Crisis nursery services and foster care prevention: An exploratory study

ObjectiveTo examine whether receiving crisis nursery services reduces the chances of subsequent placement of children into foster care.MethodThe study includes a sample of 322 children from the administrative data from a crisis nursery in Ohio. Generalized estimating equations analysis was conducted to assess the relationship between crisis nursery services (case management and parenting education) and subsequent foster care placement.ResultsThe generalized estimating equations analyses indicated that case management and parenting education provided from the crisis nursery were associated with reduced likelihood of subsequent foster care for children who were placed in the crisis nursery. Foster care placement during the previous 12 months and Caucasian race were also associated with higher odds of subsequent foster care placement.ConclusionsCrisis nursery services delivered with case management and parenting education may be an effecive intervention to reduce children's subsequent foster care placement.     

Improving access to health care for foster children: the Illinois model

Children in foster care have lower health status than do their peers and limited access to health care. The Illinois Department of Children and Family Services developed HealthWorks, a separate primary care preferred provider system for children in foster care. This study compared claims data for children in HealthWorks with children not enrolled in HealthWorks and with children in Aid to Families with Dependent Children (AFDC) who had never entered foster care. Children enrolled in HealthWorks were more likely than were other children to receive all of the services except general inpatient hospitalizations. They had greater odds of receiving general exams and physicians' services and were more likely to visit the emergency room than children who were not enrolled. They were more likely to receive all of the measured services when compared with children receiving Medicaid through AFDC.     

Post-adoption service need and access: Differences between international,kinship and non-kinship foster care

Post-adoption services are important to bolster a family's commitment to their adopted children, thus avoiding potential problems following adoption finalization. It is vitally important to assess post-adoption services in an effort to ensure families are provided with effective supports for successful family functioning. Few investigators have assessed service needs and access according to adoptive family type. This study focuses on international, foster care kin and foster care non-kin adoption types. Utilizing the National Survey of Adoptive Parents, this research investigated twelve post-adoption services. Two comparisons were made with respect to whether, according to the adoptive parents, post-adoption services were received or not received: 1) international and foster care non-kin adoptive families; and 2) foster care kin and foster non-kin adoptive families. International non-kin families were more likely to indicate they discussed post-adoption services than foster care non-kin families, particularly among those who were white, had adopted boys, had no other children in the home, and whose socio-economic background was lower. When comparing foster care non-kin families with kinship families, non-kin families tended to receive more desired services than kinship families, with kinship families indicating less need for services. Policy efforts and program design need to focus on reaching out to families and developing effective post-adoption services based on the expressed needs of families.     

Are services to prevent foster care effective?

The prevention of foster care became an important issue for child welfare services during the 1970s. Two main types of prevention models have emerged: crisis intervention programs intended to prevent imminent placement and intensive service programs designed to avert those crisis situations that precipitate placement. A critical analysis of several project evaluations leads to the conclusion that neither model has been markedly successful. Low nominal project placement rates seem attributable to inability to predict placements and to client selection biases. From a strictly financial perspective, preventive services have been considerably more expensive than regular services, including temporary family foster care. Data from a new demonstration project in New Jersey illustrate various problems in providing and evaluating preventive services to families referred to protective service agencies. Implications of the findings for prevention programs and policies are discussed, and a new direction focused on truly early intervention with children and families is proposed.     

Behavioral health service use and costs among children in foster care

This article compares behavioral health service use and cost for foster care versus nonfoster care children; children before, during, and after foster care placement; and successfully reunified versus nonsuccessfully reunified foster care children. Behavioral health service costs for children in foster care were higher than for children not in foster care. Children in foster care used more services during their foster care placement than before placement and after discharge. Nonsuccessfully reunified children received a significantly larger quantity of services than those successfully reunified.     

An innovative child welfare pilot initiative: Results and outcomes

Successful family reunification is achieved only about 50% of the time when children are in foster care. Parents' ability to access and complete court ordered services are paramount in determining whether the family can achieve reunification. However, the research on how to best facilitate service access and utilization are sparse. A matched sample of 100 families with no prior child welfare involvement and at least one child in out of home care were selected from Department of Children and Family closed administrative case files. This study compared 48 families who received traditional child welfare services to 48 families who received a Family First model intervention (PFFP) from a large urban public child welfare agency. The independent variables were the elements that distinguished the Family First model from traditional child welfare services and included the number of caseworkers for the life of the case, caseload size, and service needs met through community partnerships. The dependent variables were the stability of the children's out of home placement, the time to reunification, the length of agency involvement, the stability of reunification at one year follow up, subsequent substantiated child maltreatment reports one year after the cases were closed, the distance a placement location was from the home of the family at intake, the match between identified needs and the timely access of services. Hierarchal regression and survival models were constructed to examine elements of the intervention for their impact on family outcomes. The results suggested that a community partnership model that incorporated family engagement, enhanced service provider accessibility, reduced caseloads, one caseworker for each family, are associated with successful reunification outcomes. Moreover, the intervention families were more likely to have their needs met with clinical or economic services, experienced fewer days in out-of-home placement, shorter involvement with the agency, reduced placement moves and were more likely to be reunified sooner compared to the group who received standard child welfare services. At one year follow up, the intervention families also had fewer substantiated child maltreatment reports and children were more likely to be living in the parental home. Implications for policy, research and practice are presented.     

Understanding contextual effects on externalizing behaviors in children in out-of-home care: Influence of workers and foster families

The expression of externalizing behaviors of children in-care can be influenced by a multitude of factors. The current study examined the simultaneous levels of influence of workers and foster families on children's externalizing behaviors in those receiving out-of-home care. A cross-classified multilevel model was used to partition variance in children in-care's externalizing scores into worker, foster family and child-specific levels of influence. The extent to which processes are explained by worker and foster-family level predictors was examined. Assessment and Action Record (AAR) data from the Ontario Looking after Children (OnLAC) project were analyzed. The sample included data from 1063 children between 10 and 17 years of age (M age = 13 years, 6 months, SD = 2.08 years). While individual differences in children's externalizing behaviors were primarily attributable to child-specific effects (72%), 10% and 18% of the variance can be explained by worker and foster family influences respectively. Worker education accounted for substantial differences seen between workers where more difficult children were monitored by workers with less educational attainment. Furthermore, foster-family level predictors also explained variance in children's externalizing behaviors. Relative to children in foster care, those in kinship care displayed significantly lower levels of problem behaviors while children in group care displayed significantly higher levels. Higher levels of parental negativity within the foster family and the experience of more differential parental negativity relative to siblings were significantly associated with more externalizing behaviors. Lastly, children who were more satisfied with their placement displayed significantly lower levels of problematic behaviors. These results suggest that children in-care can be conceptualized within a multilevel framework.     

Early care and education arrangements and young children's risk of foster placement: Findings from a National Child Welfare Sample

A primary goal of the U.S. child welfare system (CWS) is to maintain children investigated for maltreatment in their parents' homes whenever safely possible. This study explores the possibility that early care and education (ECE) services (e.g., child care, preschool, day care) can help the CWS achieve this goal by using a nationally representative sample of children referred to CWS for suspected maltreatment to measure the relationship between ECE receipt and the likelihood that 0–5 year olds in the CWS will be placed in foster care approximately 18 months later. Specifically, logistic regression analyses explore the relationship between: (1) regular ECE participation (yes/no), and (2) type of ECE arrangement (Head Start, other center- or home-based ECE, family/friend/relative ECE, other ECE, and multiple types of ECE) and foster placement risk. After controlling for multiple socio-demographic characteristics and foster placement risk factors, children who received ECE (yes/no) were no less likely to be placed in foster care than children who received no ECE. However, when exploring type of ECE arrangement, children who received Head Start were 93% less likely to be placed in foster care than children with no ECE. Children who participated in multiple types of ECE were almost seven times more likely to be placed in foster care than children with no ECE. These results suggest that Head Start may help maltreated children avoid foster placement and that experiencing multiple types of ECE is a risk factor for foster placement. It is recommended that caseworkers routinely assess the ECE service history and needs of families with young children who come in contact with the CWS, paying attention to the type and number of ECE services used.     

Placement stability in non-kinship foster care: variables associated with placement disruption

In Spain research has been conducted into the outcomes of foster care, although there is a need for further analysis, especially as regards the variables associated with placement disruption. In 2008 (T1) was collated information on all foster placements that were registered in three Spanish provinces. In 2014 (T2), data were gathered by reviewing the children's case notes and through interviews with the social worker responsible for each case. The resulting sample comprised 104 non-kinship foster children in long-term foster care who were being fostered in 86 families. The results obtained at T2 showed that the percentage of children who were still living with the same family (68.3%) was greater than the proportion of children whose circumstances had changed (31.7%). The social workers considered that placement disruption had occurred in 27 of the 33 cases. One of the main finding was placement disruption was associated with the older age at the time of being fostered and the emotional relationship quality between children and foster carers. A regression analysis showed that low levels of warmth and communication in the relationship between child and foster carers were shown to be a predictor of placement breakdown. Implications for practice are discussed.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.     

Training and services for kinship and nonkinship foster families

Researchers have raised concerns about the adequacy of the training and services for foster families in general and kinship families in particular. This study examines the training and services received by kinship and nonkinship family foster caregivers. The article compares kinship and nonkinship caregivers in terms of an array of training and services. The authors examine the demographic characteristics of these two groups and the problems of the foster children placed with them to better understand their needs. Consistent with previous research, levels of training and services received were inadequate for both groups. Contrary to previous research, few differences between kinship and nonkinship caregivers were found in training or services, in demographic characteristics, or in foster children's problems.     

The gift of kinship foster care

This study examines kinship foster care as a gift relationship. Reunification rates and replacement rates into non-related foster care are analyzed within the statistical framework of competing risks to examine the effects of reciprocity, payment, empathy, and duty on the dynamics of kinship foster care. The study makes use of a unique set of survey data on 983 kinship foster children in Cook County, Illinois. Survey responses are linked to computerized administrative records from the Illinois Department of Children and Family Services to create a 5-year longitudinal file on placement changes from June 30, 1994 to June 30, 1999. Children whose parents were reported as regularly visiting and working toward regaining custody (reciprocity) were more likely to be reunified and less likely to be replaced than children whose parents were reported as non-cooperative with visitation and service plans. Controlling for reciprocity, children were also less likely to be replaced if caregivers retained the full foster care subsidy (payment), reported a good relationship with the child (empathy), and grew-up in the American South and attended church regularly (duty). The sensitivity of these findings to alternative specifications of the competing risks of foster care replacement and kinship transfers is reported.     

Kinship Care Providers: Designing an Array of Supportive Services

Kinship care, the placement of children with their relatives, has become an integral part of the child welfare system in the United States. It is also becoming a more established way of meeting the needs of children in care in other western countries (Greeff, 1999). However, kinship care did not emerge as a child welfare issue until the late 1980s, and only recently has it become a part of the formalized system for out-of-home care (Hegar & Scannapieco, 1995). Since that time, many states have come to rely more heavily on placements with relatives to meet the needs of children removed from parental custody. For example, California has placed approximately 51% of the foster care population in kinship care, while Illinois has placed 55% (GAO, 1999).Discussion about the reasons for the increases in kinship care has been widespread (Brooks & Barth, 1998; Gleeson, 1999; Harvey, 1999; Hegar & Scannapieco, 2000). Regardless of the impetus behind the increased use of kinship care, states must now incorporate kinship foster care into the traditional foster care system in order to qualify them for federal funding (O'Laughlin, 1998). The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 amended federal law to require that states give priority to relatives when deciding with whom to place children who are in the foster care system (GAO, 1999).The apparent paradigm shift from traditional foster parents to kinship care parents (Hegar, 1999) requires that agencies use both different approaches to assessment (Scannapieco & Hegar, 1996) and provide different types of intervention and services. Adapting placement services to the needs of kinship care providers is the focus of this article.     

Aggression and depression among abused and non-abused children in foster care

This study compared the aggressive coping behaviors and depressive reactions among 30 physically abused and 30 non-abused children in foster care. Multiple regression analysis identified experiencing abusive parenting, affective mood depressive themes, and school performance as accounting for 63 percent of the variance in overt aggressive behavior within the sample. The abused children connected the reasons for placement with their own behavior; the non-abused children, with a crisis event. The findings support the need for differential foster care programming for children placed in care.     

Predictors of foster care exits to permanency: A competing risks analysis of reunification, guardianship, and adoption

Although foster care is intended to be temporary, and policy explicitly requires permanency outcomes, many children experience lengthy stays and exit foster care without a permanent family. This study sought to identify which child and placement characteristics were important predictors of exit to three types of permanency outcomes: reunification, guardianship, and adoption. A sample of 3351 children who entered foster care in 2006 was observed for 30 to 42 months. Permanency outcomes were analyzed using competing risks survival analysis. Children exited foster care to different types of permanency at different rates and frequencies. Reunification occurred most quickly and frequently. Guardianship was second in terms of median duration but third in frequency. Adoption was the second most common exit but had the longest median duration. One in four children remained in foster care or exited without permanency. While patterns varied by type of permanency, three major categories of important predictors were identified: 1) demographic characteristics of age at entry and race, 2) clinical needs related to children's disabilities and mental health problems, and 3) continuity and connections represented by kin placements, sibling placements, early stability, and absence of runaway events. Implications for practice, policy, and research are discussed.     

A Comparison of Foster Care Outcomes Across Four Child Welfare Agencies

ABSTRACT

A post-discharge outcomes interview for alumni of foster care was designed by four peer foster care agencies. Across all four agencies, 222 alumni were interviewed six months after being discharged from foster care services. Outcome domains, based on common measurement practices in child welfare and on social validation studies, include type of living environment (e.g., restrictiveness), placement stability, homelessness, school performance, employment, self-sufficiency, aggression, criminal behavior, substance use, relationships, community involvement, protection from harm, satisfaction, and impact of services. Results of the outcomes were compared to nationally sampled studies of children not in care. Generally, alumni reported positive outcomes across the various domains. The type of foster care, length of care, and age of alumni influenced the results. Implications for expanding this study to establish national benchmarks for outcomes, service use, and cost in foster care conclude the article.     

Critical factors of intensive family work connected with positive outcomes for child welfare clients

Mechanisms producing positive change in troubled families were analysed. The study aimed to answer the questions: What kind of case and client outcomes does intensive family work (IFW) produce for child welfare clients? From the perspective of family workers, what kind of critical factors for positive child, parent and family outcomes can be identified? The study used child welfare case files of 35 families with 93 children from one social office and interviews with 20 family workers and IFW managers in 5 municipalities in Finland. The shades of worries scale was used in evaluating the change in each family's situation. The case outcome measures for children included changes in the child's status in open care, short-term placement or foster care. During IFW, positive changes took place in 23 families out of 35 (66%). Twenty-seven children from 16 families did not continue as child welfare clients. Eleven children were placed into foster care during IFW and two years after it. The critical processes for outcomes included time, trust building and engagement, practical help, facilitating communication and guaranteeing the best interest of the child. IFW was considered effective for positive outcomes for the majority of families with complex needs.     

Educational and employment outcomes of adults formerly placed in foster care: Results from the Northwest Foster Care Alumni Study

This study evaluated the intermediate and long-term effects of family foster care on adult functioning using a sample of 659 young adults from two public and one private child welfare agencies, case record reviews, structured interviews, and a survey response rate of 76%. Foster care alumni completed high school at a rate comparable to the general population, but a disproportionately high number of them completed high school via a GED. Alumni completion rates for postsecondary education were low. Consequently, many alumni were in fragile economic situations: one-third of the alumni had household incomes at or below the poverty level, one-third had no health insurance, and more than one in five experienced homelessness after leaving foster care. Two foster care experience areas were estimated to significantly reduce the number of undesirable outcomes in the Education outcome domain: positive placement history (e.g., high placement stability, few failed reunifications), and having broad independent living preparation (as exemplified by having concrete resources upon leaving care). For the Employment and Finances outcome domain, receiving broad independent living preparation (as exemplified by having concrete resources upon leaving care) was estimated to significantly reduce the number of undesirable outcomes.     

The experiences and outcomes of children in foster care who were removed because of a parental disability

The purpose of this study is to examine the experiences and outcomes of children in the foster care system in the United States who were removed from their homes at least partially in relation to their parent's or caretaker's disability. This study uses administrative data from the 2012 year of the Adoption and Foster Care Reporting System (AFCARS), the federal reporting system that collects case-level data on all children in foster care through state and tribal IV-E agencies. While this administrative dataset doesn't collect data on parental disability, it does collect data on parental disability as a removal reason for children in foster care. In 2012, 19.0% of children in foster care had parental disability indicated as at least one removal reason, and 5.18% had parental disability indicated as their sole removal reason. Logistic regression was used to explore how a removal reason of parental disability correlated with removal manner, type of placement, location of placement, current case plans, discharge reasons and termination of parental rights. T-tests were used to compare children with and without parental disability as a removal reason in regards to number of placements, age at removal, length of time since last removal, length of stay in current placement, and total days in foster care. As foster children could have multiple removal reasons, analyses were conducted separately for children with parental disability as at least one removal reason, and those with parental disability as their sole removal reason. Findings indicate that children who have parental disability as a removal reason have different experiences in child welfare and different child welfare outcomes than those without parental disability as a removal reason. While the AFCARS removal reason of parental disability is not a proxy for parental disability, the study points to a need for closer attention to parental disability within the child welfare system to ensure appropriate services and supports, as well as fair treatment.     

Transition from Foster Care to Independent Living: Ecological Predictors Associated with Outcomes

Nationally, the outcomes for youth aging out of foster care are dismal. Most children leaving foster care do not have the financial, medical, or social support tools necessary to bridge this transition successfully, placing a significant burden on youth leaving care (Courtney, Piliavin, Grogan, & Nesmith in Child Welfare 80:685–717, 2001; Kools & Kennedy in Pediatric Nursing 29(1):39–45, 2003; Simms, Dubowitz, & Szilagyi in Pediatrics 106:909–918, 2000). Given the poor outcomes for youth aging out of foster care, and the small body of literature on what works to improve outcomes, the purpose of this study was twofold. First to examine youth characteristics associated with better outcomes, and secondly to explore what program characteristics were correlated with outcomes. A causal comparative research design was used, employing pre-existing data. Records were collected from an agency in a large urban/suburban area in the State of Texas. Data was collected from both the Transition Resource Action Center (TRAC) and Children’s Protective Services databases. To determine outcomes, both TRAC’s Self-Sufficiency Matrix and case records were used. TRAC’s Self-Sufficiency Matrix has five domains: Education, Employment, Employability, Financial Literacy, and Shelter. t tests were used to examine differences in outcomes between youth who received TRAC services before and after leaving care. t tests were also used to examine changes in overall Self-Sufficiency Matrix scores. Furthermore, linear and stepwise regressions were conducted to determine which variables were predictive of scores on the Self-Sufficiency Matrix. The results of this study indicate that TRAC is having a positive influence on the youth receiving services. Youth show significant improvement across four of the five identified domains and maintained on the fifth domain, employment. Implications for research practice and policy are presented.