Children's voices: the perceptions of children in foster care

Foster youth's placement preferences: The roles of kin, siblings, and age

BACKGROUND

Debates exist regarding whether foster youth should be asked about their placement preferences following removal, with only youth aged 12 years and older at times assumed legally competent to provide input.

OBJECTIVES

The present study evaluated whether placement-related factors known to predict youth's well-being also shape their placement preferences and whether preferences differ between youth below and above the age at which they are considered legally competent to provide input.

METHOD

Data (N = 1033, ages 6-17 years, 54 % female) were obtained from NSCAW-I. Youth were asked open- and closed-ended questions about their placement preferences.

RESULTS

Among youth removed for shorter periods, placement with kin was related to a greater preference for their current placement (RRR = 0.31, p < .001) and desire for permanency in that placement (OR = 1.95, p = .005) relative to youth placed with non-kin. However, youth removed for longer periods (e.g., a year) were similar in their desires for their current placement to be permanent regardless of whether they were living with kin or non-kin caregivers. Among younger youth, placement with siblings (RRR = 0.42, p = .015) was linked to a preference for their current placement. Racial match between youth and their non-kin caregiver was unrelated to their placement preferences.

CONCLUSIONS

Findings revealed that both younger and older youth's placement preferences were shaped by factors objectively linked to youth's well-being and thus align with best practices in placement decisions. The paper discusses the importance of asking youth as young as 6 years about their placement preferences and offers suggestions for social service and legal professionals regarding questioning strategies.

The Role of Kinship and Siblings in Young Children's Placement Preferences

Although considerable attention has been directed toward the most appropriate placement for children following removal from home due to maltreatment, very little of this attention has focused on children's stated preferences, particularly when children are young. Specifically, children below 12 years of age are often presumed incompetent to form reasoned judgments about their best interests in placement. This assumption, however, has rarely been tested directly. We surveyed 100 4- to 11-year-olds removed from home because of maltreatment about their placement preferences. Children were less likely to indicate they wanted to return home if they were placed with siblings or with kin, consistent with statutory placement preferences. These results suggest that young children may express more mature preferences than recognized by the law, and that there may be value in asking even relatively young children about with whom they would like to live following their removal from home as a result of maltreatment.

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

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

Neighborhood disorder and child behavioral problems among kinship children: Mediated by social support and moderated by race/ethnicity?

BACKGROUND

Children in kinship care may be placed in similar neighborhoods as their birth families, which are predominantly characterized as distressed neighborhoods with high poverty and crime rates, poor-quality housing conditions, and few social resources. Disordered neighborhoods are negatively correlated to social support, but this dynamic may vary by race or ethnicity. However, children's previously established attachment and social bonding may offset the negative effects of distressed neighborhoods on child behavioral health.

OBJECTIVES

This study examined the relation between neighborhood disorder and children's internalizing and externalizing problems among children in kinship care and tested caregivers' social support as a potential mediator. Moreover, this study examined if race/ethnicity moderated the pathway from neighborhood disorder to social support, and from social support to children's internalizing and externalizing problems.

PARTICIPANTS AND SETTING

This study used NSCAW II wave 3 data for a sample of children in kinship care.

METHODS

Univariate, bivariate, and moderated mediation analyses were conducted using STATA 15.

RESULTS

Neighborhood disorder was indirectly associated with children's internalizing and externalizing problems through a mediator of social support. No racial/ethnic differences were identified.

CONCLUSIONS

Implications for improving social support for kinship caregivers to ameliorate the effects of neighborhood disorder on children's behavioral health are discussed. Implementing effective neighborhood-level interventions could promote positive outcomes for children in kinship care.

Comparing Long-Term Placement Outcomes of Residential and Family Foster Care: A Meta-Analysis

This study presents findings from three separate meta-analyses investigating differences between children placed in residential care and in family foster care with regard to three outcomes: internalizing behaviors, externalizing behaviors, and perception of care. Based on publications from the last 20 years, a total of 23 studies were included. The total sample consisted of 13,630 children in care, with 7,469 from foster care and 6,161 from residential care. The results from this study indicated that children in foster care had consistently better experiences and less problems across the three outcomes as compared to children in residential care. Analyses did not reveal evidence of publication bias, and sensitivity analyses also suggested that results were not influenced by individual studies. Additionally, moderation analyses revealed that the differences between foster and residential care could vary depending on certain factors such as the publication year, the gross domestic product of the country, and the length of care. The implications of differences in outcomes between the two placements are discussed.

Household member substance problems and children's health in the United States

A sizable number of children are exposed to household member substance problems, an adverse childhood experience (ACE), yet little research uses a nationally representative sample of U.S. children to examine this association. We used newly released data from the 2016 National Survey of Children's Health (NSCH), a nationally representative sample of noninstitutionalized children in the United States, and logistic regression models to investigate the relationship between household member substance problems and 14 indicators of children's health. We find 9.0% of children in the United States have experienced household member substance problems. We also find children exposed to household member substance problems are more likely to have health problems than children not exposed to household member substance problems, but that most of these descriptive differences can be explained by household characteristics and other ACEs. Children exposed to household member substance problems are a vulnerable population. Given that household member substance problems are concentrated among socioeconomically disadvantaged children, children at a greater risk of health problems than their counterparts, this ACE may exacerbate existing socioeconomic inequalities in children's health.

The Role of Shared Decision-Making in Shaping Intent to Access Services for Adolescents in Protective Custody

Including children in protective custody (e.g., foster care) in legal decisions positively impacts their perceptions of the legal system, with giving youth a voice being particularly important. Studies have primarily focused on including young people in legal processes; however, for adolescents in protective custody, decisions about living arrangements, education, and long-term planning are made outside the courtroom, with ramifications for young people and their perceptions of both legal and child protection systems. This study looks at such decision making using existing data from 151 adolescents who were ages 16-20 and had been in child welfare protective custody for at least 12 months. During in-person interviews we assessed their desired amount of involvement in a recent decision and their perceptions of their actual involvement. Youth named other individuals involved in decision-making. Data were coded and analysed to identify discrepancies in young people's perceptions of desired and actual levels of involvement. Results indicate that while the majority of adolescents (96%) are participating in decision-making, they generally desire more involvement in decisions made (64%). Only 7% of youth reported that their level of personal involvement and the involvement of others matched what they desired. The most common individuals identified in a decision made were child protection workers, legal professionals, and caregivers or family members. These findings enhance the existing literature by highlighting the unique issues related to giving young people in protective custody a voice, and provide an empirical foundation for guiding policies around who to involve in every-day decisions made for young people preparing for emancipation from protective custody.

Parenting Influences on Adolescent Sexual Risk-taking: Differences by Child Welfare Placement Status

Positive parenting behaviors and parent-child relationships reduce sexual risk-taking among youth, but these associations may differ for adolescents in the child welfare system. Using two cohorts of a national longitudinal dataset of youth, the authors employed linear probability modeling to investigate associations of caregiver-child closeness, monitoring, and dating communication with youth's sexual initiation, sexual partners, and unprotected intercourse over the subsequent 12 months. Moderation by placement status (non-relative foster care, kinship care, or birth parent care) was then tested. Closeness was negatively associated with risk-taking. Monitoring was positively associated with new sexual partners among youth in birth parent care, but negatively associated with new partners for youth in out-of-home care. Dating communication was positively associated with sexual initiation and additional sexual partners, and with unsafe sex among non-relative foster youth. In sum, caregiver relationships and parenting behaviors may matter differently for maltreated and foster youths' sexual risk-taking.

Suicidal because I don't feel connected or vice versa? A longitudinal study of suicidal ideation and connectedness among child welfare youth

Suicide is a major public health problem among youth involved with the child welfare system. Although social connectedness rests at the core of many prevention approaches, we know little about this relationship over time in this vulnerable population. This study tested the hypotheses that inverse relationships would exist between connectedness in three social domains (i.e., caregiver, peers, and school) and suicidal ideation over time. The current study used baseline and 18-month follow-up data from 995 youth who participated in the National Survey of Child and Adolescent Well-Being (NSCAW II)-a nationally representative study of children and families investigated by a child welfare agency conducted from 2008 to 2011. A cross-lagged path model was used for the analysis. There were significant main effects of suicidal ideation at Time 1 on peer connectedness (β= -.17, p < .01) and caregiver connectedness (β= -.12, p < .05) at Time 2, but not on school connectedness (β= -.05, ns). There was no main effect of any of the connectedness variables at Time 1 on suicidal ideation at Time 2. Screening for suicidal ideation is important for managing immediate risk but our findings suggest that such ideation also foreshadows disconnectedness from their primary caregiver and peers in the future. These findings demonstrate that there is clinical value in engaging child-welfare-involved youth and their social systems about how their suicide-related experiences may affect vital social ties. Therefore, there may be merit to designing and exploring the effects of pilot programming focused on mitigating social distancing that suicide-related experiences engender.

Substance Use Outcomes for Hispanic Emerging Adults Exposed to Incarceration of a Household Member during Childhood

This study investigates whether Hispanic emerging adults exposed to household incarceration before age 18 report higher rates of past 30-day cigarette, alcohol, binge drinking, marijuana use, and negative substance use consequences, relative to participants not exposed to incarceration of a household member. Respondents were matched on key characteristics to create balanced groups of exposed and nonexposed respondents. Negative binomial regression models assessed primary research questions. There were significant long-term associations between household incarceration and the frequency of past 30-day binge drinking, marijuana use, and number of negative substance use consequences. Policies and health programs addressing household incarceration may be a promising prevention approach to reduce negative substance use outcomes among Hispanic emerging adults.

Validation of a Measure of Foster Home Integration for Foster Youth

OBJECTIVES

This article introduces a youth-reported measure (Essential Youth Experiences [EYE]) developed to assess the experiences of foster youth in their home environment and their critical relationships across a number of service systems. Empirically, the article reports on the psychometric properties of a 9-item scale within the EYE that measures the construct of positive home integration (PHI).

METHODS

The EYE was administered to 328 preadolescent and adolescent youth (164 sibling dyads) enrolled in a larger randomized clinical trial.

RESULTS

Correlational analysis suggests that the PHI Scale shows good psychometric properties and strong current and predictive validity.

CONCLUSION

The PHI is a reliable and valid scale that measures youth perspectives of inclusion in the foster home and relationships with their foster care provider. This scale quickly gathers youth perspectives and differentiates between youth who have more versus less significant needs. Implications for research and social work practice are discussed.

Concurrent child history and contextual predictors of children's internalizing and externalizing behavior problems in foster care

This study contributes to current research on the behavior problems of children in foster care by analyzing a more comprehensive set of concurrent child history and contextual predictors. Kinship home status and sibling status (i.e., whether the sibling was a biological sibling to the foster child) were evaluated as moderators of significant associations. Data were collected at the baseline of a foster parent training intervention program prior to any intervention services using parent phone interviews (N= 310, 51.6% male, M age = 7.57 years). Two linear hierarchical regressions were used to evaluate each set of predictors' association with behavior problems as well as each individual predictor's contribution. Results indicated that as a set, the contextual variables predicted a significant and unique amount of variability in the child's internalizing and externalizing behavior scores, but the child history variables did not. Specifically, the child's placement in a non-kinship home, being in a non-ethnically matched child-parent pair, higher parent stress scores, a greater number of prior group home placements, and higher internalizing behavior scores for the child predicted higher child externalizing scores. Higher parent stress scores, higher focal sibling externalizing behavior scores, and higher externalizing behavior scores for the child predicted higher internalizing scores for the child. The association between focal sibling externalizing behavior scores and child internalizing scores was moderated by kinship home status, such that there was a stronger association between the focal sibling's externalizing score and the child's internalizing score if the child was in a kinship compared to a non-kinship home. Implications for intervention services are discussed, particularly the importance of assessing the child's foster home environment when addressing the child's behavior problems.

Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey

Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011-2012 National Survey of Children's Health (NSCH), a nationally representative sample of non-institutionalized children ages 0-17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children's health and wellbeing throughout the life course.

The impact of changing neighborhoods, switching schools, and experiencing relationship disruption on children's adjustment to a new placement in foster care

When children enter a new foster care placement they may experience several different transitions. Not only will a child move in with a new family, he or she may move to a different neighborhood, change schools, lose contact with old friends, be placed apart from one or more siblings, and have limited contact with his or her biological parents. The current study examined the impact of these transitions on foster children's adjustment to a new placement in out-of-home care. The sample consisted of 152 youth ages 6-17.5 who participated in the second National Survey of Child and Adolescent Well-Being (NSCAW II) study and who were residing with relative or non-relative foster families at the time of the Wave I interview. During the Wave I interview, youth were asked to report on the types of transitions they experienced when they moved into their current placement. Linear and Poisson regressions were used to estimate the effect of the transitions on youths' relationships with their new families, mental health, relationships with peers at school, and school engagement. The results showed that youth whose biological mothers contacted them more than once a month had more symptoms of mental health problems than youth who had less contact with their biological mothers. In contrast, changing schools had a positive impact on youths' mental health, and youth who were separated from siblings were more likely to get along well with their school peers. Implications for improving youth's adjustment to new foster care placements are discussed.

Comportamentos Pró-Sociais de Adolescentes em Acolhimento Institucional

RESUMO Realizou-se um levantamento de indicadores de comportamentos pró-sociais em adolescentes acolhidos. A pesquisa foi realizada com 61 adolescentes (11 a 18 anos; 34 meninas e 27 meninos), que viviam em instituições de acolhimento e foram avaliados por meio da Escala de Medida de Pró-Socialidade (EMPA). A análise dos resultados foi feita por subgrupos: idade (11-14 anos/15-18 anos), sexo e tempo de acolhimento (até dois anos e mais de dois anos). Resultados indicaram tendência a comportamentos pró-sociais de cuidado, principalmente, nos adolescentes com menos tempo de institucionalização. Meninas referiram mais comportamentos pró-sociais do que os meninos. Os participantes indicaram tendência à dificuldade de empatia e de partilha de objetos pessoais e de valor.

Exploring children's perspectives of engagement with their carers using factor analysis

Positive engagement between a child and carer in out-of-home care is understood to have long-term benefits for children who have experienced abuse or neglect. This study analysed data from the 'Views of Children and Young People in Foster Care 2009' survey of 937 children in out-of-home care in Queensland, Australia, to identify factors that supported or hindered engagement between a child and carer. Exploratory and confirmatory factor analysis and structural regression were used. Findings suggest that children's engagement with their carer is influenced by a range of internal and external factors including child characteristics, the care experience, contact with biological parents, and placement trajectory. Child engagement is important because it is central to positive outcomes such as placement stability in out-of-home care. Implications for policy and practice include the need for a structural response that supports building and maintaining positive child-carer relationships.

Foster home placements and the probability of family reunification: Does licensing matter?

The concept of foster care has been widely studied in child welfare. The literature is well developed with regard to the risk of initial placement, length of stay in care, placement stability, exits to permanency, and emancipation. Yet, the literature is woefully underdeveloped when it comes to understanding if variations in the types and characteristics of foster homes impact important child welfare outcomes. The current study utilizes entry cohorts pulled from statewide administrative data (N=17,960) to investigate the association between types of foster care and the probability of reunification. We focus specifically on the licensing status of foster homes. Reflecting federal benchmarks, we examined the odds of reunification at one- and two-year intervals. Propensity score analysis was used to reduce selection bias. Adjusted logistic regression models revealed that youth placed in licensed relative care (LRC) homes were the least likely to achieve reunification compared with youth placed in licensed non-relative care (LNC) homes and unlicensed relative care (URC) homes. Conversely, youth placed in URC homes were more likely to achieve reunification as compared with youth placed in LRC and LNC homes. These findings will help states to efficiently target scarce resources to specific types of foster homes that may be impacting federal reunification benchmarks.

Clinical work with people affected by public care or adoption

Most individuals who have lived in foster homes, residential care or adoptive families for substantial periods (‘people affected by public care or adoption’) show normal psychological adjustment as adults, although rates of mental disorders, hospital admission and suicide are increased. Research focusing on the experiences of this group of people can help professionals better understand their behaviour and attitude towards help. Psychiatric symptoms can be multifaceted, including complex trauma presentations. The specific mental health needs of this population are increasingly being recognised in child and adolescent mental health services but less so in adult services. In this article we describe life experiences of people affected by public care or adoption, examine the lifelong impact of these experiences on mental health and functioning, and offer practical suggestions for clinical work with them.

Maltreatment type and behaviors: does listening matter?

This article presents an exploratory assessment of whether children's perceptions of caseworker support (e.g. feeling listened to) moderates the relationship between the type of maltreatment and problematic behaviors. Relying on data collected for the National Survey of Child and Adolescent Well-Being (NSCAW I), this research measures how often children felt listened to by their caseworkers and the effect on the relationship between two types of maltreatment (e.g. physical abuse and neglect) and problematic child behaviors. Results indicate that whereas children reported feeling listened to most of the time, there are significant differences in the probabilities of problematic behavior scores between physically abused and neglected children according to how often they felt listened to. With the exception of those children who felt listened to all of the time, physically abused children have a higher probability of problematic behaviors than neglected children. Comparisons between the two maltreatment types indicate a greater impact of listening on physically abused children across the continuum of feeling listened to (e.g. never to all of the time), than for neglected children, except for at the highest level of listening, as results indicate a small, but significant difference indicating neglected children are more positively impacted by listening than physically abused kids. Implications for practice are that children's perceptions of support from caseworkers may influence behavioral outcomes differently according to maltreatment type. Additionally, these findings encourage the inclusion of children's perspectives regarding the relationships they have with caseworkers.

In search of connection: The foster youth and caregiver relationship

Placement instability is an ongoing challenge for the 125,000 foster youth aged 14 - 18 that are living in foster care, with youth living in approximately 3 placements before aging out of the system. Despite the importance caring adult relationships can play in promoting positive youth development and resiliency, there has been limited inquiry into the characteristics of the foster youth and caregiver relationship. The goal of this paper is to provide a descriptive account of the foster youth and caregiver relationship, and explore what qualities and experiences foster youth desire from their caregivers. Qualitative data were gathered from 9 focus groups. Data were analyzed using thematic content analysis approaches. Foster youth, caregivers, and child welfare staff described relationships lacking in formative bonds and connection, where youth didn't "fit in", and chaotic homes marked by reactivity and judgment. Characteristics of supportive foster homes include a sense of belonging, structure, guidance, and consistency. This research underscores the important role positive relationships can play in foster youth's feelings of well-being and points to the need for foster parent training to include tangible strategies to develop stronger bonds.

Intervening to Improve Outcomes for Siblings in Foster Care: Conceptual, Substantive, and Methodological Dimensions of a Prevention Science Framework

In recent years, the child welfare field has devoted significant attention to siblings in foster care. Policymakers and practitioners have supported efforts to connect siblings via shared foster placements and visitation while researchers have focused on illuminating the empirical foundations of sibling placement and sibling intervention in child welfare. The current paper synthesizes literature on sibling relationship development and sibling issues in child welfare in the service of presenting a typology of sibling-focused interventions for use with foster youth. The paper provides two examples of current intervention research studies focused on enhancing sibling developmental processes and understanding their connection to child welfare outcomes. The paper concludes by presenting an emerging agenda informing policy, practice, and research on siblings in foster care.

Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being.However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

OBJECTIVES

To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.

SEARCH METHODS

We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index-Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.

SELECTION CRITERIA

Controlled experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non-kinship foster care for child welfare outcomes in the domains of well-being, permanency, or safety.

DATA COLLECTION AND ANALYSIS

Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies.Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta-analysis with the results presented in written and graphical forms.

MAIN RESULTS

One-hundred-and-two quasi-experimental studies,with 666,615 children are included in this review.The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attritionbias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size -0.33, 95% confidence interval (CI) -0.49 to -0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well-being (OR 0.50,95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non-kinship foster care. For permanency, there was no difference on re unification rates, although children in non-kinship foster care were more likely to be adopted(OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non-kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).

AUTHORS' CONCLUSIONS

This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.

Estimating the "impact" of out-of-home placement on child well-being: approaching the problem of selection bias

This study used data on 2,453 children aged 4-17 from the National Survey of Child and Adolescent Well-Being and 5 analytic methods that adjust for selection factors to estimate the impact of out-of-home placement on children's cognitive skills and behavior problems. Methods included ordinary least squares (OLS) regressions and residualized change, simple change, difference-in-difference, and fixed effects models. Models were estimated using the full sample and a matched sample generated by propensity scoring. Although results from the unmatched OLS and residualized change models suggested that out-of-home placement is associated with increased child behavior problems, estimates from models that more rigorously adjust for selection bias indicated that placement has little effect on children's cognitive skills or behavior problems.

Mental health treatment of child abuse and neglect: the promise of evidence-based practice

In 2006, 3.6 million children in the United States received a child protective services' investigation and 905,000 children (about one-quarter of those investigated) were found to have been abused or neglected. Children who have been maltreated are at risk for experiencing a host of mental health problems, including depression, posttraumatic stress, dissociation, reactive attachment, low self-esteem, social problems, suicidal behavior, aggression, conduct disorder, attention-deficit hyperactivity disorder (ADHD) and problem behaviors, including delinquency, risky sexual behavior and substance use. Given the high rate of mental health problems, it is not surprising that maltreated youth are in need of mental health services. Unfortunately, only a fraction of these children and adolescents receive services. Recently, several evidence-based practices have been rigorously tested and are demonstrating efficacy in reducing mental health problems associated with maltreatment. This article details these developments.

Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being. However, children in out-of-home placements typically display more educational, behavioral, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

OBJECTIVES

To evaluate the effect of kinship care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.

SEARCH STRATEGY

The following databases were searched to Februrary 2007: CENTRAL, MEDLINE, C2- Specter, Sociological Abstracts, Social Work Abstracts, SSCI, Family and Society Studies Worldwide, ERIC, PsycINFO, ISI Proceedings, CINAHL, ASSIA, and Dissertation Abstracts International. Relevant social work journals and reference lists of published literature reviews were handsearched, and authors contacted.

SELECTION CRITERIA

Randomized experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care, were compared with children placed in non-kinship foster care on child welfare outcomes in the domains of well-being, permanency, or safety.

DATA COLLECTION AND ANALYSIS

Reviewers independently read the titles and abstracts identified in the search and selected appropriate studies. Reviewers assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, outcome data were extracted and entered into REVMAN for meta-analysis with the results presented in written and graphical forms.

MAIN RESULTS

Sixty two quasi-experimental studies were included in this review. Data suggest that children in kinship foster care experience better behavioral development, mental health functioning, and placement stability than do children in non-kinship foster care. Although there was no difference on reunification rates, children in non-kinship foster care were more likely to be adopted while children in kinship foster care were more likely to be in guardianship. Lastly, children in non-kinship foster care were more likely to utilize mental health services.

AUTHORS' CONCLUSIONS

This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being. However, children in out-of-home placements typically display more educational, behavioral, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

OBJECTIVES

To evaluate the effect of kinship care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.

SEARCH STRATEGY

The following databases were searched to Februrary 2007: CENTRAL, MEDLINE, C2- Specter, Sociological Abstracts, Social Work Abstracts, SSCI, Family and Society Studies Worldwide, ERIC, PsycINFO, ISI Proceedings, CINAHL, ASSIA, and Dissertation Abstracts International. Relevant social work journals and reference lists of published literature reviews were handsearched, and authors contacted.

SELECTION CRITERIA

Randomized experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care, were compared with children placed in non-kinship foster care on child welfare outcomes in the domains of well-being, permanency, or safety.

DATA COLLECTION AND ANALYSIS

Reviewers independently read the titles and abstracts identified in the search and selected appropriate studies. Reviewers assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, outcome data were extracted and entered into REVMAN for meta-analysis with the results presented in written and graphical forms.

MAIN RESULTS

Sixty two quasi-experimental studies were included in this review. Data suggest that children in kinship foster care experience better behavioral development, mental health functioning, and placement stability than do children in non-kinship foster care. Although there was no difference on reunification rates, children in non-kinship foster care were more likely to be adopted while children in kinship foster care were more likely to be in guardianship. Lastly, children in non-kinship foster care were more likely to utilize mental health services.

AUTHORS' CONCLUSIONS

This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Impact of kinship care on behavioral well-being for children in out-of-home care

OBJECTIVE

To examine the influence of kinship care on behavioral problems after 18 and 36 months in out-of-home care. Growth in placement of children with kin has occurred despite conflicting evidence regarding its benefits compared with foster care.

DESIGN

Prospective cohort study.

SETTING

National Survey of Child and Adolescent Well-Being, October 1999 to March 2004.

PARTICIPANTS

One thousand three hundred nine children entering out-of-home care following a maltreatment report.

MAIN EXPOSURE

Kinship vs general foster care.

MAIN OUTCOME MEASURES

Predicted probabilities of behavioral problems derived from Child Behavior Checklist scores.

RESULTS

Fifty percent of children started in kinship care and 17% of children who started in foster care later moved to kinship care. Children in kinship care were at lower risk at baseline and less likely to have unstable placements than children in foster care. Controlling for a child's baseline risk, placement stability, and attempted reunification to birth family, the estimate of behavioral problems at 36 months was 32% (95% confidence interval, 25%-38%) if children in the cohort were assigned to early kinship care and 46% (95% confidence interval, 41%-52%) if children were assigned to foster care only (P = .003). Children who moved to kinship care after a significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset.

CONCLUSIONS

Children placed into kinship care had fewer behavioral problems 3 years after placement than children who were placed into foster care. This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care.

Fostering ecologic perspectives in child psychiatry

In this article, the authors seek to instill a readiness and enthusiasm for appreciating the many-faceted influences in the lives and struggles of developing children and their families. A framework for clinical investigation is proposed that draws from ecologic, ethnographic and attributional perspectives and therein augments and extends contemporary notions of culturally competent care. This framework can be used to help illuminate the culturally-relevant geography of the child's world such as: 1) health care and social welfare zones, 2) child activity zones, and 3) cultural and religious spheres of influence. Training tools and strategies are offered for building insightful, respectful and convivial co-investigator partnerships with patients and their families.