Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

Delivery and Impact of Foster Parent Training: Similarities and Differences for Relative and Non-Relative Foster Parents

Literature on the delivery and impact of foster parent training, such as the Nurturing Parenting Program (NPP), is sparse, particularly for relative foster parents. This study investigates (a) how NPP referral, initiation, and completion rates vary between relative and non-relative foster parents, (b) reasons for not initiating NPP, and (c) changes in parenting attitudes and behaviors for relative and non-relative foster parents after participating in NPP. The study analyzed data from the Illinois Birth to Three (IB3) study for 722 relative and 397 non-relative foster parents of children ages three and younger. Relative and non-relative foster parents had similar NPP referral and initiation rates, but relatives had significantly lower completion rates. Content analysis of case notes for 498 cases showed that relative foster parents more frequently noted barriers (e.g., childcare, transportation) to NPP initiation. Among NPP completers, both groups reported similar levels of improvements in parenting attitudes and behaviors at the end of NPP, but a pattern of lower scores was observed for relative foster parents. The findings suggest a need for more support for foster parents, particularly relative foster parents.

Systematic Review of the Evaluation of Foster Care Programs

OBJETIVE

The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians.

METHOD

The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions.

RESULTS

A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified.

CONCLUSIONS

(1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

Placement disruption of children with disabilities in foster care

PURPOSE

To investigate and describe available data on children with disabilities in the United States foster care system and examine placement disruptions.

DESIGN

This quantitative descriptive study was a secondary data analysis of the Adoption and Foster Care Analysis and Reporting System (AFCARS) and included 680,611 children.

METHODS

Descriptive and regression analyses were conducted.

FINDINGS

Of 680,611 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis, requiring additional or specialized care. Children with disabilities in foster care (CDFC) had a mean of 4.0 disruptions-significantly higher than the mean 2.37 disruptions among those without a disability (p < .001, d = 0.51). CDFC spent an average of 915 days in foster care compared to 514 days for children without a disability (p < .001, d = 0.59). Predictive risk factors for disruptions were increased child age, race (American Indian or Black), and increased foster parent age. Protective factors against disruptions included married foster parents and a child being placed outside of the child's initial state of residence.

CONCLUSIONS

CDFC have significantly more disruptions and longer stays in foster care. While risk and protective factors affect all foster children similarly, they have significantly greater effect on foster children with disabilities.

PRACTICE IMPLICATIONS

Increased disruptions compound the vulnerability of CDFC as relationships and support systems are broken. Understanding the extent to which childhood disabilities play a role allows school nurses, healthcare providers, and child advocates to better design interventions to improve lifelong health outcomes.

A meta-analytic review of parenting interventions in foster care and adoption

Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.

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.

Foster and Adoptive Parent Perspectives on Needs and Services: a Mixed Methods Study

Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children's behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.

Longitudinal Relationships Between Foster Children’s Mental Health Problems and Parental Stress in Foster Mothers and Fathers

Abstract. This paper focuses on the longitudinal relationships between foster children’s mental health problems and parental stress across a 1-year interval with three measurements. A sample of 94 foster children and a comparison group of 157 biological children and their families participated in this study. The age of the children was between 2 and 7 years. At the initial assessment, the foster children had been in their foster families since 2–24 months. Based on Child Behavior Checklist (CBCL) scores, the results indicated increased internalizing and externalizing mental health problems in the foster children group. Both mental health scores remained rather stable across the longitudinal assessments in foster as well as in biological children. Internalizing as well as externalizing scores were substantially correlated with parental stress in both samples. Moreover, changes in mental health scores were associated with changes in parental stress. However, cross-lagged panel analyses showed no clear pattern of temporal relationships between children’s mental health scores and parental stress. Implications as well as strengths and limitations of the current study are addressed in the Discussion section.

Temperamental sensitivity to early maltreatment and later family cohesion for externalizing behaviors in youth adopted from foster care

Children in foster care frequently have histories of physical/sexual abuse and neglect, increasing their risk for externalizing behaviors (EB; e.g., aggression). According to the differential susceptibility theory, children with reactive temperaments (e.g., negative emotionality) may be particularly vulnerable to early maltreatment, but may also benefit the most from environmental enrichment such as family cohesion. In a high-risk longitudinal sample of 82 children adopted from foster care in Los Angeles County from 1996 and 2001, we examined predictions of EB from childhood to adolescence/young adulthood from temperament, preadoption maltreatment, and adoptive family cohesion. Overall, results from generalized linear models and generalized estimating equations (GEE) did not support differential susceptibility theory - specifically, youth with early reactive temperament did not exhibit heightened sensitivity to maltreatment nor to later adoptive family cohesion. Instead, reactive temperament was associated with higher EB at initial adoptive placement and escalating EB across childhood, controlling for age, gender, race-ethnicity, preadoption maltreatment, and adoptive family cohesion. Preadoption maltreatment history was unrelated to baseline EB, although sexual abuse history predicted escalating childhood EB post-adoption, whereas exposure to family violence (e.g., domestic violence) inversely predicted EB over time. By late adolescence/young adulthood 11-15 years post-adoption, rates of arrest and substance use in this sample were relatively comparable to normative populations of youth, although older age of adoption predicted more substance use in late adolescence/young adulthood. Findings highlight early reactive temperament and preadoption maltreatment as important risk factors to target for ameliorating patterns of EB growth in the first few years of adoption.

Foster home integration as a temporal indicator of relational well-being

This study sought to identify factors that contribute to the relational well-being of youth in substitute care. Using data from the [BLIND] study, youth responded to a 9-item measure of positive home integration, a scale designed to assess the relational experiences of youth to their caregivers and their integration into the foster home. Data were collected from youth in six month intervals, for an 18-month period of time. Latent growth curve modeling procedures were employed to determine if child, family, and case characteristics influenced youth's home integration trajectories. Results suggest stability in youth reports of home integration over time; however, children who were older at the time of study enrollment and youth who experienced placement changes during the period of observation experienced decreased home integration during the 18-month period. Results suggest youth's perspectives of home integration may in part be a function of the child's developmental stage and their experiences with foster care placement instability. Implications for practice and future research are discussed.

Permanency and Safety Among Children in Foster Family and Kinship Care: A Scoping Review

Over the past 25 years, kinship care placements have risen dramatically, such that when a child enters into care, child welfare agencies must first attempt to identify safe living arrangements with relatives or individuals known to the child before searching for alternatives. Despite the growing emphasis on kinship care, little is known about its impact on child outcomes in comparison to other placement types (e.g., foster family). Therefore, the aim of this scoping review was to evaluate quantitative research on children in out-of-home care from 2007 to 2014 with regard to the following outcomes: (1) permanency (i.e., reunification, reentry, placement stability, and adoption/guardianship) and (2) safety (e.g., additional reports to child welfare). Based on these objectives, the review identified 54 studies that examined permanency and safety among children in two major placement types, namely foster family and kinship care. Across studies, children in kinship care experienced greater permanency in terms of a lower rate of reentry, greater placement stability, and more guardianship placements in comparison to children living with foster families. Children in kinship care, however, had lower rates of adoption and reunification. The findings also indicated that differences in these variables diminish over time. Findings for safety outcomes were mixed. Study methodological limitations and recommendations for future research are considered.

The Impact of Foster Parent Training on Parenting Skills and Child Disruptive Behavior

Children in foster care are at risk for behavioral and emotional problems that require higher levels of care than other children. To meet these needs and reduce placement disruptions, foster parents require effective parenting skills. Although a number of training models have been evaluated, the findings on the efficacy of foster parent training (FPT) are mixed. We conducted a meta-analysis of the FPT outcome research from 1984 to 2014 to develop a clearer understanding of the impact of such trainings. Fifteen samples (16 studies) were identified that investigated the impact of FPT on self-reported parenting skills and knowledge and child problem behaviors. The mean effect size for child disruptive behavior using a random effects model was small but significant at -.20 (95% confidence interval [CI] = [-.39, -.01], Z = 2.05, p < .05), suggesting that, on average, foster parents who were involved in the trainings reported fewer child behavior problems than parents who did not receive the training. The mean effect size for parenting was moderate and significant at .52 (95% CI = [.22, .82], Z = 3.38, p < .05), indicating that, on average, parents in the treatment groups reported higher levels of skills and knowledge following training than did those in the control group. While these results are promising, more research is necessary to investigate the inconsistency in effect sizes across studies.

Foster care placement change: The role of family dynamics and household composition

Sibling co-placement and kinship care have each been shown to protect against the occurrence of placement change for youth in substitute care. However, little is known about the effects of different combinations of sibling placement and relative caregiver status on placement change. Nor does the field fully understand how family dynamics may differ in these households. Utilizing data from the Supporting Siblings in Foster Care study, this paper examines family dynamics across four typologies of living composition, and tests the effects of living composition membership on the odds of experiencing a placement change over an 18-month period of time. Findings suggest that across living composition typologies, children who were placed separately from their siblings in non-relative care were more likely to be older, have more extensive placement histories, and experience more placement changes both prior to and during the study than were children in other living composition groups. Family living composition was found to influence the occurrence of placement change. Specifically, children co-placed in kinship care were least likely to experience movement; however, sibling co-placement in non-relative care was also protective. Results reveal the need to conduct additional research into the experiences of children in different family living arrangements, and tailor case management services and supports to children in substitute care accordingly. Implications and future directions are discussed.

Factors Associated with Adoption and Adoption Intentions of Nonparental Caregivers

Data from the 2011-2012 National Survey of Children's Health and the 2013 National Survey of Children in Nonparental Care were used to fit a multinomial logistic model comparing three groups to those who never considered adoption: those who ever considered, but are not currently planning adoption; those planning adoption; and those who adopted. Adoption may be more likely when the caregiver is a nonkin foster parent, a foster care agency was involved, and/or financial assistance is available. Those with plans to adopt but who have not adopted may face adoption barriers such as extreme poverty, lower education and being unmarried.