from 2006–2008 were followed longitudinally for 2 years from entry into foster care. Children residing in foster care were categorized at the end of the study as early stable, late stable, or unstable, if they achieved a permanent placement prior to 45 days, between 45 days and 9 months, or failed to do so within 9 months, respectively. Children who reunified home were classified as a fourth category. Poisson regression, controlling for baseline factors, was used to compare days absent and number of schools attended across categories of placement experience.

Results

Among the 209 children, 51% were male, 79% were African American, and 55% were initially placed with kin. One third of children reunified home; among children who did not reunify, one half was early stable, and a third was unstable. Adjusted rates of school absenteeism increased in stepwise fashion as children's placements became more unstable; children with unstable placements were 37% more likely to be absent than those with early placement stability (p = 0.029). Children who reunified during the study demonstrated the highest rates of absenteeism; however, there was no significant difference in absenteeism before or after reunification. Number of schools attended increased as stability worsened, with the standardized rate of schools attended reaching 3.6 schools (95% CI 3.1–4.1) over a two year period among children in unstable placements.

Conclusions

The relationship between placement experience and school absenteeism and school change illustrates the need to better coordinate the educational experience of high-risk children in foster care. The secondary finding of high absenteeism among children in the process of returning home illustrates that educational challenges for youth may be equally if not more concerning among the greater majority of youth in child welfare who remain home with birth parents.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Are maternal and community risk factors associated with the presence of asthma among children placed in foster care?

Objective

The occurrence of pediatric asthma has been associated with exposure to chronic stress. This study examined the relationship between maternal and community risk factors and asthma in a sample of maltreated children in foster care.

Method

Interviews were conducted with 365 maltreated children in foster care. Measures included youth/caregiver reports of asthma, an index of maternal risk based on data abstracted from child welfare records and community violence exposure.

Results

After controlling for demographic variables, maternal risk was associated with the presence of asthma (OR = 1.314, 95% CI = 1.09–1.58). Community violence exposure, however, was not related to the presence of asthma.

Conclusion

Maternal risk factors were significantly associated with the presence of asthma in a foster care population. Physicians who care for maltreated children in foster care should be particularly attuned to the presence of these additional risk factors that may place high-risk children at increased risk for chronic health problems.     

Predictors of out-of-home placement following residential treatment

Objective

There is a lack of research examining predictors of out-of-home placement (OOHP) following residential treatment (RT). The current study examined how various child and family factors predict OOHP at discharge and 6-months post-discharge for a RT sample.

Methods

Three hundred and eighty-three children (11.92 years, SD = 2.63, 293 boys) with serious mental health disorders were assessed using the Brief Child and Family Phone Interview (BCFPI) and placement information forms at admission, discharge, and 6-months post-discharge from RT.

Results

OOHP at discharge was predicted by older age, OOHP at admission, child welfare involvement, deliberate self-harm, a history of physical abuse, neglect, witnessed domestic violence, and a poor family situation (p < .05). At 6-months post-discharge, OOHP was predicted by dual diagnosis, OOHP at admission, child welfare involvement, neglect, and witnessed domestic violence (p < .05).

Conclusions

Pre-treatment factors are predictive of OOHP following RT. Identifying these key predictors and developing permanency planning options for children to promote stability and consistency is essential. A systemic evidence-based approach is imperative in promoting resilience for children at risk of OOHP, including family intervention and collaboration with the community.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

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.     

Reunification in a complete entry cohort: A longitudinal study of children entering out-of-home care in Tasmania,Australia

The aim of this study was to examine the nature and predictors of family reunification patterns in Australia. Using a large representative sample, this study extends previous studies based on older, often smaller samples and encompasses a period in which kinship care comprised a substantial proportion of out-of-home care placements. Analyses were based on a sample of 468 children who entered care for the first time in the State of Tasmania between January the 1st 2006 and December 31st 2007. Administrative data and case-worker interviews were used to obtain information concerning children's demographics, family backgrounds and placement movements over 2–4 years. The results showed that around 50% of children had gone home after 2 years, but that 79% of returns occurred in the first 6 months. Reunification was slower for younger children, those in kinship care, and amongst children from families affected by poverty, substance abuse and for a cluster children with the highest prevalence family risk factors. The study contributes to international knowledge concerning the importance of assessing the multiplicity of risk factors in family reunification research and the implications of kinship care for the increased stability, but higher retention, of children in out-of-home care.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

Intention to leave in social workers and educators employed in voluntary child welfare agencies

Introduction

Individuals employed in child welfare settings can have a profound impact on children in care. Research shows that direct care staff can have an effect on emotional and physical outcomes for children with whom they work. This paper seeks to expand knowledge of the child welfare workforce by studying educators employed in child welfare settings and comparing their job satisfaction and intent to leave with that of prevention workers employed in similar settings.

Materials and methods

Data for prevention workers (n = 538) were obtained from workers employed at all preventive service programs under contract with a large municipality. Data for educators were obtained from voluntary agencies located elsewhere in the state (n = 139). The instrument was a modified version of a survey developed to examine job satisfaction and potential turnover among public child welfare workers. Domains measured included various aspects of job satisfaction, intention to leave, and whether workers regretted taking their jobs. Data were analyzed using bivariate analysis and structural equation modeling (SEM).

Results

While both educators and prevention workers varied on different domains of job satisfaction, their overall satisfaction did not differ nor did their intention to leave their jobs. Satisfaction with contingent rewards, the nature of the work and opportunities for promotion along with not regretting taking one's job were predictive of thinking about leaving one's job. Thinking about leaving was predictive of taking concrete steps towards actual leaving.

Discussion

While people both prevention workers and educators report different levels of job satisfaction and work conditions in their agencies, job title itself has less to do with a worker's intention to leave, as measured by both thinking about leaving and taking steps towards actively looking for a new job, than other factors. Larger contextual factors may be at play in workers' decisions to stay employed. Suggestions are made for reducing turnover intentions along with suggestions for further study to clarify the role of organizational factors in workers' intention to leave.     

A Comparison of Out-of-home Care for Children and Young People in Australia and Sweden: Worlds Apart?

Abstract

In this paper we present a comparative analysis of out-of-home care in Australia and Sweden. We compare the age structure of the out-of-home care population and the types of out-of-home care services provided to children and young people in both countries. Our analysis reveals that in Australia the out-of-home care service system is focused mainly on children who are deemed to be abused or neglected within their families, while in Sweden the majority of the out-of-home care population are teenagers who cannot live with their families for emotional or behavioural reasons. These population differences intersect with variations in the forms of service provision in both countries, with a much greater reliance on home-based care in Australia than in Sweden, while there is more extensive use of residential care in Sweden. We envisage that this paper will demonstrate how the age structure of the out-of-home care population, though rarely considered in international comparative child welfare research, reveals much about the assumptions on which State intervention with children and young people is based. We intend that this analysis will assist social workers to better understand and address the gaps in the quality and comprehensiveness of out-of-home care service provision to children and young people in both countries.     

Effectiveness and implementation of evidence-based practices in residential care settings

Purpose

Prompted by calls to implement evidence-based practices (EBPs) into residential care settings (RCS), this review addresses three questions: (1) Which EBPs have been tested with children and youth within the context of RCS? (2) What is the evidence for their effectiveness within such settings? (3) What implementation issues arise when transporting EBPs into RCS?

Methods

Evidence-based psychosocial interventions and respective outcome studies, published from 1990 to 2012, were identified through a multi-phase search process, involving the review of four major clearinghouse websites and relevant electronic databases. To be included, effectiveness had to have been previously established through a comparison group design regardless of the setting, and interventions tested subsequently with youth in RCS. All outcome studies were evaluated for quality and bias using a structured appraisal tool.

Results

Ten interventions matching a priori criteria were identified: Adolescent Community Reinforcement Approach, Aggression Replacement Training, Dialectical Behavioral Therapy, Ecologically-Based Family Therapy, Eye Movement and Desensitization Therapy, Functional Family Therapy, Multimodal Substance Abuse Prevention, Residential Student Assistance Program, Solution-Focused Brief Therapy, and Trauma Intervention Program for Adjudicated and At-Risk Youth. Interventions were tested in 13 studies, which were conducted in different types of RCS, using a variety of study methods. Outcomes were generally positive, establishing the relative effectiveness of the interventions with youth in RCS across a range of psychosocial outcomes. However, concerns about methodological bias and confounding factors remain. Most studies addressed implementation issues, reporting on treatment adaptations, training and supervision, treatment fidelity and implementation barriers.

Conclusion

The review unearthed a small but important body of knowledge that demonstrates that EBPs can be implemented in RCS with encouraging results.     

When caregivers are in need of care: African-American caregivers' preferences for their own later life care

To “care for one's own” is a cultural expectation within a larger ethic of care in the African-American community. Applied to caregiving of aging elders, this ethic of care emphasizes the importance of providing in-home family care rather than opting for out-of-home placement. This study explores why a subset of African-American caregivers prefer or are open to out-of-home placement over in-home family care if they are no longer able to care for themselves. In-depth interviews with 24 family caregivers are analyzed. Three themes emerged including the desire to “spare our children” the burden associated with caregiving, viewing the next generation of potential caregivers as unequipped for the task, and having no one left to provide care for them.     

Long-term changes in parenting and child behavior after the Home-Start family support program

Background

The intervention Home-Start is a wide spread program in a number of countries, among which the Netherlands. In Home-Start, trained volunteers visit families with young children in need of support once or twice a week to help them to deal with problems in family life and parenting. Little is known, however, about the effects of Home-Start. This study describes short-term and long term changes in families that participated in Home-Start.

Methods

Three groups of families with young children (at the start mean age 1 1/2 years) were followed over a period of four years. One of the groups of families participated in the Home-Start family support program in the first 6.6 months of this period. The two other groups were (1) a randomly selected community sample and (2) a group of families with elevated parenting stress and a need for support. Data were collected at the beginning of the study, (after median 1.4 months), directly after the intervention (median 6.6 months) and at two follow-up occasions (respectively, median 12.5 and 49.2 months after the first measurement). At the last measurement, data were available for 33, 45 and 34 families respectively.

Results

Multilevel analysis showed more positive changes in parental wellbeing, competence and behavior (more consistent behavior and less rejection) during the intervention period in the Home-Start group than in the two other groups. At the three year follow up, the Home-Start group showed, compared to the other groups, more improvements in parenting (more responsiveness), but also diminished child externalizing and internalizing behavior problems (less oppositional defiant behavior, affective problems and anxiety problems).

Conclusions

Home-Start seems a promising family support intervention that deserves to be studied more extensively.     

Australian Social Work Reviewers 2010

Abstract

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care.     

Delinquent and aggressive behaviors in early-adopted adolescents: Longitudinal predictions from child temperament and maternal sensitivity

Background

160 early-adopted children were followed from infancy to adolescence. Central question was whether early and concurrent parenting and child temperament predicted adolescent delinquent and aggressive behaviors.

Methods

Structural equation modeling was used to test the relations between early and concurrent observed maternal sensitivity, mother reported effortful control and teacher reported delinquent and aggressive behaviors.

Results

This longitudinal adoption study showed that lower effortful control, concurrent as well as 7 years earlier, predicted higher levels of delinquency in adolescence and aggression in middle childhood and in adolescence. Lower levels of effortful control in infancy predicted higher levels of maternal sensitivity in adolescence which in its turn predicted less adolescent delinquent behavior.

Conclusions

The findings suggest that effortful control is an important predictor of both aggressive and delinquent behaviors. Maternal sensitivity also plays a role in the development of delinquent behavior, buffering a lack of effortful control, but is not related to aggression at age 14. It is important to note that these relations were found in a sample of parents and their genetically unrelated adopted children.     

Placement stability for children in out-of-home care: a longitudinal analysis

This study examines the number of placement moves experienced over an eight-year period by 5,557 children in one state who first entered out-of-home care between birth and age six. This group comprised 28% of all young children who entered care during this period. Nearly 30% of children in kinship care and 52% of children in nonrelative care experienced placement instability (defined as three or more moves after the first year in care). Children in kinship care, regardless of age, had fewer placement moves than those in nonkinship care. A multivariate analysis found that children who had more than one placement move during their first year of care were more likely to experience placement instability in long-term out-of-home care than if they did not move or were moved only once during their first year in care.     

Actuarial risk assessment in child protective services: Construction methodology and performance criteria

Purpose

To prevent the recurrence of child maltreatment, actuarial risk assessment can help child protective services (CPS) workers make more accurate and consistent decisions. However, there are few published articles describing construction methodologies and performance criteria to evaluate how well actuarial risk assessments perform in CPS. This article describes methodology to construct and revise an actuarial risk assessment, reviews criteria to evaluate the performance of actuarial tools, and applies a methodology and performance criteria in one state.

Methods

The sample included 6832 families who were followed for two years to determine whether they were re-reported and re-substantiated for maltreatment.

Results

Both the adopted and the revised tools had adequate separation and good predictive accuracy for all families and for the state's three largest ethnic/racial groups (White, Latino, and African American). The adopted tool classified relatively few families in the low-risk category; the revised tool distributed families across risk categories.

Conclusions

The revised tool classified more families as low-risk, allowing CPS to allocate more resources to higher-risk families, but at the cost of more false negatives.     

Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults

Background

Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated.

Methods

Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day).

Results

In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration.

Conclusions

Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.