Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis

Child maltreatment and behavioral health outcomes in child welfare: Exploring the roles of severity and polyvictimization

BACKGROUND

Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

PARTICIPANTS AND SETTING

Medical records of children with child welfare involvement with at least one behavioral health condition (i.e., mental, behavioral or neurodevelopmental disorder, ICD-10 F01-F99) between 1/1/2018-12/31/2021 were extracted from a large, academic hospital system.

METHODS

Behavioral health complexity was categorized as non-chronic, non-complex chronic, or complex chronic using the Pediatric Medical Complexity Algorithm. Partial proportional logistic regression models adjusted for age, sex, race/ethnicity, caregiver type, and physical health complexity generated odds of behavioral health complexity by maltreatment type (physical abuse, sexual abuse, neglect) and maltreatment combinations.

RESULTS

The analytic sample included 3992 participants (mean age 7.6 (Standard Deviation, 5.0) 44 % female, 29 % white, 32 % black, 22 % Hispanic). Participants who experienced physical abuse (Odds Ratio [OR]: 1.79, 95 % Confidence Interval [CI]: 1.10-2.91), or neglect (OR: 1.69, 95 % CI: 1.38-2.07) were more likely to have increasing behavioral health complexity versus those without maltreatment. Participants with both physical abuse and neglect were over twice as likely (OR: 2.44, 95 % CI: 1.88-3.16) to have increasing behavioral health complexity versus those who did not experience maltreatment.

CONCLUSION

Results emphasize the differential impacts of maltreatment and polyvictimization exposures on behavioral health complexity among children with child welfare involvement that can guide risk assessment and clinical care.

Grappling with Issues of Motherhood for Women with Schizophrenia

Despite the fact that most persons with schizophrenia find steady employment difficult to sustain, many women with this diagnosis embrace and fulfill the most difficult task of all-motherhood. The aim of this paper is to specify the challenges of motherhood in this population and review the treatment strategies needed to keep mothers and children safe, protecting health and fostering growth. The review addresses concerns that had been brought to the author's earlier attention during her clinical involvement with an outpatient clinic for women with psychosis. It is, thus, a non-systematic, narrative review of topic areas subjectively assessed as essential to "good enough" mothering in the context of schizophrenia. Questions explored are the stigma against motherhood in this population, mothers' painful choices, issues of contraception, abortion, child custody, foster care and kin placement of children, the effects of antipsychotics, specific perinatal delusional syndromes, and, finally, the availability of parental support. This review is intended for clinicians. Recommendations are that care providers work collaboratively with mothers, take note of their strengths as well as their failings, offer a wide array of family services, monitor households closely for safety and for treatment adherence, appreciating the many challenges women with schizophrenia face daily.

How do kinship and foster caregivers differ in their conceptualization of family connectedness?

BACKGROUND

In out-of-home care in Australia and internationally, there is an increasing preference to place children in kinship than foster care placements as it is assumed that kinship care promotes caregiver, family, and cultural connectedness. However, little research has examined whether and how the quality of these connections differ between kinship and foster care.

OBJECTIVE

We utilized qualitative methodology to provide a richer, strengths-based exploration of caregivers' perspectives on the caregiver-child relationship and other connections (i.e., family, culture) in kinship compared to foster care.

PARTICIPANTS AND SETTING

Sixty-six kinship (N = 31) and foster (N = 35) caregivers of 8- to 16-year-olds in Australia.

METHODS

Kinship and foster caregivers provided Five-Minute Speech Samples about their child and the caregiver-child relationship. Thematic analysis was used to explore the ways caregivers described family relationships and connectedness.

RESULTS

Results highlighted the value caregivers place on strong attachment relationships with their children and the skills that help them develop a safe haven for children. Caregiver groups also differed in their discussions of commitment to the child and family and cultural connectedness, with kinship caregivers more likely to emphasize the strengths and challenges of birth family relations and the importance of cultural connectedness than foster caregivers.

CONCLUSIONS

Our findings highlight the ways in which kinship and foster caregivers emphasize different aspects of family and cultural connectedness which can be used to inform policy and practice in an area currently lacking evidence.

Childhood Experiences of Alternative Care and Callousness/Unemotionality: A Conceptual Model, Scoping Review, and Research Agenda

Individuals with experiences of alternative care (AC; i.e., out-of-home care and institutional care) are at high risk for various mental health and relational problems stemming from exposure to serious attachment disruptions, loss, and complex trauma. Yet, despite the interpersonal context of their significant adversities, surprisingly there is scant research explicitly focusing on callousness/unemotionality (e.g., lack of guilt, callous disregard for others) in this population. This paper provides the first conceptual model for, and systematic scoping review of, callousness/unemotionality in children and young people with experiences of AC. In a comprehensive search of nine databases, 22 articles involving samples of participants in AC or with histories of AC, were identified for inclusion. The pattern of findings revealed that callous-unemotional and psychopathic traits are elevated in children and young people with AC experiences, and positively associated with AC. Moreover, results showed associations between these traits and various psychosocial correlates, most consistently with externalizing and internalizing problems and attachment-related problems. Only two intervention studies were located, one of which found benefits of training and supporting foster caregivers for reducing callous-unemotional traits. These findings are discussed with respect to gaps in the literature, future research directions, and trauma-informed practice to assess and treat callousness/unemotionality in children and young people with experiences of AC.

Out-of-home care characteristics associated with childhood educational underachievement, mental disorder, and police contacts in an Australian population sample

BACKGROUND

Children in out-of-home care (OOHC) are generally at increased risk of health and social adversities compared to their peers. However, the experiences of children in OOHC are not uniform and their associated health and social indices may vary in relation to characteristics of OOHC placements and child protection contact.

OBJECTIVE

To examine associations between a range of characteristics of OOHC placements and child protection contact (e.g., number, type, and age of placement) with educational underachievement, mental disorder, and police contact (as a victim, witness, or person of interest) in childhood.

PARTICIPANTS AND SETTING

Participants were Australian children drawn from the New South Wales Child Development Study cohort who had been placed in OOHC at least once between the ages of 0-13 years (n = 2082).

METHODS

Logistic regression was used to examine prospective associations of OOHC placement and child protection contact characteristics (type of carer, placement instability, duration and frequency of maltreatment, and amount of time in care) with educational underachievement, mental disorder diagnosis and any type of police contact.

RESULTS

Placements with foster carers, greater placement instability, longer and more frequent exposure to maltreatment, and longer time spent in care were each associated with greater likelihood of consequences in all domains of functioning.

CONCLUSIONS

Children with certain placement characteristics are at higher risk of adverse consequences and should be prioritised for support services. The magnitude of relationships was not uniform across different health and social indices, highlighting the need for holistic, multiagency approaches to support children placed in care.

Sources and Types of Social Supports and Their Association with Mental Health Symptoms and Life Satisfaction among Young Adults with a History of Out-of-Home Care

Young adults with a history of out-of-home care report poorer mental health and life satisfaction compared to non-care-experienced peers. Social support is a known protective factor for mental health. There is limited evidence, however, on the relationship between sources (e.g., family members) and types (e.g., information) of social support and mental health symptoms and life satisfaction in this population. Reporting cross-sectional survey data from 215 young adults aged 18–22 years with a history of out-of-home care, the current study conducted descriptive, bivariate, and linear regression analysis to examine the different sources and types of support young adults receive and their relation to mental health symptoms and life satisfaction. Participants had high levels of support from family members, friends, and other adults. Most participants had informational support, but less than half had consistent material support. Regression analyses demonstrated that having enough informational and material support were associated with fewer mental health symptoms. Having family support and material support were associated with greater life satisfaction. Further longitudinal research is needed to understand the trajectory between social supports and mental health functioning and life satisfaction.