The mental health and socialization of siblings in care

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Abstract

The paper describes sibling-related investigations conducted within the first stage of a prospective study of the mental health of 347 children (aged 4–11) in foster and kinship care in New South Wales, Australia (the Children in Care Study). Mental health was measured with the Child Behavior Checklist and with a carer-report instrument designed to measure psychopathology specifically observed among children in care (the Assessment Checklist for Children). A large number of study factors were measured, including several confounders of sibling-related data. The analyses include: the distribution and stability of sibling placements; mental health and socialization estimates stratified by sibling placement status; and a within-pairs comparison of oldest-younger sibling dyads in shared placements. Girls separated from all of their siblings were reported to have significantly poorer mental health and socialization than girls residing with at least one sibling. Various hypotheses accounting for this gender-specific finding are proposed, with a view to being tested in the prospective stage of the study.

Introduction

In our role as clinicians assessing the developmental and psychological status of children in care, we routinely consider questions about a child's relationships with their siblings. These may be posed directly as referral questions, or they may arise from engagement with the child in the assessment setting. While the nature and significance of sibling relationships can be ascertained, caseworkers and clinicians are hampered by a lack of empirical information to guide their recommendations about placement and contact with siblings (Hegar, 1986, Staff & Fein, 1993, Wedge & Mantle, 1991). Indeed, recent reviews of research on children in care make no reference to siblings (Minty, 2000, Orme & Buehler, 2001, Rutter, 2000). This is somewhat surprising, given the predominance of sibling-related questions in assessment referrals, and an apparent demand for better practice guidelines.

What is known about siblings in care is largely descriptive. A sizeable number of studies have described sibling placement patterns and the stability of sibling placements (Hegar, 1986, Kosonen, 1996, Staff & Fein, 1992, Wedge & Mantle, 1991), though few have adequately controlled for the effects of multiple variables (Shlonsky, Webster, & Needell, 2003). A comprehensive analysis of the determinants of separation versus co-placement of siblings in care was recently conducted on case data of 35,216 children in California (Shlonsky et al., 2003). Identified determinants include: type of care (kinship versus foster care); the size of the sibling group; the age span of the sibling group; the timing of entry into care (i.e. together or separately); placement histories; as well as several other factors. Some of these are mirrored in the reasons agencies cite for splitting or maintaining sibling groups (Kosonen, 1996, Testa & Rolock, 1999). Other reasons cited by agencies include a lack of suitable placements, and the views of children (Kosonen, 1996). It has even been suggested that a substantial proportion of casework decisions about the placement of siblings in care are guided by reasons that are not child-related (Wedge & Mantle, 1991). In lieu of a comprehensive evidence base, guidelines for placement of siblings and related casework have tended to reflect principles of natural justice, professional judgment, the perceptions of siblings in care, or have made over-riding inferences from attachment theory (Begun, 1995, Forbes, 1977, Ward, 1984).

What do we need to learn about siblings in care, if we are to develop better guidelines for clinical and welfare practice? Two priorities are proposed. First, we suggest there is a need for a more precise understanding of the perceptions children have of their biological and foster siblings. Our clinical experience is that children in care have very diverse sibling relationships, ranging from intensely positive to abusive. Some siblings remain strongly attached to each other in spite of prolonged separation, while others demonstrate superficial relationships that are symptomatic of an attachment disturbance. Yet qualitative studies of children in care, and of adults who have left care, have tended to describe sibling relationships in homogenous terms. For example, adults who have left residential or foster care are said to emphasize the significance of their sibling relationships, to recall a strong sense of sadness over the loss of their siblings, and to have been reliant on their siblings for emotional support while in care (Kosonen, 1996, Triseliotis, 1984). Similarly, children in care have reported that they strongly value their relationships with their siblings (Kosonen, 1996), while children entering foster care at older ages (8–14 years) describe the loss of their siblings as being highly traumatic (Folman, 1998). While these findings are critically important, they do not explain variations in children's relationships, experiences, and perceptions.

Second, we suggest there is a need to better understand the extent to which sibling relationships shape the development, socialization, and mental health of children in care, as well as the mechanisms of such influence. This is a challenging task, not least because research designs need to control for the effects of many confounding variables (such as the presence of foster siblings), and to ensure that outcome measures are valid and well defined. The few attempts to measure the mental health of siblings in care appear to have used inadequate methods (Drapeau et al., 2000, Thorpe & Swart, 1992), while valid mental health estimates for children in care were not stratified for sibling-related factors (Armsden et al., 2000, Heflinger et al., 2000, Rushton et al., 1995, St Claire & Osborne, 1987). One study measured the mental health of preschool-aged children placed with and without their siblings in foster care (Smith, 1998). However, the study's small sample size (n=38) compromised its findings, and did not allow opportunity for gender-specific analyses.

The aim of the present paper is to describe sibling-related investigations conducted within the baseline survey of a prospective study of the mental health of children in care in New South Wales (NSW), Australia (the Children in Care Study). The study responds to the limitations of earlier research by: controlling for the effects of exposure to multiple risk factors; and obtaining valid survey estimates of mental health for a large sample of children in care. Within a larger agenda, the study addressed several research questions pertaining to siblings in care. The principal sibling-related research question was: What are the demographic, mental health and socialization characteristics of siblings in care, and to what extent do these characteristics vary according to whether one resides with, or apart from one's siblings? Additional questions were asked about the pattern and stability of sibling placements in NSW. This is somewhat challenging, as comparison of sibling data is limited by the complexity of family constellations and sibling placements, and the lack of standardized measures (Staff & Fein, 1993). Elsewhere, there has been considerable variation in reported proportions of children residing with one or more of their siblings in foster care. Estimates range from one quarter to one third in the U.K. (Kosonen, 1996), and from one half to two thirds in the US (Hegar, 1986, Staff & Fein, 1992). With one notable exception (Wedge & Mantle, 1991), the placements of separated siblings have been described as being less stable than those of siblings who reside together (Aldridge & Cautley, 1976, Drapeau et al., 2000, Staff & Fein, 1992, Thorpe & Swart, 1992). There is also some evidence that siblings who enter care together (Landsverk, Davis, Ganger, & Newton, 1996) are more likely to be restored to their parents than children who enter care alone, and that being placed with one's sibling(s) is a predictor of successful reunification (Farmer, 1996, Kosonen, 1996).

Most children (78%) recruited to the Children in Care Study (CICS) had entered care with a substantiated history of emotional or physical neglect. Oldest children in neglected sibling groups are believed to bear a large responsibility for the care of their younger siblings (Begun, 1995). In some circumstances, the combination of precocious caregiving with emotional deprivation may account for the development of the “parentified” child, in which the roles of the parent and child become reversed (Earley & Cushway, 2002). While foster and kinship care provide therapeutic opportunity for children to reclaim their childhood, our experience has been that some children actively resist attempts to relieve them of adult responsibilities, particularly if they are older siblings. Hence, two related questions were posed about “birth order”: Does a child's birth order account for differences in the placement patterns, socialization or mental health of children in care? And, what are the mental health characteristics and placement histories of “older” versus “younger” siblings placed together in care?

Finally, there has been some speculation about the extent to which children's behavior problems either directly or indirectly contribute to their entry into care. An adverse relationship may develop between a parent(s) and a single child within a sibling group, as characterized by scapegoating and other forms of selective maltreatment (Dance, Rushton, & Quinton, 2002). Factors contributing to this can include the child's biological relationship (step-children are more vulnerable), a selective failure to bond to a child, or specific child-related factors (such as the presence of problem behavior, a disability, or the child's gender). We are aware that parents at times seek to relinquish the care of a single child, ostensibly because they are unable to cope with their child's behavior disturbance. There is circumstantial support for this occurring elsewhere, with one study finding that children placed singly in care (i.e. with their siblings remaining at home) are more likely to be placed for child-related reasons, and to exhibit more behavior problems than children who entered care with their siblings (Boer, Westenberg, & van Ooyeen-Houben, 1995). However, the extent to which children's behavior or other child-related problems are cited as the primary reasons for entry into care may vary from one legal jurisdiction to another. For example, previous child welfare legislation in this state provided formal opportunity for parents to relinquish the care of a child because of an “irretrievable breakdown” in parent–child relationships. Other plausible reasons for a sibling being selectively removed from their family are: that the child is a sole victim of sexual abuse (e.g. because of age, gender, or special vulnerability); and the child perpetrates harm against their siblings. The present study afforded an opportunity to ask the following questions: What proportion of children in care are the only members of their sibling group to have ever been in care? And, do these children differ to others in terms of their socialization, mental health and placement histories?

Section snippets

Design

The CICS is a prospective epidemiological study of the mental health of 4- to 11-year-old children in alternate care in NSW, Australia. The study seeks to obtain cross-sectional and prospective estimates of the mental health and socialization of children in care, and to examine relationships between these estimates and a range of potential risk and protective factors (measured retrospectively and prospectively). The age range is sufficiently contained to yield gender-specific aggregate

The baseline survey sample

There were 819 eligible children in the two sampling frames drawn in 1999 and 2002. The contact details of the carers of 198 of these children (24%) could not be confirmed. Questionnaires were thus sent to the carers of 621 eligible children, with 347 children recruited to the study (56% response rate).

Demographic characteristics, maltreatment history, and care history were compared for 50 non-participant children versus 184 participant children, as of January 2000. This analysis suggests that

Mental health and socialization of siblings in care

The principal finding of the present study is that girls placed in care with one or more of their siblings present with better mental health than girls who are separated from their siblings. We considered various scenarios for why this might be so. First, it is feasible that some girls are separated from their siblings at the time they enter care, because they present with challenging behaviors or emotions. Second, some girls may possibly have been selectively removed from their parents' care,

Conclusion

The present findings describe the mental health of a large sample of siblings in care, and provide new insights into the significance of sibling relationships on their development. The study considered a number of sibling-related research questions, including the influences of birth order and shared placements, and provides comparative estimates for sibling placement patterns. Though the study design was compromised by a lack of data about non-participant siblings, it improves on previous

Acknowledgements

This study was funded and supported by the NSW Department of Community Services. Requests for reprints should be addressed to Michael Tarren-Sweeney, Centre for Mental Health Studies, University of Newcastle, Callaghan, NSW, 2308, Australia.

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