Who disrupts from placement in foster and kinship care?☆
Introduction
Children in foster care are at high risk of behavioral and emotional problems (Garland et al., 2001; Landsverk, Garland, & Leslie, 2002; Pears & Fisher, 2004). These problems undoubtedly contribute to the challenges faced by foster parents and child welfare caseworkers in trying to provide foster children with nurturing and supportive home environments. Improving placement stability is a key component of adequate care that has received recent attention in Federal Guidelines (2001). During any 12-month period, up to 50% of children in foster care disrupt from their placements and have to be moved to another home or to a more restrictive setting (reviewed by Smith, Stormshak, Chamberlain, & Bridges Whaley, 2001). The aim of this study was to determine if it was possible to identify reliable, inexpensive predictors of placement disruption from foster and kinship care in an ethnically diverse sample of elementary school-aged children. Identification of such predictors could be helpful in focusing limited resources on the children at highest risk of disruption.
Disruption from foster or kinship placement is highly undesirable for a number of reasons. Foster placement disruptions are associated with an increased likelihood of failed permanent placements (i.e., reunifications and adoptions). For example, using administrative records for 6831 children discharged from foster care in California, Courtney (1995) found that greater instability in a child's placements was positively associated with risk of reentry into foster care. Similarly, Wells and Guo (1999) examined records for 2616 children in foster care in Ohio and noted a positive association between the number of transitions during the first period in foster care and the likelihood of foster care reentry. Farmer (1996) reviewed records for 321 children in foster care in the United Kingdom and reported that first attempts at reunification were significantly more successful than subsequent attempts.
In addition to the increased risk of permanent placement failures, foster care disruptions carry with them financial costs for the child welfare system (CWS). We found no published analyses of the financial costs associated with foster placement disruptions. However, in a series of focus group sessions with caseworker supervisors and child welfare agency line staff in San Diego County, CA, USA, it was estimated that each placement disruption required an average of over 25 h of casework and support staff time to remediate the problem (including time spent in identifying and placing a child in a new setting, court reports, staff meetings related to placement decisions, and paperwork documenting need and processes; Price, 2005).
Significant emotional costs are associated with placement changes for both foster children and foster parents (Fanshel, Finch, & Grundy, 1990; van der Kolk, 1987). Newton, Litrownik, and Landsverk (2000) found that changes in foster placements were associated with increases in both externalizing and internalizing child behavior problems. In their study of over 400 children who had entered care at an average age of 6.6 years (SD = 3.9 years), externalizing problems was the strongest predictor of placement change. Importantly, children who initially scored within the normal range on the Child Behavior Checklist (CBCL) were particularly vulnerable to the negative effects of placement disruptions. That is, placement changes for these children were followed by increases in both internalizing and externalizing scale scores on the CBCL 18 months later, strongly suggesting that placement changes contribute to the onset and development of child emotional and behavioral difficulties in the CWS. Ryan and Testa (2005) found that placement instability increased the risk for delinquency in males over and above being involved in the CWS and being placed in substitute care.
Despite the fact that placement disruptions in the CWS are clearly harmful, there has been relatively little recent research aimed at identifying predictors of disruption (James, 2004). Three exceptions are as follows: (a) Farmer, Lipscome, and Moyers (2005) found that stressful events experienced by foster parents in the 6 months prior to placement, the presence of child conduct problems, and inaccessibility to caseworkers related to higher disruption rates for adolescents; (b) Sinclair and Wilson (2003) found that child characteristics, such as attractiveness and wanting to be fostered, and foster parent characteristics, such as warmth and child-centeredness related to low disruption rates; and (c) James (2004) found that boys, older youth, and those with externalizing and internalizing behavior problems were at an increased risk of disruption.
Externalizing behavior has been shown in other work to relate to disruptions for teenagers (Sallnas, Vinnerljung, & Weestermark, 2004). Being placed in kinship care has been found to decrease the risk of disruption (James, 2004). Other research has found discrepancies in the definition of what constitutes a disruption, making it difficult to conduct systematic research on the occurrence and prevention of this problem (Smith et al., 2001).
We used a brief telephone interview (Parent Daily Report Checklist; PDR) with foster parents to measure the occurrence of child behavioral problems in the home during the 24-h period immediately preceding the call. The PDR Checklist takes 5–10 min to complete and is typically repeated on three to five separate occasions to get a stable estimate of a child's problem behavior as experienced by the caregiver. The PDR was originally developed as an observation-based outcome measure that could be administered to parents in their homes to help verify behavioral observations by trained coders and to increase the accuracy with which low base rate events could be counted (Chamberlain, 1990). The purpose of the PDR is to obtain reliable measures of the child's problem behaviors that minimize the biases associated with retrospective reports that attempt to summarize information over longer periods of time (Tourangeau, 2000). The PDR data provide the opportunity to examine typical levels of parent-reported child problems, how much variation in those levels is observed within a given sample, and whether such variation is a meaningful predictor of future outcomes.
In the current study, the PDR was used to predict placement disruption in a 12-month timeframe for a sample of children (ages 5–12 years) in foster care in San Diego County. In addition to the PDR, we evaluated the utility of several other potential predictors of placement disruption that could be obtained easily and inexpensively (child's age, child's gender, child's ethnicity, number of other children in the home, foster parent's ethnicity, and placement type, i.e., kin or non-kin).
Section snippets
Participants
Participants were 246 children (ages 5–12 years) in foster care, including 131 boys and 115 girls, placed in non-kinship foster (n = 158) or kinship (n = 88) care who participated in a foster care “as usual” control condition in a larger study. That study tested the effectiveness of an intervention aimed at strengthening the parenting skills of foster and kinship parents in state foster homes in San Diego, CA, USA. All children in San Diego County between the ages of 5 and 12 years who were placed
Results
The mean number of problem behaviors reported on the PDR was 5.77 (4.06). Table 2 shows the Cox hazard regression results for the PDR and for each of the other potential predictors. The baseline PDR score and placement in a non-kin home had significant predictive linear effects. Baseline PDR increased the hazard of disruption by 17% for every child problem behavior reported. In addition, placement in a non-kin foster home increased the risk of placement disruption by a factor of just over 3. In
Discussion
PDR scores at baseline were predictive of placement disruptions during the subsequent 12-month period. Children with PDR scores at or below the sample mean of 6 problem behaviors per day were at low risk of subsequent disruption.
In placements where 7 or more problem behaviors occurred per day, each behavior over 6 increased the odds of disruption by an additional 25% per additional behavior. In addition, there was a trend for the number of other children in the foster home to increase even
Acknowledgements
The authors wish to thank the San Diego County Department of Health and Human Services, Courtenay Paulic (OSLC), and Jan Price (CASRC) for their assistance with recruitment, data collection, and management.
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Support for this research was provided by Grants from NIMH, U.S. PHS (MH60195), from NIMH and ORMH, U.S. PHS (MH46690), and from NIDA, U.S. PHS (DA17592).