Placement disruption in foster care: Children's behavior, foster parent support, and parenting experiences.

BACKGROUND: The majority of children in foster care 24 months or longer experience three or more placements. Children's behavior problems are a primary contributor to multiple moves, but little is known about how behavior problems and other stressors lead to disruptions. This study focused on foster parents' experiences of parenting a child at risk for moves using the determinants of parenting model (Belsky, 1984) to identify potential correlates of difficult parenting experiences and placement disruption. OBJECTIVE: To identify factors associated with difficult parenting experiences and placement disruption. PARTICIPANTS: Foster parents (N = 139) caring for children age 8-14 in long term foster care with a history of two or more moves were randomly selected in a large Midwestern state in the U.S. METHODS: Participants completed a 90-minute telephone interview (86% response rate). Placement moves were tracked prospectively for two years. Parenting experiences and disruption were analyzed using multiple and logistic regression. RESULTS: Results support aspects of the determinants of parenting model. Behavior problems, children's risk to others, low support, and stress were significantly associated with more difficult parenting experiences (ßs = .28, .22, .18, .19, respectively, ps < .05), and more difficult parenting experiences strongly predicted placement disruption (p < .01). Risk to others also predicted disruption before including parenting experiences, with this association becoming nonsignificant after including parenting experiences. Unexpectedly, African American foster parents had a higher risk for disruption, despite more positive parenting experiences. CONCLUSIONS: These findings support attending to foster parents' parenting experiences, children's risk to others, social support and stress to better support placements of children at risk for disruption.

Correction to: The Effect of a Change Agent on Use of Evidence-Based Mental Health Practices.

The original version of this article unfortunately contained a mistake.

The Effect of a Change Agent on Use of Evidence-Based Mental Health Practices.

Children's service systems are faced with a critical need to disseminate evidence-based mental health interventions. Despite the proliferation of comprehensive implementation models, little is known about the key active processes in effective implementation strategies. This proof of concept study focused on the effect of change agent interactions as conceptualized by Rogers' diffusion of innovation theory on providers' (N = 57) use of a behavioral intervention in a child welfare agency. An experimental design compared use for providers randomized to training as usual or training as usual supplemented by change agent interactions after the training. Results indicate that the enhanced condition increased use of the intervention, supporting the positive effect of change agent interactions on use of new practices. Change agent types of interaction may be a key active process in implementation strategies following training.

Use of evidence-based interventions in child welfare: Do attitudes matter?

Implementation of evidence-based programs in progressed slowly, with the majority of services in child welfare settings lacking empirical evidence for effectiveness. In other settings, research has identified providers' attitudes about evidence-based practices (EBPs) as a potential barrier to adoption of EBPs. As little research has focused on the role of attitudes in influencing use after training in an EBP in child welfare, the potential for attitudes to impede implementation efforts in child welfare is unclear. This study addressed this question in a sample of 55 caseworkers and therapists randomly assigned to enhanced support to use an EBP following training or a training-only condition. Information on providers' use of the intervention after training and their attitudes about EBPs were measured for up to five time points. Results indicate that attitudes did not predict providers' use of the EBP, and attitudes did not change overall or in the enhanced condition that provided greater exposure to the intervention. Providers perceived of requirements to use a practice as more influential in their use than their openness to EBPs. However, those who were more open to EBPs were more likely to participate in implementation support after the training, suggesting that openness facilitates participation in activities that support use of a new intervention.

Agency Culture and Climate in Child Welfare: Do Perceptions Vary by Exposure to the Child Welfare System?

Organizational culture and climate play a critical role in worker retention and outcomes, yet little is known about whether perceptions of culture and climate vary depending on the demands of particular roles. In this study, 113 staff from a child welfare agency completed Organizational Social Context profiles. Staff were divided into three groups according to their proximity to child welfare tasks to assess whether involvement in higher stress child welfare tasks is related to perceptions of the social context. Findings suggest possible differences across groups, with those involved in core child welfare tasks appearing to perceive higher resistance to new ways of providing services and those with the least involvement in traditional child welfare perceiving a more positive social context overall.

Substitute care entry: the relationship between race or ethnicity and levels of county organization.

OBJECTIVE: Past studies demonstrate a relationship between race and the likelihood of children entering state custody subsequent to a maltreatment investigation. Research also shows that community structural characteristics such as poverty and residential mobility are correlated with entry rates. The combined effect, however, of race and community characteristics on substitute care entry is unclear. We analyzed 3 years of Illinois child welfare administrative and county-level structural data to assess the combined effect of child characteristics and level of community organization on substitute care entry. METHODS: Based on county indicators of crime, socioeconomic status, residential mobility, and child care burden, a latent profile analysis classified Illinois counties into three levels of social organization (high, moderate, and low). To test the relationship between community and child level predictors of substitute care entry, a dichotomous variable representing substitute care entry was regressed onto county level and individual covariates (child age, race or ethnicity, gender, and allegation). To test the combined relationship of community and individual level characteristics, interactions between county level of organization and race were explored. RESULTS: Like previous studies, results showed that individual factors of race, age, and allegation were associated with the decision to place children in substitute care. Also consistent with past research, they revealed a general trend in which decreasing levels of social organization were associated with relatively higher odds of entry to care. The magnitude of this effect at each level of social organization, however, varied by race, with African American children in disorganized communities experiencing the greatest risk of removal. CONCLUSIONS: These findings suggest that efforts to understand the decision to place a child in substitute care may need to be community specific. In particular the level of community organization may influence the response of the system to maltreatment investigations. In communities with different characteristics and across racial groups, child welfare systems may need to examine decision making processes regarding children's removal from parental care.

Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children?

OBJECTIVES: Adoption is particularly important for foster children with special mental health needs who are unable to return home, as adoption increases parental support often critically needed by youth with mental health issues. Unfortunately, significant behavior problems frequently inhibit foster parents from adopting, and little is known about factors that predict adoption when a child has behavior problems. Previous research suggests that foster parent behavioral training could potentially increase rates of successful adoptions for pre-school-aged foster children with behavior problems (Fisher, Kim, & Pears, 2009), but this has not been previously tested in older samples. In older children, effective treatment of behavior problems might also increase adoption by reducing the interference of behavior problems and strengthening the child's foster home integration. This pilot study focused on this question by testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. METHODS: This study used an intent-to-treat design to compare foster home integration and adoption likelihood for 31 foster children with histories of abuse and neglect whose foster parents received a foster behavioral parenting intervention (see Chamberlain, 2003) or usual services. Random effect regression analyses were used to estimate outcomes across four time points. RESULTS: As expected, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. However, the intervention did not have a direct effect on either foster home integration or adoption despite its positive effect on behavior problems. CONCLUSIONS: Results from this preliminary study provide further evidence of the negative effect of externalizing behavior problems on adoption. Its findings also suggest that foster home integration is an important dimension of foster home adaptation that appears particularly relevant to chances for adoption. While behavior problems appear to weaken foster home integration, integration is also an independent predictor of adoption likelihood. If these results are replicated in a larger study, consideration of foster home integration in case planning and future intervention studies focused on increasing permanency could potentially improve outcomes for foster children with behavior problems.

Use of a Parent Management Training Intervention with Urban Foster Parents: A Pilot Study.

The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (age 4-12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.

Predicting family reunification, adoption, and subsidized guardianship among adolescents in foster care.

Although national legislation has attempted to decrease the length of time that children spend in foster care, these policies have been less effective with adolescents than with children, raising questions about how best to promote permanency for adolescents. This study examined factors that predict adolescent adoption, subsidized guardianship, and reunification. The caseworkers and foster parents of 203 randomly selected 12- to 13-year-olds placed in traditional or specialized foster care were interviewed. Permanency outcomes were prospectively tracked for 8 years. By the end of the study, over 40% of the adolescents were placed in permanent homes. As hypothesized, a strong relationship with a biological mother predicted successful reunification, and a high degree of integration into a foster home predicted adoption. Additionally, when compared with adoption, subsidized guardianship with foster parents occurred more frequently for youth with strong relationships with their biological mothers and weaker relationships with their foster families. Unexpectedly, behavior problems were not related to any permanency outcomes. Results suggest that promotion of strong relationships with adults is the key in efforts to find permanent families for foster children. Furthermore, efforts to attain permanency should not cease during adolescence.

Context Specific Mental Health Services for Children in Foster Care.

Although a high proportion of foster children receive mental health services, existing research suggests limited accessibility and effectiveness of these services. This paper discusses strategies to develop a model to deliver evidence-based services using the unique opportunities apparent within publicly funded child welfare systems. An ecologically-focused model providing enhanced services in children's homes and schools could capitalize on these opportunities and radically improve access and effectiveness of mental health services for foster children. We present data from four focus groups conducted with foster parents, caseworkers, and therapists to understand the feasibility of implementing this type of service model. Results support the need for services focused on enhancing interactions in children's foster homes and schools, but also suggest that issues related to priorities and primary roles could limit the extent that caseworkers and agency-based mental health providers would follow through with the proposed service model.

Trends in Child Welfare's Focus on Children's Mental Health and Services from 1980-2004.

This study examined how one of the oldest and most widely distributed child welfare practice journals addressed children's mental health issues over a 25-year period. The content of 478 articles was coded. Logistic regression findings indicate that mental health issues were discussed less frequently over the first half of the period examined, and then more frequently over the last decade. Residential treatment was discussed less frequently over time, but other community-based alternatives to residential treatment were rarely discussed at any point, so that overall the content related to treatment of mental health issues decreased as discussion of residential treatment decreased. These findings suggest that although the child welfare literature has recently focused more on children's mental health, dissemination of specific concepts from the mental health to the child welfare literature does not naturally occur over time. Efforts targeted at dissemination of effective community-based mental health interventions for foster children may be needed to support this process.

Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs.

Foster youth emancipating from care: caseworkers' reports on needs and services.

This article presents findings from a survey mailed to caseworkers, who answered questions about special needs, independent living skills, educational attainment, and services for 416 randomly selected foster youth in Illinois. A third of the adolescents had a mental health disorder, developmental disability, or other special need that their caseworkers believed would interfere with their ability to live independently. Additionally, urban youth were underserved relative to other youth. Youth with more behavior problems and educational and job skill deficits were less likely than other youth to continue to receive child welfare services past age 18, suggesting that services must be provided throughout adolescence to meet the needs of the most vulnerable clients.

Placement disruption and negative placement outcomes among adolescents in long-term foster care: the role of behavior problems.

OBJECTIVE: This study examined risk of placement disruption and negative placement outcomes (e.g., residential treatment and incarceration) among adolescents placed in traditional family foster care for a year or longer. A foster parent's report of externalizing behavior problems was expected to be a stronger predictor of disruption and negative outcomes than a caseworker's report. Additionally, the association between behavior problems and placement disruption was expected to be mediated by the youth's degree of belonging and integration in the foster home. METHOD: The caseworkers and foster parents of 179 randomly selected 12-13-year-old adolescents placed in traditional foster care were interviewed by telephone. Interviews included standardized measures of externalizing behavioral problems and several other variables that have been previously associated with placement movement. Disruption from the youth's foster home at the time of the interview was prospectively tracked for 5 years. RESULTS: Over half of the youth experienced a disruption of their placement. Contrary to expectations, behavior problems as reported by caseworkers, but not foster parents, were predictive of placement disruption. However, the foster parent's report of behavior problems predicted risk of negative outcome after a period of 5 years. As hypothesized, integration in the foster home was highly predictive of placement stability and mediated the association between behavior problems and risk of disruption. CONCLUSIONS: Results suggest that integration in the foster home might be an important dimension of placement adaptation that should be considered during service planning for foster youth in long-term foster care. In addition, using standardized measures of behavior with both foster parents and caseworkers might be necessary to assess both long-term risk of negative outcomes and more immediate risk of placement disruption.

Family characteristics associated with duration of breastfeeding during early infancy among primiparas.

This investigation examined the association of relationship characteristics and parental gender roles with duration of breastfeeding among primiparous women during the early postpartum period. An ethnically diverse group of urban middle-class women (n = 115) who initiated breastfeeding were individually surveyed by telephone along with their male partners. Results of the Cox regression analyses confirmed earlier findings reported in the literature. Reporting higher relationship distress was predictive of early breastfeeding cessation at a marginal level of significance. However, levels of maternal responsibility for household tasks and infant care were highly significant predictors of breastfeeding cessation but in opposite directions. These results suggest that the effects of paternal gender roles on breastfeeding success may vary depending on the area of involvement. Findings have implications for further research examining breastfeeding duration, gender roles, and relationship quality and for clinical practice that facilitates adaptive roles and relationships among new parents.

Parental visiting and family reunification: could inclusive practice make a difference?

This study examines whether inclusive practice, or parental involvement in foster children's lives while in placement, is correlated with more frequent visiting and a greater likelihood of reunification. This hypothesis was tested among a random sample of 230 twelve- and thirteen-year-olds placed in traditional family foster care. Results suggest that mothers who visit their child and are involved in case reviews and child care activities visit more frequently than mothers who visit in settings such as agency offices and have no other types of involvement. In addition, visiting frequency is highly predictive of reunification. These associations were not explained by maternal substance abuse, mental illness, or the child's placement history.