Exploring the interplay: Maternal electronic health literacy and its impact on early childhood development and parenting practices.

BACKGROUND: Mothers need a competent electronic health literacy (eHL) skill for beneficial gains for the health of their children in the virtual environment, which is a new health platform. We predict that a competent eHL of mothers who play a central role in early childhood will positively affect the health of their children. This study aimed to determine the level of eHL of mothers of young children and investigate the relationship between mothers' eHL and early childhood development (ECD) and early parenting practices (EPP). METHODS: This cross-sectional study was conducted on mothers with children aged 36-59 months using eHealth. Sociodemographic and personal characteristics form, Early Childhood Development Module and eHealth Literacy Scale were administered to the participating mothers. RESULTS: The data from 440 mother-child pairs were analysed. Children of mothers with sufficient eHL levels were more likely to be Early Childhood Development Index (ECDI)-on-track, adjusted odds ratio (AOR), 95% confidence interval (CI): 2.16 (1.29-3.61); have adequate support in learning, AOR (%95 CI): 3.23 (1.69-6.18); and have adequate daily meals and snacks, AOR (%95 CI): 2.43 (1.56-3.78). CONCLUSION: These results revealed that there is a need for interventions that will contribute to child health by improving mothers' eHL levels.

Maternal Depressive Symptoms in the First Year after Childbirth Predict Long-Term Developmental Risks in Sons and Daughters.

Under-diagnosed and thus under-treated, maternal depression remains the most common complication of childbearing. Varying symptoms suggest persistence up to more than a decade following childbirth. This implies distinct vulnerabilities for the physical and emotional care of children. Using a prospective-longitudinal sex-stratified birth cohort of 2120 infants, we examined the relationship between early maternal depression symptoms and subsequent child psycho-social and relational characteristics. Mothers self-reported the severity and frequency of depressive symptoms 5 months after childbirth. Parents, teachers, and target participants reported on child mental health and relationships with adults, from kindergarten to tenth grade. A series of least-squares regressions were estimated, while controlling for pre-existing/concurrent child and family confounds. Both sons and daughters of mothers with more depressive symptoms were at risk of experiencing greater psycho-social impairment, classroom rule defiance, difficult relationships with teachers, less enjoyable mealtimes (age 6 years) and sleep, and coercive or inconsistent parenting practices in childhood and adolescence. For boys, these prospective associations were mostly consistent through ages 12 and 15 years. Girls also experienced more problematic interactions through to age 15 years. This study provides observations of distinct long-term vulnerabilities for sons and daughters in association with early maternal distress at important transitional periods of development in early, middle, and later childhood.

Understanding the relationships between acculturation, food insecurity, and food parenting practices among socioeconomically/racially diverse parents.

Research suggests that acculturation and food insecurity are factors that are separately associated with the use of specific food parenting practices among United States (US) families. Certain food parenting practices, such as coercive control and unstructured food parenting practices, are related to negative health consequences in children, such as disordered eating behaviors. The current study aimed to explore associations between acculturation strategies and food parenting practices in a sample of 577 Latinx, Hmong, Somali/Ethiopian, and Multiracial families. A secondary objective was to understand whether food security status significantly modified the relationships between acculturation strategies and food parenting practices. Results showed that acculturation strategies were significantly related to food parenting practices, and patterns in these relationships differed across race and ethnicity. Further, food security status significantly modified the relationship between acculturation strategies and food parenting practices for Latinx, Hmong, and Somali/Ethiopian families, but not for Multiracial families. These results point to the complex relationships among acculturation strategies, food security status, and food parenting practices in immigrant populations in the US. Longitudinal studies exploring the temporal relationships between acculturation strategies, food security status, and food parenting practices would help tease apart how food parenting practices may evolve upon migrating to the US.

Parenting Practices and Externalizing Behaviors in Autistic Children: A Systematic Literature Review.

There is limited recent research on the association between parenting practices and externalizing behaviors in autistic children. To address this gap, the current systematic review examined the associations between parenting practices and externalizing behaviors in autistic children, along with the mediating and moderating effects of parent and child variables (PROSPERO registration number CRD42022268667). Study inclusion criteria were (1) Peer-reviewed journals, (2) Participants included parents of autistic children and their children, (3) Quantitative measures of both parenting practices or behaviors/style and child externalizing behaviors, (4) Cross-sectional or longitudinal studies only, and (5) Studies published in English. Study exclusion criteria were: (1) Qualitative studies, (2) Published in a language other than English, (3) Participants included non-human participants, (4) Participants that did not include parents and their autistic children as participants or did not report this group separately, (5) Systematic review and meta-analyses, and (6) No quantitative measures of parenting practices and/or child externalizing behaviors. Quality appraisal and risk of bias were conducted using the McMaster Tool and results were synthesized in Covidence and Excel. Thirty studies were included in the review. Results demonstrated that mindful parenting was associated with fewer or lower levels of externalizing behaviors; positive parenting practices had non-significant associations with externalizing behaviors; specific parenting practices had differing associations with externalizing behaviors; and negative parenting practices were associated with higher levels of externalizing behaviors. We are unable to draw causal relationships due to focus on cross-sectional and longitudinal articles only. The potential for future research to target specific parent practices to support children's externalizing behaviors is discussed.

The Family Game to support parents with intellectual disability in managing challenging behaviours: A replication.

BACKGROUND: Although many parents with intellectual disability (ID) demonstrate good parenting practices, some parents experience difficulties in managing challenging behaviours. One potential solution to this issue involves using The Family Game, a program designed to teach parents with ID how to manage challenging behaviours in their child. AIMS: The purpose of our study was to conduct an independent replication of an investigation that had been performed by the developer of the program. MATERIALS & METHODS: We used a multiple baseline design to examine the effects of The Family Game on the behaviour of two parents with ID who had a 3-year-old child. RESULTS: Similarly to the original study, our results indicate that The Family Game improved the use of effective parenting strategies during role play, but that these gains failed to generalise to real-life settings. CONCLUSION: The study further supports the necessity of adding novel strategies to the game to better promote generalisation.

Community-Delivered Evidence-Based Practice and Usual Care for Adolescent Attention-Deficit/Hyperactivity Disorder: Examining Mechanistic Outcomes.

Previous research suggests that routine psychosocial care for adolescents with attention-deficit/hyperactivity disorder (ADHD) is an eclectic and individualized mix of diluted evidence-based practices (EBPs) and low-value approaches. This study evaluated the extent to which a community-delivered EBP and usual care (UC) for adolescents with ADHD produce differential changes in theorized behavioral, psychological, and cognitive mechanisms of ADHD. A randomized community-based trial was conducted with double randomization of adolescent and community therapists to EBP delivery supports (Supporting Teens' Autonomy Daily [STAND]) versus UC delivery. Participants were 278 culturally diverse adolescents (ages 11-17) with ADHD and caregivers. Mechanistic outcomes were measured at baseline, post-treatment, and follow-up using parent-rated, observational, and task-based measures. Results using linear mixed models indicated that UC demonstrated superior effects on parent-rated and task-based executive functioning relative to STAND. However, STAND demonstrated superior effects on adolescent motivation and reducing parental intrusiveness relative to UC when it was delivered by licensed therapists. Mechanisms of community-delivered STAND and UC appear to differ. UC potency may occur through improved executive functioning, whereas STAND potency may occur through improved teen motivation and reducing low-value parenting practices. However, when delivered by unlicensed, community-based therapists, STAND did not enact proposed mechanisms. Future adaptations of community-delivered EBPs for ADHD should increase supports for unlicensed therapists, who comprise the majority of the community mental health workforce.

Child rearing or childbearing? Risk of cardiovascular diseases associated to parity and number of children.

BACKGROUND: An increased risk of cardiovascular diseases (CVD) has been associated with women's parity, but whether or not this association reflects a direct pregnancy effect, or exposure to factors related to childrearing, still appears unclear. We assessed the CVD risk associated with number of children separately by gender and tested effect modification by socioeconomic position (SEP) and employment status, in order to elucidate the possible mechanisms underlying this association. METHODS: The study population was composed of 20,904 men and 25,246 women who were interviewed in one of two National Health Surveys conducted in 2000 and 2005 in Italy. These subjects were followed for CVD incidence up to 2014 through record-linkage with national archives of mortality and hospitalisations. CVD risk was estimated by Cox regression models that were adjusted for socio-demographics, perceived health, lifestyles, biological CVD risk factors and for other potential confounders. RESULTS: CVD incidence was significantly increased among men with 3 or more children (HR = 1.26, 95% CI: 1.02-1.56) and among women with 2 and with 3 or more children (HR = 1.42, 95% CI: 1.10-1.83; and HR = 1.39, 95% CI: 1.03-1.87, respectively) compared to subjects without children and no significant gender differences were observed. Subjects with lower SEP displayed stronger associations with parity and a higher number of children for both genders; by contrast, no modifying effect of employment status was observed. CONCLUSIONS: Taken together, the significant association between higher parity and CVD risk in both genders, and the higher risk of CVD associated with higher parity among lower SEP parents, suggests that childrearing has a potential effect on the development of CVD that is more pronounced among disadvantaged families, although a concurrent effect of childbearing cannot be completely excluded.

"You just have to spread it thin": Perceptions and feeding experiences of Australian fathers of young children living with disadvantage.

The role of fathers in feeding is an emerging field within child feeding literature. Fathers have unique contributions to make to family mealtimes and child eating behaviours. However, qualitative research on fathers' experiences is limited, especially in the context of disadvantage. This study explored fathers' perceptions of their roles and feeding practices and their lived experience of disadvantage through a symbolic interactionism lens. Twenty-five Australian fathers of children aged six months to five years who experienced socioeconomic disadvantage participated in semi-structured interviews. Five themes were constructed from reflexive thematic analysis: (i) responsibilities for foodwork are based on strengths, opportunities, and values, (ii) negotiating fatherhood identity from a place of tension to acceptance, (iii) struggling with financial and mental strain, and food insecurity, (iv) managing adversity whist prioritising feeding children, and (v) paternal feeding practices are driven by values, adversity, and emotions. The division of foodwork was contingent on family capability and employment, maternal gatekeeping, paternal attitudes and values, and intergenerational, cultural and gender norms around earning and childrearing. Economic, environmental, and emotional stressors triggered changes to fathers' feeding practices, often contradicting their ideals (e.g., providing alternative meals, using rewards and electronic devices, unstructured settings). Fathers described income and food-based strategies to protect children's food intake, which may involve caregivers forgoing meals. These findings provide insight into fathers' feeding experiences through recognising personal, interpersonal, and systemic enablers and barriers. Promoting optimal feeding practices should include targeted feeding support and broader structural interventions to address inequality. Fathers' experiences as they navigate child mealtime interactions within a context of adversity can be used to inform child feeding interventions to improve child health and development.

Family-Focused Universal Substance Use Prevention in Primary Care: Advancing a Pragmatic National Healthcare Agenda.

This article advances ideas presented at a National Academies of Sciences, Engineering, and Medicine workshop in 2022 that highlighted clinical practice and policy recommendations for delivering universal, family-focused substance use preventive interventions in pediatric primary care. Pediatric primary care is a natural setting in which to offer families universal anticipatory guidance and links to systematic prevention programming; also, several studies have shown that offering effective parenting programs in primary care is feasible. The article describes a blueprint for designing a pragmatic national agenda for universal substance use prevention in primary care that builds on prior work. Blueprint practice schematics leverage efficacious family-focused prevention programs, identify key program implementation challenges and resources, and emphasize adopting a core element approach and utilizing digital interventions. Blueprint policy schematics specify avenues for improving cross-sector policy and resource alignment and collaboration; expanding, diversifying, and strengthening the prevention workforce; and enhancing financing for family-focused prevention approaches. The article then draws from these schematics to assemble a candidate universal prevention toolkit tailored for adolescent patients that contains four interlocking components: education in positive parenting practices, parent and youth education in substance use risks, a parent-youth structured interaction task, and parent and youth linkage to in-person and web-based prevention resources.

The gradients of the relationship between child discipline practices at home and early childhood development of young children.

BACKGROUND: Although the literature suggests a negative association between early childhood development (ECD) and violent disciplinary measures, little is known about the gradient of this relationship. OBJECTIVE: This study examined the gradient of the relationship between the number and types of child discipline practices at home and the ECD of children aged from 36-to-59 months. PARTICIPANTS AND SETTING: The study used nationally representative data from the Multiple Indicator Cluster Survey Bangladesh 2019. METHODS: We analysed secondary data using multivariable logistic regression to examine the relationship between child discipline practices and ECD. The gradients were measured using three sets of summative indexes of disciplinary practices and psychometric approach to the physical, literacy-numeracy, learning and social-emotional domains of ECD. RESULTS: About 94 % of children had at least one of the eight violent disciplinary measures during the month preceding the survey. Approximately three-quarters of the children were on track in their ECD. The probability that children were on track in ECD significantly increased with non-violent disciplinary practices and decreased with violent disciplinary practices used. For one unit increase in the overall violent disciplinary index, the odds of children being on track in their ECD was reduced by 12 %, and the reduction was significant (adjusted odds ratio = 0.88; 95%CI: 0.86-0.91). CONCLUSIONS: Children who had experienced several forms of violent disciplinary measures were more likely than those who did not to be delayed in their ECD. Banning violent punishments in all settings and positive parenting programs are recommended.

Parenting a child with Down syndrome: A qualitative study on parents' experiences and behaviors from a self-determination theory perspective.

PURPOSE: Raising a child with Down syndrome (DS) brings unique challenges to parents' psychological functioning. Extensive quantitative research has shown that these parents tend to experience higher levels of parental stress and lower well-being. However, a more in-depth and balanced insight is essential to fully grasp the complexity of parenting a child with DS. To address this gap, this study uses a qualitative approach to explore the experiences and behaviors of parents raising a child with DS. DESIGN AND METHODS: By adopting the Self-Determination Theory as a comprehensive theoretical framework, this study attends to both opportunities and challenges for parents' psychological needs of autonomy, relatedness, and competence, and provides insights into how they support the psychological needs of their child with DS. Eleven in-depth interviews were conducted with parents of a child with DS (aged 4 to 23 years). RESULTS: Through thematic analysis, six themes of parental experiences and three themes of parenting behaviors were distinguished. CONCLUSIONS: The findings indicated that parents experience many opportunities for need satisfaction, predominantly in their need for relatedness. However, raising a child with DS also involves challenges for the parents' family relationships, personal freedom, professional ambitions, and feelings of competence. Regarding their parenting behaviors, parents considered stimulating independence, tuning into the child's mental world, and being patient as essential practices when raising a child with DS. PRACTICAL IMPLICATIONS: This study provides important clues to promote parents' well-being as well as their engagement in need-supportive parenting practices towards their child with DS.

Practitioner Review: A core competencies perspective on the evidence-based treatment of child conduct problems.

BACKGROUND: The effective treatment of child conduct problems is understood to rely on a range of therapist competencies, yet these have rarely been an explicit focus of research. In this practitioner review, we examine core competencies for the delivery of evidence-based parenting interventions for conduct problems in early-to-middle childhood. These are examined in light of research into the common elements shared by these interventions, literature regarding common challenges in these interventions, and conceptualisations of such competencies in other fields of mental health. METHODS: We report on the development of a novel consensus-based model of core competencies for evidence-based practice in this field, based on consultation with an international expert panel. This includes competencies as they apply to complex presentations of conduct problems. RESULTS: Despite considerable variation among widely disseminated programmes in terms of content, format and skills-training practices, there is strong consensus among practitioners regarding core competencies. These relate to three broad domains: (a) generic therapeutic competencies; (b) parenting intervention competencies; (c) specific parenting skills/techniques. CONCLUSIONS: Practitioners working with conduct problems, particularly complex presentations thereof, require competencies for engaging not only mothers, but fathers and diverse/non-traditional caregivers and other stakeholders, in evidence-based parenting interventions. Moreover, the successful delivery of these interventions necessitates competencies that extend beyond behaviour management and encompass broader aspects of the family system and the wider ecology of the child.

It takes a safe village to raise a child-a commentary on Dana McCoy et al. (2023).

This commentary on the study by McCoy et al. (2023) examining the negative effects of neighborhood violence on the development of toddlers growing up in the city of São Paulo (Brazil) interprets these outcomes from the perspective of ecological system theory, modern brain research, and the prospect of resilience. We argue that societies should give children the opportunity to grow up in a safe and sufficiently affluent social environment in order to give them a chance to achieve their full developmental potential. Governments and the health care system should, therefore, first and foremost invest in safe and stimulating child-rearing environments, informed by scientific research.

Understanding and Changing Community Attitudes Toward Vulnerable Families: A Review of Literature and Practice.

Communities can play an important role in protecting children and supporting vulnerable families. However, there is currently a lack of understanding of what communities actually think and do regarding these groups. The purpose of this study was to review and synthesize evidence on community attitudes and behaviors toward vulnerable families. A rapid systematic literature review was conducted, supplemented by 6 semistructured interviews with experienced practitioners. Four databases were searched using key words related to community attitudes and behaviors, parents and families, and family and child protection services. Database searches returned 10 135 unique records, of which 23 met the inclusion criteria. The identified articles investigated a range of attitudes and behaviors, including reporting abuse and neglect; assisting victims of intimate partner violence; attitudes toward parenting practices; and participating in activities that build social support and social capital. Correlates of these attitudes and behaviors included sociodemographic characteristics, individual differences, community characteristics, and incident characteristics. A number of interventions to change community attitudes and behaviors were also identified. Practitioners indicated that success factors for interventions included facilitating active participation from community members; using multifaceted approaches; and increasing empathy toward vulnerable families. Despite increasing evidence around how community members think and act toward vulnerable families, more (particularly review-level) research is needed to determine how to effectively change these attitudes and behaviors.

Sex-related differences in parental rearing patterns in young adults with bipolar disorder.

The aim of this study was to examine the parenting characteristics of young patients with bipolar disorder (BD) and explore the sex differences. The parental rearing pattern of young patients with BD was measured and compared with the healthy control of young adults. The EMBU scale was used to assess parental rearing patterns. Patients with BD reported significantly higher scores in the punishment and severity index, as well as of the rejection and denial index, but lower scores in the warmth & affectionate index in the paternal rearing pattern, compared with healthy controls. In addition, patients scored higher on the punishment and severity index and rejection and patterns index in maternal rearing patterns. More importantly, we found significant sex differences in maternal rearing patterns (pBonferroni < 0.05). Specifically, in the maternal rearing patterns, male patients had higher scores on the favoring index than male controls, whereas female patients had lower scores on the warmth & affectionate index than female controls. This study shows significant differences in parental rearing patterns between patients and control subjects. Male patients were overprotective by their mothers and female patients were overlooked by their mothers during upbringing.

Design, Implementation and Evaluation of an Innovative Pilot Intervention to Improve the Family Quality of Life of Children with Specific Learning Disabilities-A Randomized Controlled Trial.

Background: The high prevalence of learning disabilities among children confirm that learning disabilities are surprisingly common. In the absence of routine screening, many children still go undetected with a huge individual and family burden, while at the same time, the findings of existing interventions are conflicting. This study reports on the design, implementation and evaluation of an innovative pilot intervention aiming at improving the quality of life of the family of children with specific learning disabilities. Method: For the purposes of this study, we ran a randomized controlled trial employing an experimental research design with two groups (intervention and control). The study population comprised parents of children with specific learning disabilities. Out of the 71 individuals that were eligible for randomization, 42 were allocated to the intervention, and 29 to the control group. A brief parenting intervention model was employed, aiming at improving parenting skills through a stepwise process. The intervention included four skill building sessions conducted over a period of 6 weeks. "Parenting style" (including three dimensions: "Authoritative", "Authoritarian" and "Permissive") and "Family Quality of life" (including five dimensions: "Family Interaction", "Parenting", "Emotional Well-being", "Physical/Material Wellbeing" and "Disability-Related Support") were employed as the outcome measures of this study. Two validated questionnaires were used to measure the study outcomes: "the Parenting Style Questionnaire" and the "Family Quality of Life Scale (FQOL) Questionnaire". The questionnaires were applied at the pre- and post-intervention level. Findings: An analysis showed that except for the "permissive parenting style", the intervention and control group had statistically significant differences in all the "Parenting style" and the "Quality of life" dimensions at the post-intervention level. In the intervention group, none of the study dimensions improved at a statistically significant level at the post-intervention level compared to pre-intervention level. According to the cluster analysis, which re-examined successful vs. unsuccessful cases, the intervention was found to have an effect on the average values of all the "quality of life" and "parenting style" dimensions, except for the "Authoritarian Parenting Style". Conclusions: The study offers evidence on the dimensions of parenting and quality of life mostly affected by a brief intervention as well as on the feasibility, practicality and acceptance of such interventions in local communities.

The Effect of Virtual Education in Parenting Skills on the Parenting Sense of Competence in First-time Mothers with a 0-2-year-old Baby: A Quasi-experimental Study.

Background: Parental competence is a key aspect of parenting. Since they have no previous experience of having a baby, first-time mothers should acquire certain skills to be competent enough in caring for their baby. The present study aimed to investigate the effect of virtual education in parenting skills on the parenting competence of first-time mothers with a 0-2-year-old baby. Methods: This quasi-experimental study was conducted through convenience sampling; 72 first-time mothers were selected from 12 healthcare centers, 62 of whom met the criteria for entering the study, and divided into an experimental (n=31) and a control (n=31) group. The mothers in the experimental group received virtual education in parenting skills in six sessions, each lasting 10 minutes for two weeks. The data were collected using a demographics questionnaire and Gibaud-Wallston's parenting sense of competence scale. Sense of competence was assessed in three stages: before, immediately after, and one month after the completion of the intervention. The collected data were analyzed using SPSS v. 22 at a significance level of less than 0.05. Results: Results showed a statistically significant increase in the experimental group's parenting competence mean score immediately and one month after the intervention (P<0.001). There was a statistically significant difference between the mean scores of the study groups as measured immediately after (P=0.043) and one month after the intervention (P<0.001). Conclusion: Virtual education of parenting skills could have a positive impact on the mothers' parenting competence. It is suggested that first-time mothers should be educated in parenting skills on a face-to-face basis in maternity wards and online after discharge.

Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus.

BACKGROUND: Parenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population. METHODS: This study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction. RESULTS: ABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning. CONCLUSIONS: A fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders' experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.

A qualitative exploration of the drivers for the transfer of foster children in Gauteng, South Africa.

BACKGROUND: Many children in South Africa are orphaned or subjected to maltreatment, leaving them in need of care and protection. Foster care is one form of alternative care for such children. Retention of foster parents, or foster care placement stability, is one of the many challenges related to foster care, globally and in South Africa. This instability can have an adverse impact on children, and although some research speaks to the problem, the experiences of South African role players regarding this problem have not been documented, to date. To improve foster care retention in South Africa, local, contextualized studies exploring the drivers of foster care placement instability are required. AIM: The aim of this qualitative study was thus to explore designated social workers' (DSWs) and foster parents' experiences about the reasons prompting foster care transfers. PARTICIPANTS AND SETTING: A purposively selected sample of ten foster parents and ten DSWs in the Gauteng province of South Africa took part in the study. METHODS: A descriptive qualitative study was adopted as basis for this study, which entailed thematic analysis of 20 semi-structured interviews. RESULTS: It was found that children's behavioural problems, a shortage of resources, a lack of parenting skills, problematic relationships between foster parents and foster children, and previous traumatic events, led to most foster care transfers. A key finding from this study, which appears not to be evident in previous studies, centres on the critical role played by money, or rather its absence, in contributing to foster care placement instability. CONCLUSIONS: When considered in conjunction with findings emerging from previous studies, our findings underscore the importance of obtaining a contextualized understanding of local, cultural factors at play in foster care delivery. To improve foster care retention in South Africa, which is fraught with challenges not yet reported elsewhere, it is recommended that screening procedures for foster parents be revised, and that allocation of resources to DSWs be prioritized.