Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

Key decisions in child protection services in cases of domestic violence: maintaining services and out‐of‐home placement

This paper looks at the response of the child protection services (CPS) system in cases where exposure to domestic violence occurs alone or together with abuse or neglect, focusing on the factors involved in decisions to maintain the case open for ongoing services or remove children from the home. The study is based on an analysis of clinical and administrative data from the files on children reported to a CPS agency in Montreal, Canada. A total of 1 071 substantiated reports were documented, including 337 cases of co‐occurrence (32%). Analysis of the data shows that domestic violence does not by itself constitute a factor liable to lead to more intrusive intervention. The CPS response appears to be influenced more by the existence of other forms of maltreatment and risk factors. Additionally, while domestic violence may be associated with more severe individual and family problems, it does not influence the decision to keep the case open because the child still need services. The lack of any connection between domestic violence and this decision is a cause for concern, as results indicate that such families need help. Knowing how to respond to their needs therefore remains a major challenge.     

Putting the child at the centre of inter‐professional cooperation in out‐of‐home care

A large part of most children's childhood is about taking part in educational and leisure‐time activities together with other children across various contexts. However, children in out‐of‐home care do not always have easy access to these possibilities for participation. In general, parents coordinate their children's everyday lives, but in the case of children in out‐of‐home care, the responsibility of care is distributed between several professionals and institutions. Research often recommends that inter‐professional cooperation should put the child at the centre and be more child focused. But what does that mean? The paper investigates theoretical understandings of ‘child centredness’ in inter‐professional cooperation. It also includes an empirical example taken from a research project that followed four children in their everyday lives in two residential homes in Denmark. The research explored how professionals work together across contexts in order to support children to take part in school and leisure‐time activities. The overall reasoning leads to the point that for children in out‐of‐home care, the possibility of exercising personal agency in their everyday life constitutes a difficult but vital issue. How children in out‐of‐home care learn how to conduct their everyday lives, is closely related to the ways professionals cooperate across contexts. It points to the need for close inter‐professional cooperation in order to encourage and support children's initiatives and engagements in activities in communities with other children.     

Towards best practice: combining evidence‐based research,structured assessment and professional judgement

Limitations of instruments adopting consensus and actuarial approaches are well documented when assessing risk of abusive behaviour. Whilst the consensus approach is flexible and useful for structuring information, it relies upon the practitioner's ability to combine information and apply knowledge of empirical research. The actuarial approach involves a graduated probability measure in the form of a score that determines the likelihood of a particular event occurring; however, this approach focuses upon static risk factors and tends to be inflexible given its necessary reliance on nomothetic factors. A third approach, structured professional judgement comprises evidence‐based risk factors and decision‐making guidelines to inform professional judgement and standardize assessments. Instruments focus upon dynamic risk factors that assist practitioners monitor risk levels and manage risk. This approach is useful for social work practice that commonly requires ongoing risk assessments and risk management. Structured professional judgement has not been meaningfully explored in Australian child protection practice despite it being used successfully for approximately two decades for assessing a range of offending and violent behaviour. Given the complexity of child protection cases, further research on approaches to risk assessment that combine evidence‐based research, structured assessment and clinical judgement, is warranted.     

Breakdown of teenage placements in Danish out‐of‐home care

This study deals with the problem of breakdown in out‐of‐home placements for Danish teenagers. How often are these placements prematurely terminated against the requests and intentions of the child welfare authorities? Which factors seem to increase and decrease placement breakdown? The sample consists of 225 youths and 367 placements during the years 2004–2008. Among the 225 youths, 44% experienced a breakdown, and 33% of the 367 placements ended with a breakdown. A large proportion of the placement breakdowns (20%) occurred before 4 months, and within the first year, 62% of the placement breakdowns had taken place. Replacements took place in 61% of all placement breakdowns. The analysis showed that type of placement and number of youth at the same placement had significant association to placement breakdown, but variables based on the social worker's clinical assessment showed no association to breakdown. However, while the logistic regression model was significant, it explained only 6% of the variance. Earlier studies have indicated that breakdown is a substantial problem of child welfare in several other western countries, Denmark is no exception. These corresponding breakdown rates point out that no child welfare system yet have found a method to reduce breakdown substantially.     

Stability and change – a 7‐ to 8‐year follow‐up study of mental health problems in Norwegian children in long‐term out‐of‐home care

The aim of the study was to explore stability and change in mental health problems in Norwegian children aged 6–12 years old (n = 70) in long‐term out‐of‐home care. The children's mental health problems were assessed shortly after the placement and 7–8 years later by the caregivers and the teachers on the Revised Rutter Scales. Information on pre‐placement and placement factors were collected from the child welfare workers. At a group level the children's mental health problems had improved significantly over time according to the teachers' reports. According to the caregivers' reports, however, the children's problems were high and stable across time. Analyses aimed at detecting individual changes revealed a great variability in development according to both informants, indicating that treating the placed children as a homogenous group could be misleading. Several pre‐placement and placement variables were associated with the change in the children's mental health problems from the time of placement to the follow‐up time according to both informants' reports. However, all the predictors were accounted for by the strong effect of the children's problem scores when entering care.     

Predicting chronic neglect: Understanding risk and protective factors for CPS‐involved families

Child neglect continues to receive less attention in research literature compared to other forms of maltreatment, despite accumulating evidence of serious negative impacts on child well‐being. Chronic neglect is also poorly understood. Although such cases comprise a relatively small percentage of workers' caseloads, they represent accumulation of harm that impacts the cognitive and social development of children. These cases can also disproportionately utilize protective service resources. This study contributes to the literature by examining risk and protective factors of chronic neglect. We utilized administrative data (N = 2,074) from a midsize city in the Northeast to examine the use of existing risk assessment tools to distinguish families with and without chronic neglect, including an analysis of the predictive capacity of risk and protective factors. We found that families with chronic neglect were younger, had more children, were more likely to have children under age one, and had higher rates of domestic violence, mental health problems, and cognitive impairment. None of the assessed protective factors differed significantly. The overall predictive value of the assessment was low. Implications include the need to expand risk assessment tools to incorporate patterns over time and identify early indicators specific to chronic neglect.     

“I did not know there was another life”: Meanings of life in the out‐of‐home Mothers Unit reunification programme

The Mothers Unit is a reunification and treatment programme in a welfare emergency centre in Israel. The unit is the only one in Israel offering joint residence for mothers at risk of abusing or neglecting their children. The unit provides an alternative to out‐of‐home care for young children suffering from maltreatment in order to enable them and their mothers to return to the community together at the end of the treatment. The current qualitative study examines the lived experiences of the women and their children from the subjective perspective of the women currently or previously involved in the programme and of the professionals working with them. Thematic analysis of 36 in‐person semi‐structured interviews reveals the multiple meanings they attribute to life in the Mothers Unit and its perceived effects on their children and themselves.     

Mapping the journey: outcome‐focused practice and the role of interim outcomes in family support services

Longitudinal costly evaluations will always be important in order to understand the factors that impact on child, family and community well‐being over the long and medium term. However, in a policy era that accords major importance to the achievement of outcomes, e.g. payment by results, ‘outcome theology’ can pose threats to service access and professional morale in family support. It is essential therefore, to ascertain the short‐term outcomes of services in order to capture the trajectory of progress by families under stress. This paper critiques the concept of ‘the outcome’. It traces the development of this trend in policy and describes an alternative but complementary approach, which is based on capturing interim outcomes in family support services.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

Psychometric properties of an adapted version of the parental sense of competence (PSOC) scale for Portuguese at‐risk parents

Parental sense of competence is one of the central dimensions targeted on psychosocial interventions aimed at supporting at‐risk families. Researchers and practitioners need reliable instruments to assess the parental role adapted for these families. Although the parental sense of competence (PSOC) scale has been frequently used to assess this construct, there is still no adapted version for Portuguese parents. In this study, the reliability, validity and factor structure of the PSOC scale is examined with a clinical sample of 146 mothers from at‐risk families receiving psychosocial interventions for family preservation from Child Protective Services. Results show that the Portuguese version of the PSOC measures three distinct constructs with acceptable psychometric properties: efficacy, dissatisfaction and controllability. As expected, the obtained factors were significantly and positively related to parenting alliance and family cohesion, and negatively associated with parenting stress. In sum, the proposed Portuguese version shows reliability and validity evidences to measure three relevant dimensions of parental self‐evaluation, and it constitutes a cost‐ and time‐effective instrument suited for at‐risk mothers.     

Troubled families: vulnerable families' experiences of multiple service use

This paper draws on a small‐scale study examining the experiences of highly vulnerable families with complex and enduring needs. The previous UK government and the current government have sought to develop policy and service initiatives that target families who present high levels of need and require high cost services. However, to date remarkably little is known about family perspectives and experiences. In this paper, family accounts of their experiences are presented and it is suggested that from these come some difficult practice questions. The family data reveal evident gaps in existing practice and challenges social work to ‘think family’ in new ways. The paper explores how families understand they are understood at the point of engagement, the assumptions that are made about family knowledge, and how families share and withhold information about their needs and experiences. In the discussion, the argument is made for the development of nuanced practice capable of recognizing and working with the ways highly vulnerable families ‘do family’, and the processes that support and inhibit professional interventions.     

Caregivers' perspectives on the SafeCare® programme: Implementing an evidence‐based intervention for child neglect

This qualitative study examined caregivers' experiences with SafeCare®, an evidence‐based programme that focuses on child neglect through modules on health, safety, and parenting. Shortly after completing SafeCare, 30 caregivers participated in a semi‐structured interview about their experiences with the programme. Overall, caregivers indicated that the programme helped with improvements in their parenting skills. Among the factors that contributed to a positive experience were the simplicity of language, the skills‐based approach, and the quality of the relationship with the SafeCare provider. Caregivers also noted several factors that made it difficult to fully benefit from the programme, including financial constraints, removal of their child from the home, and general distrust towards the child welfare system. Findings provide relevant information for SafeCare providers in terms of identifying areas that work well for caregivers completing the programme, as well as areas that might serve as impediments. Implications for contemporary child welfare practice are also considered.     

What social workers do in performing child protection work: evidence from research into face‐to‐face practice

Little research has been done into what social workers do in everyday child protection practice. This paper outlines the broad findings from an ethnographic study of face‐to‐face encounters between social workers, children and families, especially on home visits. The social work practice was found to be deeply investigative. Children's bedrooms were routinely inspected and were the most common place where they were seen alone. A high proportion of children were not seen on their own because they were too young and the majority of the time was spent working with parents and children together. Small amounts of time were spent with children on their own and some first encounters were so rushed that social workers did not even introduce themselves to the child. This arose from two key factors: firstly, organisational pressures from high workloads and the short timescales that social workers were expected to adhere to by managers and Government; secondly, practitioners had varying levels of communication skills, playfulness and comfort with getting close to children and skills at family work. Where these skills and relational capacities were present, social workers were found to have developed deep and meaningful relationships with some children and families, for whom it was apparent that therapeutic change had occurred.     

Children's and young people's participation within child welfare and child protection services: a state‐of‐the‐art review

This state‐of‐the‐art literature review, based on a literature search of multiple scientific bibliographic databases, aims to shed light on what is known about barriers and factors facilitating child participation within the child protection and child welfare services from both children's and social workers' perspectives. The personal relationship between the child and the social worker is mentioned as one of the most important facilitators for participation, although multiple barriers in creating this relationship are demonstrated by both children and case managers and social workers. In studies, children say they should always participate while social workers and case managers identify many situations where, according to them, participation is inappropriate. Professionals' objections to participation mainly stem from the socio‐cultural image of children as vulnerable and in need of adult protection, and a lack of understanding of what participation actually entails. Interventions to strengthen participation should be directed at making social workers and case managers aware that children are knowledgeable social actors.     

Dialogic literary gatherings and out‐of‐home child care: Creation of new meanings through classic literature

Research on out‐of‐home child care has revealed that foster care programmes focused on educational attainment and reading have the potential to improve the academic outcomes of children in care. However, no studies have examined which elements of these programmes positively benefit children's emotional well‐being. This article presents evidence of the positive effects of implementing a successful educational action, dialogic literary gatherings, in a children's residential care institution. A qualitative study using a communicative‐oriented methodology was conducted and involved five participant observations and eight daily life stories with children in out‐of‐home care in Catalonia (Spain). The children's reflections demonstrated that reading classic books, such as Dickens' Oliver Twist, deeply influenced their feelings and self‐conceptions and created new and exciting meaning in their lives.     

The effects of autonomy support and psychological capital on readiness for independent living through personal growth initiative among youth in out‐of‐home care

This study explored the effects of the factors on independent living readiness among youth under out‐of‐home care. Specifically, this study focused on the effects of caregivers' autonomy support and psychological capital on independent living readiness through personal growth initiative. A total of 215 youth who were expected to be discharged from caring institution within three years were gathered for the survey, and the final sample was 194 after excluding incomplete responses. Structural equation modeling with Mplus (version 7) was used to test research model and hypotheses in the study. Results showed that the research model was appropriated with several fit indices satisfied and that all the hypotheses were supported. Also, direct and indirect effects of independent variables were fully supported. However, the indirect effect of psychological capital was marginally significant. The results implicate that both caregiver's autonomy support and psychological capital are important for increasing personal growth initiative and that personal growth initiative served as a motivation to facilitating the readiness for independent living among children under institutional care.     

Parents' involvement in care order decisions: a cross‐country study of front‐line practice

This article examines parents' involvement in care order decision‐making in four countries at one particular point in the care order process, namely, when the child protection worker discusses with the parents his or her considerations regarding child removal. The countries represent different child welfare systems with Norway and Finland categorized as ‘family service systems’ and the USA as a ‘child protection system’, with England somewhere in between. The focus is on whether the forms and intensity of involvement are different in these four countries and whether the system orientation towards family services or child protection influences practice in the social welfare agencies with parents. Involvement is studied in terms of providing information to parents, collecting information from parents and ensuring inclusion in the decision‐making processes. A vignette method is employed in a survey with 768 responses from child protection workers in four countries. The findings do not show a consistent pattern of difference regarding parental involvement in care order preparations that align with the type of child welfare system in which staff work. The goal in each child welfare system is to include parents, but the precise ways in which it is carried out (or not) vary. Methodological suggestions are given for further studies.