Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

An exploration of the differential usage of residential childcare across national boundaries

The use of residential placements for children needing out‐of‐home care remains controversial. This article considers the discourse of ‘residential’ and ‘institutional’ care before describing, mainly through administrative data sources, the wide variations in group‐care usage in different jurisdictions. In some countries, its use is minimal, with foster care, kinship care and in some cases, adoption being the preferred options. This is not so in other countries where a high percentage of children in care are in residential placements. There is also diversity in the type of residential services, ranging from small group homes to large institutions. The challenges inherent in making process and outcome comparisons across national boundaries are explored. The authors concur with those who argue for more systematic ways of describing and analysing the aims and characteristics of residential settings. Only then can meaningful comparisons be made between outcomes from group‐care regimes in different jurisdictions.     

The time costs of children

In this study of household time allocations, Turchi argues that children play a crucial part in the trade-off that members of a household must make between time at home and the pursuit of economic gains in the marketplace. Turchi examined data collected by Baumann, Udry, and Turchi in 1977 for a study of marriage and fertility to study how families handle the time that children add to their schedules. Using the data and the theory of utility maximization from economics, the researchers were able to look at the amounts of time a group of parents reported spending in various child-related activities and the impact this had on their economic status. The average number of hours a wife devotes to various activities varies considerably with having children. For example, wives spend 21 hours/week on general housework before having children, 16 hours/week when the children are preschool age, and 13 hours/week when the children are school-age. The child-related housework increased from 0 to 26 hours with preschool children, and then decreased to 21 hours with school-age children. Child care increased to 26 hours/week with preschoolers, and decreased to 20 with school-age children. Outside employment dropped from 29 hours/week to 11 with preschoolers, and increased to 18 with school-age children. Turchi has developed a method for measuring the value of time for nonworking women; it allows more precise understanding of the factors that determine the time allocation of wives, and, in particular, their fertility decision. This method allows the estimation of the monetary value of time spent in housework and child care, which is of great interest to lawyers who specialize in personal injury and divorce cases. While findings may support the argument that individuals who grow up without siblings are more successful, more intelligent, and better educated because of more quality time from parents, Turchi offers a different interpretation. He suggests that sharing a parent's time with siblings also results in quality time spent with a child. 2 children do not necessarily double the time costs of 1. He further argues than the psychological costs per child may even drop as family size increases.     

Infants who stay in foster care: child characteristics and permanency outcomes of legally free children first placed as infants

Despite growing concern in the United States about the number of children who are entering child welfare care as infants, little empirical attention has been given to the sizable group of these children who are not reunified with their biological families and who then remain in care for long periods. This study examined length of stay and permanency outcomes for 458 legally free children who initially entered out-of-home care as infants. Using a Cox proportional-hazards event history model, the study also explored the effects of race/ethnicity and gender on the likelihood of these children achieving a permanent placement (legalized adoption or guardianship) within a reasonable period of time. African–American children and boys were found to be significantly less likely to achieve permanence than Caucasian children or girls. Across all groups of children in the sample, however, long stays in care were the norm. These findings suggest the need for flexible approaches to permanency, for efforts to better differentiate among infants in care, and for attention to children's long-term developmental needs as well as to strategies that better assure placement stability.     

Child Care Costs and Women's Employment: A Comparison of Single and Married Mothers With Pre-School-Aged Children

Objectives . The effects of child care costs on the employment of single and married mothers with pre-school-aged children were analyzed. Methods . Both demographic and employment data from the March Current Population Survey were used, supplemented by child care data from various sources. Results . We find that child care costs have strong effects on employment for women with pre-school-aged children and that these effects are larger for single mothers than for married mothers. Conclusions . Our simulation results suggest that policies that reduce the costs of child care could raise the employment rate of married mothers by 3 to 14 percentage points and the employment rate of single mothers by 5 to 21 percentage points.     

Nurturing the virtuous circle: Looked After Children's participation in reviews,a cyclical and relational process

Children's participation in decision making of all kinds is of increasing interest across the world as more and more countries seek to comply with Article 12 of the United Nations Convention on the Rights of the Child. The participation rights of children who are in the care of the state are of particular concern. Recent research in England suggests that Independent Reviewing Officers (IROs) can play a crucial role in ensuring that looked after and accommodated children are able to participate in care planning and review processes. This paper outlines the findings of the first Scottish study to investigate the role of Reviewing Officers in encouraging children's participation in reviews. Surveys were collected from social workers, Reviewing Officers and young people after 69 review meetings as part of an action research study. Follow‐up qualitative interviews were then completed with 10 young people and a focus group held with the five participating Reviewing Officers. The findings suggest that participation in looked after reviews can best be understood as a cyclical and relational process and that taking part in action research may enhance participation practices. While the role of the Reviewing Officer was found to be important, the findings suggest that everyone involved in the care and support of the young person needs to encourage participation processes that are individualized.     

Excluding Children: Autonomy, Friendship and the Experience of the Care System

The concept of social exclusion is increasingly important in policy and research but has rarely been addressed from a child-centred perspective. Childhood is a social experience in itself, one that has its own norms and customs, and where the demands of participation and inclusion may be considerable, likewise the costs of exclusion. This paper explores the meaning and experience of social exclusion for children by focusing on a particular group of children and young people, those 'looked after' in the public care system. The sample involved children who had minimal contact with their parents, and who although not currently materially poor were vulnerable to a high future risk of experiencing poverty. They thus provided a valuable opportunity to explore some of the relational aspects of social exclusion. Using in-depth interviews to explore the meaning of friendship in their lives, the study revealed the importance of social relationships for these children, andin particular the impact of the care system on their capacity to make and sustain social networks. The findings suggest that the relational aspects of poverty are not just consequences of material poverty but can have a dynamic of their own, one that may have a particular resonance for children. This has implications not just for children in the care system, but also for children in families, where family poverty and the restricted social and economic integration of parents may also have an impact on children's capacity for developing social relationships and wider social networks.     

The proof of the pudding: What difference does multi‐agency working make to families with disabled children with complex health care needs?

More than 20 years of research with disabled children, young people and their families has highlighted the need for the different professionals and services that support them to work more closely together. The British policy and legal framework for ‘joined up working’ has never been stronger. However, there has been an assumption that multi‐ or inter‐agency working will inevitably be a ‘good thing’ for families. This paper discusses findings from a 3‐year research project which looked at both the process and impact of multi‐agency working on families with a disabled child with complex health care needs. Interviews with 25 parents and 18 children and young people who used six developed, multi‐agency services were carried out. Findings suggested that the services had made a big difference to the health care needs of disabled children but were less able to meet the wider needs of the child and the family – particularly in relation to social and emotional needs. Multi‐agency working appeared to make some positive, but not significant, differences to the lives of families.     

What is a family? Constructions of family and parenting after a custody transfer from birth parents to foster parents

The subject of stability for children in long‐term foster care is an emerging field within social work with vulnerable children. In Sweden, the adoption of foster children is not a common occurrence. Instead, when a child has been placed in foster care for 3 years, the local social welfare committee will consider whether the custody of the child should be transferred to the foster parents regardless of the circumstances of the birth parents, in order to secure stability and a sense of family belonging. Consequently, custody transfers raise questions such as “who is family?” and “who is a parent?” This qualitative interview study with custodians and young people who have experienced custody transfer highlights that who counts as family and as a parent is ambiguous. This article draws attention to how negotiations about family and parenthood revolve around biological, emotional, and relational dimensions. Furthermore, we show that stability for children in care has to be understood in terms of processes over time and not as the result of a single decision of custody transfer. Consequently, social workers need to take several aspects into account when they assess family belonging and stability for children in foster care.     

Settling In and Moving On: Transience and Older People in Care Homes

This paper reports on a study which examined the experiences of 46 older people who moved into nursing and residential care homes, interviewing them at four points, from before the move to up to six months afterwards. A key finding was that older people were actively involved in the process of settling into homes and forming new friendships. Participant data also indicated that these older people had often experienced many moves in recent years, as their need for care had changed, and following them through after their inclusion in the study indicated that, for some, there were more moves to come. These data place the debates about assessment, and the identified problem of "misplacement" in a different light. The problem is not simply one of improving assessment techniques so that needs and provision can be matched more accurately, but it may mean accepting that the needs of older people are likely to change over time. The question then is whether we can develop services and forms of provision which ensure that care moves to older people, rather than older people having to move to care.     

The Economic and Gender Consequences of South Africa's Home‐based Care Policy

South Africa's approach to care provision in the era of HIV/AIDS is home‐ and community‐based care, but in reality care for ill people in the home is provided on an unpaid basis, predominantly by women. But how much do they spend on this care work, in time and money? And what economic consequences does this policy have, particularly for poorer women? This article is based on findings from a study that focuses on unpaid care provision within the home for those in late‐stage HIV/AIDS in KwaZulu‐Natal, South Africa, and specifically on the costs of such provision. The findings show that female caregivers are bearing the bulk of the costs of care provision for ill people within the home on an unpaid basis. Home‐based care is cost‐effective for the provincial government but not for unpaid caregivers who are subsidizing the provincial economy. While hospital care for people with HIV/AIDS has been capped, home‐based care services have not been increased to a commensurate level. Unpaid caregivers and ill people within the home are largely disconnected from the health system. The analysis clearly shows that the home‐based care policy is not resulting in appropriate or sufficient support for these individuals in need and needs to be revised.     

A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Risk,resilience and identity construction in the life narratives of young people leaving residential care

The role of residential care for children has developed very differently internationally, but in all cultural contexts, there are questions about the extent to which it can help young people recover from high risk backgrounds. In the UK, residential care has come to be seen as the placement of last resort, yet new government guidance on permanence has suggested that residential care can provide security and a sense of belonging. Narrative analysis of interviews with 20 care leavers identified their different pathways from birth families through residential care to early adulthood. Some experienced a transformation from a negative sense of self as victims or ‘bad children’ to survivors, while others continued to struggle. Key to successful turning points were four interacting factors, all associated with resilience; connection, agency, activity and coherence. These narratives revealed the importance of nurturing relationships and a sense of ‘family’, and also the role of support after leaving residential care, when transitions workers helped them to move on but stay connected. The study highlighted how residential care leavers from adverse backgrounds attribute very different meanings to their experiences, which affects identity construction, resilience and the need for support.     

Working with managers to improve services: changes in the role of research in social care

The setting of specific objectives for children's services and the identification of key outcome indicators, together with the development of a core information specification for children's services with its practical application in the implementation of the Integrated Children's System, all mean that substantially more data are now available to child welfare agencies. Not so long ago in the UK it was the role of research teams to collect and analyse such data. Now that so much of it is already available to agencies, are researchers who work in this area of applied social policy research becoming redundant? Using data from the cohorts of looked after children being studied at the Centre for Child and Family Research, Loughborough University, the paper demonstrates how researchers can work in consultation with the managers of child welfare agencies to make better sense of the data at their disposal. It considers three issues: what additional variables need to be explored to help agencies better understand their performance; how groups of children could be identified who follow predictable pathways through social care; and how qualitative information is necessary to gain a true picture of what is happening. All of these examples demonstrate a fundamental role for researchers in working with social services personnel to identify how services can be improved.     

Kinship Foster Care and Its Impact on Grandmother Caregivers

Summary

Kinship foster care programs are designed to address the needs of relatives, usually grandparents, who have taken in children who have been removed from their homes voluntarily, or following a substantiated report of neglect and/or abuse. The author reviews the history of kinship foster care nationally and examines related research. Reported are findings on a survey of kinship foster care programs nationwide and from qualitative interviews with nine grandmothers from New York City who were kinship foster care providers. Particular attention was paid in these surveys to the impact of kinship foster care on families caring for children with disabilities.     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

The Grief Experience of Prison Inmate Hospice Volunteer Caregivers

Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals.     

Needs and availability of support among care‐leavers: A mixed‐methods study

Data are scarce on the long‐term needs of care‐leavers and on the support resources that are available for them in the years after leaving care. This mixed‐methods study presents data on the needs and availability of support of 222 Israeli care‐leavers, suggesting that the most urgent needs of care‐leavers are a lasting need for a stable and available support figure and assistance with educational issues. For some care‐leavers, these needs are fulfilled by their mentors. Parents and other familial figures were found to be the most common support resource for care‐leavers, which highlights the need for the intervention of social workers to improve relationships within families while the children are still in care. Due to high rate of young people who have no support resources and a low rate of services utilization, social services should provide a platform to support this group, using mentors and other supporters. The longitudinal data of up to 4 years after leaving care indicated that the availability of various types of informal support improved over the years, and the reports on difficulties in relationships of the care‐leavers with their parents were significantly fewer 4 years after leaving care than on the verge of leaving care.     

No place like home: lessons learned and lessons forgotten –the Children Act 1948

The Children Act 1948 emphasizes foster care as the alternative provision for children who cannot be cared for by their own families; it also underlines the responsibility of the state to provide good alternative homes where necessary. The Act reflects contemporary developments in psychological thinking about the importance of attachment relationships, and a recognition, derived in part from the experiences of evacuation, of the harmful effects on children of separation from their families. However, greater awareness, from the 1970s on, of the deficiencies of the state as parent and the complexity of relationships between children, their birth parents and foster families led to the promulgation of 'inclusive' and 'task-centred' models of foster care, reflected in the shift of nomenclature from foster 'parenting' to foster 'caring'. These approaches may, however, be in danger of minimizing both the attachment needs of many children and young people within the foster placement and the parenting role which is appropriate in many placements. A model of foster care, derived directly from the first Children Act, which stresses these core relationships, should be developed alongside that which emphasizes task-centred, time-limited provision.     

More Daughters in Child Care? Child Gender and the Use of Nonrelative Child Care Arrangements*

Objectives. This article examines whether families with white mothers make different child care decisions for sons than for daughters before the children start school. Methods. We estimate logistic regressions of the use of nonrelative child care for the youngest child in the family six years old or younger with data from the 1990 National Child Care Survey. Results. We find that girls are significantly more likely than boys to be in regular, nonrelative care when they are between three and six years old. Conclusions. Recent evidence from the United States indicates that child gender influences various aspects of family dynamics. These differences tend to put boys at an advantage. Our findings add to this literature by showing that child care decisions are also related to child gender. Gender differences in the use of child care may reflect appropriate responses to children's developmental needs. However, they may contribute to gender differences in children's well‐being.