Fifteen-month follow-up of children at risk: Comparison of the quality of life of children removed from home and children remaining at home

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Abstract

This is a prospective, longitudinal study of the psychological, physical, social and cultural quality of life of 93 children at risk who were removed from home or kept at home. Assessments were made by social workers who made the decisions, at three points of time. The findings show that the quality of life of the children who were removed from home improved incrementally over the 15 months, while that of the children who stayed at home remained at the same low level as at the first measure. The findings suggest that removing children at risk from abusive or neglectful homes can improve their quality of life, while leaving them in such homes generally does not. Pending further research on larger samples and using multiple sources of information, they also suggest that it may be worth reexamining current policy on removal.

Introduction

The need for outcome studies of policies and interventions is widely recognized by practitioners and researchers in the field of child welfare. Such studies are needed to better provide for the well being of children under agency care, to permit follow up of the consequences of polices and practices, and to make it possible to base policies and practice on empirically obtained information rather than on personal proclivities or political considerations (Fluke, 1993, Maluccio et al., 2000, Poertner et al., 2000).

The need for outcome studies is particularly acute with regard to children at risk, towards whom society bears a legal obligation (Poertner et al., 2000). A central dilemma in this area is the question of whether to remove a child at risk from home. It is not only that decisions on removal and alternative placement are bound to have significant long-term effects on the children, their families, and the society as a whole. It is also that such decisions are notoriously difficult. The laws that govern the decisions tend to be ambiguous (Besharov, 1985, Besharov, 1986). Our present knowledge of child development does not provide clear guidelines about when the child's well being would be best served by removal and when by being kept at home (DePanfilis & Scannapieco, 1994, Lindsey, 1992, Munro, 1996). Complicating matters is the fact that the instruments used to assess risk suffer from multitudinous shortcomings (Camasso & Jagannathan, 1995, Doueck et al., 1993, English & Pecora, 1994, Lyons et al., 1996).

The safety of the child standard used for removal is in itself problematic. Most children at risk are in what is known as the “gray area”, where they are not in clear, immediate danger of physical harm (Petras et al., 2002, Rossi et al., 1999), but are from homes where their parental care is so poor that it is viewed as endangering their normal, healthy development. Moreover, there is increasing evidence that removal from home does not necessarily guarantee children's physical safety and that children placed in foster or institutional care may be exposed to neglect and to physical and sexual abuse (Benedict et al., 1994, Groze, 1990, Rosenthal et al., 1991, Blatt, 1992).

To be sure, a large number of outcome studies have been conducted on children removed from home. Most of these, with relatively few exceptions (Festinger, 1983, Hell et al., 1996), found high rates of psychological, behavioral, educational, and social problems. They record high rates of psychological disorders (Clausen et al., 1998, McIntyre & Keesler, 1986), adjustment problems (Iglehat, 1994, Schor, 1987), depression, and hospitalization (Barth, 1990, Cook, 1992), as well as low self-esteem (Cook, 1992, Hagino, 2002), and problems in intimacy and interpersonal relations (Buehler et al., 2000, Cook, 1992, Hagino, 2002, Rest & Watson, 1984, Stein & Corey, 1986). They note high rates of behavioral problems in the clinical or borderline range of the Child Behavior Checklist (Clausen et al., 1998, Heath et al., 1989, Iglehat, 1994, McIntyre & Keesler, 1986), as well as relatively high rates of antisocial behavior and criminality (Benedict et al., 1996; Famshel, Finch, & Grundy, 1990; Kraus, 1981). They also observe school problems and low educational achievement (Heath et al., 1989, Blome, 1997, Buehler et al., 2000, Heath et al., 1994, Iglehat, 1994), and, in adulthood, high unemployment and welfare dependence and low objective and subjective economic well being (Barth, 1990, Blome, 1997, Buehler et al., 2000, Famshel et al., 1990).

The problem with these studies is that it is not at all clear that the multitudinous difficulties to which they point stem from the children's placement in out of home care. Several researchers have pointed out that the prevalence of these problems among persons who have been removed from home is not significantly different from that among persons who grew up in poor socioeconomic circumstances, suggesting that the problems may stem from their socioeconomic deprivations before coming into care (Buehler et al., 2000, Heath et al., 1989, Cook, 1992).

Furthermore, clinical and empirical findings show that children who grow up in neglectful or abusive homes suffer from similar problems, including impairments in their basic trust, self-esteem, and ability to form and maintain relationships (Cicchetti & Lynch, 1995, Mullen et al., 1996, Wodarski et al., 1990), delayed cognitive development and poor school achievement; severe behavioral problems (Eckenrode et al., 1993, Wodarski et al., 1990), from noncompliance and temper tantrums through delinquency, violence, and other forms of antisocial behavior (Jonson-Reid, 1998, Fatout, 1990); and increased tendency to serious personality disorders and other psychopathology as adults Mullen et al., 1996, Rosenthal, 1988, Verduyn & Calam, 1999). These findings suggest that the problems of children removed from home may have preceded their removal and been anchored in the neglect and abuse on account of which they were removed.

Outcome studies conducted on family preservation programs aimed at enabling children at risk to remain at home are similarly limited. Starting with the assumption that keeping the child at home is preferable to removal, they use as their outcome measures such variables as avoidance of external placement, the length of time out of home, or the restrictiveness of the out of home arrangement. These criteria, it has been pointed out, do not take into account the possibility of harm to the child at home or of greater well-being in alternative care (Bath & Haapala, 1994, Berry, 1992, Blythe et al., 1994, Thomlison & Krysik, 1993).

Critics of the outcome research to date have pointed to various problems in the design of these studies. One set of problems concerns their method. Many use biased samples and lack a control group. Their data collection is retrospective, and they assess children at one point of time. Moreover, most of the outcome studies lack a baseline (Buehler et al., 2000) and few, if any, compare the outcomes of children removed from abusive or neglectful homes to those of children who stay in such homes. This makes it impossible to know whether and how much their problems stem from their removal and alternative placement or from their prior abuse and neglect (Heath et al., 1989, Iglehat, 1994). In addition to the contributing to the problems of attribution noted above, these methodological limitations make it impossible to assess the children's progress and deterioration (Maluccio et al., 2000, Minty, 2000, pp. 8–21).

Another set of problems concerns the unresolved questions of what outcomes are important to follow up and how to examine them. While it is generally agreed that the outcomes for the child must include safety, stability, and normal development, the specific operationalization of these values is in dispute (Maluccio et al., 2000, Poertner et al., 2000, pp. 1–14). Moreover, although there has been relatively extensive follow-up of child safety and permanency, relatively few studies have followed up the child's well being, whether in alternative care or at home. This is an important omission in view of the growing consensus that although safety and permanency are necessary outcomes, they are not sufficient results for children served in the child welfare system (Poertner et al., 2000). Several scholars have advanced the claim that decisions on removal must endeavor to ensure the well-being of the child (Chapman, 1997, Nasuti, 1998). How to measure well being is also an unresolved issue, in large part because of the complexity of the construct. An individual's well being is the product of a potentially unlimited number of variables which are extremely difficult, if not impossible, to identify and assess one by one.

The present study attempts to address both sets of problems. It is the second of two studies that follow up the well being of two groups of children at risk—those who were removed from home and those who remained at home. The first study measured the well being of the children at two points of time: when their removal was first considered, and a baseline evaluation was made, and 6 months later, when those who had been removed had been in placement for about 4 months. It found that the children in alternative care showed, in the view of the social workers who made the assessments, significant improvement in their well being, while those who remained at home had not (Davidson-Arad, Englechin-Segal, & Wozner, 2003). The present study continues the follow up 15 months after the baseline assessment. It is thus a prospective, longitudinal, and comparative study, which includes a baseline measure for all of the children and which compares children at risk who have similar socioeconomic and injury features, for whom different courses of action were taken.

Moreover, like the first study, it assesses the children's well being using a measure that tries to encompass the complexity of the concept. No model with concretely phrased components can possibly encompass, or even come near to encompassing, all the components that might go into an individual's well being. The measure used to assess well being in this study is based on Shye's Systemic Quality of Life Model (QLM; Shye, 1979, Shye, 1985, Shye, 1989)—with quality of life standing as a proxy for well being. As described below, this measure attempts to circumvent the limitations of detailed questionnaires by an inherent abstractness, which enables users to relate to whatever components of the individual's quality of life that they consider relevant.

Section snippets

The systemic quality of life model

The concept of quality of life used in this study is based on the Systemic Quality of Life Model developed by Shye, 1979, Shye, 1985, Shye, 1989. This is a rather abstract model, which rests on the idea that the human being is an “action system” that operates in four fields and four modes. Using Gutmann's (1957) facet theory, the model defines the fields of action and the modes of action as two distinct facets of the person's quality of life.

The fields are the psychological, physical, social,

Subjects

The subjects of the study were 93 children at risk whose cases had been brought to the Child and Youth divisions of two municipal welfare departments in the center of Israel. In accord with Israeli law, these departments are responsible for children at risk. All of the children were under consideration for removal from home by the departments' social workers.

Of the 93 children, 56% were girls, 44% boys. At the time of the baseline measure, some 15 months prior to the assessment for the present

Findings

The study examined five questions.

The first question concerned the changes in the QOL of children who were removed from home (N=22) and children who remained at home (N=59) over the 15 months since it was first assessed, when the social workers began to consider the question of removal. To address this question, the author first compared the QOL of the two groups of children at the beginning of the decision making process, when the social worker was still considering the best course of action.

Discussion

This study suffers from a number of methodological problems, which will be discussed below, that make it necessary to take the findings with some caution. The following paragraphs discuss the findings and their implications, while keeping in mind that stronger findings on larger samples and using multiple sources of information are required to reach reliable conclusions on policy and practice.

The findings of the present study indicate that, in the judgment of the social workers, the QOL of the

References (67)

  • C. Verduyn et al.

    Cognitive behavioral interventions with maltreated children and adolescent

    Child Abuse and Neglect

    (1999)
  • H.I. Bath et al.

    Family preservation services: What does the outcome research really tell us?

    Social Service Review

    (1994)
  • R.P. Barth

    On their own: The experiences of youth after foster care

    Child and Adolescent Social Work

    (1990)
  • M.I. Benedict et al.

    Adult functioning of children who lived in kin versus nonrelative family foster homes

    Child Welfare

    (1996)
  • M. Berry

    An evaluation of family preservation services: Fitting agency services to family needs

    Social Work

    (1992)
  • D.J. Besharov

    Right versus right. The dilemma of child protection

    Public Welfare

    (1985)
  • D.J. Besharov

    Child welfare liability: The need for immunity legislation

    Children Today

    (1986)
  • W.W. Blome

    What happens to foster kids: Educational experiences of a random sample of foster care youth and a matched group of non foster care youth

    Child and Adolescent Social Work Journal

    (1997)
  • B. Blythe et al.

    A review of intensive family preservation services research

    Social Work Research

    (1994)
  • Cairns, D. (1990). Quality of life, Assessment of haemodialysis patients: An application of a systemic life quality...
  • M.J. Camasso et al.

    Prediction accuracy of Washington and Illinois risk assessment instruments: An application of receiver operating characteristic curve analysis

    Social Work Research

    (1995)
  • B.S. Chapman

    Child protection risk assessment and African-American children: Cultural ramifications for families and communities

    Child Welfare

    (1997)
  • D. Cicchetti et al.

    Failures in the expectable environment and their impact on individual development: The case of child maltreatment

  • J.M. Clausen et al.

    Mental health problems of children in foster care

    Journal of Child and Family Studies

    (1998)
  • Cook, S. K. (1992). Long term consequences of foster care for adult well being. Unpublished doctoral dissertation,...
  • B. Davidson-Arad et al.

    The least detrimental alternative. Deciding whether to remove children at risk from their homes

    International Social Work

    (2000)
  • B. Davidson-Arad et al.

    The use of shye's Systematic Quality of Life model in the examination of child protection officers decision

    Social Indicators Research

    (2001)
  • D. DePanfilis et al.

    Assessing the safety of children at risk of maltreatment; decision making models

    Child Welfare

    (1994)
  • H.J. Doueck et al.

    Decision making in child protective services; a comparison of selected risk assessment systems

    Child Welfare

    (1993)
  • L. Eckenrode et al.

    Scholl performance and disciplinary problems among abused and neglected children

    Developmental Psychology

    (1993)
  • D. Elizur et al.

    Quality of work life and its relation to quality of life

    Applied Psychology: An International Review

    (1990)
  • D. English et al.

    Risk assessment as a practice method in child protective services

    Child Welfare

    (1994)
  • V.L. Fahlberg

    A child journey through placement

    (1991)
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