The Canadian Association of Social Workers is reporting that "On March 14, 2011, the Canadian Human Rights (CHR) Tribunal dismissed on a legal technicality the complaint filed in 2007 by the First Nations Child and Family Caring Society of Canada (FNCFCS) and the Assembly of First Nations, which alleged that the Federal Government is racially discriminating against First Nations children by providing less child welfare benefit on reserves."
I have written before about the high impact on Aboriginal communities of public policies in the past. These policies certainly include the decision to take thousands of children away from families and place them in residential schools. About half of those children would not survive having been subject to abuse of various kinds, malnutrition and maltreatment in the form of loss of love, caring and nurturing. The legacy was inevitable. The Aboriginal communities of Canada lost generations of family and parenting modeling. Now we have children being raised by adults who lacked the teaching needed to build healthy inter generational parenting.
Several studies have shown that the impact has been dramatic problems with children that have resulted in very high rates of Aboriginal children within the child protection systems.
The First Nations Child and Family Caring Society of Canada notes on their website, "The inequalities in First Nations child welfare funding are longstanding and well documented (Royal Commission on Aboriginal Peoples [RCAP], 1996; McDonald & Ladd, 2000; Loxley et. al., 2005; Amnesty International, 2006; Assembly of First Nations, 2007; Auditor General of Canada, 2008; Standing Committee on Public Accounts, 2009) as are the tragic consequences of First Nations children going into child welfare care due, in part, to the unavailability of equitable family support services (McDonald & Ladd, 2000; Blackstock and Trocme, 2005; Amnesty International, 2006; Clarke, 2007; Auditor General of Canada, 2008; National Council on Welfare, 2008). This inequity is further amplified for First Nations children by shortfalls in education funding, housing and publically funded voluntary sector supports (Blackstock, 2008)."
It is our nation that created the legacy and our nation should be willing to find solutions - but solutions need to be properly funded. We underfunded care of Aboriginal children in the residential schools which led to some of the problems (although the program should never have been established) and now we underfund the solution.
This is a political issue and should be raised during our present Federal election.
Thursday, March 31, 2011
Sunday, March 27, 2011
More research on foster care impacts
J.J. Doyle of MIT has again done an extensive review of whether foster care is good for children. He concludes not using a large data base and builds on earlier work that he has done. Critics of foster care may well start to salivate at these results but, before they do, it is vital to see that the results again focus on a particular part of the foster care population.
His results show:
"The results suggest that placing children in foster care increases their likelihood of becoming delinquent during adolescence and requiring emergency health care in the short term. Along this one dimension of child safety, it does not appear that foster care is serving a protective role."
This is an important caution that replicates earlier work by not only Doyle but other researchers through the Chapin Hall Center for Children at the University of Chicago. But Doyle also notes that his work applies to a particular subset of children in the child protection system:
"The results do apply to a particularly policy-relevant group: those children where the investigator does matter. These are marginal cases where investigators could disagree about how to proceed. This variation is at the heart of the policy question of whether the child-protection system is too aggressive or not aggressive enough."
From a policy perspective this is quite crucial. How to proceed with cases for which the answer may not be clearly place or clearly keep in the family. In general, his work suggests that keeping those children in the family may be better. Bear in mind that other research tells us that effective supports are a crucial element to making that work.
Doyle places one other caveat: "Further, the results apply to somewhat older children, between the ages of 5 and 15, who were investigated for abuse or neglect in Illinois during the 1990s. To the extent that other foster care systems perform better than this one, the answer could change. Future research that considers younger children, other states, and other time periods would allow an examination of whether the results apply more generally to child protection policies in the U.S."
Thus, important questions related to younger children in particular remain unanswered. It is crucial that we continue to see the degree to which these impacts are true for younger children. Research in the UK suggests that getting a stable answer for children by age 7 is vital. As children age and family patterns (along with other related environmental problems) become more entrenched, negative outcomes become more likely.
As Doyle says in the introduction to his article: There is no dispute that severely abused or neglected children should be protected, and a foster family home has been judged the best alternative whenever possible. A key policy question is one of degree: how aggressive should child protective services be? Child protection agencies trade off two competing goods: family preservation and child protection ... More aggressive child protection may reduce child abuse or neglect, but removal from parents may be traumatic to children as well. For example, much has been written about the potential for such instability to hinder child development, and multiple placements once a child has been placed in foster care has been associated with greater emotional and behavioral problems among foster children."
Doyle's article is currently in press with the Children and Youth Services Review.
His results show:
"The results suggest that placing children in foster care increases their likelihood of becoming delinquent during adolescence and requiring emergency health care in the short term. Along this one dimension of child safety, it does not appear that foster care is serving a protective role."
This is an important caution that replicates earlier work by not only Doyle but other researchers through the Chapin Hall Center for Children at the University of Chicago. But Doyle also notes that his work applies to a particular subset of children in the child protection system:
"The results do apply to a particularly policy-relevant group: those children where the investigator does matter. These are marginal cases where investigators could disagree about how to proceed. This variation is at the heart of the policy question of whether the child-protection system is too aggressive or not aggressive enough."
From a policy perspective this is quite crucial. How to proceed with cases for which the answer may not be clearly place or clearly keep in the family. In general, his work suggests that keeping those children in the family may be better. Bear in mind that other research tells us that effective supports are a crucial element to making that work.
Doyle places one other caveat: "Further, the results apply to somewhat older children, between the ages of 5 and 15, who were investigated for abuse or neglect in Illinois during the 1990s. To the extent that other foster care systems perform better than this one, the answer could change. Future research that considers younger children, other states, and other time periods would allow an examination of whether the results apply more generally to child protection policies in the U.S."
Thus, important questions related to younger children in particular remain unanswered. It is crucial that we continue to see the degree to which these impacts are true for younger children. Research in the UK suggests that getting a stable answer for children by age 7 is vital. As children age and family patterns (along with other related environmental problems) become more entrenched, negative outcomes become more likely.
As Doyle says in the introduction to his article: There is no dispute that severely abused or neglected children should be protected, and a foster family home has been judged the best alternative whenever possible. A key policy question is one of degree: how aggressive should child protective services be? Child protection agencies trade off two competing goods: family preservation and child protection ... More aggressive child protection may reduce child abuse or neglect, but removal from parents may be traumatic to children as well. For example, much has been written about the potential for such instability to hinder child development, and multiple placements once a child has been placed in foster care has been associated with greater emotional and behavioral problems among foster children."
Doyle's article is currently in press with the Children and Youth Services Review.
Thursday, March 24, 2011
The sad case of Nubia Barahona
This is a child who died in Florida despite possible ways in which the child protection system may have saved her. Like so many cases before her, this is not a case where her death should lead to over reaction by CPS resulting in over apprehension of children - it should act as a way to reconsider how well we are doing with cases that do need protection. Like so many cases before, there were many opportunities to intervene if the voices being raised had been heard:
"The red flag of caution and warning was raised many times: By teachers and principals,by a Guardian Ad Litem (GAL) and her attorney, by a nurse, by a psychologist, byNubia's "family" stonewalling the search for fundamental information.But nobody seemingly put it all together" (p.2).
The case raises a number of flags that we have seen before:
* parents who stonewalled
* parents who withdrew from systems (e.g. school in this case) where behaviors were getting noticed -- "After the end ofthe 2009-2010 school year, the Barahonas chose to home school the children,taking away most of their visibility to outside eyes and increasing the dangerthat abuse and neglect would go unrecognized. This was further compoundedby the lack of formal requirements relating to the monitoring of students being home schooled" (p.7)
* professionals who failed to bring together data that would create a more global than partial picture of what was happening. As the report states at p. 5: " failed to consider critical information presented by thechildren’s principal and school professionals about potential signs of abuseand neglect by the Barahonas."
* parents refusing services
This death review offered something different than has been seen in many prior reviews which is a comment on the parenting assessment that had been done. There was a failure to properly gain data from multiple reliable sources that would have shown the assessor a broader picture. It also would have shown contradictory information such as school progress. A poor parenting capacity assessment creates the opportunity for child protection authorities to make bad clinical risk judgments that leave children vulnerable. As they state on p. 11, "What’s needed are clearly articulated expectations for any psychologicalevaluation as well as clear criteria for reviewing the performance of anycontracted psychologist or other expert called on to evaluate children on behalfof the court." Such guidelines do exist in the professional literature as well as a variety of publications.
The authors also note that delays in assessments leave cases without appropriate consideration. Such delays may not be the fault of anyone person but rather of processes that just move slowly. If assessment is going to be effective, then it must have access to a wide range of data. This point has been made by many authors and is repeated by this review. In addition, this assessor appears to have wrongly considered that attachment in a care home should have priority over the safety of the child. This is a growing area of concern given that legal processes leave young children in alternate care for long periods creating attachment between the child and the alternate caregivers that will need to be broken if a child is to come back to family.
A further area of concern that we have again seen too often in death reviews is the failure of CPS staff to properly assess and coordinate information coming in. Fragmented data has been behind many CPS failures. As the authors state on p. 10, "A serious deficiency, however, was the failure of individuals involvedin the case to talk with each other rather than relying on inadequateinformation technology. Many of the communications problems that can beidentified in this and other cases can be overcome by prompt and coordinatedinterpersonal interaction among those involved in the care of the child."
As one says with so many of these cases, let us hope that Nubia did not die in vain.
"The red flag of caution and warning was raised many times: By teachers and principals,by a Guardian Ad Litem (GAL) and her attorney, by a nurse, by a psychologist, byNubia's "family" stonewalling the search for fundamental information.But nobody seemingly put it all together" (p.2).
The case raises a number of flags that we have seen before:
* parents who stonewalled
* parents who withdrew from systems (e.g. school in this case) where behaviors were getting noticed -- "After the end ofthe 2009-2010 school year, the Barahonas chose to home school the children,taking away most of their visibility to outside eyes and increasing the dangerthat abuse and neglect would go unrecognized. This was further compoundedby the lack of formal requirements relating to the monitoring of students being home schooled" (p.7)
* professionals who failed to bring together data that would create a more global than partial picture of what was happening. As the report states at p. 5: " failed to consider critical information presented by thechildren’s principal and school professionals about potential signs of abuseand neglect by the Barahonas."
* parents refusing services
This death review offered something different than has been seen in many prior reviews which is a comment on the parenting assessment that had been done. There was a failure to properly gain data from multiple reliable sources that would have shown the assessor a broader picture. It also would have shown contradictory information such as school progress. A poor parenting capacity assessment creates the opportunity for child protection authorities to make bad clinical risk judgments that leave children vulnerable. As they state on p. 11, "What’s needed are clearly articulated expectations for any psychologicalevaluation as well as clear criteria for reviewing the performance of anycontracted psychologist or other expert called on to evaluate children on behalfof the court." Such guidelines do exist in the professional literature as well as a variety of publications.
The authors also note that delays in assessments leave cases without appropriate consideration. Such delays may not be the fault of anyone person but rather of processes that just move slowly. If assessment is going to be effective, then it must have access to a wide range of data. This point has been made by many authors and is repeated by this review. In addition, this assessor appears to have wrongly considered that attachment in a care home should have priority over the safety of the child. This is a growing area of concern given that legal processes leave young children in alternate care for long periods creating attachment between the child and the alternate caregivers that will need to be broken if a child is to come back to family.
A further area of concern that we have again seen too often in death reviews is the failure of CPS staff to properly assess and coordinate information coming in. Fragmented data has been behind many CPS failures. As the authors state on p. 10, "A serious deficiency, however, was the failure of individuals involvedin the case to talk with each other rather than relying on inadequateinformation technology. Many of the communications problems that can beidentified in this and other cases can be overcome by prompt and coordinatedinterpersonal interaction among those involved in the care of the child."
As one says with so many of these cases, let us hope that Nubia did not die in vain.
Saturday, March 12, 2011
Willful Blindness in Child Protection
I have spoken about Heffernan's recent book on willful blindness in a prior post. Its a rather amazing read and I again recommend it. The book raises a number of issues that are quite relevant to child protection work. Here are a few of the themes:
1. Belonging in the group - It is hard to dissent in a group. Her report of a broad range of research in a number of fields of endeavor shows that, even when an individual knew that the decision was likely wrong. The notion that a professional group might be stronger as a result of collective wisdom may well not be true. It appears that, within a corporate team, dissent is difficult to do and often not welcome. There is a strong need for affiliation in human beings. To dissent is to step outside that and create the risk of being ostracized. We do not do well in such a position.
2. Using case plans that don't work - Case planning in many child protection agencies is done under the heavy burden of high caseloads, high turnovers and a favored way of doing things. There is a "corporate" culture about "how" things are done. Unfortunately, this can also lead to interventions that are familiar but for which there is little evidence of effectiveness. For example, there is a great deal of in-home parenting programming for which there is scant data that suggests that any long term changes occur.
3. Failing to look at the research that tells us what does work. In the United States Senate Committee on Finance Hearings on March 10, 2011 a former Oregon foster child, Isha "Charlie" McNeely pointed out a fact that systems often ignore. Foster children, in very large numbers, will experience multiple placements meaning that home may be far less stable and nurturing than before coming into care. Thus, we may be blind to the impact of child protection decisions in which we may be doing harm in the name of protection. The practice question, of course, is whether or not we are considering that in our case planning. Does this child need to come into care, and if so, what is going to make that safe and productive.
4. Family connections matter but in child protection that can be messy so, once parental rights are terminated, it is easier to ignore them. McNeely notes that most foster children will make steps to find the biological roots either during or after aging out of foster care. So instead of being blind to that, how do we manage that? Finding ways to sustain relationships may serve many foster youth better. Child protection workers are reluctant because that can interfere with adoption planning. Even in cases where adoption will not occur, case managing difficult biological relationships is quite challenging within an overworked environment. Biological links may not mean, however, the parents who were incapable. There may be healthier people in the family system who can provide support.
5. Budget cuts mean reduced services. To be blind to that must be willful. In the media we have seen more and more reporting that as the economy has worsened, pressures on family have increased, there is growing poverty and children are in increased need of protective supports. With the right services, we can help families under these economic strains stay safe. The demand for the services is increasing while budgets in Canada, the United States and the United Kingdom are getting squeezed. A current example is a story out of Pittsburg in the United States ( http://www.pittsburghlive.com/x/pittsburghtrib/news/regional/s_726933.html
Good child protection has eyes wide open. These are but a few examples. Of course, a major challenge is to get the eyes of politicians open to the reality of their decisions.
1. Belonging in the group - It is hard to dissent in a group. Her report of a broad range of research in a number of fields of endeavor shows that, even when an individual knew that the decision was likely wrong. The notion that a professional group might be stronger as a result of collective wisdom may well not be true. It appears that, within a corporate team, dissent is difficult to do and often not welcome. There is a strong need for affiliation in human beings. To dissent is to step outside that and create the risk of being ostracized. We do not do well in such a position.
2. Using case plans that don't work - Case planning in many child protection agencies is done under the heavy burden of high caseloads, high turnovers and a favored way of doing things. There is a "corporate" culture about "how" things are done. Unfortunately, this can also lead to interventions that are familiar but for which there is little evidence of effectiveness. For example, there is a great deal of in-home parenting programming for which there is scant data that suggests that any long term changes occur.
3. Failing to look at the research that tells us what does work. In the United States Senate Committee on Finance Hearings on March 10, 2011 a former Oregon foster child, Isha "Charlie" McNeely pointed out a fact that systems often ignore. Foster children, in very large numbers, will experience multiple placements meaning that home may be far less stable and nurturing than before coming into care. Thus, we may be blind to the impact of child protection decisions in which we may be doing harm in the name of protection. The practice question, of course, is whether or not we are considering that in our case planning. Does this child need to come into care, and if so, what is going to make that safe and productive.
4. Family connections matter but in child protection that can be messy so, once parental rights are terminated, it is easier to ignore them. McNeely notes that most foster children will make steps to find the biological roots either during or after aging out of foster care. So instead of being blind to that, how do we manage that? Finding ways to sustain relationships may serve many foster youth better. Child protection workers are reluctant because that can interfere with adoption planning. Even in cases where adoption will not occur, case managing difficult biological relationships is quite challenging within an overworked environment. Biological links may not mean, however, the parents who were incapable. There may be healthier people in the family system who can provide support.
5. Budget cuts mean reduced services. To be blind to that must be willful. In the media we have seen more and more reporting that as the economy has worsened, pressures on family have increased, there is growing poverty and children are in increased need of protective supports. With the right services, we can help families under these economic strains stay safe. The demand for the services is increasing while budgets in Canada, the United States and the United Kingdom are getting squeezed. A current example is a story out of Pittsburg in the United States ( http://www.pittsburghlive.com/x/pittsburghtrib/news/regional/s_726933.html
Good child protection has eyes wide open. These are but a few examples. Of course, a major challenge is to get the eyes of politicians open to the reality of their decisions.
Sunday, February 20, 2011
Willful Blindness
Margaret Heffernen's book Willful Blindness was published this past week. In it, there are lesson for those who work in and around child protection. Indeed, there are lessons for any of us who work in the mental health fields, criminal justice, business, physical health and just being in a relationship.
As I read her book, I was deeply reminded of the death of Logan Marr just over 10 years ago - a needless death in which I suspect that, like many other child protection deaths, the workers were suffering from a form of Willful Blindness. This happens when a child protection team forms a view on a case which is then becomes the common view of the team. It is hard to stand up with a different and perhaps unpopular view suggesting that the common view may be wrong. In Logan Marr, there appeared to be a view that her mother was not capable and that the former child welfare worker who was now the foster mother was. This would be tragically wrong. You can see the fixed view in the e-mails sent from the case manager that are reported in the Frontline story on the case.
You can see Willful Blindness in the Victoria Climbe case as well. Here, the common view that developed was that this was a housing case and one where the aunt needed to go back to France. This caused various people to be blind to what was quite observable if they were willing to look.
One wonders if Willful Blindness might also have been an issue in the Jeffrey Baldwin case where a decision seems to have been made that the grandmother who would starve Jeffrey to death was a better caregiver than the parents and that was the end of it.
It is difficult to decide to look beyond the commonly held belief. It can result in a worker being seen as a troublemaker who dissents - not a team player. It can disrupt already accepted case plans. It can result in more work. It can buck the view of management and affect promotions and careers. The less powerful a person might be within a hierarchy or the more that an individual has to lose by dissenting, the easier that Willful Blindness really can be.
Willful Blindness also allows us to develop our own view and then go onto believe that what we have decided is right! Why then question our own decisions; our own capacity to analyze a case and draw appropriate case plans from that analysis?
In essence, we need to cure the blindness to recognize that we never have all the data. With that, we can then give ourselves permission to re-consider. But going up against the established view of the team or the agency - that can be very difficult indeed.
As I read her book, I was deeply reminded of the death of Logan Marr just over 10 years ago - a needless death in which I suspect that, like many other child protection deaths, the workers were suffering from a form of Willful Blindness. This happens when a child protection team forms a view on a case which is then becomes the common view of the team. It is hard to stand up with a different and perhaps unpopular view suggesting that the common view may be wrong. In Logan Marr, there appeared to be a view that her mother was not capable and that the former child welfare worker who was now the foster mother was. This would be tragically wrong. You can see the fixed view in the e-mails sent from the case manager that are reported in the Frontline story on the case.
You can see Willful Blindness in the Victoria Climbe case as well. Here, the common view that developed was that this was a housing case and one where the aunt needed to go back to France. This caused various people to be blind to what was quite observable if they were willing to look.
One wonders if Willful Blindness might also have been an issue in the Jeffrey Baldwin case where a decision seems to have been made that the grandmother who would starve Jeffrey to death was a better caregiver than the parents and that was the end of it.
It is difficult to decide to look beyond the commonly held belief. It can result in a worker being seen as a troublemaker who dissents - not a team player. It can disrupt already accepted case plans. It can result in more work. It can buck the view of management and affect promotions and careers. The less powerful a person might be within a hierarchy or the more that an individual has to lose by dissenting, the easier that Willful Blindness really can be.
Willful Blindness also allows us to develop our own view and then go onto believe that what we have decided is right! Why then question our own decisions; our own capacity to analyze a case and draw appropriate case plans from that analysis?
In essence, we need to cure the blindness to recognize that we never have all the data. With that, we can then give ourselves permission to re-consider. But going up against the established view of the team or the agency - that can be very difficult indeed.
Tuesday, February 15, 2011
Interesting USA Data on foster care usage
Childtrends databank has provided some new American data on foster care trends. They place the data in context helping us to see its importance. It also helps us to see that this is largely a troubled population. There is a foster care narrative that all foster care is bad and that kinship care is better. Let's look first at the American data:
"Because of their history, children in foster care are more likely than other children to exhibit high levels of behavioral and emotional problems. They are also more likely to be suspended or expelled from school and to exhibit low levels of school engagement and involvement with extracurricular activities. Children in foster care are also more likely to have received mental health services in the past year, to have a limiting physical, learning, or mental health condition, or to be in poor or fair health.1 One study found that almost 60 percent of young children (ages 2 months to two years) in foster care were at a high risk for a developmental delay or neurological impairment.2
Youth who “age out” of foster care instead of returning home may face challenges to making a successful transition to adulthood. According to the only national study of youth aging out of foster care, 38 percent had emotional problems, 50 percent had used illegal drugs, and 25 percent were involved with the legal system. Preparation for further education and career was also a problem for these young people. Only 48 percent of foster youth who had “aged out” of the system had graduated from high school at the time of discharge, and only 54 percent had graduated from high school two to four years after discharge. As adults, children who spent long periods of time in multiple foster care homes were more likely than other children to encounter problems such as unemployment, homelessness, and incarceration, as well as to experience early pregnancy.3,4"
The report adds:
"In 2009, nearly half (48 percent) of all foster children lived in homes of non-relatives. Nearly a quarter (24 percent) lived in foster homes with relatives—often known as “kinship care.” Sixteen percent of foster children lived in group homes or institutions, four percent lived in pre-adoptive families, and the rest lived in other types of facilities (based on preliminary estimates)."
A study published this past week, shows that there are pluses and minuses to being in foster care and also in kinship care. It also highlights the needs to better support kinship care. To do this may increase the benefits of kinship care and decrease the negative outcomes of children who cannot live in their biological parental homes. ScienceDaily on February 7, 2011 summed up the research:
"Children placed with a relative after being removed from their home for maltreatment have fewer behavioral and social skills problems than children in foster care, but may have a higher risk for substance use and pregnancy as teenagers, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. These relatives -- known as kinship caregivers -- appear more likely to be single, unemployed, older, and live in poorer households, yet receive fewer support services than do foster caregivers....
Kinship caregivers were more likely than foster parents to have a low socioeconomic status -- they were four times more likely not to have graduated high school and three times more likely to have an annual household income of less than $20,000. However, they were less than half as likely as foster parents to receive any form of financial support, about four times less likely to receive any form of parent training and seven times less likely to have peer support groups or respite care.
At the three-year follow-up, children in kinship care were more likely to be with a permanent caregiver than were children in foster care (71 percent vs. 56.4 percent). They also had 0.6 times the risk of behavioral and social skills problems and half the risk of using outpatient mental health services or taking psychotropic medications. However, adolescents in kinship care had seven times the risk of pregnancy (12.6 percent vs. 1.9 percent) and twice the risk of substance abuse (34.6 percent vs. 16.9 percent).
"Our findings indicate that kinship caregivers need greater support services," the authors write. "The findings also indicate that kinship care may be associated with a reduced risk of ongoing behavioral and social skills problems and decreased use of mental health therapy and psychotropic medications. Conversely, adolescents in kinship care have higher odds of reported substance use and pregnancy. These findings suggest that increased supervision and monitoring of the kinship environment and increased caregiver support services are urgently needed to improve outcomes of children in kinship care."
The value of kinship care for children is significant. It allows them to sustain connection with family ensuring a greater sense of belonging. There appears to be lower risks for multiple placements as well allowing for greater stability in neighborhood, school and peer connections. By supporting these families, you can create the greater stability and perhaps also offset some of the economic issues. Clearly some of the negative outcomes require addressing if we are to truly make kinship care an overall better choice. Of course, not all kinship opportunities are better when the original problems that brought child protection in are systemic to the larger family system but that is certainly not always the case.
Note: the foster care data can be found at http://www.childtrendsdatabank.org/?q=node/199
"Because of their history, children in foster care are more likely than other children to exhibit high levels of behavioral and emotional problems. They are also more likely to be suspended or expelled from school and to exhibit low levels of school engagement and involvement with extracurricular activities. Children in foster care are also more likely to have received mental health services in the past year, to have a limiting physical, learning, or mental health condition, or to be in poor or fair health.1 One study found that almost 60 percent of young children (ages 2 months to two years) in foster care were at a high risk for a developmental delay or neurological impairment.2
Youth who “age out” of foster care instead of returning home may face challenges to making a successful transition to adulthood. According to the only national study of youth aging out of foster care, 38 percent had emotional problems, 50 percent had used illegal drugs, and 25 percent were involved with the legal system. Preparation for further education and career was also a problem for these young people. Only 48 percent of foster youth who had “aged out” of the system had graduated from high school at the time of discharge, and only 54 percent had graduated from high school two to four years after discharge. As adults, children who spent long periods of time in multiple foster care homes were more likely than other children to encounter problems such as unemployment, homelessness, and incarceration, as well as to experience early pregnancy.3,4"
The report adds:
"In 2009, nearly half (48 percent) of all foster children lived in homes of non-relatives. Nearly a quarter (24 percent) lived in foster homes with relatives—often known as “kinship care.” Sixteen percent of foster children lived in group homes or institutions, four percent lived in pre-adoptive families, and the rest lived in other types of facilities (based on preliminary estimates)."
A study published this past week, shows that there are pluses and minuses to being in foster care and also in kinship care. It also highlights the needs to better support kinship care. To do this may increase the benefits of kinship care and decrease the negative outcomes of children who cannot live in their biological parental homes. ScienceDaily on February 7, 2011 summed up the research:
"Children placed with a relative after being removed from their home for maltreatment have fewer behavioral and social skills problems than children in foster care, but may have a higher risk for substance use and pregnancy as teenagers, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. These relatives -- known as kinship caregivers -- appear more likely to be single, unemployed, older, and live in poorer households, yet receive fewer support services than do foster caregivers....
Kinship caregivers were more likely than foster parents to have a low socioeconomic status -- they were four times more likely not to have graduated high school and three times more likely to have an annual household income of less than $20,000. However, they were less than half as likely as foster parents to receive any form of financial support, about four times less likely to receive any form of parent training and seven times less likely to have peer support groups or respite care.
At the three-year follow-up, children in kinship care were more likely to be with a permanent caregiver than were children in foster care (71 percent vs. 56.4 percent). They also had 0.6 times the risk of behavioral and social skills problems and half the risk of using outpatient mental health services or taking psychotropic medications. However, adolescents in kinship care had seven times the risk of pregnancy (12.6 percent vs. 1.9 percent) and twice the risk of substance abuse (34.6 percent vs. 16.9 percent).
"Our findings indicate that kinship caregivers need greater support services," the authors write. "The findings also indicate that kinship care may be associated with a reduced risk of ongoing behavioral and social skills problems and decreased use of mental health therapy and psychotropic medications. Conversely, adolescents in kinship care have higher odds of reported substance use and pregnancy. These findings suggest that increased supervision and monitoring of the kinship environment and increased caregiver support services are urgently needed to improve outcomes of children in kinship care."
The value of kinship care for children is significant. It allows them to sustain connection with family ensuring a greater sense of belonging. There appears to be lower risks for multiple placements as well allowing for greater stability in neighborhood, school and peer connections. By supporting these families, you can create the greater stability and perhaps also offset some of the economic issues. Clearly some of the negative outcomes require addressing if we are to truly make kinship care an overall better choice. Of course, not all kinship opportunities are better when the original problems that brought child protection in are systemic to the larger family system but that is certainly not always the case.
Note: the foster care data can be found at http://www.childtrendsdatabank.org/?q=node/199
Thursday, February 10, 2011
Mental Disorders in Children
When we talk about child protection issues, we see that there are high frequencies of mental disorders in children within that population. It is helpful to see the average rates of disorders in children as that gives us a base of comparison. In the USA, the National Institute of Mental Health has published data that helps us to see the "average" rate of mental health issues within the general population of children.
Describing this data, they state:
The Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) includes prevalence data for children ages 8 to 15; a slightly younger age range than the data from the NCS-A chart above. These data show that approximately 13 percent of children ages 8 to 15 had a diagnosable mental disorder within the previous year. The most common disorder among this age group is attention-deficit/hyperactivity disorder (ADHD), which affects 8.5 percent of this population. This is followed by mood disorders broadly at 3.7 percent, and major depressive disorder specifically at 2.7 percent.
Describing this data, they state:
The Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) includes prevalence data for children ages 8 to 15; a slightly younger age range than the data from the NCS-A chart above. These data show that approximately 13 percent of children ages 8 to 15 had a diagnosable mental disorder within the previous year. The most common disorder among this age group is attention-deficit/hyperactivity disorder (ADHD), which affects 8.5 percent of this population. This is followed by mood disorders broadly at 3.7 percent, and major depressive disorder specifically at 2.7 percent.
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