Kinship care for the safety, permanency, and well‐being of children removed from the home for maltreatment
Abstract
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 attrition bias, 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 reunification 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.
PICOs
Plain language summary
Kinship care for the safety, permanency, and well‐being of maltreated children
Child abuse and neglect are common problems across the world that result in negative consequences for children, families, and communities. Children who have been abused or neglected are often removed from the home and placed in residential care or with other families, including foster families. Foster care was traditionally provided by people that social workers recruited from the community specifically to provide care for children whose parents could not look after them. Typically they were not related to the children placed with them, and did not know them before the placement was arranged. In recent years many societies have introduced policies that favour placing children who cannot live at home with other members of their family or with friends of the family. This is known as 'kinship care' or 'families and friends care'. We do not know what type of out‐of‐home care (placement) is best for children.
This review was designed to help find out if research studies could tell us which kind of placement is best. We found 102 studies with 666,615 children that met the methodological standards we considered acceptable. Wherever possible we combined the data from studies looking at the same outcome for children, in order to be more confident about what the research was telling us. Current best evidence suggests that children in kinship foster care may do better than children in traditional foster care in terms of their behavioural development, mental health functioning, and placement stability. Children in traditional foster care placements may do better with regard to achieving adoption and accessing services they may need. There were no negative effects experienced by children who were placed in kinship care. The major limitation of this systematic review is that the quality of research on kinship care is weakened by the poor methods of the included studies. Implications for practice and future research are discussed.
Authors' conclusions
Background
Description of the condition
Every year a large number of children around the world are removed from their homes because they are abused, neglected, or otherwise maltreated. For example, there were 408,425 children in foster care in the United States as of September 2010 (USDHHS 2011a), 64,400 looked‐after children in England as of March 2010 (DFE 2010), 35,895 children in out‐of‐home care in Australia as of 2010 (AIHW 2012), 15,892 looked‐after children in Scotland as of July 2010 (Scottish Government 2011), 8408 children in out‐of‐home therapeutic placement in Israel as of 2010 (CBS 2011), 5419 looked‐after children in Wales as of March 2011 (NAW 2011), and 7270 looked‐after children in state custody in Norway as of 2011 (Statistics Norway 2011). Except for the United States which has experienced a 20% decrease in the number of children in foster care from 2005, the other countries all experienced an increase in the number of children placed in foster care. Specifically, England had a 5% increase from 2005, Israel had an 8% increase, Wales had a 16% increase, Norway had a 21% increase, Scotland had a 23% increase, and Australia had a 50% increase from 2005.
The main reasons for the removal of children in the United States are neglect, physical abuse, sexual abuse, psychological maltreatment, abandonment, threats of harm, and drug addiction (USDHHS 2011b). Abuse and neglect are the most prevalent causes of children being removed from the home in other countries as well (e.g., Wales) (NAW 2011).
Internationally, child welfare systems are accountable for the safety, permanency, and well‐being of children in their care. For children removed from the home, child welfare professionals are responsible for placing them in out‐of‐home settings that will facilitate these outcomes. Specifically, the primary placement options are traditional foster care, kinship care, institutional care, and group homes (AIHW 2012; USDHHS 2011a). Children in out‐of‐home placements typically display more educational, behavioural, physical, and psychological problems than do their peers (Gleeson 1999), although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system. In addition to experiencing poor adult outcomes, these children are at risk for drifting in out‐of‐home care until, in some cases, they 'graduate' from the system because of age (Zuravin 1999).
Description of the intervention
Kinship Care
Kinship care is broadly defined as, "the full‐time nurturing and protection of children who must be separated from their parents, by relatives, members of their tribes or clans, godparents, stepparents, or other adults who have a kinship bond with a child" (CWLA 1994, p. 2). This is contrasted with traditional foster care or non‐kinship foster care, which is the placement of children removed from the home with unrelated foster parents. Kinship care is known by many other names around the world, including family and friends care in the United Kingdom, kith and kin care in Australia, and kinship foster care in the United States. For this review, kinship care will refer to kinship foster care placements, while foster care will refer to non‐kinship foster care placements.
There are several variations of kinship care, including formal, informal, and private placements. Formal kinship care is a legal arrangement in which a child welfare agency has custody of a child (Ayala‐Quillen 1998). Informal kinship care is when a child welfare agency assists in the placement of a child but does not seek custody (Geen 2000). Private kinship care is a voluntary arrangement between the birth parents and family members without the involvement of a child welfare agency (Dubowitz 1994a).
The most commonly perceived benefits are that kinship care "enables children to live with persons whom they know and trust, reduces the trauma children may experience when they are placed with persons who are initially unknown to them, and reinforces children's sense of identity and self esteem which flows from their family history and culture" (Wilson 1996, p. 387). The primary aims of kinship placements are family preservation, in which the permanency goal is reunification with birth parents, and substitute care, in which kinship care is considered to be a long‐term arrangement when restoration is not possible or the permanency goal is adoption or guardianship by kin caregivers (Scannapieco 1999). Kinship care is also considered to be the least restrictive (Scannapieco 1999) and safest setting (Gleeson 1999) on the continuum of out‐of‐home placements.
Intervention context
Although an ancient practice in many cultures, formal kinship care is a newer placement paradigm in countries like the United States and Australia, due to its recent adoption by the child welfare field as the placement of choice, when appropriate, in the continuum of out‐of‐home care services for children (Ainsworth 1998; Geen 2000; Scannapieco 1999). For example, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 explicitly required U.S. states to give preference to family members when placing a child outside of the home (Leos‐Urbel 2002). The Adoption and Safe Families Act of 1997 continued this federal commitment towards promoting and supporting kinship care (Ayala‐Quillen 1998). In Australia, the Aboriginal Child Placement Principle has resulted in the increased use of kinship placements, although this differs by state or territory (Paxman 2006). In addition, the New South Wales Children and Young Persons (Care and Protection) Act 1998 encourages the 'least intrusive' principle, which is interpreted by caseworkers as placements with kin (Spence 2004). In some European countries, there has also been a shift in policy regarding kinship placements. Specifically, the Children Act 1989 (United Kingdom), the Children Act 1995 (Scotland), and the Children Order 1995 (Northern Ireland) are generally supportive of kinship care (Broad 2005a), as are regulations from 2003 in Norway (MCESI 2003). However, there is no legislation in Israel concerning kinship care, and a lack of consensus about how to define and serve the population of children at risk for maltreatment (Schmid 2007).
For the countries included in this review (i.e., Australia, Ireland, Israel, Netherlands, Norway, Spain, Sweden, United Kingdom, and U.S.), there are essential differences in child welfare policy and practice for placing children in out‐of‐home care. Outside of the U.S., long‐term foster or kinship care is the preferred placement, which implies that parents have right of access to their child provided it is not considered damaging, and also a right to express their opinion on important issues like education and religion. In Australia, Israel, Netherlands, Norway, and Sweden, foster care placement is not time‐limited and can be extended until the child emancipates from care (e.g., Strijker 2003). As the preferred option is long‐term stable placements, there are foster children in Norway and Sweden who remain in foster homes throughout their entire childhood (e.g., Sallnas 2004). The concept of breakdown (premature termination of placement), therefore, is a more relevant measure in the evaluation of foster care than is reunification or adoption (Sallnas 2004).
During the past 25 years in many countries, there has been a rapid increase in the number of children removed from home and placed with relatives (Cuddeback 2004). The main reasons for the growth of this placement option include an influx of abused and neglected children into out‐of‐home care (Berrick 1998), concern about poor outcomes for children leaving care (Broad 2005b), a persistent shortage in foster care homes (Berrick 1998), and a shift in policy toward treating kin as appropriate caregivers with all of the legal rights and responsibilities of foster parents (Leos‐Urbel 2002). In New South Wales, Australia, the most important factor accounting for historically high numbers of children in foster care is the low use of residential care (Tarren‐Sweeney 2006a). This trend toward lower use of residential care also exists in the United Kingdom (Berridge 1998). Although the use of residential care has increased for older children in Israel and Sweden (Mosek 2001; Sallnas 2004), this practice runs counter to official childcare policies in Sweden (Sallnas 2000).
Similar to other child welfare interventions, kinship care is faced with its fair share of controversial issues. The major controversy centres on the unequal financial support (Brooks 2002) and service provision received by kinship caregivers compared with traditional foster parents (Dubowitz 1994a). The licensing and certification of kinship caregivers is also a source of much disagreement and dissatisfaction (Gibbs 2000). Relatedly, the appropriate level of oversight of kinship caregivers by child welfare agencies is another area of discord (Cohen 1999). One of the key debates is over the appropriate level of involvement for biological parents prior to and after the removal of their children (Ayala‐Quillen 1998).
In a comprehensive review of the American literature, Cuddeback 2004 confirmed much of the conventional wisdom about kinship care while identifying many of the weaknesses of quantitative research on the topic. Cuddeback found that kinship caregivers are more likely to be older, single, less educated, unemployed, and poor than are foster parents and non‐custodial grandparents. Furthermore, Cuddeback reported that kin caregivers report less daily physical activity, more health problems, higher levels of depression, and less marital satisfaction. Cuddeback also concluded that kinship care families receive less training, services, and financial support than do foster care families. In addition, Cuddeback reported that birth parents rarely receive family preservation services, which means that children in kinship care are less likely than children in foster care to be reunified. Lastly, Cuddeback found inconclusive evidence that children in kinship care have greater problems related to overall functioning than do children in foster care.
Why it is important to do this review
In 2004, Geen argued that, "despite the centrality of kinship foster care in child welfare, our understanding of how best to utilize and support kin caregivers, and the impact of kinship foster care on child development, is limited" (Geen 2004 p. 144). Furthermore, it is difficult for social work researchers to keep up with the exponential growth of kinship care as a placement option (Berrick 1994a; Dubowitz 1994a).
Ethical standards preclude the random assignment of children to kinship or foster care, as these placements typically are based on the appropriateness and availability of kinship caregivers or foster parents (Barth 2008a). However, recent studies have used propensity score matching as a means of statistically simulating random assignment to placement conditions (Barth 2008b).
Even the better‐designed studies need to be brought together and appropriately synthesised to provide child welfare professionals with an accessible summary of research on which to make evidence‐based decisions (Goerge 1994).
In 2005, we identified a need to undertake a systematic review of the available evidence from those quasi‐experimental study designs best able to provide ‘good enough’ evidence of the effectiveness of kinship care. That review was published in January 2009. Unfortunately, the best available evidence on kinship care was seriously lacking in many ways, especially in regard to controlling for baseline differences in non‐randomised studies. In keeping with Cochrane Collaboration Policy we have updated this review, which now includes studies published between March 2007 and March 2011.
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.
Methods
Criteria for considering studies for this review
Types of studies
Controlled experimental and quasi‐experimental studies, in which children placed in kinship care are compared cross‐sectionally or longitudinally with children placed in foster care. The types of eligible quasi‐experimental designs include studies that employ matching, covariates, or ex post facto comparisons of children in kinship care and foster care. Studies that compare kinship care to more restrictive out‐of‐home settings (e.g., residential treatment centres) were not considered for this review. Relative to children who are placed in kinship or foster care, children placed in more restrictive settings tend to differ in important ways. These differences complicate inferences about the effects of placement and as such, the review focuses on kinship and foster care placements only.
Types of participants
Children and youth under the age of 18 who were removed from the home for abuse, neglect, or other maltreatment, and subsequently placed in kinship care.
Types of interventions
Formal kinship care placements, irrespective of whether the kin caregivers were licensed (paid) or unlicensed (unpaid). Thus, studies that exclusively examine informal or private kinship care arrangements were not considered. Studies were considered if participants experienced other placement types in conjunction with the kinship care intervention. For example, the treatment group may include children for whom kinship care was their first, last, or only placement in out‐of‐home care. However, these children must have spent the majority (i.e., more than 50%) of their total time in out‐of‐home care in kinship care.
Types of outcome measures
Eligible studies must analyse child welfare outcomes in the well‐being, permanency, or safety domains. Although caregiver and birth parent outcomes are very relevant, they were not considered in this review because child outcomes are what drive the policy and practice of kinship care. However, these outcomes may mediate or moderate the effect of kinship care on child welfare outcomes and should be explored in future research on the topic.
Primary outcomes for the review are behavioural development, mental health, placement stability, and permanency. Secondary outcomes include educational attainment, family relations, service utilisation, and re‐abuse. The following list of outcome domains is meant to be exhaustive, although the examples in each domain are illustrative of the outcomes to be considered in this review.
Behavioural development
Behaviour problems, adaptive behaviours, delinquency.
Measured by case records, caregiver reports, teacher reports, self reports, and standardised instruments.
Mental health
Psychiatric illnesses, psychopathological conditions, well‐being.
Measured by case records, caregiver reports, self reports, and standardised instruments.
Placement stability
Number of placements, re‐entry, length of stay.
Measured by child welfare administrative databases.
Permanency
Reunification, adoption, guardianship.
Measured by child welfare administrative databases.
Educational attainment
Graduation, grades, test scores, attendance, academic success.
Measured by school and case records, caregiver reports, self reports, and standardised instruments.
Family relations
Problem‐solving, tolerance, commitment, conflicts, emotional availability, home environment.
Measured by caregiver reports, self reports, and standardised instruments.
Service utilisation
Mental health services, foster support groups, family therapy, developmental services, physician services.
Measured by medical records, caregiver reports, self reports, and child welfare administrative databases.
Re‐abuse
Recurrence of abuse, institutional abuse.
Measured by child welfare administrative databases.
Search methods for identification of studies
Preliminary searches indicated that a narrowing of the search strategy using a methodological filter resulted in the exclusion of potentially relevant studies so we ran the searches without a study methods filter. The original search strategies (Appendix 1) were revised for this update by adding appropriate controlled vocabulary terms for foster care, where they were available. We also included additional free text phrases (for example 'custodial grandparent') to increase the sensitivity of the updated search strategies (Appendix 2). We ran the updated searches from the inception of each database and imported the records into Procite. We compared these with records from the previous searches and discarded any duplicates. New records identified by the updated searches were imported records into Reference Manager 11/12 for screening. Searches were not limited by language, date, or geographic area.
Electronic searches
We ran updated searches of the following databases in March 2011:
Cochrane Central Register of Controlled Trials (CENTRAL), 2011 Issue 1, part of The Cochrane Library;
Ovid MEDLINE,1948 to March Week 1 2011;
PsycINFO, 1887 to 14 March 2011;
CINAHL, 1937 to current;
Sociological Abstracts, 1952 to current;
Social Sciences Citation Index (SSCI), 1970 to 12 March 2011;
Conference Proceedings Citation Index ‐Social Science and Humanities (CPCI‐SSH), 1990 to 12 March 2011;
ERIC, 1966 to current;
Applied Social Sciences Index and Abstracts (ASSIA), 1987 to current;
Dissertation Abstracts (via Dissertation Express), last searched 14 March 2011.
We could not update the searches of the following three databases because they have either ceased to function or are no longer available to us:
Campbell Collaboration's Social, Psychological, Educational, and Criminological Trials Register (C2‐SPECTR), last searched 9 March 2007;
Social Work Abstracts, last searched February 2007;
Family and Society Studies Worldwide, last searched February 2007.
Searching other resources
For the original review, we handsearched volumes of Child Abuse & Neglect, Children and Youth Services Review, Child Welfare, Research on Social Work Practice, andFamilies in Society from 2006 and 2007. We contacted several authors of studies included in this review for knowledge of other studies not yet identified. Lastly, we screened the reference lists of published literature reviews for relevant studies.
Data collection and analysis
The procedures for collecting and analysing the data for this review are detailed below.
Selection of studies
Two review authors independently read the titles and abstracts of identified articles and reports to select those that described an empirical study of kinship care. A study was obtained if either review author believed it was appropriate. Once the studies were retrieved, two review authors used a 'keywording' rubric to categorise each study by the type of design, participants, intervention, and outcome measure(s). Two review authors then determined if each study was eligible for selection based on the aforementioned criteria for considering studies for this review. When we could not reach a consensus regarding selection decisions, we resolved it through discussion with a third review author.
Data extraction and management
We entered citations for all selected studies into Reference Manager 11/12, which is an interactive literature management software package. We then uploaded the citations for included studies into The Cochrane Collaboration's Review Manager 5 software (RevMan). We extracted outcome data from studies and entered them into RevMan, where they were meta‐analysed for this review. We present the statistical results in both narrative form, and in figures and tables. Specifically, RevMan‐generated forest plots are used to display effect size estimates and confidence intervals from the meta‐analyses. We use funnel plots generated from RevMan to examine the presence of publication bias in the evidence base. In addition, we present data from the quality assessment process in a table created in RevMan.
Assessment of risk of bias in included studies
Existing scales for measuring the quality of controlled trials have not been properly developed, are not well‐validated, and are known to give differing (even opposing) ratings of trial quality in systematic reviews (Moher 1999). At present, evidence indicates that "scales should generally not be used to identify trials of apparent low quality or high quality in a given systematic review. Rather, the relevant methodological aspects should be identified a priori and assessed individually" (Juni 2001, p. 45). Thus, studies were assessed in regard to the following research quality dimensions: selection bias, performance bias, detection bias, reporting bias, and attrition bias (Higgins 2011).
Two review authors independently extracted data from each study before coming to consensus on the assessment of risk of bias for each of the following domains for each study. The methodological criteria were operationalised as follows:
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Selection bias: Was group assignment determined randomly or might it have been related to outcomes or the interventions received?
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The studies rated at high risk did not attempt to equate the kinship care and foster care groups through matching or controlling for covariates AND did not provide evidence on the comparability of the groups on setting (e.g., urbanicity), placement characteristics (e.g., age at placement, removal reason), or child demographics (e.g., gender, ethnicity). The studies rated at unclear risk either attempted to equate the groups OR provided evidence on the comparability of the groups. The studies rated at low risk attempted to equate the groups AND provided evidence on the comparability of the groups. For example, these studies provided evidence that the groups were comparable at baseline in regard to placement history, visits to biological parents, and caregiver characteristics (e.g., family composition, age, education).
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Performance bias: Could the services provided have been influenced by something other than the interventions being compared?
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In the studies that were rated at high risk, the kinship care and foster care groups experienced different exposure to the intervention (e.g., length of stay) AND received different services during placement (e.g., caseworker contact). In the studies that were rated at unclear risk, the groups either experienced different exposure OR received different services. In the studies that were rated at low risk, the groups did not experience different exposure AND did not receive different services.
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Detection bias: Were outcomes influenced by anything other than the constructs of interest, including biased assessment or the influence of exposure on detection?
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In the studies rated at high risk, the kinship care and foster care groups were not defined in the same way (e.g., caregiver licensure, caregiver characteristics) AND there was evidence of biased assessment resulting from the type of placement (e.g., caregiver reports only). In the studies rated at unclear risk, the groups were not defined in the same way OR there was evidence of biased assessment. In the studies rated at low risk, the groups were defined in the same way AND there was no evidence of biased assessment.
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Reporting bias: Were the outcomes, measures, and analyses selected a priori and reported completely? Were participants biased in their recall or response?
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In the studies rated at high risk, the instrumentation used to measure the outcomes was not specified completely (e.g., data collection procedures) AND reliability with or without validity information was not reported for the instrumentation. In the studies rated at unclear risk, the instrumentation used to measure the outcomes was specified completely OR reliability with or without validity information was reported for the instrumentation. In the studies rated at low risk, the instrumentation was completely specified AND reliability with or without validity information was reported.
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Attrition bias: Could deviations from protocol, including missing data and dropout, have influenced the results?
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In the studies rated at high risk, not all participants were accounted for in the reporting of results (e.g., low response rate, missing outcome data) AND attrition could have influenced the results (e.g., significant difference between participants and non‐participants). In the studies rated at unclear risk, not all participants were accounted for OR attrition could have influenced the results. In the studies rated at low risk, all participants were accounted for AND attrition could not have influenced the results.
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Measures of treatment effect
Continuous data
We computed a standardised mean difference (SMD) effect size for the continuous outcome variables. For this review, we created a corrected Hedges' g by dividing the difference between group means by the pooled and weighted standard deviation of the groups. Specifically, Hedges' g corrects for a bias (overestimation) that occurs when the uncorrected standardised mean difference effect size is used on small samples. The combined effect size for each outcome was computed as a weighted mean of the effect size for each study, with the weight being the inverse of the square of the standard error. Thus, a study was given greater weight for a larger sample size and more precise measurement, both of which reduce standard error. We computed a 95% confidence interval for each combined effect size to test for statistical significance; if the confidence interval did not include zero, we rejected the null hypothesis that there is no difference between the group means.
Dichotomous data
We computed Mantel‐Haenszel odds ratios (ORs) for the dichotomous outcome variables. Based on the assumption of proportional odds, ORs can be compared between variables with different distributions, including very rare and more frequent occurrences. Specifically, the odds of an event (e.g., reunification) were calculated for each group by dividing the number of events (i.e., re‐entry, reunification) by the number of non‐events (i.e., re‐entry, no reunification). We then calculated an OR by dividing the odds of the kinship care group by the odds of the foster care group. In addition, we calculated and reported 95% confidence intervals for the dichotomous effect size estimates.
Unit of analysis issues
The unit of analysis for this review was children. There were no unit of analysis issues identified for the included studies.
Dealing with missing data
Although studies with incomplete outcome data (e.g., missing means, standard deviations, sample sizes) were included in the review, they were excluded from the meta‐analyses unless the review authors could calculate an effect size from the available information. When outcome data were missing from an article or report, we made reasonable attempts to retrieve these data from the original researchers. Attrition overall and by group were accounted for in the quality assessment and sensitivity analyses.
Assessment of heterogeneity
We assessed the consistency of results using the I² statistic (Higgins 2002; Higgins 2003). If there was evidence of heterogeneity (P value from test of heterogeneity < 0.1 coupled with an I² value of 25% or greater), we also considered sources of methodological and practice diversity according to prespecified subgroup and sensitivity analyses (see below). The values of the Q heterogeneity statistic and the between‐studies variance component Tau² were also reported.
Assessment of reporting biases
With the additional studies identified in the updated review, we assessed publication bias through the use of funnel plots. This method of assessing reporting bias was only used for outcomes that included meta‐analytic findings from at least 10 studies (Higgins 2011).
Data synthesis
As heterogeneity is to be expected with similar interventions provided under different circumstances and by different providers, we used a random‐effects model for data synthesis. If a study reported multiple effect sizes (e.g., grades, behaviour problems), the results were included in the meta‐analysis for each outcome. If a study reported effect sizes for multiple samples (e.g., male, female), we aggregated the results for the main effects meta‐analyses before splitting them for the subgroup meta‐analyses. We conducted data synthesis for outcomes in which at least three studies contributed effect sizes to the meta‐analysis.
Subgroup analysis and investigation of heterogeneity
We considered subgroup analyses to explore different effects of the intervention (if any) by gender, ethnicity, and age at placement.
Sensitivity analysis
We planned sensitivity analyses to explore the impact of the risk of bias dimensions on the specific outcomes of the review. Specifically, we considered the following planned comparisons:
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Studies that used matching or covariates versus studies that did not control for confounders;
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Studies with outcomes measured by caregiver or teacher reports versus studies with outcomes measured by self reports;
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Studies at low risk of attrition bias versus studies at high risk of attrition bias;
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Studies at low risk of selection bias versus studies at high risk of selection bias.
We conducted the sensitivity analyses using simple unweighted ANOVA models.
Results
Description of studies
The included studies are described in terms of the location, participants, interventions, and outcome measures.
Results of the search
As displayed in the study flow diagram (Figure 1), a comprehensive electronic search of the kinship care literature base up until March 2011 yielded 9643 records with eight additional records identified through other sources. After 72 duplicates were removed, there were 9579 records with 4797 records from the search during the original review and 4782 records from the search during the updated review (of which 2728 were records found using the modified search strategy for the period covered by the original review).
Study flow diagram (complete review)
Included studies
9174 studies, which were not empirical studies of kinship care, were eliminated by screening titles and abstracts . We made every effort to retrieve the full text of the remaining 405 records (271 records from the original search and 134 records from the updated search). Of these 405 records, 16 were intractably unavailable as full‐text articles and were transferred to the excluded studies. We assessed the remaining 389 full‐text articles for eligibility and identified studies which had multiple reports: 102 studies (comprised of 105 papers) met the inclusion criteria and 280 studies (comprised of 284 papers) were excluded. Thus, a total of 102 studies were identified and included in the qualitative synthesis (62 from the original review and 40 from the updated review, of which six were published pre‐2007), while 71 studies were included in the meta‐analysis (46 from the original review and 25 from the updated review, of which none was published pre‐2007).
Location of Studies
All but 13 of the 102 studies were conducted in the U.S. The 13 international studies were Del Valle 2009 and Palacios 2009 conducted in Spain, Holtan 2005 conducted in Norway, Lernihan 2006 conducted in Ireland, Lutman 2009 conducted in the United Kingdom, Mosek 2001 conducted in Israel, Sallnas 2004 conducted in Sweden, Strijker 2003 and Strijker 2008 conducted in the Netherlands, and Tarren‐Sweeney 2006a, Tarren‐Sweeney 2006b, Tarren‐Sweeney 2008a, and Tarren‐Sweeney 2008b conducted in Australia.
Participants
As displayed in the Participant Baseline Characteristics Table (Table 1), 87 of the 102 studies reported data for at least one of the following participant characteristics: age at placement, gender, ethnicity, removal reason, or urbanicity.
| Study | Age at Placement | Gender | Ethnicity | Removal Reason | Urbanicity |
| Female (O) ‐ 49% | Black (O) ‐ 16% | Neglect (O) ‐ 24% | |||
| Female (K) ‐ 59% | Black (O) ‐ 63% | ||||
| Female (O) ‐ 51% | Black (O) ‐ 84% | Neglect (O) ‐ 27% | Urban (O) ‐ 100% | ||
| (O) ‐ 3.4 years | Female (O) ‐ 41% | Black (O) ‐ 56% | Neglect (O) ‐ 92% | ||
| Female (K) ‐ 52% | Black (K) ‐ 46% | ||||
| (K) ‐ 7 years | Female (O) ‐ 62% | Black (O) ‐ 19% | |||
| Female (K) ‐ 52% | Black (K) ‐ 47% | ||||
| Female (O) ‐ 53% | Black (O) ‐ 19% | ||||
| Female (O) ‐ 51% | Black (O) ‐ 37% | ||||
| Female (O) ‐ 44% | Black (O) ‐ 62% | Neglect (O) ‐ 100% | |||
| (O) ‐ 9.5 years | Female (O) ‐ 71% | Black (O) ‐ 30% | Neglect (O) ‐ 41% | ||
| Female (K) ‐ 46% | Black (K) ‐ 73% | ||||
| (K) ‐ 1 year | Female (K) ‐ 58% | Black (K) ‐ 83% | |||
| (O) ‐ 9.4 years | Female (O) ‐ 45% | Black (O) ‐ 18% | Neglect (O) ‐ 40% | ||
| Female (O) ‐ 45% | Black (O) ‐ 18% | Neglect (O) ‐ 40% | |||
| Female (O) ‐ 53% | Black (O) ‐ 26% | ||||
| Female (O) ‐ 64% | Black (O) ‐ 31% | ||||
| Female (O) ‐ 53% | Black (O) ‐31% | Neglect (O) ‐ 67% | Urban (O) ‐ 94% | ||
| Female (O) ‐ 50% | Black (O) ‐ 35% | Neglect (O) ‐ 72% | Urban (O) ‐ 40% | ||
| (K) ‐ 8.8 years | Female (O) ‐ 40% | Black (O) ‐ 100% | Neglect (O) ‐ 77% | ||
| Female (O) ‐ 47% Female (K) ‐ 38% Female (F) ‐ 58% | Black (O) ‐ 51% Black (K) ‐ 60% Black (F) ‐ 42% Hispanic (O) ‐ 17% Hispanic (K) ‐ 19% Hispanic (F) ‐ 15% | ||||
| Urban (O) ‐ 67% Rural (O) ‐ 33% | |||||
| (O) ‐ 9.9 years | Female (O) ‐ 50% | Black (O) ‐ 30% Hispanic (O) ‐ 46% | |||
| Female (O) ‐ 50% | Black (O) ‐ 28% Hispanic (O) ‐ 18%) | Neglect (O) ‐ 59% | |||
| Female (O) ‐ 55% | Black (O) ‐ 40% Hispanic (O) ‐ 36% | Urban (O) ‐ 100% | |||
| (O) ‐ 8.0 years (K) ‐ 7.8 years (F) ‐ 8.3 years | Female (O) ‐ 50% Female (K) ‐ 60% Female (F) ‐ 40% | Black (O) ‐ 100% | Neglect (O) ‐ 48% Neglect (K) ‐ 56% Neglect (F) ‐ 48% | Urban (O) ‐ 100% | |
| Female (O) ‐ 51% | Black (O) ‐ 37% | Neglect (O) ‐ 82% | |||
| Female (O) ‐ 53% | Black (O) ‐ 45% | Neglect (O) ‐ 58% | |||
| Female (O) ‐ 42% | Black (O) ‐ 46% Hispanic (O) ‐ 3% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 54% | Black (O) ‐ 29% | Neglect (O) ‐ 66% | Urban (O) ‐ 37% | ||
| Female (O) ‐ 55% | Black (O) ‐ 55% | Neglect (O) ‐ 63% | |||
| (O) ‐ 3.4 years | Female (O) ‐ 60% | Black (O) ‐ 27% Hispanic (O) ‐ 8% | |||
| (K) ‐ 3.8 years | Female (K) ‐ 45% | ||||
| Black (O) ‐ 21% Hispanic (O) ‐ 33% | |||||
| Female (O) ‐ 62% | Black (O) ‐ 43% | Neglect (K) ‐ 62% | |||
| Female (K) ‐ 52% | Black (K) ‐ 69% | ||||
| Female (O) ‐ 49% | Black (O) ‐ 45% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 50% | Black (O) ‐ 60% | Neglect (O) ‐ 47% | |||
| Female (O) ‐ 55% | Neglect (O) ‐ 40% | ||||
| (O) ‐ 10.8 years | Female (O) ‐ 52% | Black (O) ‐ 57% Hispanic (O) ‐ 9% | |||
| Female (K) ‐ 51% Female (F) ‐ 50% | Black (K) ‐ 54% Black (F) ‐ 54% | Neglect (K) ‐ 73% Neglect (F) ‐ 71% | |||
| Female (K) ‐ 49% | Neglect (K) ‐ 80% | ||||
| Female (K) ‐ 38% Female (F) ‐ 50% | Black (O) ‐ 33% Hispanic (O) ‐ 13% | Urban (O) ‐ 100% | |||
| Female (K) ‐ 41% Female (F) ‐ 54% | |||||
| Female (O) ‐ 55% | Black (O) ‐ 28% | Neglect (O) ‐ 68% | |||
| (K) ‐ 6.9 years (F) ‐ 6.5 years | Female (K) ‐ 43% Female (F) ‐ 60% | Black (K) ‐ 46% Black (F) ‐ 56% Hispanic (K) ‐ 20% Hispanic (F) ‐ 31% | Neglect (K) ‐ 93% Neglect (F) ‐ 79% | ||
| Female (K) ‐ 86% Female (F) ‐ 58% | Black (K) ‐ 76% Black (F) ‐ 75% Hispanic (K) ‐ 5% Hispanic (F) ‐ 8% | ||||
| Female (O) ‐ 46% | Black (O) ‐ 45% | Neglect (O) ‐ 60% | |||
| McMillen 2004 | (O) ‐ 10.9 years | Female (O) ‐ 56% | Black (O) ‐ 51% | Neglect (O) ‐ 46% | |
| (O) ‐ 10.6 years | Female (O) ‐ 56% | Black (O) ‐ 52% | Neglect (O) ‐ 48% | ||
| Female (O) ‐ 50% | Black (O) ‐ 40% Hispanic (O) ‐ 35% | ||||
| Female (K) ‐ 56% | Black (K) ‐ 61% | Neglect (K) ‐ 87% | |||
| Female (K) ‐ 56% Female (F) ‐ 49% | Neglect (K) ‐ 62% Neglect (F) ‐ 53% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 100% | |||||
| Female (O) ‐ 52% | Black (O) ‐ 12% Hispanic (O) ‐ 4% | Neglect (O) ‐ 28% | |||
| (O) ‐ 8.3 years | Female (O) ‐ 48% Female (K) ‐ 51% Female (F) ‐ 47% | Black (O) ‐ 14% Black (K) ‐ 16% Black (F) ‐ 14% Hispanic (O) ‐ 46% Hispanic (K) ‐ 41% Hispanic (F) ‐ 47% | Neglect (O) ‐ 86% Neglect (K) ‐ 86% Neglect (F) ‐ 86% | ||
| (K) ‐ 3.2 years (F) ‐ 4.7 years | |||||
| Female (O) ‐ 50% | Black (O) ‐ 30% Hispanic (O) ‐ 21% | Neglect (O) ‐ 64% | |||
| Black (K) ‐ 41% Hispanic (K) ‐ 13% | Neglect (O) ‐ 59% Neglect (K) ‐ 59% | ||||
| Female (K) ‐50% | Black (K) ‐ 14% | ||||
| Female (O) ‐ 55% Female (K) ‐ 54% Female (F) ‐ 56% | Black (O) ‐ 29% Black (K) ‐ 30% Black (F) ‐ 29% Hispanic (O) ‐ 51% Hispanic (K) ‐ 50% Hispanic (F) ‐ 52% | Neglect (K) ‐ 42% Neglect (F) ‐ 42% | |||
| Female (K) ‐ 60% Female (F) ‐ 48% | Black (K) ‐ 33% Black (F) ‐ 38% Hispanic (K) ‐ 14% Hispanic (F) ‐ 15% | Neglect (K) ‐ 62% Neglect (F) ‐ 58% | |||
| Female (K) ‐ 45% Female (F) ‐ 45% | Black (K) ‐ 18% Black (F) ‐ 17% Hispanic (K) ‐ 70% Hispanic (F) ‐ 65% | Urban (O) ‐ 100% | |||
| (O) ‐ 9.5 years | Female (O) ‐ 51% | Black (O) ‐ 64% | |||
| (K) ‐ 4.7 years | Female (O) ‐ 53% | Black (O) ‐ 52% | Neglect (O) ‐ 78% | ||
| Female (K) ‐ 47% | Black (K) ‐ 80% | ||||
| Female (O) ‐ 48% | Black (O) ‐ 48% | Neglect (O) ‐ 56% | |||
| Female (O) ‐ 44% | Black (O) ‐ 70% | Neglect (K) ‐ 75% | Urban (O) ‐ 100% | ||
| Female (O) ‐ 50% | |||||
| Female (K) ‐ 56% | Black (K) ‐ 72% | ||||
| (O) ‐ 3.5 years | Female (O) ‐ 49% | Neglect (O) ‐ 78% | Urban (O) ‐ 52% | ||
| Female (O) ‐ 49% | |||||
| Female (O) ‐ 49% | Urban (O) ‐ 52% | ||||
| (K) ‐ 3.2 years (F) ‐ 3.5 years | Female (O) ‐ 49% | ||||
| (K) ‐ 5.4 years | Female (K) ‐ 50% | Black (O) ‐ 100% | |||
| Female (O) ‐ 36% | Black (O) ‐ 39% | ||||
| Female (O) ‐ 50% | Black (O) ‐ 57% | ||||
| (O) ‐ 6 years | |||||
| Female (O) ‐ 67% Female (K) ‐ 77% Female (F) ‐ 59% | |||||
| (O) ‐ 6.3 years | Female (O) ‐ 50% | Black (O) ‐ 83% | |||
| Female (O) ‐ 51% | Black (O) ‐ 77% | Neglect (O) ‐ 87% | |||
| Female (K) ‐ 54% Female (F) ‐ 54% | Black (K) ‐ 14% Black (F) ‐ 14% Hispanic (K) ‐ 37% Hispanic (F) ‐ 37% | ||||
| Female (O) ‐ 53% | Black (O) ‐ 34% | ||||
| (K) ‐ 1.8 years | Female (O) ‐ 50% | Black (O) ‐ 70% | Neglect (O) ‐ 70% | Urban (O) ‐ 100% | |
| Female (K) ‐ 51% Female (F) ‐ 52% | Black (K) ‐ 57% Black (F) ‐ 49% Hispanic (K) ‐ 6% Hispanic (F) ‐ 5% | Neglect (K) ‐ 48% Neglect (F) ‐ 54% | |||
| Urban (O) ‐ 100% |
O: Overall
K: Kinship
F: Foster
For age at entry into the specific placement, there was an overall unweighted mean age at placement of 7 years 10 months, based on 14 studies. Eleven studies reported a mean age at placement by placement type. For the kinship care group, the unweighted mean age at placement was 4 years 10 months. For the foster care group, the unweighted mean age at placement was also 4 years 10 months.
For gender, there were overall unweighted frequencies of 52% female and 48% male children, based on 57 studies. Furthermore, 33 studies reported gender frequencies by placement type. For the kinship care group, the unweighted frequencies were 50% female and 50% male. For the foster care group, the unweighted frequencies were 52% female and 48% male.
For ethnicity, there was an overall unweighted frequency of 45% African‐American children, based on 53 studies. There was an overall unweighted frequency of 22% Hispanic children based on 45 studies. Furthermore, 25 studies reported the frequency of African‐American children by placement type. For the kinship care group, the unweighted frequency was 51% African‐American. For the foster care group, the unweighted frequency was 44% African‐American. In addition, 20 studies reported the frequency of Hispanic children by placement type. For the kinship care group, the unweighted frequency was 24% Hispanic. For the foster care group, the unweighted frequency was 26% Hispanic.
For removal reason, there was an overall unweighted frequency of 60% of children removed for neglect, based on 31 studies. Furthermore, 15 studies reported the frequency of children removed for neglect by placement type. For the kinship care group, the unweighted frequency was 67% of children removed for neglect. For the foster care group, the unweighted frequency was 63% of children removed for neglect.
For urbanicity, there was an overall unweighted frequency of 80% of children from urban settings, based on 17 studies. In addition, there was an overall unweighted frequency of 13% of children from rural settings based on four studies. However, no studies reported the urbanicity of children by placement type.
Interventions
As displayed in Table 2, all 102 studies reported data for at least one of the following intervention characteristics: caregiver licensure, timing of placement, length of stay, or timing of data collection.
| Study | Kin Placement Type | Placement Timing | Length of Stay | Data Collection |
| Not Reported/Unclear | First | Longitudinal ‐ 30 ‐ 42 months | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 29.0 months | Cross‐sectional | |
| Licensed | First | Longitudinal ‐ 4 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 39.0 months (F) ‐ Placement ‐ 28.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 18.0 months (F) ‐ Placement ‐ 18.0 months | Cross‐sectional | |
| Not Reported/Unclear | First | Longitudinal ‐ up to 7 years | ||
| Not Reported/Unclear | Only | Longitudinal ‐ 1 ‐ 2 years | ||
| Not Reported/Unlcear | Not Reported/Unclear | (K) ‐ Placement ‐ 43.2 months (F) ‐ Placement ‐ 32.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 12.0 months (F) ‐ Placement ‐ 12.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 21.2 months (F) ‐ OOH ‐ 17.5 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ up to 5 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 5 years | ||
| Not Reported/Unclear | Last | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First (Reunification) | Longitudinal ‐ 6 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 4 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 16.0 months (F) ‐ Placement ‐ 39.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 4 ‐ 8 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 57.6 months (F) ‐ Placement ‐ 40.8 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 18 months | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Licensed (52%) | Not Reported/Unclear | (K) ‐ Placement ‐ 36 months (F) ‐ Placement ‐ 30 months | Cross‐sectional | |
| Not Reported/Unclear | Last | Longitudinal ‐ 4 ‐ 6 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 3.5 ‐ 4.5 years | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reporte/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 61.2 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 4‐12 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Licensed | Not Reported/Unclear | (K) ‐ Placement ‐ 31.6 months | Cross‐sectional | |
| Not Reported/Unclear | First | Longitudinal ‐ 15 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | Longitudinal ‐ 4.5 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | First | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 46.8 months (F) ‐ Placement ‐ 60 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1.5 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 3‐10 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Unlicensed | Not Reported/Unclear | (K) ‐ Placement ‐ 74.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 74 months (F) ‐ OOH ‐ 78 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 104.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unlcear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 6 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 5 ‐ 6 years | ||
| Not Reported/Unclear | First | Longitunidal ‐ 18 and 36 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 53.2 months (F) ‐ Placement ‐ 53.7 months | Longitudinal ‐ 6.1 years | |
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 26 months (F) ‐ OOH ‐ 19.3 months | Longitudinal ‐ 3 years | |
| Not Reported/Unclear | First | Longitudinal ‐ 5 years | ||
| Licensed | Not Reported/Unclear | (K) ‐ OOH ‐ 33.6 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unlcear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 96.0 months | Cross‐sectional | |
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 47.3 months | Cross‐sectional | |
| Unlicensed | First | (K) ‐ Placement ‐ 13.4 months | Longitudinal ‐ 2 ‐ 3 years | |
| Not Reported/Unclear | Last | Longitudinal ‐ 11 months | ||
| Licensed | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 13.2 months (F) ‐ Placement ‐ 20.4 months | Longitudinal ‐ 2.33 years | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 22.9 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1 ‐ 3 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 63.1 months | Longitudinal ‐ up to 8 years | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Licensed and Unlicensed | Not Reported/Unclear | (K) ‐ OOH ‐ 31.3 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 38.4 months (F) ‐ Placement ‐ 14.4 months (K) ‐ OOH ‐ 45.6 months (F) ‐ OOH ‐ 32.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 18.8 months | Longitudinal ‐ up to 2 years | |
| Not Reported/Unclear | First (Reunification) | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | (K) ‐ OOH ‐ 12 months (F) ‐ OOH ‐ 12 months | Longitudinal ‐ 1 year | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unlcear | Not Reported/Unclear | Longitudinal ‐ 5 ‐ 9 years | ||
| Licensed | Not Reported/Unclear | Longitudinal ‐ 5 years |
OOH: out‐of‐home
For caregiver licensure, nine studies reported information on whether kinship caregivers were licensed or unlicensed. Specifically, six studies included licensed kinship placements, two studies included unlicensed kinship placements, and one study included both licensed and unlicensed kinship placements.
For the timing of placement, 40 studies reported information on whether children were in their first, last, or only kinship or foster placement. Specifically, the kinship or foster placement was the first in 29 of the studies, the last in eight of the studies, the only placement in one study, and either the first or last placement depending on the outcome being measured in two studies.
For length of stay, there was an unweighted mean length of placement of 36.0 months for the kinship care group and 34.2 months for the foster care group, based on 16 studies. In addition, there was an unweighted mean length of stay in out‐of‐home care of 48.7 months for the kinship care group and 45.5 months for the foster care group based on 14 studies.
For the timing of data collection, 62 studies used a cross‐sectional data collection approach while 40 studies used a longitudinal data collection approach with a follow‐up ranging from one year to 10 years.
Outcome measures
There were eight outcome categories and 29 specific outcomes considered in this review (including the same outcome measured both dichotomously and continuously). The following narrative contains the definitions and instrumentation used to measure the outcome variables in which bivariate data were extracted for the meta‐analyses. The Outcomes Measures Table (Table 3) displays the outcomes and measures for all 102 studies in the review.
| Study | Behavioural Development | Mental Health | Placement Stability | Permanency | Educational Attainment | Family Relations | Service Utilisation | Re‐abuse |
| Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database | ||||||||
| Outcome categories: Adoption, Still in Placement. | ||||||||
| Outcome category: Adaptive behaviours (Continuous). | Outcome category: Psychiatric Disorders (Continuous). | Outcome categories: Number of Placements (Continuous), Length of Stay (OOH Care). | ||||||
| Outcome category: Institutional Abuse. | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive behaviours (Continuous). | ||||||||
| Outcome category: Behavioural Problems (Continuous). Measured using standardised instrumentation ‐ Child Behaviour Checklist | ||||||||
| Outcome category: Length of Stay (Placement). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||||
| Outcome category: Conflict (Continuous) | ||||||||
| Outcome category: Re‐entry. | Outcome categories: Reunification, Adoption, Guardianship, Still in Placement. | |||||||
| Outcome category: Psychiatric Disorders (Continuous). | Outcome categories: Mental Health Services, Physician Services, Developmental Services. | |||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Length of Stay (Placement). | Outcome category: Repeated a Grade. | ||||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Attachment (Continuous). | ||||||||
| Outcome category: Attachment (Continuous). | ||||||||
| Outcome category: Educational Attainment. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services, Developmental Services | |||||||
| Outcome category: Length of Stay (Placement). | Outcome category: Attachment (Dichotomous). | |||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Re‐entry. | ||||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome category: Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome category: Number of Placements (Dichotomous). | ||||||||
| Outcome category: Behaviour Porblems (Continuous). | Outcome categories: Number of Placements (Continuous), Length of Stay (Placement). | Outcome category: Attachment (Continuous). | ||||||
| Outcome category: Behaviour Problems (Dichotomous and Continuous). Measured using standardised instrumentation ‐ Child behaviour Checklist; behavioural Intent Assessment | ||||||||
| Outcome category: Placement Disruption. Measured using case records; caseworker interviews | Outcome categories: Reunification, Adoption. Measured using case records; caseworker interviews | |||||||
| Outcome category: Well‐being (Dichotomous). Measured using standardised instrumentation ‐ Foster Care Questionnaire | ||||||||
| Outcome category: Mental Health. Measured using standardised instrumentation ‐ Child and Adolescent Services Assessment | ||||||||
| Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ National Longitudinal Study of Adolescent Health | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ Self‐perception Profile for Children | Outcome category: Repeated a grade. Measured using caregiver and self reports | Outcome category: Home Environment. Measured using standardised instrument ‐ Elementary HOME Inventory | |||||
| Outcome category: Re‐entry. | ||||||||
| Outcome category: Re‐entry. | Outcome categories: Reunification, Still in Placement. | |||||||
| Outcome category: Recurrence of Abuse. | ||||||||
| Outcome categories: Graduation, Test Scores, GPA, Attendance. Measured using school records | ||||||||
| Outcome category: Reunification. | ||||||||
| Outcome category: Psychiatric Disorders (Dichotomous). | Outcome category: Number of Placements (Dichotomous). | |||||||
| Outcome category: Placement Disruption. Measured using caregiver report | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | ||||||||
| Outcome category: Placement Disruption. Measured using caregiver report | ||||||||
| Outcome category: Behaviour Problems (Dichotomous). | Outcome category: Psychiatric Disorders (Dichotomous). | Outcome category: Grade Level. | ||||||
| Outcome category: Grade Level. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome category: Attachment (Dichotomous). | Outcome category: Mental Health Services. | ||||||
| Outcome category: Still in Placement. Measured using administrative database | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive behaviours (Continuous). | ||||||||
| Outcome category: Re‐entry. | Outcome category: Recurrence of Abuse. | |||||||
| Outcome category: Pyschiatric Disorders (Dichotomous). Measured using standardised instrument ‐ Composite International Diagnostic Interview | ||||||||
| Outcome categories: Number of Placements (Dichotomous), Length of Stay (OOH), Placement Disruption, Re‐entry. Measured using administrative database (AFCARS) | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database (AFCARS) | |||||||
| Outcome category: Placement Disruption. Measured using administrative database (AFCARS) | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database (AFCARS) | |||||||
| Outcome category: Placement Disruption. Measured using administrative database (AFCARS) | ||||||||
| Outcome category: Behaviour Problems (Continuous) | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Emotional Availability (Continuous). Measured using standardised instrument ‐ Emotional Availability Scales | |||||||
| Outcome category: Length of Stay (Placement). Measured using administrative database | ||||||||
| Outcome category: Mental Health Services. | ||||||||
| Outcome category: Behavioural Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | ||||||||
| Outcome category: Still in Placement. Measured using case records | ||||||||
| Outcome category: Behaviour problems (Dichotomous). Measured using standardised instrument ‐ Behavioural Assessment Scoring System for Children | ||||||||
| Outcome category: Reunification. | ||||||||
| Outcome category: Mental Health Services. | ||||||||
| Outcome category: Psychiatric Disorders (Dichotomous). | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instruments ‐ Child Behaviour Checklist; Youth Self Report | Outcome categories: Psychiatric Disorders, Well‐being (Continuous). Measured using standardised instruments: Columbia Impairment Scale; Self Perception Profile of Adolescents | |||||||
| Outcome category: Behavioural Problems (Continuous). | Outcome category: Well‐Being (Continuous). | Outcome categories: Number of Placements (Dichotomous), Length of Stay (Placement). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Festinger Rating of Behavioural Reactions Scale | Outcome category: Attachment (Continuous). Measured using standardised instrument ‐ Kansas Parental Satisfaction Scale | |||||||
| Outcome category: Well‐Being (Continuous). | Outcome category: Attachment (Dichotomous). | |||||||
| Outcome category: behaviour problems (Continuous) Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Attachment (Dichotomous) Measured using standardised instrument ‐ Relationship Story Completion Test | |||||||
| Outcome category: Number of Placements (Dichotomous). Measured using administrative database | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database | |||||||
| Outcome category: Behaviour Problems (Continuous) Measured using standardised instrument ‐ Strength and Difficulties Questionnaire | Outcome category ‐ Well‐being Measured using standardised instrument ‐ Child Well‐being Scales | |||||||
| Outcome category: Behaviour Problems (Dichotomous), Adaptive Behaviours (Dichotomous). Measured using standardised instrument ‐ Child Behaviour Checklist; Vineland Adaptive Behaviour Scale | Outcome categories: Mental Health Services, Developmental Services. Measured using Child and Adolescent Services Assessment | |||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using Child Behaviour Checklist | Outcome category: Placement Disruption. Measured using administrative database | |||||||
| Outcome category: Behaviour Problems (Continuous). | ||||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using administrative database | Outcome categories: Placement Settings; Length of Stay (Placement). Measured using administrative database | |||||||
| Outcome category: Behavioural Problems (Continuous). Measured using Child Behaviour Checklist | Outcome Cateogry: Psychiatric disorders ‐ Depression & PTSD (Dichotomous). Measured using Child Depression Inventory; Trauma Symptoms Checklist for Children | Outcome categories: Number of Placements, Length of Stay (OOH Care). Measured using caseworker report | Outcome category: Still in Placement. Measured using caseworker report | Outcome categories: Mental Health Service Utilisation and Physician Service Utilisation. Measured using caregiver report | ||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services. | |||||||
| Outcome category: Physician Services. Measured using caregiver report | ||||||||
| Outcome category: Grade Level. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome category: Still in Placement. | Outcome category: Mental Health Services. | ||||||
| Outcome categories: Reunification, Adoption, Still in Placement. | ||||||||
| Outcome category: Still in Placement. | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Problems (Continuous). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||||
| Outcome category: Behaviour Problems (Continuous). | Outcome category: Attachment (Continuous). | |||||||
| Outcome categories: Number of Placements (Continuous), Length Stay (Placement), Placement Disruption. Measured using case records | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Length of Stay (Placement). | Outcome category: Attachment (Continuous). | ||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | ||||||||
| Outcome category: Psychiatric Disorder (Continuous) Measured using caregiver report | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ Assessment Checklist for Children | Outcome category: Placement Disruption. Measured using administrative database | ||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using standardised instrument ‐ Assessment Checklist for Children | ||||||||
| Outcome categories: Reunification, Adoption, Guardianship. | ||||||||
| Outcome category: Placement Disruption. | Outcome categories: Adoption, Guardianship. | |||||||
| Outcome category: Behaviour Problems (Continuous). | ||||||||
| Outcome category: Well‐Being (Dichotomous). | Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services. | ||||||
| Outcome category: Attachment. Measured using self report | ||||||||
| Outcome category: Behaviour problems (Dichotomous). Measured using case records | Outcome categories: Psychiatric Disorders (Dichotomous), Well‐being (Continuous). Measured using standardised instrument ‐ Children's Global Assessment Scale; DSM‐IV | Outcome categories: Number of Placements (Continuous) , Length of Stay (Placement). Measured using case records | Outcome categories: Reunification, adoption. Measured using case records | Outcome category: Repeated a grade. Measured using case records | Outcome category: Physician Services. Measured using case records | |||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Mental Health Services. Measured using Children and Adolescent Services Assessment | |||||||
| Outcome category: Length of Stay (OOH Care). | ||||||||
| Outcome category: Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome category: Well‐Being (Dichotomous). | ||||||||
| Outcome categories: Number of Placements (Continuous), Length of Stay (OOH Care), Re‐entry. Measured using administrative database | Outcome categories: Reunification, Adoption, Guardianship, Still in Placement. Measured using administrative database | Outcome category: Institutional Abuse. Measured using administrative database | ||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Repeated a Grade. | |||||||
| Outcome category: Number of Placements (Dichotomous), Length of Stay (OOH), Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome categories: Reunification, Adoption. Measured using administrative database | ||||||||
| Outcome category: Institutional Abuse. |
AFCARS: Adoption and Foster Care Analysis and Reporting System
GPA: Grade point average
OOH: out‐of‐home
PTSD: Post‐traumatic Stress Disorder
Behavioural development
The two behavioural development outcomes were behaviour problems and adaptive behaviours. Behaviour problems were defined dichotomously as the presence or absence of internalising (e.g., withdrawn, passive) and externalising (e.g., aggressive, delinquent) problem behaviours and continuously as the level of these behaviours. The continuous outcome was measured by the total problems scale of the Child Behavior Checklist (CBCL) in 12 studies (Davis 2005; Ford 2007; Holtan 2005; Jones‐Karena 1998; Lawler 2008; Linares 2010; Orgel 2007; Rudenberg 1991; Strijker 2003; Tarren‐Sweeney 2006a; Timmer 2004; Villagrana 2008), the Behaviour Problems Index (Brooks 1998), and caregiver reports in two studies (Metzger 1997; Surbeck 2000). The dichotomous outcome was measured by the CBCL in two studies (Ringeisen 2009; Sakai 2011), the Behavioural Assessment Scoring System for Children (McCarthy 2007), an administrative database (Ryan 2010a), and case records in two studies (Iglehart 1994; Landsverk 1996). Adaptive behaviours were defined continuously as the level of competence or positive behaviours and were measured by the total competence scale of the CBCL in three studies (Holtan 2005; Tarren‐Sweeney 2006a; Villagrana 2008), the adaptive composite score on the Vineland Adaptive Behavior Scales (VABS) in three studies (Belanger 2002; Jones‐Karena 1998; Villagrana 2008), and caregiver reports (Surbeck 2000).
Mental health
The two mental health outcomes were psychiatric disorders and well‐being. Psychiatric disorders were defined dichotomously by the presence or absence of mental illness and continuously by scores on a measure of psychopathology. The dichotomous outcome was measured by the Composite International Diagnostic Interview (Keller 2010), the Child Depression Inventory and Trauma Symptoms Checklist for children (Sakai 2011), paid claims data (Bilaver 1999), the DSM‐IV (McMillen 2005), and case records in two studies (Harris 2003; Iglehart 1994). The continuous outcome was measured by the Devereaux Scales of Mental Disorders (Belanger 2002) and the Columbia Impairment Scale and the Self‐Perception Profile of Adolescents (Mennen 2010). Well‐being was defined dichotomously by the presence or absence of positive emotional health and continuously by the level of well‐being or self worth. The dichotomous outcome was measured by the Foster Care Questionnaire (Dunn 2010), child self reports (Wilson 1999), the R.C. Monitoring Protocol (Harris 2003), and caseworker reports (Tompkins 2003). The continuous outcome was measured by the Personal Attribute Inventory for Children (Metzger 1997) and a measure from the National Longitudinal Study of Adolescent Health (Farruggia 2009).
Placement stability
The four placement stability outcomes were number of placements, length of stay, placement disruption, and re‐entry as measured by secondary data from administrative databases for all studies except for case records in two studies (Strijker 2008; Valicenti‐McDermott 2008), and caseworker reports in two studies (Del Valle 2009; Sakai 2011). Number of placements was measured both continuously by the number of out‐of‐home placements and dichotomously by experiencing either two or fewer or three or more placement settings. The dichotomous outcome was used in six studies (Courtney 1997b; Harris 2003; Metzger 1997; Pabustan‐Claar 2007a; Ryan 2010a; Zimmerman 1998). The continuous outcome was used in six studies (Belanger 2002; Davis 2005; Ryan 2010a; Sakai 2011; Strijker 2008; Winokur 2008). Length of stay in placement was measured continuously in six studies (Berrick 1994; Brooks 1998; Cole 2006; Davis 2005; Surbeck 2000; Valicenti‐McDermott 2008). Length of stay in out‐of‐home care was measured continuously in nine studies (Belanger 2002; Clyman 1998; Jenkins 2002; Ryan 2010a; Sivright 2004; Strijker 2008; Tompkins 2003; Valicenti‐McDermott 2008; Winokur 2008). It should be noted that longer lengths of stay in placement or in out‐of‐home care are considered negative outcomes in the U.S., as reunification within 12 months is the primary permanency goal for children placed in short‐term kinship or foster care. Placement disruption was measured dichotomously by whether the kin or foster placement ended without permanency in five studies (Del Valle 2009; Koh 2008b; Rubin 2008; Sallnas 2004; Testa 2001). Re‐entry was measured dichotomously by whether there was a re‐entry to out‐of‐home care after achieving permanency in two studies (Frame 2000; Winokur 2008).
Permanency
The four permanency outcomes were reunification, adoption, guardianship, and still in placement. All four outcomes were measured dichotomously by secondary data from administrative databases in 15 studies (Akin 2011; Barth 1994; Berrick 1999; Johnson 2005; Koh 2008b; McIntosh 2002; Pabustan‐Claar 2007a; Sivright 2004; Smith 2002; Smith 2003; Testa 1999; Testa 2001; Wells 1999; Winokur 2008; Zimmerman 1998) and case records or caseworker reports in four studies (Del Valle 2009; Lutman 2009; Sakai 2011; Valicenti‐McDermott 2008). Reunification was defined as a return home to biological or birth parents after placement in out‐of‐home care. Adoption was defined as a termination of parental rights with legal custody transferred to adoptive parents (in most cases non‐relatives). Guardianship was defined as an allocation of parents' rights with legal custody to relative caregivers (in most cases relatives). 'Still in placement' was defined as remaining in either kinship or foster care at the time data were collected for the study.
Educational attainment
The three educational attainment outcomes were repeating a grade, graduation, and grade level, and all were measured dichotomously. It should be noted that these outcomes are all U.S. measures of educational attainment. Repeating a grade was defined by whether a child had been retained in one or more grades as measured by caregiver or self reports in five studies (Berrick 1994; Brooks 1998; Ford 2007; Metzger 1997; Sripathy 2004) and case records (Valicenti‐McDermott 2008). Graduation was defined by whether a child completed high school and was measured by case records (Christopher 1998). Grade level was defined by whether a child's academic performance was below their actual grade level and was measured by child self reports (Iglehart 1995) and case records (Iglehart 1994).
Family relations
The three family relations outcomes were attachment, conflict, and home environment. Attachment was defined as perceived level of relatedness or attachment between child and caregiver and was measured continuously by child self reports (Chapman 2004), the Attachment Q‐Sort Version 3 Assessment (Chew 1998), caregiver reports (Strijker 2003), the Assessment of Interpersonal Relations (Davis 2005), and the Child Well‐Being Scales (Surbeck 2000). Attachment was measured dichotomously by the Ainsworth Strange Situation Procedure (Cole 2006), case records (Jenkins 2002), the Offer Self‐Image Questionnaire (Mosek 2001), and the Relationship Story Completion Test (Orgel 2007). Conflict was defined continuously as the level of family functioning as measured by the Index of Family Relations (Berrick 1997). Home environment was defined as the milieu within the foster and kinship care households (e.g., emotional climate, paternal involvement, and family participation) and was measured by the Elementary HOME Inventory (Ford 2007).
Service utilisation
The three service utilisation outcomes were mental health services, physician services, and developmental services defined dichotomously as whether a child actually received services (not just referral). Mental health service utilisation was measured by paid claims data (Bilaver 1999), caseworker reports in two studies (Metzger 1997; Tompkins 2003), case records in three studies (Jenkins 2002; Scannapieco 1997; Sivright 2004), caregiver reports in three studies (Berrick 1994; Sakai 2011; Sripathy 2004), The Young Kids Early Services Assessment (TYKES) (Clyman 1998), and the Child and Adolescent Services Assessment in three studies (Farmer 2010; Ringeisen 2009; Villagrana 2008). Physician service utilisation was measured by paid claims data (Bilaver 1999), caseworker reports (Tompkins 2003), case records in two studies (Scannapieco 1997; Valicenti‐McDermott 2008), caregiver reports in two studies (Sakai 2011; Schneiderman 2010), and the TYKES (Clyman 1998). Developmental services were measured by paid claims data (Bilaver 1999), the TYKES (Clyman 1998), and the Child and Adolescent Services Assessment (Ringeisen 2009).
Re‐abuse
The two re‐abuse outcomes were recurrence of abuse and institutional abuse, as measured dichotomously by secondary data from administrative databases. Recurrence of abuse was defined as whether a new substantiated incident of intrafamilial abuse or neglect (by birth or biological parent(s) not kin caregiver(s) or foster parent(s)) occurred after a previous substantiated incident and was reported in one study (Fuller 2005). Institutional abuse was defined as whether a substantiated incident of abuse or neglect occurred in an out‐of‐home placement setting (by kin caregiver(s) or foster parent(s) not birth or biological parent(s)) and was reported in three studies (Benedict 1996a; Winokur 2008; Zuravin 1993).
Excluded studies
As displayed in the Characteristics of excluded studies table, 296 studies (comprised of 300 reports) were excluded from the review for the following reasons: 102 were excluded because there was no formal kinship care group or the kinship care group was not disaggregated from the foster care group; 40 studies were excluded because there was no foster care comparison group or the foster care group was not disaggregated from other out‐of‐home placement types; 38 studies were excluded because they reported on an intervention other than out‐of‐home placement; 37 studies were excluded because they were non‐empirical (e.g. literature reviews); 29 studies were excluded because they were survey, descriptive, or qualitative research designs; 23 studies were excluded because child welfare outcomes were not reported; 16 studies were excluded because they were intractably unavailable; 11 studies were excluded because they were based on an adult sample.
Risk of bias in included studies
The included studies were assessed for risk of selection bias, performance bias, detection bias, reporting bias, and attrition bias. Specifically, each study was rated either at low risk, unclear risk, or high risk based on two sub‐questions for each of these areas. The 'Risk of bias' tables included with the Characteristics of included studies display the ratings for each type of bias and the support for these judgements. Specifically, selection bias is reported in 'allocation concealment', performance bias is reported in 'blinding of participants and personnel', detection bias is reported in 'blinding of outcome assessment', reporting bias is reported in 'selective reporting', and attrition bias is reported in 'incomplete outcome data'. There is nothing reported for 'random sequence generation', 'blinding', and 'other bias' because of the different dimensions of risk of bias assessed for the quasi‐experimental studies that comprise this evidence base. As displayed in the 'Risk of bias' Summary Figure (Figure 2), the risk of bias analysis indicates that the evidence base contains studies with unclear risk in all five categories, with the highest risk associated with selection bias and the lowest risk associated with reporting bias. It should be noted that there were some changes in the risk of reporting bias ratings for studies included in the original review. Specifically, studies from the original review that utilised administrative databases for outcome measurement were categorised as being at low risk of reporting bias rather than at unclear risk of reporting bias, to align them with the judgements made on the studies added for the updated review.
Risk of bias summary: Review authors' judgements about each risk of bias item for each included study.
Allocation
For selection bias, 21 studies (Belanger 2002; Berger 2009; Clyman 1998; De Robertis 2004; Ford 2007; Holtan 2005; Koh 2008a; Koh 2008b; Koh 2009; Lawler 2008; Linares 2010; Metzger 1997; Rudenberg 1991; Ryan 2010a; Sakai 2011; Schneiderman 2010; Tarren‐Sweeney 2008a; Tarren‐Sweeney 2008b; Winokur 2008; Testa 2001; Zinn 2009) were rated at low risk, 55 studies were rated at unclear risk, and 26 studies were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for selection bias were the lack of equating procedures and uncertainty or non‐reporting for placement and demographic data.
Blinding
For performance bias, four studies (Berrick 1997; Holtan 2005; Metzger 1997; Sivright 2004) were rated at low risk, 92 were rated at unclear risk, and six were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for performance bias were uncertainty regarding both the length of stay and receipt of services during placement.
For detection bias, six studies (Benedict 1996a; Cole 2006; Jenkins 2002; Leslie 2000a; Scannapieco 1997; Zuravin 1993) were rated at low risk, 90 were rated at unclear risk, and six were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for detection bias were uncertainty in how the groups were defined and the use of only caregiver or self reports to measure the outcome. Although biased assessment is not necessarily due to the type of placement, it may differentially impact the detection of a placement's effect on child welfare outcomes.
Incomplete outcome data
For attrition bias, 44 studies were rated at low risk, 54 studies were rated at unclear risk, and four studies were rated at high risk. The primary reason that studies were assessed to have unclear or high risk for attrition bias was the loss of participants due to missing outcome data.
Selective reporting
For reporting bias, 71 studies were rated at low risk, 28 studies were rated at unclear risk, and three studies were rated at high risk. The primary reason that studies were assessed to have unclear or high risk for report bias was the lack of reliability and/or validity information.
Other potential sources of bias
There were no other potential sources of bias assessed.
Effects of interventions
Meta‐analyses
There were sufficient data for meta‐analysis for 21 of the 29 outcomes in the review. As a result, we generated at least one meta‐analysis for each outcome category. We report the results for these 21 outcomes as the statistical significance of the effect, the direction and magnitude of the effect size, the 95% confidence interval around the effect size estimate, and the evidence of heterogeneity for the individual effect sizes. The effect sizes were drawn exclusively from the studies reporting bivariate data, and thus do not reflect adjustment by covariates (although bivariate data from studies that used matching designs were included in the effect size analyses). It should be noted that all standardised mean difference (SMD) effect sizes that are negative indicate better outcomes for the kinship care group, while all odds ratio (OR) effect sizes that are less than 1.0 also indicate better outcomes for the kinship care group.
Behavioural Development
There was a statistically significant overall effect size for the 15 studies (Brooks 1998; Davis 2005; Ford 2007; Holtan 2005; Jones‐Karena 1998; Lawler 2008; Linares 2010; Metzger 1997; Orgel 2007; Rudenberg 1991; Strijker 2003; Surbeck 2000; Tarren‐Sweeney 2006a; Timmer 2004; Villagrana 2008) that reported sufficient bivariate continuous data to generate effect size estimates for behaviour problems. Specifically, the overall effect size estimate was g = ‐0.33, 95% confidence interval (CI) ‐0.49 to ‐0.17 (see Analysis 1.1). Thus, children in kinship care (N = 1158) had lower reported levels of internalising and externalising behaviour problems than did children in foster care (N = 1657). The test of heterogeneity was significant for this outcome (P < .00001; I² = 73%; Tau² = 0.07; Chi² = 51.23).
There was a statistically significant overall effect size for the six studies (Iglehart 1994; Landsverk 1996; McCarthy 2007; Ringeisen 2009; Ryan 2010a; Sakai 2011) that reported sufficient bivariate dichotomous data to generate effect size estimates for behaviour problems. Specifically, the overall effect size estimate was reported OR 0.62, 95% CI 0.41 to 0.93 (see Analysis 1.2). Thus, children in foster care (N = 8407) had 1.6 times the odds of reporting internalising and externalising behaviour problems than did children in kinship care (N = 8042). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 92%; Tau² = 0.21; Chi² = 59.90).
There was a statistically significant overall effect size for the six studies (Belanger 2002; Holtan 2005; Jones‐Karena 1998; Surbeck 2000; Tarren‐Sweeney 2006a; Villagrana 2008) that reported sufficient bivariate data to generate effect size estimates for adaptive behaviours. Specifically, the overall effect size estimate was g = ‐0.42, 95% CI ‐0.61 to ‐0.22 (see Analysis 1.3). Thus, children in kinship care (N = 491) had higher reported levels of competence than did children in foster care (N = 796). The test of heterogeneity was significant for this outcome (P = 0.03; I² = 61%; Tau² = 0.03; Chi² = 12.69).
Mental health
There was a statistically significant overall effect size for the six studies (Bilaver 1999; Harris 2003; Iglehart 1994; Keller 2010; McMillen 2005; Sakai 2011) that reported sufficient bivariate dichotomous data to generate effect size estimates for psychiatric disorders. Specifically, the overall effect size estimate was OR 0.51, 95% CI 0.42 to 0.62 (see Analysis 2.1). Thus, children in foster care (N = 35448) had 2.0 times the odds of experiencing mental illness as did children in kinship care (N = 15303). The test of heterogeneity was not significant for this outcome (P = 0.26; I² = 23%; Tau² = 0.01; Chi² = 6.51).
There was a statistically significant overall effect size for the four studies (Dunn 2010; Harris 2003; Tompkins 2003; Wilson 1999) that reported sufficient bivariate dichotomous data to generate effect size estimates for well‐being. Specifically, the overall effect size estimate was reported OR 0.50, 95% CI 0.38 to 0.64 (see Analysis 2.2). Thus, children in kinship care (N = 126054) had 2.0 times the odds of reporting positive emotional health as did children in foster care (N = 191955). The test of heterogeneity was not significant for this outcome (P = 0.33; I² = 12%; Tau² = 0.02; Chi² = 3.41).
Placement stability
There was a statistically significant overall effect size for the six studies (Courtney 1997b; Harris 2003; Metzger 1997; Pabustan‐Claar 2007a; Ryan 2010a; Zimmerman 1998) that reported sufficient bivariate dichotomous data to generate effect size estimates for placement settings. Specifically, the overall effect size estimate was OR 0.39, 95% CI 0.33 to 0.45 (see Analysis 3.1). Thus, children in foster care (N = 15729) had 2.6 times the odds of experiencing three or more placement settings as did children in kinship care (N = 10763). The test of heterogeneity was significant for this outcome (P = 0.05; I² = 55%;Tau² = 0.01; Chi² = 11.14).
There was a statistically significant overall effect size for the six studies (Belanger 2002; Davis 2005; Ryan 2010a; Sakai 2011; Strijker 2008; Winokur 2008) that reported sufficient bivariate continuous data to generate effect size estimates for number of placements. Specifically, the overall effect size estimate was g = ‐0.38, 95% CI ‐0.58 to ‐0.17 (see Analysis 3.2). Thus, children in kinship care (N = 7749) had fewer mean number of placements as did children in foster care (N = 7928). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 90%; Tau² = 0.05; Chi² = 51.14).
There were six studies (Berrick 1994; Brooks 1998; Cole 2006; Davis 2005; Surbeck 2000; Valicenti‐McDermott 2008), with a total sample size of N = 634 for the kinship care group and N = 883 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for length of placement. The overall effect size estimate was g = 0.90, 95% CI ‐0.66 to 2.46 (see Analysis 3.3). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 99%; Tau² = 3.73; Chi² = 631.50).
There were nine studies (Belanger 2002; Clyman 1998; Jenkins 2002; Ryan 2010a; Sivright 2004; Strijker 2008; Tompkins 2003; Valicenti‐McDermott 2008; Winokur 2008), with a total sample size of N = 129503 for the kinship care group and N = 201218 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for length of stay in out‐of‐home care. The overall effect size estimate was g = 0.02 with a confidence interval of ‐0.04 to 0.09 (see Analysis 3.4). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 75%; Tau² = 0.00; Chi² = 32.46).
There was a statistically significant overall effect size for the five studies (Del Valle 2009; Koh 2008b; Rubin 2008; Sallnas 2004; Testa 2001) that reported sufficient bivariate data to generate effect size estimates for placement disruption. Specifically, the overall effect size estimate was OR 0.52, 95% CI 0.40 to 0.69 (see Analysis 3.5). Thus, children in foster care (N = 3541) had 1.9 times the odds of experiencing a placement disruption as did children in kinship care (N = 3340). The test of heterogeneity was significant for this outcome (P = 0.00003; I² = 81%; Tau² = 0.07; Chi² = 21.12).
Permanency
There were 13 studies (Akin 2011; Berrick 1999; Del Valle 2009; Koh 2008b; McIntosh 2002; Pabustan‐Claar 2007a; Smith 2002; Testa 1999; Testa 2001; Valicenti‐McDermott 2008; Wells 1999; Winokur 2008; Zimmerman 1998), with a total sample size of N = 22907 for the kinship care group and N = 44496 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for reunification. The overall effect size estimate was OR 1.09, 95% CI 0.85 to 1.40 (see Analysis 4.1). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 93%; Tau² = 0.15; Chi² = 173.03).
There was a statistically significant overall effect size for the 12 studies (Akin 2011; Barth 1994; Berrick 1999; Del Valle 2009; Koh 2008b; Pabustan‐Claar 2007a; Smith 2002; Testa 1999; Testa 2001; Valicenti‐McDermott 2008; Winokur 2008; Zimmerman 1998) that reported sufficient bivariate data to generate effect size estimates for adoption. Specifically, the overall effect size estimate was OR 2.52, 95% CI 1.42 to 4.49 (see Analysis 4.2). Thus, children in foster care (N = 44600) had 2.5 times the odds of being adopted as did children in kinship care (N = 22217). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 98%; Tau² = 0.86; Chi² = 533.68).
There was a statistically significant overall effect size for the eight studies (Akin 2011; Berrick 1999; Koh 2008b; Pabustan‐Claar 2007a; Testa 1999; Testa 2001; Winokur 2008; Zimmerman 1998) that reported sufficient bivariate data to generate effect size estimates for guardianship. Specifically, the overall effect size estimate was OR 0.26, 95% CI 0.17 to 0.40 (see Analysis 4.3). Thus, children in kinship care (N = 21590) had 3.8 times the odds of having relatives assume legal custody as did children in foster care (N = 43143). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 91%; Tau² = 0.29; Chi² = 82.29).
There was a statistically significant overall effect size for the 11 studies (Barth 1994; Berrick 1999; Johnson 2005; Lutman 2009; Sakai 2011; Sivright 2004; Smith 2002; Smith 2003; Testa 2001; Winokur 2008; Zimmerman 1998) that reported sufficient bivariate data to generate effect size estimates for the still‐in‐placement outcome. Specifically, the overall effect size estimate was OR 1.18, 95% CI 0.77 to 1.80 (see Analysis 4.4). Thus, children in kinship care (N = 19416) had 1.2 times the odds of still being in care as did children in foster care (N = 37830). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 96%; Tau² = 0.42; Chi² = 237.39).
Educational attainment
There were six studies (Berrick 1994; Brooks 1998; Ford 2007; Metzger 1997; Sripathy 2004; Valicenti‐McDermott 2008), with a total sample size of N = 546 for the kinship care group and N = 673 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for the 'repeated a grade' outcome. The overall effect size estimate was OR 0.73, 95% CI 0.50 to 1.07 (see Analysis 5.1). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was not significant for this outcome (P = 0.16; I² = 37%; Tau² = 0.08; Chi² = 7.94).
Family relations
There were five studies (Chapman 2004; Chew 1998; Davis 2005; Strijker 2003; Surbeck 2000), with a total sample size of N = 217 for the kinship care group and N = 282 for the foster care group, that reported sufficient bivariate continuous data to generate effect size estimates for the attachment outcome. The overall effect size estimate was g = ‐0.01, 95% CI ‐0.30 to 0.28 (see Analysis 6.1). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P = 0.09; I² = 50%; Tau² = 0.05; Chi² = 8.04).
There were four studies (Cole 2006; Jenkins 2002; Mosek 2001; Orgel 2007), with a total sample size of N = 163 for the kinship care group and N = 212 for the foster care group, that reported sufficient bivariate dichotomous data to generate effect size estimates for the attachment outcome. The overall effect size estimate was OR 1.21, 95% CI 0.56 to 2.59 (see Analysis 6.2). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was not significant for this outcome (P = 0.08; I² = 56%; Tau² = 0.33; Chi² = 6.80).
Service utilisation
There was a statistically significant overall effect size for the 13 studies (Berrick 1994; Bilaver 1999; Clyman 1998; Farmer 2010; Jenkins 2002; Metzger 1997; Ringeisen 2009; Sakai 2011; Scannapieco 1997; Sivright 2004; Sripathy 2004; Tompkins 2003; Villagrana 2008) that reported sufficient bivariate data to generate effect size estimates for mental health service utilisation. Specifically, the overall effect size estimate was OR 1.79, 95% CI 1.35 to 2.37 (see Analysis 7.1). Thus, children in foster care (N = 107705) had 2.4 times the odds of receiving mental health services as did children in kinship care (N = 44921). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 96%; Tau² = 0.17; Chi² = 289.17).
There were three studies (Bilaver 1999; Clyman 1998; Ringeisen 2009), with a total sample size of N = 14314 for the kinship care group and N = 33744 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for developmental service utilisation. The overall effect size estimate was OR 0.94, 95% CI 0.38 to 2.32 (see Analysis 7.2). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < .03; I² = 72%; Tau² = 0.44; Chi² = 7.02).
There were seven studies (Bilaver 1999; Clyman 1998; Sakai 2011; Scannapieco 1997; Schneiderman 2010; Tompkins 2003; Valicenti‐McDermott 2008), with a total sample size of N = 74354 for the kinship care group and N = 139651 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for physician service utilisation. The overall effect size estimate was OR 1.37, 95% CI 0.48 to 3.93 (see Analysis 7.3). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 99%; Tau² = 1.84; Chi² = 454.25).
Re‐abuse
There was a statistically significant overall effect size for the three studies (Benedict 1996a; Winokur 2008; Zuravin 1993) that reported sufficient bivariate data to generate effect size estimates for institutional abuse. Specifically, the overall effect size estimate was OR 0.27, 95% CI 0.10 to 0.71 (see Analysis 8.1). Thus, children in foster care (N = 659) had 3.7 times the odds of experiencing institutional abuse as did children in kinship care (N = 543). The test of heterogeneity was significant for this outcome (P = 0.003; I² = 83%; Tau² = 0.62; Chi² = 11.62).
Multivariate analyses
As studies that reported multivariate data controlled for covariates, such as age at placement, gender, ethnicity, socioeconomic status, geographic region, behaviour and health problems, placement reason and history, and caregiver variables, they potentially provide a stronger level of evidence regarding the effect of kinship care on child welfare outcomes. Thus, results from the weaker quasi‐experimental designs comprising the meta‐analytical data could also be considered stronger evidence if corroborated by the multivariate results which are summarised in the Outcomes for Studies with Multivariate Analysis Table (Table 4). It should be noted that some studies reported both bivariate and multivariate data, and were included in both analyses. Overall, the multivariate results generally support the results generated from the meta‐analyses.
| Study | 0utcome | Results |
| Reunification, Adoption | 1. When all other variables are held constant, children whose initial placement was in family foster care were less likely to exit to reunification than children initially placed in kinship care (HR = 0.76, P = 0.002). 2. When all other variables are held constant, children whose initial placement was in family foster care were more likely to exit to adoption than children initially placed in kinship care (HR = 2.25, P = 0.004). | |
| Adoption | 1. Initial placement in a kinship home decreases the odds of adoption by 50 percent (OR = 0.50) | |
| Adaptive Behaviours, | 1. The interaction of type of placement, home index, and temperament match did not account for more of the variance in VABS and DSMD scores than did type of placement alone. | |
| Institutional Abuse | 1. Placement in foster care increases the likelihood of association with maltreatment by 4.4 times. | |
| Behaviour Problems, | 1. Children in kinship placements (unstandardised beta = ‐5.596) were significantly less likely to be rated as exhibiting externalising behaviours (CBCL scale). | |
| Behaviour Problems | 1. Time spent in non‐kinship foster care homes was associated with decreased externalising behaviour problems. | |
| Reunification, Re‐entry | 1. Children in kinship care (AFDC subset) 2% (OR = 1.02) more likely to be reunified than children in non‐kin foster care (within 4 years of placement). | |
| Adaptive Behaviours | 1. Kinship foster care group significantly more likely than those from non‐relative foster care group to demonstrate pro‐social behaviours. | |
| Placement Disruption | 1. Placement in a non‐kin foster home significantly increased the risk of placement disruption by a factor of just over 3 (RR = 3.18). | |
| Mental Health, Physican, and Developmental Services | 1. Children in foster care had significantly higher rates of mental health service utilisation. | |
| Reunification, | 1. Children placed in a non‐relative foster care home (RR = 1.16) experienced significantly higher rates of reunification than children in relative foster homes. | |
| Placement Disruption | 1. Children placed in non‐relative foster care (RR = 3.18) have statistically significant higher rates of changes in placement than children in relative foster care. | |
| Re‐entry | 1. Children returned home after leaving kinship care placements (RR = 0.69) re‐entered care at a significantly lower rate than those discharged from foster home placements. | |
| Reunification, | 1. Placement with kin (OR = 1.90) at the time of final discharge from foster care significantly improved the odds of returning home or being adopted over unsuccessful discharge. | |
| Reunification, | 1. Placement in kinship home associated with lowered hazards of both reunification (RR = 0.82) and adoption (RR = 0.49) as compared to foster home placements. | |
| Re‐entry, | 1. No significant difference in rates of reunification based on child's initial placement in foster home vs kinship home. | |
| Relatedness | 1. Type of placement not found to be predictor of relationship with caregiver. | |
| Behaviour Problems | 1. Kinship status did not contribute significantly to the prediction off aggressive responses (CBCL ‐ OR = 0.65, P = 0.560; BIA ‐ OR ‐1.34, P = 0.510) | |
| Mental Health Services | 1. Increased likelihood of any mental health service use for non‐relative foster care placement (OR = 1.94) than for kinship care (OR = 1.08). | |
| Well‐being | 1. Type of placement not significant predictor of global self worth. | |
| Re‐entry | 1.Children placed with kin (OR = 0.19 to 0.25) just prior to reunification were about 80% less likely to re‐enter care than those whose last placement was with non‐kin. | |
| Re‐entry, | 1. Type of placement not found to have statistically significant relationship with reunification | |
| Recurrence of Abuse | 1. Children whose initial placement was in kinship foster care (OR = 9.60), and whose initial placement was family foster care (OR = 2.40) were more likely to experience maltreatment recurrence, within 60 days of reunification, than those whose initial placement was a group home/institution; thus, children whose initial placement was in kinship foster care were 4 times more likely to experience maltreatment recurrence, within 60 days of reunification, than those whose initial placement was family foster care. | |
| Reunification | 1. Placement into kinship foster home (RR = 1.06) compared to foster home with non‐relatives increased the probability that a child would be reunified from foster care (1998 to 1995 cohort). | |
| Placement Disruption | 1. Living with a kin caregiver decreased the odds of disruption 0.16 times compared to living with a non‐kin caregiver. | |
| Behaviour Problems | 1. Non‐kinship placement (OR = 1.90) significantly associated with scoring within the borderline range on CBCL Total Problems scale. | |
| Placement Disruption | 1. Children living with non‐relative foster parents had 3 times the odds of experiencing a negative placement disruption as children living with kin foster parents. | |
| Still in Placement | 1. Interaction terms such as child's initial placement were nonsignificant predictors of permanency within 15 months after entering out‐of‐home care. | |
| Recurrence of Abuse, | 1. Children who exited from care following placement with kin (RR = 0.82) were significantly less likely than children who exited from foster care to return for a subsequent report. | |
| Placement Disruption, Number of Placements, Length of Stay (OOH Care), Reentry, Guardianship, Adoption, Reunification, Still in Placement | 1. Children in relative foster care were less likely to experience initial placement disruption than those in non‐relative foster care. 2. Children in relative foster care were less likely to experience 3 or more placements within a year of entry than those in non‐relative foster care. 3. The findings were mixed for length of OOH stay with children in relative foster homes reported to stay longer in care in 3 states and shorter in 3 states. 4. The findings were mixed for re‐entry with children in relative foster homes more likely to re‐enter care in 1 state, less likely to re‐enter in 2 states, and as likely to re‐enter in 1 state. 5. The findings were mixed for guardianship, with children in relative foster care having a higher likelihood of guardianship in 5 states and a similar likelihood in 1 state. 6. The findings were mixed for adoption, with children in non‐relative foster care having a higher likelihood of adoption in 4 states and a lower likelihood in 2 states. 7. The findings were mixed for reunification, with children in relative foster care having a higher likelihood of reunification in 3 states and a lower likelihood in 3 states. 8. The findings were mixed for still in placement, with children in relative foster care more likely to remain in care in 3 states and less likely to remain in care in 3 states. | |
| Placement Disruption | 1. Children in kinship foster homes were more likely to remain in their initial placement with kin than children initially placed in non‐kinship foster homes. | |
| Emotional Availability | 1. The model's ability to predict emotional availability was not improved by the addition of the kin status of foster mothers. | |
| Mental Health Service Utilisation | 1. Children placed in non‐relative foster care had significantly higher numbers of outpatient mental health visits compared to those residing in kin only (rate estimate = 0.57). | |
| Behaviour Problems | 1. Type of foster parent did not contribute to child internalising or externalising behaviour. | |
| Mental Health Service Utilisation | 1. Kinship care significantly associated with current outpatient therapy services; children in kinship care (OR = 0.39) less likely to utilise outpatient therapy services than non‐kin foster care. | |
| Psychiatric Disorders | 1. No significant differences in rates of past year psychiatric disorders (any disorder) based on living situation (kinship care (OR = 0.87) vs non‐kin family foster care). | |
| Behaviour Problems, Well‐being | 1. In no instance did the maltreated children differ from each other by placement type for behaviour problems. 2. In no instance did the maltreated children differ from each other by placement type for well‐being. | |
| Well‐being | 1. Placement type remained the strongest variable in explaining the variability in child well‐being as measured by the Personal Attribute Inventory for Children. | |
| Behaviour Problems | 1. Controlling for placement stability, baseline risk, and reunification status at 18 and 36 months, children in early kinship care had lower marginal probability of behavioural problems by 36 months. The estimate of behavioural problems was 46% if all children had been assigned to general foster care only, compared with 32% if the children had been assigned to early kinship care. | |
| Behaviour Problems, Psychiatric Disorders, Mental Health Services | 1. Kinship care compared to foster care was associated with a lower risk of continuing behavioural problems (RR = 0.59). 2. Kinship care compared to foster care was associated with a lower risk of prevalence of depression (RR = 0.73), but was associated with a higher risk of prevalence of PTSD (RR = 1.42) 3. Kinship care compared to foster care was associated with a lower risk of mental health therapy use (RR = 0.45). | |
| Physician Services | 1. Although the reference group was birth parents, children in kinship care had an OR = 1.41 for physician services as compared to children in foster care OR = 0.45. | |
| Test Scores | 1. Adolescents placed in relative foster care (beta = 0.24) showed significantly higher scores on reading skills than those in non‐kin foster care. | |
| Still in Care | 1. Compared to children in adoptive placements, children in kinship care placements were 72% less likely (HR = 0.28) to exit care, children in non‐relative placements were 52% less likely (HR = .48) to exit and children in institutional or other placement types were 59% less likely (HR = .41) to exit care; thus, children in non‐relative placement are 1.7% more likely to exit care than children in kinship placement. | |
| Behaviour Problems | 1. The difference in behaviour problems by placement type was not maintained when other determinants of child behaviour were included in the specification of the model. | |
| Psychiatric Disorders | 1. Residing in kinship care did not contribute significantly to the prediction of psychiatric disorders (P = 0.180). | |
| Behaviour Problems, Well‐being | 1. Type of care did not contribute significantly to the prediction of behaviour problem scores (P = 0.290). 2. Type of care did not contribute significantly to the prediction of well‐being scores (P = 0.170). | |
| Behaviour Problems | 1. Type of care did not contribute significantly to the prediction of sexual behaviour problems (P = 0.240). | |
| Placement Disruption | 1. At placement start, kinship care is 86% to 82% less prone to disruption than non‐related foster care (cohort samples); placement with relatives 67% less likely to disrupt from the start than placements into non‐related foster homes (matched cross‐sectional sample). | |
| Attachment | 1. Children in kinship foster care reported higher levels of agreement than did children in foster care for "like who they are living with" (97% to 91%) and "feel like part of the family" (95% to 90%). | |
| Length of Stay (Placement) | 1. Children in caretaker placements (beta = ‐1.22) spent significantly more time in care than their counterparts. | |
| Re‐entry, | 1. Rate of reunification did not differ between children placed in kinship and non‐relative family foster care (RR = 0.94). | |
| Behaviour Problems, Adaptive behaviours, | 1. No significant difference between non‐kinship family foster home and kinship family foster home on CBCL Total Problems or Total Competence scale. | |
| Reunification | 1. Type of placement not directly related to likelihood of family reunification (kinship placement HR = 1.07). | |
| Institutional Abuse | 1. Regular care homes were 2.7 times (OR) more likely to have confirmed report of maltreatment than were kinship homes. |
AFDC: Aid to Families with Dependent Children
BIA: Behavioural Influences Analysis
CBCL: Child Behaviour Checklist
DSMD: Devereux Scales of Mental Disorder
OOH: Out‐of‐home
VABS: Vineland Adaptive Behaviour Scales
For behavioural development, Bennett 2000, Holtan 2005, Rubin 2008, and Sakai 2011 found that children in kinship care had significantly lower likelihood of behaviour problems than did children in foster care. Furthermore, three studies reporting multivariate adaptive behaviours data (Belanger 2002; Bennett 2000; Brooks 1998) found that children in kinship care had significantly greater adaptive behaviours than did children in foster care. However, De Robertis 2004, Linares 2010, Mennen 2010, Surbeck 2000, Tarren‐Sweeney 2008b, and Zima 2000 did not find a significant difference between the groups on behaviour problems, while Berger 2009 found that time spent in foster care homes was associated with decreased externalising behaviour problems. Again, Zima 2000 did not find a significant difference between the groups on adaptive behaviours.
For mental health, Belanger 2002 and Metzger 1997 found that children in kinship care had significantly better reported well‐being and fewer psychiatric disorders than did children in foster care. However, Ford 2007, Mennen 2010, and Tarren‐Sweeney 2008a found that type of placement was not a significant predictor of well‐being, while McMillen 2005 and Tarren‐Sweeney 2006a found no significant difference between the groups on psychiatric disorders. Sakai 2011 found that children in kinship care had a lower risk of depression but a higher risk of post‐traumatic stress disorder (PTSD).
For service utilisation, Clyman 1998, Farmer 2010, Leslie 2000a, McMillen 2004, and Sakai 2011 found that children in foster care were significantly more likely to utilise mental health services than were children in kinship care. As for physician service utilisation, Clyman 1998 found no significant difference between the groups, while Schneiderman 2010 found that children in kinship care had a greater likelihood of utilising physician service than did children in foster care.
The greatest amount of multivariate data was reported for the permanency outcomes. Similar to the nonsignificant meta‐analysis results for reunification, the findings from the 12 studies reporting multivariate data were also inconclusive. Specifically, four studies (Akin 2011, Berrick 1999; Courtney 1996a; Grogan‐Kaylor 2000) found that children in kinship care were more likely to reunify, while two studies (Connell 2006a; Courtney 1996b) found that children in foster care were more likely to reunify. Furthermore, Courtney 1997a, Frame 2002, Wells 1999, and Zimmerman 1998 found no significant difference between the groups on reunification, while Koh 2008a reported mixed findings on reunification depending on the state being analysed. As for adoption, Akin 2011, Barth 1994, and Courtney 1996b found that children in foster care were significantly more likely to be adopted than were children in kinship care. However, Courtney 1996a found that children in kinship care were more likely to be adopted, while Connell 2006a found no significant difference between the groups, and Koh 2008a reported mixed findings on adoption depending on the state being analysed. Berrick 1999 and Smith 2003 found that children in foster care were significantly less likely to still be in placement than were children in kinship care, while Frame 2002 and Johnson 2005 found no significant difference between the groups, and Koh 2008a reported mixed findings on this permanency outcome depending on the state being analysed.
For placement stability, Chamberlain 2006, Connell 2006b, Helton 2010, Hurlburt 2010, Koh 2008a, Koh 2009, and Testa 2001 found that children in kinship care were less likely to disrupt from placement than were children in foster care. Perhaps the most compelling evidence from the multivariate analyses was for re‐entry, in that seven studies (Berrick 1999; Courtney 1995; Courtney 1997a; Frame 2000; Frame 2002; Jonson‐Reid 2003; Wells 1999) reported that children in kinship care were significantly less likely to re‐enter care than were children placed in foster care, while only one study (Koh 2008a) reported mixed findings on re‐entry depending on the state being analysed. Vogel 1999 found that children in kinship care had significantly longer lengths of stay than did children in foster care, while Koh 2008a reported that children in kinship care were less likely to experience three or more placements within a year.
For the safety outcomes, Benedict 1996a and Zuravin 1993 found that children in kinship care were less likely to experience institutional abuse than were children in foster care. However, the multivariate results were inconclusive for recurrence of abuse, as Jonson‐Reid 2003 found that children in kinship care were less likely to experience recurrence of abuse, while Fuller 2005 found that children in kinship care were more likely to experience recurrence of abuse.
For family relations, the USDHHS 2005 study reported that children in kinship care had higher levels of attachment, while Davis 2005 and Lawler 2008 found that type of placement was not a significant predictor of relatedness or emotional availability, respectively. Finally, for educational attainment, Shin 2003 found that children in kinship care had significantly higher reading scores than did children in foster care, while Zinn 2009 found no difference between the groups on educational attainment.
Bivariate analyses
As summarised in the Outcomes for Studies with Bivariate Analysis Table (Table 5), there were several studies that reported findings from bivariate analyses but did not report sufficient information for effect size calculation. Typically, these studies reported nonsignificant findings in the narrative but did not include the relevant data in a table. For example, five studies (De Robertis 2004; Landsverk 1996; Sripathy 2004; Tarren‐Sweeney 2008b; Valicenti‐McDermott 2008) found no difference between children in kinship care and foster care on the level of behaviour problems as measured by the Child Behavior Checklist (CBCL). However, Berrick 1994, Metzger 2008, Palacios 2009, and Tarren‐Sweeney 2008b confirmed the results from the meta‐analysis, in that children in kinship care had significantly fewer reported behavioural problems than did children in foster care. As for adaptive behaviours, Sripathy 2004 found no difference between children in kinship care and foster care on the level of adaptive behaviours as measured by the CBCL.
| Study | Outcomes | Results |
| Behaviour Problems | 1. Children in kinship care had a lower mean total score on the Behaviour Problems Index (BPI) than children in foster care. | |
| Behaviour Problems | 1. No significant differences on CBCL aggressive behaviours were found between kinship (M = 9.83) and non‐kinship (M = 10.49) groups. | |
| Educational Attainment | 1. Students placed in non‐relative foster care had significantly higher cumulative GPA and a greater number of cumulative earned credits toward graduation than students placed in relative or kinship foster care. No other differences were found for type of placement on the academic variables of number of days absent, number of grades retained, and performance on standardised state testing in maths and reading. | |
| Placement Disruption | 1. A significantly greater proportion of disrupted children were living with a non‐kin caregiver at baseline compared to the stable group. | |
| Behaviour Problems | 1. Differences between 2 groups not statistically different on CBCL. | |
| Length of Stay (Placement) | 1. No significant differences in the length of time in placement for the kinship foster care and traditional foster care groups. | |
| Length of Stay (Placement) | 1.Children placed in traditional foster homes (M = 78 months) had longer lengths of stay than children placed in kinship foster homes (M = 74 months). | |
| Behaviour Problems, Attachment | 1. Kinship foster children showed significantly better ratings of behavioural reaction than family foster children (P = 0.017). 2. Kinship foster parents had significantly greater satisfaction with their relationships with the children than the family foster parents (P = 0.039). | |
| Well‐being | 1. The self concept of adolescents growing up with kin foster families is higher than the self concept of adolescents in non‐relative care. | |
| Well‐being, Behaviour Problems | 1. Higher scores were obtained from non‐relative carers than relative carers in relation to meeting basic needs and educational supervision on the Child Well‐being Scales. 2. Those in unrelated foster care were almost all the ones who received the highest behaviour problem scores according to carers, while there was no difference in behaviour problems linked to the type of foster care according to teachers. | |
| Length of Stay (OOH) | 1. There was no significant difference in length of stay (P = 0.42) between children placed initially in kinship care (M = 791 days) and children initially placed in foster care (M = 588 days). | |
| Length of Stay (Placement) | 1. Children in kinship care differ significantly from children in traditional foster care on length of time in care, with kinship care reporting significantly higher lengths of placement. | |
| Behaviour Problems, | 1. No significant differences found between the two types of care (kinship and non‐kinship children) on CBCL Total Problems and Total Competence scales. | |
| Placement Disruption | 1. No significant difference between the number of placement disruptions in foster family care and kinship foster care. | |
| Placement Disruption, Behaviour Problems, Well‐being | 1. Placement disruption did not vary according to whether children presently resided in foster or kinship care 2. Children in foster care had higher scores on the CBCL (more behaviour problems) than children in kinship care (P = 0.007). 3. Children in foster care had higher scores on well‐being than children in kinship care (P = 0.010). | |
| Behaviour Problems | 1. Type of placement was not associated with sexual behaviour problems scores. | |
| Attachment | 1. Children in kinship foster care reported higher levels of agreement than did children in foster care for "like who they are living with" (97% to 91%) and "feel like part of the family" (95% to 90%). | |
| Behaviour Problems, Psychiatric Disorders, Number of Placements, Well‐being | 1. Behavioural problems did not vary between children according to their placement. 2. Psychiatric disorders did not vary between children according to their placement. 3. The foster care groups had a mean of 2 placements while the kinship group had a mean of 1 placement. 4. There was no difference in well‐being scores between the 2 groups. | |
| Length of Stay (OOH), | 1. Children in non‐kinship foster placements had a much shorter median length of stay than children in kinship placements. | |
| Reunification, Adoption | 1. Estimated rates of reunification were not found to be significantly different for children placed with kinship foster families than for children placed with non‐relative foster families (HR = 1.03). 2. Estimated rates of adoption were not found to be significantly different for children placed with kinship foster families than for children placed with non‐relative foster families (HR = 1.09). |
CBCL: Child Behaviour Checklist
GPA: Grade point average
HR: hazard ratio
OOH: Out‐of‐home
M: mean
For mental health, Mosek 2001 and Tarren‐Sweeney 2008a found that children in kinship care had significantly higher well‐being than did children in foster care, while Palacios 2009 found that foster parents reported greater well‐being in regard to basic needs and educational supervision, and Valicenti‐McDermott 2008 found no difference in well‐being or psychiatric disorders between the groups. For family relations, Metzger 2008 and USDHHS 2005 found higher levels of attachment for children in kinship care than for children in foster care. For educational attainment, Geenen 2006 found that children in foster care had significantly higher grade point averages and earned credits than did children in kinship care, although there were no differences for attendance, number of grades retained, and test scores.
For placement stability, two studies, Scannapieco 1997 and Zimmerman 1998, found that children in foster care had significantly shorter placement lengths than did children in kinship care, while Metzger 1997 found that children in kinship care had significantly shorter lengths of placement, and Lernihan 2006 found no differences between the groups on length of placement. The bivariate results were similar for length of stay in out‐of‐home care, as Zimmerman 1998 found that children in foster care had significantly shorter lengths of stay than did children in kinship care, while Sakai 2011 found no difference between the groups on length of stay in out‐of‐home care. Helton 2010 found that children in kinship care had significantly lower rates of placement disruption, while Strijker 2008 and Tarren‐Sweeney 2008a found no difference between the groups on placement disruption. Zimmerman 1998 found no difference between the groups on re‐entry rates. Lastly, Zinn 2009 found no differences between the groups on the permanency outcomes of reunification and adoption.
Sensitivity analyses
Sensitivity analyses comparing studies with high risk of attrition bias and low risk of attrition bias were planned but were not conducted because only four studies were rated at high risk. Furthermore, attrition rates could not be accurately determined for the quasi‐experimental studies included in the review. Specifically, all of these studies were post‐test only, so there were often incomplete data on how many children were originally placed in kinship or foster care and no pre‐measures to indicate how many children 'dropped out' of the study by the time of the post‐measures data collection. There were missing data in some of the studies, in that multiple measures had different sample sizes, presumably because data were either not available from case files or not collected. However, the missing data are presumed to be missing at random, so no sensitivity analysis is warranted.
Sensitivity analyses comparing studies with child self reports and parent/teacher/caregiver reports were planned for the review, but were not conducted because of the lack of such comparisons for the included outcomes. For example, there were no studies that measured behavioural development by child self report and only one study each that measured service utilisation and educational attainment by child self report. Furthermore, there were only two studies that measured mental health by child self report. Lastly, three studies used child self reports for family relations, but there were no studies that measured family relations by caregiver reports.
Sensitivity analyses comparing studies that controlled for confounders with those that did not were not possible using statistical techniques because of differences in the type of data reported. Specifically, the studies that controlled for confounders used multivariate analyses rather than matching (except for Koh 2008a; Rudenberg 1991; Testa 2001; Winokur 2008). As such, many of the multivariate data were reported as correlation and beta coefficients or odds and risk ratios. These data could not be used in the meta‐analyses to generate multivariate effect sizes to compare with the bivariate data effect sizes. However, we employed vote counting for the multivariate studies to provide some comparison with the results from the bivariate studies.
We conducted sensitivity analyses comparing studies at low, unclear, and high risk for selection bias, as there were 21 studies rated at low risk, 55 studies rated at moderate risk, and 26 studies rated at high risk. Specifically, we conducted sensitivity analyses for selection bias on behaviour problems and mental health service utilisation because these two outcomes had at least three studies in each of the risk groups. For the continuous behaviour problems outcome, we used a simple unweighted ANOVA model with the risk groups as the independent variable and the standard mean difference from each study as the dependent variable. The following are the mean effect sizes and 95% confidence intervals for the low risk group: ‐0.65 (95% CI ‐1.56 to 0.24), the unclear risk group: ‐0.23 (95% CI ‐0.36 to ‐0.10); and the high risk group: ‐0.17 (95% CI ‐0.66 to 0.33). The result was nonsignificant (F = 1.53, P = 0.257), which indicates that the effect sizes for behaviour problems are similar between the low risk (Ford 2007; Holtan 2005; Lawler 2008; Linares 2010; Metzger 1997; Rudenberg 1991), the unclear risk (Brooks 1998; Davis 2005; Orgel 2007; Surbeck 2000; Timmer 2004), and the high risk (Jones‐Karena 1998; Strijker 2003; Tarren‐Sweeney 2006a; Villagrana 2008) for selection bias groups.
For the mental health service utilisation outcome, we used a simple unweighted ANOVA model with the risk groups as the independent variable and the odds ratios as the dependent variable. Before conducting the ANOVA, the odds ratios were transformed into standard mean differences using a method from Chinn 2000, in which the log transformation of each odds ratio is divided by 1.81. The following are the mean effect sizes and 95% confidence intervals for the low risk group: 0.39 (95% CI ‐0.84 to 1.62), the unclear risk group: 0.19 (95% CI ‐0.13 to 0.51); and the high risk group: 0.39 (95% CI 0.19 to 0.60). The result was nonsignificant (F = 0.75, P= 0.496), which indicates that the effect sizes for mental health service utilisation are similar between the low risk (Clyman 1998; Metzger 1997; Sakai 2011), unclear risk (Berrick 1994; Farmer 2010; Sivright 2004; Sripathy 2004; Tompkins 2003), and high risk groups (Bilaver 1999; Jenkins 2002; Ringeisen 2009; Scannapieco 1997; Villagrana 2008) for selection bias.
Subgroup analyses
There were insufficient data to examine different effects of the intervention by gender, ethnicity, and age at placement. Specifically, only three studies (Farruggia 2009; Holtan 2005; Ryan 2010a) reported outcome data by gender for each placement type, only Farruggia 2009 and Smith 2002 reported outcome data by ethnicity for each placement type, and no studies reported outcome data by age at placement for each placement type.
Discussion
Summary of main results
Based on the preponderance of the available evidence, it appears that children in kinship care experience better outcomes in regard to behaviour problems, adaptive behaviours, psychiatric disorders, well‐being, placement stability (placement settings, number of placements, and placement disruption), guardianship, and institutional abuse than do children in foster care. There were no detectable differences between the groups on reunification, length of stay (in placement or out‐of‐home care), educational attainment, family relations, developmental service utilisation, and physician service utilisation. However, children placed with kin are less likely to achieve adoption and to utilise mental health services, while being more likely to still be in placement than are children in foster care. Although there were some findings of no difference between the groups for certain outcomes, the multivariate results generally support the findings from the meta‐analyses while indicating that children in kinship care are less likely to re‐enter out‐of‐home care than are children in foster care. However, these conclusions are tempered by the pronounced methodological and design weaknesses of the included studies and particularly the absence of conclusive evidence on the comparability of groups. It is clear that researchers and practitioners must do better to mitigate the biases that cloud the study of kinship care.
Although 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, policies mandating kinship placements may not always be in the best interest of children and families. Professional judgement from child welfare practitioners must also be used to assess the individual needs of children and the ability of kin caregivers to attend to these needs.
Overall completeness and applicability of evidence
With the inclusion of 40 new studies and an overall evidence base of 102 studies, this systematic review represents the most complete synthesis of kinship care research to date. The findings presented here are robust, in that the addition of the 40 studies did not change any of the previous results and in fact consolidated many of them. Although two years have passed since the updated search date of March 2011, it would take an additional 40 studies with dramatically different results to have any impact on the findings. Furthermore, the context in which kinship care is practised (at least in the U.S.) has not changed in the past two years, as kinship care is still the preferred out‐of‐home placement option. Thus, the decision was made to proceed with the publication of the updated systematic review to maximise the applicability of the evidence for child welfare practitioners and policymakers. All studies produced after March 2011 will be considered for the next update of this systematic review.
Overall, a very secure picture of the outcomes for kinship care has emerged. However, the applicability of the evidence is still worth considering, especially for the key outcomes. For example, the lack of a baseline measurement of initial behavioural functioning makes ambiguous the conclusion that children in foster care have lower levels of current behavioural functioning. Furthermore, caregiver reports may be biased because foster parents have more incentive to report behavioural and mental health issues, whereas relatives are more apt to view the behaviour as acceptable and thus less likely to report it as problematic.
The mixed findings for the permanency outcomes could be interpreted in the context that long‐term kinship care arrangements satisfy the definition of permanency in many countries, as kinship caregivers are allocated the parental rights for a child. Thus, an undesirable outcome (e.g., remaining in care) might actually be desirable if the kinship care placement is considered to be safe and stable. Adoption and guardianship are secondary permanency goals, which are considered only after reunification has been ruled out. Furthermore, these permanency outcomes are fundamentally dependent on the public and legal policy of individual countries. For example, adoption is not a viable permanency option in many countries outside of the U.S., including Australia, Israel, Netherlands, and the Nordic nations.
The commonly‐held idea that foster parents are more 'system involved' may explain the greater propensity for children in foster care to receive mental health services. Furthermore, the training and supervision of foster parents may contribute to the higher identification of mental health problems, and as such contribute to higher levels of service utilisation. The lower licensure rate for kin caregivers may be another factor in the unequal receipt of services for children in kinship care. However, the greater likelihood for children in foster care to utilise mental health services may have less to do with the type of placement and more to do with these children having a greater need for services.
Quality of the evidence
The major limitation encountered in this systematic review is the weak standing of quantitative research on kinship care (Cuddeback 2004). Specifically, the "differences between the children who enter kinship care and those who enter nonkinship care" lead to a lack of confidence regarding the comparability of groups and the subsequent lack of control over contaminating events such as family preservation services (Barth 2008b, p. 218). In general, the included studies also have unclear to high risks of performance, detection, reporting, and attrition bias, which compromise the tenability of the findings from the systematic review. However, the sensitivity analyses indicate that the results for behavioural development and mental health service utilisation are more robust, in that the effect sizes for studies with low, unclear, and high risk of selection bias were comparable.
Another concern regarding the quality of evidence is the potential misalignment between the intervention and child welfare outcomes, in that the fullest representation of the effects of kinship care has yet to be truly measured (Cuddeback 2004). When compared to traditional foster care, in which the relationship between foster parents and the 'system' is more standardised, the effect of kinship care may be more difficult to detect. For example, there is seemingly a lack of implementation fidelity within and across countries in regard to kinship care. Furthermore, kinship placements, especially with unlicensed caregivers, are often more private and out of the control of child welfare agencies than are foster placements. The concepts, terminology, and outcomes typically ascribed to out‐of‐home care may not always be appropriate for kinship placements. As a result of these limitations, it is more appropriate to research kinship care after it has been fully and consistently integrated into the fabric of child welfare policy and practice.
Potential biases in the review process
One potential bias in the review process is that the robustness of the meta‐analysis results is weakened by challenges confronted during the effect size calculations. Specifically, the heterogeneity statistic was significant for 17 of the 21 outcomes, which indicates that the effect sizes were not always consistent within the same outcome. In addition, bivariate data were not reported in every study, which restricted the meta‐analysis of some outcomes to the bare minimum of three studies and eliminated other outcomes from consideration. Another potential bias is that many studies analysed a small sample of children, while others utilised a much larger dataset. However, this was somewhat mitigated by the use of random‐effects weighting, which gave more weight to the studies with smaller sample sizes and less weight to the studies with larger sample sizes, than would a fixed‐effect analysis.
The presence of publication bias in this review was examined for behavioural problems (continuous), reunification, adoption, still in placement, and mental health service utilisation, as these outcomes had at least 10 studies included in the respective meta‐analyses. Overall, a visual inspection of the funnel plots suggests that publication bias is likely not present for these outcomes. Specifically, the funnel plots for behavioural problems, mental health service utilisation, reunification, and still in placement appear symmetrical. The funnel plot for adoption (Figure 3) appears asymmetrical with a gap in the bottom left corner of the graph. However, the three studies represented in the bottom right corner have the smallest sample sizes, the largest effect sizes, and the largest standard errors, which may indicate poor methodological quality rather than publication bias. Furthermore, these three studies are in favour of the control condition, so it does not appear that any studies that may be 'missing' are missing because of negative findings.
Funnel plot of comparison: 4.2 Adoption.
Agreements and disagreements with other studies or reviews
The results of this review are in strong agreement with the only previous narrative review of kinship care, conducted by Cuddeback 2004.
Study flow diagram (complete review)
Risk of bias summary: Review authors' judgements about each risk of bias item for each included study.
Funnel plot of comparison: 4.2 Adoption.
Comparison 1 Behavioural Development, Outcome 1 Behaviour problems continuous.
Comparison 1 Behavioural Development, Outcome 2 Behavioural problems dichotomous.
Comparison 1 Behavioural Development, Outcome 3 Adaptive behaviours.
Comparison 2 Mental Health, Outcome 1 Psychiatric disorders dichotomous.
Comparison 2 Mental Health, Outcome 2 Well‐being dichotomous.
Comparison 3 Placement Stability, Outcome 1 Number of placements dichotomous.
Comparison 3 Placement Stability, Outcome 2 Number of placements continuous.
Comparison 3 Placement Stability, Outcome 3 Length of stay in placement.
Comparison 3 Placement Stability, Outcome 4 Length of stay in out‐of‐home care.
Comparison 3 Placement Stability, Outcome 5 Placement disruption.
Comparison 4 Permanency, Outcome 1 Reunification.
Comparison 4 Permanency, Outcome 2 Adoption.
Comparison 4 Permanency, Outcome 3 Guardianship.
Comparison 4 Permanency, Outcome 4 Still in placement.
Comparison 5 Educational Attainment, Outcome 1 Repeated a grade.
Comparison 6 Family Relations, Outcome 1 Attachment continuous.
Comparison 6 Family Relations, Outcome 2 Attachment dichotomous.
Comparison 7 Service Utilisation, Outcome 1 Mental health services.
Comparison 7 Service Utilisation, Outcome 2 Developmental services.
Comparison 7 Service Utilisation, Outcome 3 Physician services.
Comparison 8 Re‐abuse, Outcome 1 Institutional abuse.
| Section | Methods |
| Search Strategy | Search Child Welfare Information Gateway, National Data Archive on Child Abuse and Neglect, and System for Information on Grey Literature in Europe (OpenSIGLE). |
| Search Strategy | Search the websites of international child welfare organizations, University libraries, and State departments to identify governmental and non‐governmental reports and texts. |
| Selection of Trials | If we cannot reach a consensus regarding future selection decisions through discussion with a third reviewer, we will resolve it by appeal to external advisers. |
| Sensitivity Analyses | Should sufficient data exist, we will analyse the following planned comparisons: |
| Subgroup Analyses | Should sufficient data exist, we will generate subgroup analyses to examine different effects of the intervention (if any) by gender, ethnicity, and age at placement. |
| Study | Age at Placement | Gender | Ethnicity | Removal Reason | Urbanicity |
| Female (O) ‐ 49% | Black (O) ‐ 16% | Neglect (O) ‐ 24% | |||
| Female (K) ‐ 59% | Black (O) ‐ 63% | ||||
| Female (O) ‐ 51% | Black (O) ‐ 84% | Neglect (O) ‐ 27% | Urban (O) ‐ 100% | ||
| (O) ‐ 3.4 years | Female (O) ‐ 41% | Black (O) ‐ 56% | Neglect (O) ‐ 92% | ||
| Female (K) ‐ 52% | Black (K) ‐ 46% | ||||
| (K) ‐ 7 years | Female (O) ‐ 62% | Black (O) ‐ 19% | |||
| Female (K) ‐ 52% | Black (K) ‐ 47% | ||||
| Female (O) ‐ 53% | Black (O) ‐ 19% | ||||
| Female (O) ‐ 51% | Black (O) ‐ 37% | ||||
| Female (O) ‐ 44% | Black (O) ‐ 62% | Neglect (O) ‐ 100% | |||
| (O) ‐ 9.5 years | Female (O) ‐ 71% | Black (O) ‐ 30% | Neglect (O) ‐ 41% | ||
| Female (K) ‐ 46% | Black (K) ‐ 73% | ||||
| (K) ‐ 1 year | Female (K) ‐ 58% | Black (K) ‐ 83% | |||
| (O) ‐ 9.4 years | Female (O) ‐ 45% | Black (O) ‐ 18% | Neglect (O) ‐ 40% | ||
| Female (O) ‐ 45% | Black (O) ‐ 18% | Neglect (O) ‐ 40% | |||
| Female (O) ‐ 53% | Black (O) ‐ 26% | ||||
| Female (O) ‐ 64% | Black (O) ‐ 31% | ||||
| Female (O) ‐ 53% | Black (O) ‐31% | Neglect (O) ‐ 67% | Urban (O) ‐ 94% | ||
| Female (O) ‐ 50% | Black (O) ‐ 35% | Neglect (O) ‐ 72% | Urban (O) ‐ 40% | ||
| (K) ‐ 8.8 years | Female (O) ‐ 40% | Black (O) ‐ 100% | Neglect (O) ‐ 77% | ||
| Female (O) ‐ 47% Female (K) ‐ 38% Female (F) ‐ 58% | Black (O) ‐ 51% Black (K) ‐ 60% Black (F) ‐ 42% Hispanic (O) ‐ 17% Hispanic (K) ‐ 19% Hispanic (F) ‐ 15% | ||||
| Urban (O) ‐ 67% Rural (O) ‐ 33% | |||||
| (O) ‐ 9.9 years | Female (O) ‐ 50% | Black (O) ‐ 30% Hispanic (O) ‐ 46% | |||
| Female (O) ‐ 50% | Black (O) ‐ 28% Hispanic (O) ‐ 18%) | Neglect (O) ‐ 59% | |||
| Female (O) ‐ 55% | Black (O) ‐ 40% Hispanic (O) ‐ 36% | Urban (O) ‐ 100% | |||
| (O) ‐ 8.0 years (K) ‐ 7.8 years (F) ‐ 8.3 years | Female (O) ‐ 50% Female (K) ‐ 60% Female (F) ‐ 40% | Black (O) ‐ 100% | Neglect (O) ‐ 48% Neglect (K) ‐ 56% Neglect (F) ‐ 48% | Urban (O) ‐ 100% | |
| Female (O) ‐ 51% | Black (O) ‐ 37% | Neglect (O) ‐ 82% | |||
| Female (O) ‐ 53% | Black (O) ‐ 45% | Neglect (O) ‐ 58% | |||
| Female (O) ‐ 42% | Black (O) ‐ 46% Hispanic (O) ‐ 3% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 54% | Black (O) ‐ 29% | Neglect (O) ‐ 66% | Urban (O) ‐ 37% | ||
| Female (O) ‐ 55% | Black (O) ‐ 55% | Neglect (O) ‐ 63% | |||
| (O) ‐ 3.4 years | Female (O) ‐ 60% | Black (O) ‐ 27% Hispanic (O) ‐ 8% | |||
| (K) ‐ 3.8 years | Female (K) ‐ 45% | ||||
| Black (O) ‐ 21% Hispanic (O) ‐ 33% | |||||
| Female (O) ‐ 62% | Black (O) ‐ 43% | Neglect (K) ‐ 62% | |||
| Female (K) ‐ 52% | Black (K) ‐ 69% | ||||
| Female (O) ‐ 49% | Black (O) ‐ 45% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 50% | Black (O) ‐ 60% | Neglect (O) ‐ 47% | |||
| Female (O) ‐ 55% | Neglect (O) ‐ 40% | ||||
| (O) ‐ 10.8 years | Female (O) ‐ 52% | Black (O) ‐ 57% Hispanic (O) ‐ 9% | |||
| Female (K) ‐ 51% Female (F) ‐ 50% | Black (K) ‐ 54% Black (F) ‐ 54% | Neglect (K) ‐ 73% Neglect (F) ‐ 71% | |||
| Female (K) ‐ 49% | Neglect (K) ‐ 80% | ||||
| Female (K) ‐ 38% Female (F) ‐ 50% | Black (O) ‐ 33% Hispanic (O) ‐ 13% | Urban (O) ‐ 100% | |||
| Female (K) ‐ 41% Female (F) ‐ 54% | |||||
| Female (O) ‐ 55% | Black (O) ‐ 28% | Neglect (O) ‐ 68% | |||
| (K) ‐ 6.9 years (F) ‐ 6.5 years | Female (K) ‐ 43% Female (F) ‐ 60% | Black (K) ‐ 46% Black (F) ‐ 56% Hispanic (K) ‐ 20% Hispanic (F) ‐ 31% | Neglect (K) ‐ 93% Neglect (F) ‐ 79% | ||
| Female (K) ‐ 86% Female (F) ‐ 58% | Black (K) ‐ 76% Black (F) ‐ 75% Hispanic (K) ‐ 5% Hispanic (F) ‐ 8% | ||||
| Female (O) ‐ 46% | Black (O) ‐ 45% | Neglect (O) ‐ 60% | |||
| McMillen 2004 | (O) ‐ 10.9 years | Female (O) ‐ 56% | Black (O) ‐ 51% | Neglect (O) ‐ 46% | |
| (O) ‐ 10.6 years | Female (O) ‐ 56% | Black (O) ‐ 52% | Neglect (O) ‐ 48% | ||
| Female (O) ‐ 50% | Black (O) ‐ 40% Hispanic (O) ‐ 35% | ||||
| Female (K) ‐ 56% | Black (K) ‐ 61% | Neglect (K) ‐ 87% | |||
| Female (K) ‐ 56% Female (F) ‐ 49% | Neglect (K) ‐ 62% Neglect (F) ‐ 53% | Urban (O) ‐ 100% | |||
| Female (O) ‐ 100% | |||||
| Female (O) ‐ 52% | Black (O) ‐ 12% Hispanic (O) ‐ 4% | Neglect (O) ‐ 28% | |||
| (O) ‐ 8.3 years | Female (O) ‐ 48% Female (K) ‐ 51% Female (F) ‐ 47% | Black (O) ‐ 14% Black (K) ‐ 16% Black (F) ‐ 14% Hispanic (O) ‐ 46% Hispanic (K) ‐ 41% Hispanic (F) ‐ 47% | Neglect (O) ‐ 86% Neglect (K) ‐ 86% Neglect (F) ‐ 86% | ||
| (K) ‐ 3.2 years (F) ‐ 4.7 years | |||||
| Female (O) ‐ 50% | Black (O) ‐ 30% Hispanic (O) ‐ 21% | Neglect (O) ‐ 64% | |||
| Black (K) ‐ 41% Hispanic (K) ‐ 13% | Neglect (O) ‐ 59% Neglect (K) ‐ 59% | ||||
| Female (K) ‐50% | Black (K) ‐ 14% | ||||
| Female (O) ‐ 55% Female (K) ‐ 54% Female (F) ‐ 56% | Black (O) ‐ 29% Black (K) ‐ 30% Black (F) ‐ 29% Hispanic (O) ‐ 51% Hispanic (K) ‐ 50% Hispanic (F) ‐ 52% | Neglect (K) ‐ 42% Neglect (F) ‐ 42% | |||
| Female (K) ‐ 60% Female (F) ‐ 48% | Black (K) ‐ 33% Black (F) ‐ 38% Hispanic (K) ‐ 14% Hispanic (F) ‐ 15% | Neglect (K) ‐ 62% Neglect (F) ‐ 58% | |||
| Female (K) ‐ 45% Female (F) ‐ 45% | Black (K) ‐ 18% Black (F) ‐ 17% Hispanic (K) ‐ 70% Hispanic (F) ‐ 65% | Urban (O) ‐ 100% | |||
| (O) ‐ 9.5 years | Female (O) ‐ 51% | Black (O) ‐ 64% | |||
| (K) ‐ 4.7 years | Female (O) ‐ 53% | Black (O) ‐ 52% | Neglect (O) ‐ 78% | ||
| Female (K) ‐ 47% | Black (K) ‐ 80% | ||||
| Female (O) ‐ 48% | Black (O) ‐ 48% | Neglect (O) ‐ 56% | |||
| Female (O) ‐ 44% | Black (O) ‐ 70% | Neglect (K) ‐ 75% | Urban (O) ‐ 100% | ||
| Female (O) ‐ 50% | |||||
| Female (K) ‐ 56% | Black (K) ‐ 72% | ||||
| (O) ‐ 3.5 years | Female (O) ‐ 49% | Neglect (O) ‐ 78% | Urban (O) ‐ 52% | ||
| Female (O) ‐ 49% | |||||
| Female (O) ‐ 49% | Urban (O) ‐ 52% | ||||
| (K) ‐ 3.2 years (F) ‐ 3.5 years | Female (O) ‐ 49% | ||||
| (K) ‐ 5.4 years | Female (K) ‐ 50% | Black (O) ‐ 100% | |||
| Female (O) ‐ 36% | Black (O) ‐ 39% | ||||
| Female (O) ‐ 50% | Black (O) ‐ 57% | ||||
| (O) ‐ 6 years | |||||
| Female (O) ‐ 67% Female (K) ‐ 77% Female (F) ‐ 59% | |||||
| (O) ‐ 6.3 years | Female (O) ‐ 50% | Black (O) ‐ 83% | |||
| Female (O) ‐ 51% | Black (O) ‐ 77% | Neglect (O) ‐ 87% | |||
| Female (K) ‐ 54% Female (F) ‐ 54% | Black (K) ‐ 14% Black (F) ‐ 14% Hispanic (K) ‐ 37% Hispanic (F) ‐ 37% | ||||
| Female (O) ‐ 53% | Black (O) ‐ 34% | ||||
| (K) ‐ 1.8 years | Female (O) ‐ 50% | Black (O) ‐ 70% | Neglect (O) ‐ 70% | Urban (O) ‐ 100% | |
| Female (K) ‐ 51% Female (F) ‐ 52% | Black (K) ‐ 57% Black (F) ‐ 49% Hispanic (K) ‐ 6% Hispanic (F) ‐ 5% | Neglect (K) ‐ 48% Neglect (F) ‐ 54% | |||
| Urban (O) ‐ 100% | |||||
| O: Overall K: Kinship F: Foster | |||||
| Study | Kin Placement Type | Placement Timing | Length of Stay | Data Collection |
| Not Reported/Unclear | First | Longitudinal ‐ 30 ‐ 42 months | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 29.0 months | Cross‐sectional | |
| Licensed | First | Longitudinal ‐ 4 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 39.0 months (F) ‐ Placement ‐ 28.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 18.0 months (F) ‐ Placement ‐ 18.0 months | Cross‐sectional | |
| Not Reported/Unclear | First | Longitudinal ‐ up to 7 years | ||
| Not Reported/Unclear | Only | Longitudinal ‐ 1 ‐ 2 years | ||
| Not Reported/Unlcear | Not Reported/Unclear | (K) ‐ Placement ‐ 43.2 months (F) ‐ Placement ‐ 32.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 12.0 months (F) ‐ Placement ‐ 12.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 21.2 months (F) ‐ OOH ‐ 17.5 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ up to 5 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 5 years | ||
| Not Reported/Unclear | Last | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First (Reunification) | Longitudinal ‐ 6 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 4 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 16.0 months (F) ‐ Placement ‐ 39.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 4 ‐ 8 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 57.6 months (F) ‐ Placement ‐ 40.8 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 18 months | ||
| Not Reported/Unclear | Last | Cross‐sectional | ||
| Licensed (52%) | Not Reported/Unclear | (K) ‐ Placement ‐ 36 months (F) ‐ Placement ‐ 30 months | Cross‐sectional | |
| Not Reported/Unclear | Last | Longitudinal ‐ 4 ‐ 6 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 3.5 ‐ 4.5 years | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reporte/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 61.2 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 4‐12 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Licensed | Not Reported/Unclear | (K) ‐ Placement ‐ 31.6 months | Cross‐sectional | |
| Not Reported/Unclear | First | Longitudinal ‐ 15 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | Longitudinal ‐ 4.5 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | First | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | First | Longitudinal ‐ 1 year | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 46.8 months (F) ‐ Placement ‐ 60 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1.5 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 3‐10 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Unlicensed | Not Reported/Unclear | (K) ‐ Placement ‐ 74.0 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 74 months (F) ‐ OOH ‐ 78 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 104.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unlcear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 6 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Longitudinal ‐ 5 ‐ 6 years | ||
| Not Reported/Unclear | First | Longitunidal ‐ 18 and 36 months | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 53.2 months (F) ‐ Placement ‐ 53.7 months | Longitudinal ‐ 6.1 years | |
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 26 months (F) ‐ OOH ‐ 19.3 months | Longitudinal ‐ 3 years | |
| Not Reported/Unclear | First | Longitudinal ‐ 5 years | ||
| Licensed | Not Reported/Unclear | (K) ‐ OOH ‐ 33.6 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unlcear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 96.0 months | Cross‐sectional | |
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 47.3 months | Cross‐sectional | |
| Unlicensed | First | (K) ‐ Placement ‐ 13.4 months | Longitudinal ‐ 2 ‐ 3 years | |
| Not Reported/Unclear | Last | Longitudinal ‐ 11 months | ||
| Licensed | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 13.2 months (F) ‐ Placement ‐ 20.4 months | Longitudinal ‐ 2.33 years | |
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 22.9 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | Longitudinal ‐ 1 ‐ 3 years | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ OOH ‐ 63.1 months | Longitudinal ‐ up to 8 years | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Licensed and Unlicensed | Not Reported/Unclear | (K) ‐ OOH ‐ 31.3 months | Cross‐sectional | |
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unclear | Not Reported/Unclear | (K) ‐ Placement ‐ 38.4 months (F) ‐ Placement ‐ 14.4 months (K) ‐ OOH ‐ 45.6 months (F) ‐ OOH ‐ 32.4 months | Cross‐sectional | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | (K) ‐ OOH ‐ 18.8 months | Longitudinal ‐ up to 2 years | |
| Not Reported/Unclear | First (Reunification) | Longitudinal ‐ 3 years | ||
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | Last | (K) ‐ OOH ‐ 12 months (F) ‐ OOH ‐ 12 months | Longitudinal ‐ 1 year | |
| Not Reported/Unclear | Not Reported/Unclear | Cross‐sectional | ||
| Not Reported/Unclear | First | Cross‐sectional | ||
| Not Reported/Unlcear | Not Reported/Unclear | Longitudinal ‐ 5 ‐ 9 years | ||
| Licensed | Not Reported/Unclear | Longitudinal ‐ 5 years | ||
| OOH: out‐of‐home | ||||
| Study | Behavioural Development | Mental Health | Placement Stability | Permanency | Educational Attainment | Family Relations | Service Utilisation | Re‐abuse |
| Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database | ||||||||
| Outcome categories: Adoption, Still in Placement. | ||||||||
| Outcome category: Adaptive behaviours (Continuous). | Outcome category: Psychiatric Disorders (Continuous). | Outcome categories: Number of Placements (Continuous), Length of Stay (OOH Care). | ||||||
| Outcome category: Institutional Abuse. | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive behaviours (Continuous). | ||||||||
| Outcome category: Behavioural Problems (Continuous). Measured using standardised instrumentation ‐ Child Behaviour Checklist | ||||||||
| Outcome category: Length of Stay (Placement). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||||
| Outcome category: Conflict (Continuous) | ||||||||
| Outcome category: Re‐entry. | Outcome categories: Reunification, Adoption, Guardianship, Still in Placement. | |||||||
| Outcome category: Psychiatric Disorders (Continuous). | Outcome categories: Mental Health Services, Physician Services, Developmental Services. | |||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Length of Stay (Placement). | Outcome category: Repeated a Grade. | ||||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Attachment (Continuous). | ||||||||
| Outcome category: Attachment (Continuous). | ||||||||
| Outcome category: Educational Attainment. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services, Developmental Services | |||||||
| Outcome category: Length of Stay (Placement). | Outcome category: Attachment (Dichotomous). | |||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Re‐entry. | ||||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome categories: Reunification, Adoption. | ||||||||
| Outcome category: Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome category: Number of Placements (Dichotomous). | ||||||||
| Outcome category: Behaviour Porblems (Continuous). | Outcome categories: Number of Placements (Continuous), Length of Stay (Placement). | Outcome category: Attachment (Continuous). | ||||||
| Outcome category: Behaviour Problems (Dichotomous and Continuous). Measured using standardised instrumentation ‐ Child behaviour Checklist; behavioural Intent Assessment | ||||||||
| Outcome category: Placement Disruption. Measured using case records; caseworker interviews | Outcome categories: Reunification, Adoption. Measured using case records; caseworker interviews | |||||||
| Outcome category: Well‐being (Dichotomous). Measured using standardised instrumentation ‐ Foster Care Questionnaire | ||||||||
| Outcome category: Mental Health. Measured using standardised instrumentation ‐ Child and Adolescent Services Assessment | ||||||||
| Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ National Longitudinal Study of Adolescent Health | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ Self‐perception Profile for Children | Outcome category: Repeated a grade. Measured using caregiver and self reports | Outcome category: Home Environment. Measured using standardised instrument ‐ Elementary HOME Inventory | |||||
| Outcome category: Re‐entry. | ||||||||
| Outcome category: Re‐entry. | Outcome categories: Reunification, Still in Placement. | |||||||
| Outcome category: Recurrence of Abuse. | ||||||||
| Outcome categories: Graduation, Test Scores, GPA, Attendance. Measured using school records | ||||||||
| Outcome category: Reunification. | ||||||||
| Outcome category: Psychiatric Disorders (Dichotomous). | Outcome category: Number of Placements (Dichotomous). | |||||||
| Outcome category: Placement Disruption. Measured using caregiver report | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | ||||||||
| Outcome category: Placement Disruption. Measured using caregiver report | ||||||||
| Outcome category: Behaviour Problems (Dichotomous). | Outcome category: Psychiatric Disorders (Dichotomous). | Outcome category: Grade Level. | ||||||
| Outcome category: Grade Level. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome category: Attachment (Dichotomous). | Outcome category: Mental Health Services. | ||||||
| Outcome category: Still in Placement. Measured using administrative database | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive behaviours (Continuous). | ||||||||
| Outcome category: Re‐entry. | Outcome category: Recurrence of Abuse. | |||||||
| Outcome category: Pyschiatric Disorders (Dichotomous). Measured using standardised instrument ‐ Composite International Diagnostic Interview | ||||||||
| Outcome categories: Number of Placements (Dichotomous), Length of Stay (OOH), Placement Disruption, Re‐entry. Measured using administrative database (AFCARS) | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database (AFCARS) | |||||||
| Outcome category: Placement Disruption. Measured using administrative database (AFCARS) | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database (AFCARS) | |||||||
| Outcome category: Placement Disruption. Measured using administrative database (AFCARS) | ||||||||
| Outcome category: Behaviour Problems (Continuous) | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Emotional Availability (Continuous). Measured using standardised instrument ‐ Emotional Availability Scales | |||||||
| Outcome category: Length of Stay (Placement). Measured using administrative database | ||||||||
| Outcome category: Mental Health Services. | ||||||||
| Outcome category: Behavioural Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | ||||||||
| Outcome category: Still in Placement. Measured using case records | ||||||||
| Outcome category: Behaviour problems (Dichotomous). Measured using standardised instrument ‐ Behavioural Assessment Scoring System for Children | ||||||||
| Outcome category: Reunification. | ||||||||
| Outcome category: Mental Health Services. | ||||||||
| Outcome category: Psychiatric Disorders (Dichotomous). | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instruments ‐ Child Behaviour Checklist; Youth Self Report | Outcome categories: Psychiatric Disorders, Well‐being (Continuous). Measured using standardised instruments: Columbia Impairment Scale; Self Perception Profile of Adolescents | |||||||
| Outcome category: Behavioural Problems (Continuous). | Outcome category: Well‐Being (Continuous). | Outcome categories: Number of Placements (Dichotomous), Length of Stay (Placement). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Festinger Rating of Behavioural Reactions Scale | Outcome category: Attachment (Continuous). Measured using standardised instrument ‐ Kansas Parental Satisfaction Scale | |||||||
| Outcome category: Well‐Being (Continuous). | Outcome category: Attachment (Dichotomous). | |||||||
| Outcome category: behaviour problems (Continuous) Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Attachment (Dichotomous) Measured using standardised instrument ‐ Relationship Story Completion Test | |||||||
| Outcome category: Number of Placements (Dichotomous). Measured using administrative database | Outcome categories: Reunification, Adoption, Guardianship. Measured using administrative database | |||||||
| Outcome category: Behaviour Problems (Continuous) Measured using standardised instrument ‐ Strength and Difficulties Questionnaire | Outcome category ‐ Well‐being Measured using standardised instrument ‐ Child Well‐being Scales | |||||||
| Outcome category: Behaviour Problems (Dichotomous), Adaptive Behaviours (Dichotomous). Measured using standardised instrument ‐ Child Behaviour Checklist; Vineland Adaptive Behaviour Scale | Outcome categories: Mental Health Services, Developmental Services. Measured using Child and Adolescent Services Assessment | |||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using Child Behaviour Checklist | Outcome category: Placement Disruption. Measured using administrative database | |||||||
| Outcome category: Behaviour Problems (Continuous). | ||||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using administrative database | Outcome categories: Placement Settings; Length of Stay (Placement). Measured using administrative database | |||||||
| Outcome category: Behavioural Problems (Continuous). Measured using Child Behaviour Checklist | Outcome Cateogry: Psychiatric disorders ‐ Depression & PTSD (Dichotomous). Measured using Child Depression Inventory; Trauma Symptoms Checklist for Children | Outcome categories: Number of Placements, Length of Stay (OOH Care). Measured using caseworker report | Outcome category: Still in Placement. Measured using caseworker report | Outcome categories: Mental Health Service Utilisation and Physician Service Utilisation. Measured using caregiver report | ||||
| Outcome category: Placement Disruption. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services. | |||||||
| Outcome category: Physician Services. Measured using caregiver report | ||||||||
| Outcome category: Grade Level. | ||||||||
| Outcome category: Length of Stay (OOH Care). | Outcome category: Still in Placement. | Outcome category: Mental Health Services. | ||||||
| Outcome categories: Reunification, Adoption, Still in Placement. | ||||||||
| Outcome category: Still in Placement. | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Problems (Continuous). | Outcome category: Repeated a Grade. | Outcome category: Mental Health Services. | ||||||
| Outcome category: Behaviour Problems (Continuous). | Outcome category: Attachment (Continuous). | |||||||
| Outcome categories: Number of Placements (Continuous), Length Stay (Placement), Placement Disruption. Measured using case records | ||||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Length of Stay (Placement). | Outcome category: Attachment (Continuous). | ||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | ||||||||
| Outcome category: Psychiatric Disorder (Continuous) Measured using caregiver report | ||||||||
| Outcome category: Behaviour Problems (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Well‐being (Continuous). Measured using standardised instrument ‐ Assessment Checklist for Children | Outcome category: Placement Disruption. Measured using administrative database | ||||||
| Outcome category: Behaviour Problems (Dichotomous). Measured using standardised instrument ‐ Assessment Checklist for Children | ||||||||
| Outcome categories: Reunification, Adoption, Guardianship. | ||||||||
| Outcome category: Placement Disruption. | Outcome categories: Adoption, Guardianship. | |||||||
| Outcome category: Behaviour Problems (Continuous). | ||||||||
| Outcome category: Well‐Being (Dichotomous). | Outcome category: Length of Stay (OOH Care). | Outcome categories: Mental Health Services, Physician Services. | ||||||
| Outcome category: Attachment. Measured using self report | ||||||||
| Outcome category: Behaviour problems (Dichotomous). Measured using case records | Outcome categories: Psychiatric Disorders (Dichotomous), Well‐being (Continuous). Measured using standardised instrument ‐ Children's Global Assessment Scale; DSM‐IV | Outcome categories: Number of Placements (Continuous) , Length of Stay (Placement). Measured using case records | Outcome categories: Reunification, adoption. Measured using case records | Outcome category: Repeated a grade. Measured using case records | Outcome category: Physician Services. Measured using case records | |||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). Measured using standardised instrument ‐ Child Behaviour Checklist | Outcome category: Mental Health Services. Measured using Children and Adolescent Services Assessment | |||||||
| Outcome category: Length of Stay (OOH Care). | ||||||||
| Outcome category: Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome category: Well‐Being (Dichotomous). | ||||||||
| Outcome categories: Number of Placements (Continuous), Length of Stay (OOH Care), Re‐entry. Measured using administrative database | Outcome categories: Reunification, Adoption, Guardianship, Still in Placement. Measured using administrative database | Outcome category: Institutional Abuse. Measured using administrative database | ||||||
| Outcome categories: Behaviour Problems (Continuous), Adaptive Behaviours (Continuous). | Outcome category: Repeated a Grade. | |||||||
| Outcome category: Number of Placements (Dichotomous), Length of Stay (OOH), Re‐entry. | Outcome category: Reunification. | |||||||
| Outcome categories: Reunification, Adoption. Measured using administrative database | ||||||||
| Outcome category: Institutional Abuse. | ||||||||
| AFCARS: Adoption and Foster Care Analysis and Reporting System | ||||||||
| Study | 0utcome | Results |
| Reunification, Adoption | 1. When all other variables are held constant, children whose initial placement was in family foster care were less likely to exit to reunification than children initially placed in kinship care (HR = 0.76, P = 0.002). 2. When all other variables are held constant, children whose initial placement was in family foster care were more likely to exit to adoption than children initially placed in kinship care (HR = 2.25, P = 0.004). | |
| Adoption | 1. Initial placement in a kinship home decreases the odds of adoption by 50 percent (OR = 0.50) | |
| Adaptive Behaviours, | 1. The interaction of type of placement, home index, and temperament match did not account for more of the variance in VABS and DSMD scores than did type of placement alone. | |
| Institutional Abuse | 1. Placement in foster care increases the likelihood of association with maltreatment by 4.4 times. | |
| Behaviour Problems, | 1. Children in kinship placements (unstandardised beta = ‐5.596) were significantly less likely to be rated as exhibiting externalising behaviours (CBCL scale). | |
| Behaviour Problems | 1. Time spent in non‐kinship foster care homes was associated with decreased externalising behaviour problems. | |
| Reunification, Re‐entry | 1. Children in kinship care (AFDC subset) 2% (OR = 1.02) more likely to be reunified than children in non‐kin foster care (within 4 years of placement). | |
| Adaptive Behaviours | 1. Kinship foster care group significantly more likely than those from non‐relative foster care group to demonstrate pro‐social behaviours. | |
| Placement Disruption | 1. Placement in a non‐kin foster home significantly increased the risk of placement disruption by a factor of just over 3 (RR = 3.18). | |
| Mental Health, Physican, and Developmental Services | 1. Children in foster care had significantly higher rates of mental health service utilisation. | |
| Reunification, | 1. Children placed in a non‐relative foster care home (RR = 1.16) experienced significantly higher rates of reunification than children in relative foster homes. | |
| Placement Disruption | 1. Children placed in non‐relative foster care (RR = 3.18) have statistically significant higher rates of changes in placement than children in relative foster care. | |
| Re‐entry | 1. Children returned home after leaving kinship care placements (RR = 0.69) re‐entered care at a significantly lower rate than those discharged from foster home placements. | |
| Reunification, | 1. Placement with kin (OR = 1.90) at the time of final discharge from foster care significantly improved the odds of returning home or being adopted over unsuccessful discharge. | |
| Reunification, | 1. Placement in kinship home associated with lowered hazards of both reunification (RR = 0.82) and adoption (RR = 0.49) as compared to foster home placements. | |
| Re‐entry, | 1. No significant difference in rates of reunification based on child's initial placement in foster home vs kinship home. | |
| Relatedness | 1. Type of placement not found to be predictor of relationship with caregiver. | |
| Behaviour Problems | 1. Kinship status did not contribute significantly to the prediction off aggressive responses (CBCL ‐ OR = 0.65, P = 0.560; BIA ‐ OR ‐1.34, P = 0.510) | |
| Mental Health Services | 1. Increased likelihood of any mental health service use for non‐relative foster care placement (OR = 1.94) than for kinship care (OR = 1.08). | |
| Well‐being | 1. Type of placement not significant predictor of global self worth. | |
| Re‐entry | 1.Children placed with kin (OR = 0.19 to 0.25) just prior to reunification were about 80% less likely to re‐enter care than those whose last placement was with non‐kin. | |
| Re‐entry, | 1. Type of placement not found to have statistically significant relationship with reunification | |
| Recurrence of Abuse | 1. Children whose initial placement was in kinship foster care (OR = 9.60), and whose initial placement was family foster care (OR = 2.40) were more likely to experience maltreatment recurrence, within 60 days of reunification, than those whose initial placement was a group home/institution; thus, children whose initial placement was in kinship foster care were 4 times more likely to experience maltreatment recurrence, within 60 days of reunification, than those whose initial placement was family foster care. | |
| Reunification | 1. Placement into kinship foster home (RR = 1.06) compared to foster home with non‐relatives increased the probability that a child would be reunified from foster care (1998 to 1995 cohort). | |
| Placement Disruption | 1. Living with a kin caregiver decreased the odds of disruption 0.16 times compared to living with a non‐kin caregiver. | |
| Behaviour Problems | 1. Non‐kinship placement (OR = 1.90) significantly associated with scoring within the borderline range on CBCL Total Problems scale. | |
| Placement Disruption | 1. Children living with non‐relative foster parents had 3 times the odds of experiencing a negative placement disruption as children living with kin foster parents. | |
| Still in Placement | 1. Interaction terms such as child's initial placement were nonsignificant predictors of permanency within 15 months after entering out‐of‐home care. | |
| Recurrence of Abuse, | 1. Children who exited from care following placement with kin (RR = 0.82) were significantly less likely than children who exited from foster care to return for a subsequent report. | |
| Placement Disruption, Number of Placements, Length of Stay (OOH Care), Reentry, Guardianship, Adoption, Reunification, Still in Placement | 1. Children in relative foster care were less likely to experience initial placement disruption than those in non‐relative foster care. 2. Children in relative foster care were less likely to experience 3 or more placements within a year of entry than those in non‐relative foster care. 3. The findings were mixed for length of OOH stay with children in relative foster homes reported to stay longer in care in 3 states and shorter in 3 states. 4. The findings were mixed for re‐entry with children in relative foster homes more likely to re‐enter care in 1 state, less likely to re‐enter in 2 states, and as likely to re‐enter in 1 state. 5. The findings were mixed for guardianship, with children in relative foster care having a higher likelihood of guardianship in 5 states and a similar likelihood in 1 state. 6. The findings were mixed for adoption, with children in non‐relative foster care having a higher likelihood of adoption in 4 states and a lower likelihood in 2 states. 7. The findings were mixed for reunification, with children in relative foster care having a higher likelihood of reunification in 3 states and a lower likelihood in 3 states. 8. The findings were mixed for still in placement, with children in relative foster care more likely to remain in care in 3 states and less likely to remain in care in 3 states. | |
| Placement Disruption | 1. Children in kinship foster homes were more likely to remain in their initial placement with kin than children initially placed in non‐kinship foster homes. | |
| Emotional Availability | 1. The model's ability to predict emotional availability was not improved by the addition of the kin status of foster mothers. | |
| Mental Health Service Utilisation | 1. Children placed in non‐relative foster care had significantly higher numbers of outpatient mental health visits compared to those residing in kin only (rate estimate = 0.57). | |
| Behaviour Problems | 1. Type of foster parent did not contribute to child internalising or externalising behaviour. | |
| Mental Health Service Utilisation | 1. Kinship care significantly associated with current outpatient therapy services; children in kinship care (OR = 0.39) less likely to utilise outpatient therapy services than non‐kin foster care. | |
| Psychiatric Disorders | 1. No significant differences in rates of past year psychiatric disorders (any disorder) based on living situation (kinship care (OR = 0.87) vs non‐kin family foster care). | |
| Behaviour Problems, Well‐being | 1. In no instance did the maltreated children differ from each other by placement type for behaviour problems. 2. In no instance did the maltreated children differ from each other by placement type for well‐being. | |
| Well‐being | 1. Placement type remained the strongest variable in explaining the variability in child well‐being as measured by the Personal Attribute Inventory for Children. | |
| Behaviour Problems | 1. Controlling for placement stability, baseline risk, and reunification status at 18 and 36 months, children in early kinship care had lower marginal probability of behavioural problems by 36 months. The estimate of behavioural problems was 46% if all children had been assigned to general foster care only, compared with 32% if the children had been assigned to early kinship care. | |
| Behaviour Problems, Psychiatric Disorders, Mental Health Services | 1. Kinship care compared to foster care was associated with a lower risk of continuing behavioural problems (RR = 0.59). 2. Kinship care compared to foster care was associated with a lower risk of prevalence of depression (RR = 0.73), but was associated with a higher risk of prevalence of PTSD (RR = 1.42) 3. Kinship care compared to foster care was associated with a lower risk of mental health therapy use (RR = 0.45). | |
| Physician Services | 1. Although the reference group was birth parents, children in kinship care had an OR = 1.41 for physician services as compared to children in foster care OR = 0.45. | |
| Test Scores | 1. Adolescents placed in relative foster care (beta = 0.24) showed significantly higher scores on reading skills than those in non‐kin foster care. | |
| Still in Care | 1. Compared to children in adoptive placements, children in kinship care placements were 72% less likely (HR = 0.28) to exit care, children in non‐relative placements were 52% less likely (HR = .48) to exit and children in institutional or other placement types were 59% less likely (HR = .41) to exit care; thus, children in non‐relative placement are 1.7% more likely to exit care than children in kinship placement. | |
| Behaviour Problems | 1. The difference in behaviour problems by placement type was not maintained when other determinants of child behaviour were included in the specification of the model. | |
| Psychiatric Disorders | 1. Residing in kinship care did not contribute significantly to the prediction of psychiatric disorders (P = 0.180). | |
| Behaviour Problems, Well‐being | 1. Type of care did not contribute significantly to the prediction of behaviour problem scores (P = 0.290). 2. Type of care did not contribute significantly to the prediction of well‐being scores (P = 0.170). | |
| Behaviour Problems | 1. Type of care did not contribute significantly to the prediction of sexual behaviour problems (P = 0.240). | |
| Placement Disruption | 1. At placement start, kinship care is 86% to 82% less prone to disruption than non‐related foster care (cohort samples); placement with relatives 67% less likely to disrupt from the start than placements into non‐related foster homes (matched cross‐sectional sample). | |
| Attachment | 1. Children in kinship foster care reported higher levels of agreement than did children in foster care for "like who they are living with" (97% to 91%) and "feel like part of the family" (95% to 90%). | |
| Length of Stay (Placement) | 1. Children in caretaker placements (beta = ‐1.22) spent significantly more time in care than their counterparts. | |
| Re‐entry, | 1. Rate of reunification did not differ between children placed in kinship and non‐relative family foster care (RR = 0.94). | |
| Behaviour Problems, Adaptive behaviours, | 1. No significant difference between non‐kinship family foster home and kinship family foster home on CBCL Total Problems or Total Competence scale. | |
| Reunification | 1. Type of placement not directly related to likelihood of family reunification (kinship placement HR = 1.07). | |
| Institutional Abuse | 1. Regular care homes were 2.7 times (OR) more likely to have confirmed report of maltreatment than were kinship homes. | |
| AFDC: Aid to Families with Dependent Children | ||
| Study | Outcomes | Results |
| Behaviour Problems | 1. Children in kinship care had a lower mean total score on the Behaviour Problems Index (BPI) than children in foster care. | |
| Behaviour Problems | 1. No significant differences on CBCL aggressive behaviours were found between kinship (M = 9.83) and non‐kinship (M = 10.49) groups. | |
| Educational Attainment | 1. Students placed in non‐relative foster care had significantly higher cumulative GPA and a greater number of cumulative earned credits toward graduation than students placed in relative or kinship foster care. No other differences were found for type of placement on the academic variables of number of days absent, number of grades retained, and performance on standardised state testing in maths and reading. | |
| Placement Disruption | 1. A significantly greater proportion of disrupted children were living with a non‐kin caregiver at baseline compared to the stable group. | |
| Behaviour Problems | 1. Differences between 2 groups not statistically different on CBCL. | |
| Length of Stay (Placement) | 1. No significant differences in the length of time in placement for the kinship foster care and traditional foster care groups. | |
| Length of Stay (Placement) | 1.Children placed in traditional foster homes (M = 78 months) had longer lengths of stay than children placed in kinship foster homes (M = 74 months). | |
| Behaviour Problems, Attachment | 1. Kinship foster children showed significantly better ratings of behavioural reaction than family foster children (P = 0.017). 2. Kinship foster parents had significantly greater satisfaction with their relationships with the children than the family foster parents (P = 0.039). | |
| Well‐being | 1. The self concept of adolescents growing up with kin foster families is higher than the self concept of adolescents in non‐relative care. | |
| Well‐being, Behaviour Problems | 1. Higher scores were obtained from non‐relative carers than relative carers in relation to meeting basic needs and educational supervision on the Child Well‐being Scales. 2. Those in unrelated foster care were almost all the ones who received the highest behaviour problem scores according to carers, while there was no difference in behaviour problems linked to the type of foster care according to teachers. | |
| Length of Stay (OOH) | 1. There was no significant difference in length of stay (P = 0.42) between children placed initially in kinship care (M = 791 days) and children initially placed in foster care (M = 588 days). | |
| Length of Stay (Placement) | 1. Children in kinship care differ significantly from children in traditional foster care on length of time in care, with kinship care reporting significantly higher lengths of placement. | |
| Behaviour Problems, | 1. No significant differences found between the two types of care (kinship and non‐kinship children) on CBCL Total Problems and Total Competence scales. | |
| Placement Disruption | 1. No significant difference between the number of placement disruptions in foster family care and kinship foster care. | |
| Placement Disruption, Behaviour Problems, Well‐being | 1. Placement disruption did not vary according to whether children presently resided in foster or kinship care 2. Children in foster care had higher scores on the CBCL (more behaviour problems) than children in kinship care (P = 0.007). 3. Children in foster care had higher scores on well‐being than children in kinship care (P = 0.010). | |
| Behaviour Problems | 1. Type of placement was not associated with sexual behaviour problems scores. | |
| Attachment | 1. Children in kinship foster care reported higher levels of agreement than did children in foster care for "like who they are living with" (97% to 91%) and "feel like part of the family" (95% to 90%). | |
| Behaviour Problems, Psychiatric Disorders, Number of Placements, Well‐being | 1. Behavioural problems did not vary between children according to their placement. 2. Psychiatric disorders did not vary between children according to their placement. 3. The foster care groups had a mean of 2 placements while the kinship group had a mean of 1 placement. 4. There was no difference in well‐being scores between the 2 groups. | |
| Length of Stay (OOH), | 1. Children in non‐kinship foster placements had a much shorter median length of stay than children in kinship placements. | |
| Reunification, Adoption | 1. Estimated rates of reunification were not found to be significantly different for children placed with kinship foster families than for children placed with non‐relative foster families (HR = 1.03). 2. Estimated rates of adoption were not found to be significantly different for children placed with kinship foster families than for children placed with non‐relative foster families (HR = 1.09). | |
| CBCL: Child Behaviour Checklist | ||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Behaviour problems continuous Show forest plot | 15 | 2815 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.33 [‐0.49, ‐0.17] |
| 2 Behavioural problems dichotomous Show forest plot | 6 | 16449 | Odds Ratio (M‐H, Random, 95% CI) | 0.62 [0.41, 0.93] |
| 3 Adaptive behaviours Show forest plot | 6 | 1287 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.42 [‐0.61, ‐0.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Psychiatric disorders dichotomous Show forest plot | 6 | 50751 | Odds Ratio (M‐H, Random, 95% CI) | 0.51 [0.42, 0.62] |
| 2 Well‐being dichotomous Show forest plot | 4 | 318009 | Odds Ratio (M‐H, Random, 95% CI) | 0.50 [0.38, 0.64] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Number of placements dichotomous Show forest plot | 6 | 26492 | Odds Ratio (M‐H, Random, 95% CI) | 0.39 [0.33, 0.45] |
| 2 Number of placements continuous Show forest plot | 6 | 15677 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.38 [‐0.58, ‐0.17] |
| 3 Length of stay in placement Show forest plot | 6 | 1517 | Std. Mean Difference (IV, Random, 95% CI) | 0.90 [‐0.66, 2.46] |
| 4 Length of stay in out‐of‐home care Show forest plot | 9 | 330721 | Std. Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.04, 0.09] |
| 5 Placement disruption Show forest plot | 5 | 6881 | Odds Ratio (M‐H, Random, 95% CI) | 0.52 [0.40, 0.69] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Reunification Show forest plot | 13 | 67403 | Odds Ratio (M‐H, Random, 95% CI) | 1.09 [0.85, 1.40] |
| 2 Adoption Show forest plot | 12 | 66817 | Odds Ratio (M‐H, Random, 95% CI) | 2.52 [1.42, 4.49] |
| 3 Guardianship Show forest plot | 8 | 64733 | Odds Ratio (M‐H, Random, 95% CI) | 0.26 [0.17, 0.40] |
| 4 Still in placement Show forest plot | 11 | 57246 | Odds Ratio (M‐H, Random, 95% CI) | 1.18 [0.77, 1.80] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Repeated a grade Show forest plot | 6 | 1219 | Odds Ratio (M‐H, Random, 95% CI) | 0.73 [0.50, 1.07] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Attachment continuous Show forest plot | 5 | 499 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.01 [‐0.30, 0.28] |
| 2 Attachment dichotomous Show forest plot | 4 | 375 | Odds Ratio (M‐H, Random, 95% CI) | 1.21 [0.56, 2.59] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mental health services Show forest plot | 13 | 152626 | Odds Ratio (M‐H, Random, 95% CI) | 1.79 [1.35, 2.37] |
| 2 Developmental services Show forest plot | 3 | 48058 | Odds Ratio (M‐H, Random, 95% CI) | 0.94 [0.38, 2.32] |
| 3 Physician services Show forest plot | 7 | 214005 | Odds Ratio (M‐H, Random, 95% CI) | 1.37 [0.48, 3.93] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Institutional abuse Show forest plot | 3 | 1202 | Odds Ratio (M‐H, Random, 95% CI) | 0.27 [0.10, 0.71] |
