What happens to children placed in care?

This is the essential question that a new UK study posed. American research previously referred to on this blog has suggested poorer life trajectories. Thus, the British study adds more to the picture. There were 431individuals who, at age 30, provided details on what had occurred in their life trajectory. The report notes that "Compared with cohort members with no public care history, a greater proportion...from public care were from poorer socio-economic background, single motherhood and were underweight at birth." There was also a larger minority representation, particularly blacks. This is not an unexpected result given the long history of poor and minority populations within child protection systems throughout the western countries.

However, for those children admitted to foster care earlier and younger, the outcomes are more favourable. Non foster care outcomes, such as residential care, are less favourable. Pre-care characteristics could not full explain the differences. One vital conclusion is the quality of staff in residential group care really does seem to matter.

Some of the key findings in this research include:

• longer stays in care tended towards poorer outcomes;
• placement instability was also related to poorer outcomes;
• care systems are typically not able to offer all of the supports and roles that a family offers;
• a single, stable and caring long term placement generally leads to better outcomes and, not surprisingly, unstable placements and frequent placement changes lead to poorer outcomes;
• one-off placement, even short term, may have long term negative implications if that placement was a traumatic process for the child, if that admission was mishandled;
• older age at placement is also related to poorer outcomes;
• placement prior to age 1 did not seem to have the poorer outcomes which may challenge some of the assumptions of attachment theory according to the authors;
• Adverse events of the first year appear to be overcome-able by longer term subsequent positive events.

They also postulate that pre-placement negative events and the effects of placement may be countered by providing good support to a family such that the family environment is much improved for the child upon return. They also note that it is important to support the family changing while the child is out but also offering specific services to support the child. If, upon return home, the family life is one of continuing adversity for the child, then longer term outcomes may well continue to be poorer.

This research has real implications for clinical practice. Perhaps the most vital lessons are that the child protection system continues to be one that is most likely to serve the poor, disadvantaged and minority populations. The life circumstances of these populations are such that they are more likely to come to the attention of CPS. Society, which has the power to solve many of these complex problems seems unwilling to do so. A recent report in Canada from the National Council of Welfare presents data that tells us that a 2% increase in the goods and services tax, with proceeds targeted to poverty reduction, could provide the funds needed to eliminate poverty. It is highly improbable that this would happen. Such policy options exist but instead, we are going to see governments avoid such solutions meaning that CPS will continue to end up dealing with the implications of poverty and its related challenges.

Child protection is a clean up service, in some respects, for the problems that larger society does not wish to effectively address. Yet child protection will also face criticisms at three crucial points: when a child known to child protection dies; when a child is wrongly apprehended and when child protection remains over involved in disadvantaged populations creating an image of focusing upon them.

Reference:

Dregan, A. & Guilford, M. (2011). Foster care, residential care and public care placement patterns are associated with adult life trajectories: Population-based cohort study. Social Psychiatry and Psychiatric Epidemiology, In Press. DOI 10.1007/s00127-011-0458-5.