Intergenerational families in child welfare: Assessing needs and estimating permanency

Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1196 caregivers, most of whom are single African American females, and 2143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. We sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Our findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.     

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.     

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.     

Permanency Planning in Foster Care: A Research Review and Guidelines for Practitioners

Abstract

Permanency planning is a systematic, goal-directed and timely approach to case planning for children subject to child protection intervention aimed at promoting stability and continuity. The present paper reviews research into the area of permanency planning within the foster care system, with the aim of promoting research-informed policy and practice. Research published in both journals and books between 1998 and 2005 was reviewed. Exceptions to this were previously published seminal articles and texts that are theoretically and empirically important. The results of the present review indicate that permanency planning is theoretically informed by attachment theory and understandings of child development and identity formation. Decision making should be individualised, timely and culturally appropriate. Children themselves, their parents and carers all need to be involved in planning. Practitioners must be prepared to undertake extensive observation and assessment to serve the best interests of children when making permanency decisions.     

Kinship care for children in the UK: messages from research,lessons for policy and practice1

This article presents a comprehensive overview of kinship care, or as it is also known, family and friends care, paying particular attention to the UK child welfare, legal, policy/practice contexts. The aim of the article is to raise awareness, and provide information, about a hitherto largely invisible, yet expanding placement option being widely used in child welfare systems in the UK, in Europe and elsewhere. The article places kinship care within a UK and European child welfare legal context, including the European Convention on Human Rights 1998 [Articles 8 and 14] and European kinship care developments are also highlighted. It contains the main findings of a kinship care research study conducted by the author, based on interviews with children and young people living with kinship carers, as well as with the kinship carers. Following an examination of theoretical and policy issues, the article examines ways forward for developing and supporting kinship care. In the final section, and based on the research findings and literature review, a new paradigm for child welfare is introduced. It is argued that this new paradigm is necessary in order for kinship care practice and policy to develop within a supported and sustainable family support framework.     

School connectedness in community and residential treatment schools: The influence of gender, grades, and engagement in treatment

This study compared perceptions of school connectedness to traditional community schools and residential treatment center (RTC) schools for youths between the ages of 12 and 18 receiving treatment within two RTCs. The influence of gender, report card grades, and engagement in treatment were also examined in relation to school connectedness in the RTC schools. Findings indicated that youths reported greater connectedness to the residential schools and that engagement in treatment led to higher levels of school connectedness while in residence. Results are discussed in the context of practices that may increase school connectedness in community and RTC schools.     

Characteristics related to family involvement in youth residential mental health treatment

This study examined family involvement among youth in residential mental health treatment facilities in Florida. Data were obtained from the provider reports from January 2005 through December 2007. Treatment episodes were divided into 30-day periods with family involvement measured by the number of contacts by all family members, the mother, and the father. In addition, we examined contacts by all family members for in-person treatment, treatment-related phone contacts, treatment planning, campus visits, and therapeutic home passes. Families averaged 3.4 contacts per 30 days for the 1333 treatment episodes. Sixty-seven percent of the contacts included mothers, while 22% of the contacts involved fathers. A majority of contacts were for family therapy, either by phone (29% of contacts) or in person (43%). Nearly twenty percent of residential stays had no family contact. After the first 30 days of treatment, contacts did not vary significantly over the course of the treatment episode, although there was some evidence that youth with longer treatment episodes had fewer contacts throughout the residential stay. Total contacts were lower for girls than boys, for blacks than whites, and for older youth, and were higher when the youth lived in the same county as the residential treatment provider. Outreach programs could target specific demographic groups with low involvement, and the alternative methods for involvement that use internet conferencing tools should be explored for parents that live far from the treatment provider.     

Abused children and foster care—the need for specialist resources

Estimates vary on how many abused and neglected children are admitted to care and how many children in care are there because of abuse and neglect. Nevertheless, it is important to examine their special needs and the problems they present to carers. Although research findings are difficult to interpret, there is enough evidence to show that abused and neglected children in care have special needs in three particular areas: education, health and social behaviour. The evidence is available from research into children in care and research into child maltreatment. Children in care run the risk of disrupted educational careers; abused and neglected children have additional problems in school. Many children in care have a patchy and neglected medical history; abused and neglected children are seriously at risk of further ill-health. Abused and neglected children have been shown to have behaviour problems that jeopardize their relationships with peers and adults; they run the risk of placement breakdown. Foster care of abused and neglected children is a specialist and demanding task, requiring knowledge of, and sensitivity to special needs. Because many abused and neglected children return to their parents, foster carers also need to include the natural family in their task. High expectations of these foster carers, however, should not lead to exploitation but rather an enhancing of fostering assessment, preparation, support and training.     

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.     

Youth engagement and service dosage in a mandated setting: A study of residential treatment centers

Treatment theory in residential treatment centers (RTCs) is conceived as a two-stage process of first engaging the client and then delivering services or interventions aimed at presenting problems. This treatment logic has been criticized for “creaming clients” or reserving services for clients easier to engage or more amenable to treatment but less in need. The present study examines whether higher early levels of engagement by youth in RTCs leads to more intervention and compares the relative effects of engagement and seriousness of presenting problems on the quantity of services provided by the mid-point in the adolescents' stay. Data come from interviews with a clinical sample of 71 male and 59 female adolescents in two RTCs in an eastern state. Findings indicate that higher level of engagement predicts more treatment interventions. Treatment staff delivered higher dosages of services to youth with more current behavioral problems, not those with problematic behaviors at intake. Youth with positive peer group backgrounds also received more services. Findings extend knowledge of how treatment staff provide treatment to clients and the role engagement plays in RTC service delivery.     

Nonresident father support and reunification outcomes for children in foster care

Over the past decade an interest in fathers and their contributions to family stability and children's healthy development has heightened the attention paid within the child welfare field to identifying, locating, and involving fathers. The article presents findings from analyses of data on nonresident fathers and child welfare case outcomes for foster children. Using data available from a telephone survey of child welfare caseworkers, together with administrative data on case outcomes, a positive association between nonresident father support and reunification outcomes for foster children is shown. The sample of foster children with nonresident fathers who provided financial support, nonfinancial support, or both types of supports, were far more likely to experience a reunification outcome than children whose fathers did not provide these supports. The findings demonstrate associations between support and reunification but cannot demonstrate causality given the cross-sectional nature of the dataset. More research is needed to better understand the nature of nonresident father support in the lives of foster children, and the quantity and quality of interactions between mothers, nonresident fathers, and their children.     

Measuring the willingness to foster children with emotional and behavioral problems

Many children in foster care have emotional or behavioral problems or are at risk for these problems. It is important to identify parents willing to foster children with these problems in order to ensure placement, care, stability and well-being of such children. This study presents a new 40-item self-report measure of the willingness of parents to foster children with emotional and behavioral problems, and two 20-item parallel forms of this measure. In addition, this study presents evidence of reliability and validity of scores derived from these measures with a national sample of 297 foster mothers. Coefficient alpha for these measures was .92 or greater, indicating excellent internal consistency reliability. Scores from these measures were unrelated to demographic characteristics, providing evidence of discriminant validity. In addition, scores from these measures were higher for foster mothers licensed to provide treatment foster care than for mothers only licensed to provide regular foster care, providing support for known groups validity. Finally, support for construct validity is provided by the fact that foster mothers with higher scores on these measures had fostered longer, were fostering more children at the time of this study, and had fewer children removed from their home at their request.     

Stepping Down and Stepping In: Youth's Perspectives on Making the Transition from Residential Treatment to Treatment Foster Care

Older youth preparing to emancipate from the foster care system are often served in residential treatment settings where they have limited opportunities to practice skills for independent living in a community setting. Stepping these youth down to less restrictive environments such as treatment foster care is a growing trend, especially for youth with mental health issues. Yet, few studies have explored the youth's perspective on making this transition. This study utilized qualitative interviews with youths who were participating in a treatment foster care intervention study (n = 8) to gain their perspectives on the process of transitioning from residential care. Youths were interviewed right before they exited residential care and two months after placement in the new foster home. Youths reported hopes for gaining family in the new home as well as fears of placement disruption. Findings point to the need to enlist youths in discussion and problem solving about difficulties they anticipate in the new home and expectations for their relationship with the new foster parents. In addition, the struggles described after two months in the home point to the need for youths to build specific skills to better manage ongoing relationships with foster parents and for foster parent training on how to help build these skills.     

Foster care: The protection and training of carers' children

One of the risk factors in foster placement breakdown is the presence of the carers' own children. A project is described through which carers' children express their feelings and conflicts and present a demand for a review of foster care, to be seen as care by families, not only parents. Many children in care have a powerful psychological impact on their carers, and the impact on other children in the household is underestimated and poorly understood. There is a confusion of role between carers' children and children who are fostered—on the one hand, the former are peers, and on the other, considerable demands of patience and understanding are made on them. This understanding, and perhaps also fear of allegations, may make them prematurely adult and distort aspects of their own development. The need for further research into the direct experience of foster care is highlighted and a training model of preparation for carers and their children is described, based on direct work with adolescents.     

Planned treatment and outcomes in residential youth care: Evidence from Sweden

A recurring theme in evaluations of Swedish residential youth care is that treatment is often unplanned. Using a data set of teenagers placed in youth care in 1991 (N = 357), we show that planned treatment — in the sense of a known expected duration of treatment — is strongly positively associated with treatment outcomes. In the short term, teenagers with planned treatment are 32% less likely to experience a treatment breakdown and 25% less likely to be reassigned to other forms of residential care after completed treatment. In the long term, teenagers with planned treatment are 21% less likely to engage in criminal behavior and 40% less likely to be hospitalized for mental health problems. The results are robust to controlling for a rich set of potentially confounding factors: Even though observable pre-treatment teenager characteristics explain about one fifth of the variation in criminal behavior 5-10 years after treatment, they have almost no predictive power for whether treatment is planned or unplanned.     

Using Family-Oriented Treatment to Improve Placement Outcomes for Children and Youth in Residential Treatment

Abstract

Traditionally, caregivers of children with severe emotional and behavioral disturbances have been excluded from treatment planning, and service providers have often blamed caregivers for children's mental health problems. More recently, an approach to treatment based on Systems of Care has emphasized the importance of including caregivers in every aspect of treatment. This article describes a family-oriented residential treatment program in eastern North Carolina and reports initial results of a pilot study in which caregiver participation is valued and emphasized. Implications for practice, policy, and professional training are discussed.     

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.     

Childhood maltreatment and motivation for treatment in girls in compulsory residential care

The first objective of the current study was to examine the relationship between childhood maltreatment, trauma-related symptoms and motivation for treatment in girls in compulsory residential treatment facilities. The second objective was to examine the extent to which various forms of childhood maltreatment, trauma-related symptoms and motivation for treatment predicted (time to) dropout from these facilities. Participants were 154 adolescent girls recruited from three residential treatment settings in The Netherlands. Multiple linear regression analysis revealed that age and ethnicity were associated with motivation for treatment. Furthermore, emotional abuse contributed to motivation for treatment. In addition, internalizing symptoms (e.g., anxiety and depression) significantly predicted level of distress; symptoms of dissociation predicted doubt about treatment. Logistic regression analyses with multiple imputation and competing risk regression analyses revealed no significant predictors for (time to) dropout. The findings suggest that clinicians and therapists should focus on experiences of emotional abuse, traumatic symptoms and treatment motivation in girls in compulsory residential care settings.