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  1. 1. Research findings<br />BEST PRACTICES: Out-Of-Home Foster Care Placements<br />
  2. 2. A summary of out-of-home foster care placement information and a presentation of the risks of out-of-home foster care placements.<br />Background Information<br />
  3. 3. Out-of-Home Foster Care Placements<br /><ul><li>A brief overview of the facts including causes and participants</li></ul>Out-of-home placements refer to any living situation for a child removed from the legal home (biological or adoptive family) and include primarily foster homes and group homes, both public and private<br />Children are removed, generally by Child Protective Services, from homes with abuse or neglect, unsafe conditions or other risk factors <br />
  4. 4. Group Homes <br />Foster Homes<br />Similar to a hospital or boarding school in that full time skilled care is provided continually on rotating shifts<br />School is often provided onsite<br />Counseling and therapeutic services are provided onsite<br />Considered to be a more restrictive environment<br />Designed for children with complex needs or those not functioning well in traditional foster homes<br />Often used for hard-to-place and older children especially those who have experienced prior multiple placements<br />Segregates children by gender, age and type of disability, often separating sibling groups<br />Residential home with a family trained in foster care<br />Children attend neighborhood schools alongside their peers<br />Counseling and therapeutic services are provided in home when needed and when available, some services may be provided at school<br />Considered to be a less restrictive environment<br />Designed for children in care who do not present a danger to themselves or others <br />Can function as respite care, emergency care, short and long term care, as well as pre-adoptive homes<br />Can often accommodate sibling groups<br />Can also include kinship placements<br />Types of Out-Of-Home Care<br />
  5. 5. Problems In Out-Of-Home Placements<br />Separation of sibling groups leading to decreased contact with siblings resulting in deteriorated relationships<br />Instability in placements resulting in multiple movements leading to increased behavioral and psychiatric problems<br />Inconsistency of access to services: psychiatric, medical, academic, and others impairing quality of care<br />Decreased contact with stability forces including positive biological family relationships as well as contacts with clergy, teachers, and mentors<br />
  6. 6. A compilation of best practice recommendations collected from research projects reported from 2004-2009 in the united states, WITH SUPPLEMENTARY INFORMATION FROM OTHER SOURCES INCLUDING GOVERNMENT STATISTICS AND REPORTS<br />Best Practices in Out-Of-Home Foster Care Placements<br />
  7. 7. Best Practices Background Information<br />Foster care as an institution of social welfare has only been used in the United States since the mid twentieth century and as a result, there are few longitudinal studies on its effectiveness. <br />There is little documentation on best practices in out-of-home care other than that which is mandated through such legislation as the Adoption Assistance and Child Welfare Act of 1980 and the Adoption and Safe Families Act of 1997. <br />Professional research has revealed interesting trends and correlations between successful out-of-home placements and certain present factors, which can be viewed as potential best practices if duplicated in other situations<br />
  8. 8. Best Practices Overview<br />Pre-screen foster home availability for suitability matches with placement children<br />Provide consistency of quality medical, dental, psychiatric, academic and early intervention services <br />Recruit and match mentor figures to incoming placements<br />Reduce turnover in social services staffing<br />Minimize multiple placements or movements<br />Increased involvement in case planning by child, biological family, foster family and social services members<br />Decrease time in out-of-home placement<br />Encourage and support attachment bonding<br />Consider biological family bonds as well as foster family bonds when arranging permanency placements with special note given to child age and time of placement ratios<br />
  9. 9. Pre-screen foster home availability for suitability matches with placement children<br />Currently, legislation requires a pre-screening of potential foster homes in regards to criminal history, in such that anyone with a felony conviction for certain crimes cannot be approved as a foster caregiver, as designated in the Adoption and Safe Families Act of 1997.<br />Each state typically has a requirement list for background checks, including criminal backgrounds (non-felony), driving records, verification of home and fire safety, expectations of completion of state-provided training including CPR/1st Aid, and proof of insurance. <br />Independent agencies may also require additional factors to be present.<br />
  10. 10. Pre-screen foster home availability for suitability matches with placement children(continued)<br />Research shows that matching foster children to homes similar in cultural practices, native language, socioeconomic status and personality results in better transitions. <br />When possible, keep children in the same community: same school, same church/place of worship, and same support network to help children maintain early connections for stability and attachment<br />
  11. 11. SUGGESTED APPLICATION OF BEST PRACTICE: Pre-screening and Matching<br />Use basic demographics information such as home address and school district assignment, as well as racial, cultural and religious background information to connect waiting foster homes with new admittance cases into foster care<br />Use proven standardized testing such as the CASI-FC to help identify “foster children from birth to age 19 who are at risk for more than two placements within 12 months, consistent with federal outcomes and accountability standards” (The Child & Adolescent Screening Inventory 2010) and then implement support strategies to offset risks<br />Conduct pre-placement interviews between the child entering foster care and the potential foster family to insure basic compatibility, and have an alternate family prepared if the first placement is not suitable<br />
  12. 12. Provide consistency of quality medical, dental, psychiatric, academic and early intervention services <br />Current legislation varies from state to state and there are no federal regulations designating the specific method of record keeping, however, the Fostering Connections To Success and Increasing Adoptions Act of 2008 does require “coordination of health care services, including mental health and dental services” and “include a plan for ensuring the educational stability” for children in care<br />
  13. 13. Provide consistency of quality medical, dental, psychiatric, academic and early intervention services (continued)<br />Research proves that children in foster care are less likely to receive necessary medical care and are more likely to suffer educational setbacks<br />Continuity of care in these five key areas encourages progress during the out-of-home placement and can contribute to the confidence and positive development of the child in care<br />Failure to care for these five key areas can result in children who display problem behaviors due to low self-esteem, insecurity, physical or psychological pain, or as the result of bullying from peers because of deficiencies in these areas. These types of problems are often linked to placement failures and numerous successive placements or graduated care needs to more restrictive environments.<br />
  14. 14. SUGGESTED APPLICATION OF BEST PRACTICE:Continuity of Medical/Dental/Academic/Psychological Care<br />Centralize and computerize records to link the child’s practitioner notes with the foster care file, and maintain an online data entry system for foster caregivers to give real-time updates on children in care, with automatic email updates sent to social workers and case coordinators, to reduce backlog time in filing systems and approval systems as well as prevent lost paperwork<br />Require immediate reviews of all children entering care or changing placements by a case coordinator who then arranges with the foster family for changes in all required services including medical and therapeutic<br />Conduct entrance examinations to identify urgent needs, including a psychological assessment for behavioral or academic needs as well as dental and medical needs<br />
  15. 15. Recruit and match mentor figures to incoming placements<br />Currently, very few public or private agencies have established mentoring programs for children entering out-of-home care<br />Programs using mentor relationships reflect a lower turnover of both foster care staff and movements for children in care<br />Users of mentor programs report difficulty in recruitment of suitable mentors, however, groups like Youth Villages have developed working models for recruitment using outreach programs with local corporations<br />
  16. 16. Recruit and match mentor figures to incoming placements(continued)<br />Mentoring is very effective, especially amongst African-American teens in care<br />Mentoring allows the child in care to have a neutral contact (someone not involved in the foster care process like a therapist, social worker, foster parent, biological parent, guardian ad litem) with an objective perspective who can offer advice on success in school, work and normal relationships, giving the child in care an opportunity to focus on things within his/her power to control such as ethics, effort and attitude <br />
  17. 17. SUGGESTED APPLICATION OF BEST PRACTICE:Identify & Match Mentors to Children in Care<br />Arrange cooperative relationships with mentor groups such as Big Brothers Big Sisters or civic groups for ongoing tandem programs linking incoming placements or existing high risk placements with suitable mentors<br />Survey community support such as fellow church members of the child or biological family, neighbors or other non-relative family members with an existing relationship with the child for interest in mentoring the child through the out-of-home placement period<br />
  18. 18. Reduce turnover in social services staffing<br />Turnover rates for public and private agencies are often high due to burgeoning caseloads, inadequate internal support, and unrealistic expectations. Burnout is commonly reported by social workers who seek to leave due to the frustration of seeing the children in their caseload not find permanency or after children are returned to biological homes then returned to subsequent substitute care situations<br />The effects of social worker turnover affect the children in care directly- it often means a lapse in supervision, failure to communicate needs and circumstances to the new worker, and often leaves the child with another broken attachment to a care provider<br />
  19. 19. Reduce turnover in social services staffing(continued)<br />However, children who maintain a continuous connection to a social worker often report lower levels of anxiety and display fewer emotional and behavioral issues in school and at home<br />Foster parents report a higher sense of satisfaction when they have an ongoing relationship with a social worker they feel is interested and invested in their circumstance and the children in their care, improving the overall attitude in the foster home<br />
  20. 20. SUGGESTED APPLICATION OF BEST PRACTICE: Reduce Social Work Staff Turnover<br />Hire sufficient staff to avoid caseworker overload<br />Implement support programs to help workers with paperwork requirements, visit supervision and other routine tasks<br />Accommodate flexibility in scheduling so that home visits, court dates and traveling time are worked around other time requirements<br />Monitor employees and respond to feedback regarding potential changes to help improve the workplace<br />Observe staff for signs of pending burnout and offer intervention if noted<br />Focus on team building and emotional support especially through difficult cases<br />
  21. 21. Minimize multiple placements or movements<br />Children in foster care for longer than 12 months typically experience more than one placement. As the time in care increases, statistically so do the number of placements. Every disrupted placement equates to disrupted attachment in the emotional development of the child, which is tied to increasing levels of behavioral and emotional dysfunction.<br />Children with special needs, children with sibling groups, children under the age of 5 and children over the age of 13, especially boys, are the most likely to be moved due to circumstances related to the child’s needs rather than the retirement or relocation of the foster parents<br />
  22. 22. Minimize multiple placements or movements(continued)<br />Some placement changes cannot be avoided, such as in the death of a foster care provider or when a provider is transferred out-of-jurisdiction due to a spouse’s employment. <br />Use of contracts to ensure foster home stability can be effective, as can pre-screening foster home candidates for potential longevity<br />Providing wrap-around in-home services can assist foster homes in caring for children with high ranges of issues. <br />Establishing respite plans are also effective in minimizing placement abruptions<br />
  23. 23. SUGGESTED BEST PRACTICE APPLICATION:Minimize Multiple Placements<br />Identify children at risk for multiple placement through earlier screening tests and implement support practices to help alleviate concerns<br />Match the child’s behavior, personality and needs with a family suitably trained and prepared for them<br />Contract with foster families and agencies providing financial incentives for remaining with the assigned client through the entire placement period<br />Involve the foster family in the child’s treatments, welcoming their input and taking their concerns seriously<br />Give immediate response to the foster family’s concerns and needs in regards to the child’s behavior<br />Be sensitive to the foster family’s time, resources and personal needs<br />Provide respite services with easy-to-use guidelines and encourage its use especially with problematic cases<br />
  24. 24. Increased involvement in case planning by child, biological family, foster family and social services members<br />Current legislation (ASFA 1997) “*Requires Notice of Court Reviews and Opportunity to be Heard to Foster Parents, Preadoptive Parents and Relatives,” meaning that the adults involved in the case have the right to be present for all hearings. <br />Many states allow for children over the age of 14 to not only testify on their own behalf but also to be present in the planning meetings, hearings and trials. Children under age 14 often have their desires heard through representation from a Guardian Ad Litem or through letters, pictures or drawings.<br />A lack of participation by the child often leaves the child feeling detached and/or victimized by the system, leading to additional behavioral problems and in the case of older teens, often motivates runaway situations<br />
  25. 25. Increased involvement in case planning by child, biological family, foster family and social services members(continued)<br />The benefits of full involvement by the members of the case include allowing the child to have input on their future, giving ownership and empowerment to that child client, a key principle of social work<br />Encouraging participation from all members of the foster and biological families as well as the support staff allows the team to better decide what is needed to reach permanency for the case<br />
  26. 26. SUGGESTED APPLICATION OF BEST PRACTICE:Full Team and Child Involvement in Planning<br />Notify the entire team in writing 10 days prior to scheduled events, earlier if notice is available<br />Attempt to schedule meetings during a time conducive to full attendance (after school for children, after work in the early evenings for foster and biological families)<br />When the full team is not available to attend, solicit involvement through email or other communication, which can be presented at the meeting<br />Allow the child in care to have input over what decisions are made. Even if the child does not get what is asked for (such as a return to an unsafe home), the opportunity to speak and defend his or her request builds empowerment<br />
  27. 27. Decrease time in out-of-home placement<br />It is important to note that “out-of-home” placement refers to the time in foster care, not time out of the biological home. Placement in an adoptive home is not considered “out-of-home”<br />The goals of the majority of the legislation on foster care and adoption passed over the previous four decades include expediency in reaching permanence. <br />Specifically, the ASFA of 1997 mandates that after 15 of 22 prior months in foster care, the state must file for termination of parental rights if reunification has not occurred. <br />Concurrent planning is also required by several pieces of recent legislation, in an effort to decrease foster placement time<br />
  28. 28. Decrease time in out-of-home placement(continued)<br />Shorter stays in foster care allow the child to remain focused on either reunifying with the biological family (continuing existing attachment) or to begin transitioning to attachment to the potential adoptive family, whereas longer stays in out-of-home situations cause bonded attachments to the foster parents that can cause emotional setbacks if disruption occurs<br />Shorter times in out-of-home placements also reduce the risks of multiple placements and disruptions<br />
  29. 29. SUGGESTED APPLICATION OF BEST PRACTICE: Reduce Time Spent in Out-Of-Home Care<br />Follow federal laws governing 15/22 month rule and concurrent planning<br />Solicit involvement from potential adoptive families including relative placements and encourage contact once the 15 month timeframe has passed<br />Fully involve the biological family in the reunification process simultaneously with the concurrent planning, giving them full support and access to services than can facilitate a prompt reunification<br />Complete all court-required paperwork efficiently and promptly to avoid unnecessary delays in the court process<br />Keep attorneys, families, team members and child informed of the status of the case on a regular basis so to avoid unnecessary rescheduling of hearings<br />
  30. 30. Encourage and support attachment bonding<br />Attachment cycles are a relatively new aspect to consider in terms of psychological and behavioral issues, although psychology leaders such as Erik Erikson have studied the concept for years<br />In many situations for child removal by CPS, there exists poor attachment models: Insecure attachment, where the child is rejected by a caretaker, Resistant attachment, where the child’s needs are met inconsistently, and Disorganized attachment, which occurs in abuse situations as well as any situation in which the child fears the caretaker<br />Poor attachment patterns are tied to a multitude of disruptive behaviors and psychological disorders and are often a strong indicator of future problems with social and relationship circumstances<br />
  31. 31. Encourage and support attachment bonding(continued)<br />Research shows that children with healthy attachments to their biological families continue with positive strides even when removed into out-of-home care<br />Children with secure attachment fare better during trials and challenges in life because they have a support in place. Because their needs were met consistently in early childhood, they do not view the world distrustfully.<br />Many foster children display behaviors that discourage healthy attachment, such as violence, rejection and withdrawal. Foster parents need special training to help overcome these issues, as do the biological family in regards to reunification<br />
  32. 32. SUGGESTED APPLICATION OF BEST PRACTICE:Encouraging healthy attachments<br />Provide foster parents with quality and in-depth training in attachment cycles, both the psychological aspect as well as suggested methods of building attachment so that they have a full understanding of its importance<br />Provide foster parents, upon placement of a child, with an overview of the age-appropriate milestones of the child as well as the actual developmental level of the child, so that they do not have unrealistic expectations<br />Train foster parents of older children in how to encourage healthy attachment after infancy and how to address signs of insecure, disorganized and resistant attachment<br />In biological families, develop and implement a basic psychological parenting class that focuses not on simple skills like cooking and cleaning, but on healthy and secure attachment, positive reinforcements and relationships, presented on a 5th grade level. <br />
  33. 33. Consider biological and foster family bonds when arranging permanency placements with special note given to child age and time of placement ratios<br />Current standards guide social workers towards reunification with the biological family, assuming that the bonds of DNA supersede other ties, however, research indicates that this is not always in the best interest of the child<br />Previous case law has negated any rights the foster family may have on behalf of the child in foster care and does not take into consideration the bond the child in care may have developed with the foster family and their support network despite length of time in care and age of the child upon placement<br />
  34. 34. Consider biological and foster family bonds when arranging permanency placements with special note given to child age and time of placement ratios(continued)<br />Recent studies have shown that disrupting a secure attachment with the foster family can be as destructive as the initial removal of the child from the biological home, especially if the child is very young upon the removal and subsequent placement<br />Considering the “best interests” of the child in terms of health and security need to include an assessment of attachment and security with the foster family (or relative placement) especially if the time of placement has been greater than the recommended 18 months<br />
  35. 35. SUGGESTED APPLICATION OF BEST PRACTICE:Consider Foster and Biological Family Attachment<br />Utilize psychological screenings to determine attachment levels and types with potential permanency options, looking at the types and depth of relationships with foster or biological siblings, grandparents and parents in both the foster and biological homes<br />Minimize out-of-home placement lengths and follow ASFA requirements on requesting termination of parental rights at 15/22 months<br />Place young children entering care into concurrent planning homes- those open to adoption if reunification does not occur<br />Emphasize the importance of timely and consistent response to the parenting plan when working with the biological family<br />Present the “health” aspect of the court’s plan as including the mental and emotional health as well as the physical health<br />When reunification is warranted, but the child in care presents a secure attachment to the foster family, encourage ongoing contact and support between the foster and biological family to smooth the transition for the child<br />
  36. 36. Expectations of risk reduction through use of successful experienced based practice findings<br />Effects of Best Practice Implementation<br />
  37. 37. Best Practice Results <br />Standard Practice Results<br />Attached children with healthy emotional connections able to weather trials using healthy relationship-based coping mechanisms<br />Better results when reunified or fewer movements while in placement<br />Insecurely attached children who resort to unhealthy behaviors when faced with challenges<br />Increased movements while in care or multiple returns to foster care from the biological home post-reunification<br />Comparison of Practice Results<br />
  38. 38. Best Practice Results <br />Standard Practice Results<br />Can assist in the establishment of a healthy attachment pattern, decreasing the probability of negative mental and emotional effects including psychiatric disorders <br />Are linked to better transitions out of foster care into mainstream adult society, including lowered rates of adult homelessness and incarceration<br />Often result in increased presence of psychiatric disorders such as ADHD, Bipolar Disorder, RAD, and ODD due to the disrupted attachment cycle. <br />Are tied to post-care mainstream lifestyles involving risky behaviors including drug and alcohol abuse, prostitution, homelessness and criminal activity.<br />Comparison of Practice Results (cont)<br />
  39. 39. Conclusion<br />Using the best practices in foster care can help prevent unnecessary trauma related to attachment to the child in care by encouraging the development of secure attachments in substitute care. <br />Secure attachment is the foundation for healthy development and an indicator of low risk for future concerning behaviors such as drug or alcohol usage, cutting, promiscuity, unprotected sexual activity, and so forth. <br />Secure attachment is linked to positive accomplishments in school, low placement movement rate, and overall life success<br />
  40. 40. Sources<br />Administration for Children and Families. (2010, October). Trends In Foster Care and Adoption- FY 2002-FY 2008. Retrieved February 8, 2010, from U.S. Department of Health and Human Services:<br />Beth Troutman, S. R. (2003, December 15). The Effects On Foster Care Placement on Young Children's Mental Health. Retrieved February 8, 2010, from University of Iowa Hospitals and Clinics, Iowa Consortium for Mental Health:<br />Chapman, B. F. (2004). Mental Health Risks to Infants and Toddlers in Foster Care. Clinical Social Work Journal , 121-140.<br />CWLA. (2010). Health Care Services for Children in Out-of-Home Care: Facts and Figures. Retrieved March 6, 2010, from Child Welfare League of America:<br />CWLA. (2010). Summary of the Adoption and Safe Families Act of 1997. Retrieved March 7, 2010, from Child Welfare League of America, Inc.:<br />David M. Rubin, E. A. (2004). Placement Stability and Mental Health Costs for Children in Foster Care. Pediatrics , 1336-1341.<br />Eggertsen, L. (2008). Primary Factors Related to Multiple Placements for Children in Out-Of-Home Care. Child Welfare Journal, Vol. 87 #6 , 71-90.<br />
  41. 41. Additional Sources<br />Hindle, D. (2007). Clinical Research: A Psychotherapeutic Assessment Model for Siblings in Care. Journal of Child Psychology Vol. 33 No. 1 , 70-93.<br />Jessica Strolin-Goltzman, S. K. (2010). Listening to the Voices of Children in Foster Care: Youths Speak Out About Child Welfare Workforce Turnover and Selection. Social Work, Vol. 55 #1 , 47-53.<br />Joseph P. Ryan, M. F. (2008). African American Males in Foster Care and the Risk of Delinquency: The Value of Social Bonds and Permanence. Child Welfare, Volume 87, #1 , 115-140.<br />Karger, H. J. (1996). Suffer the children: how government fails its most vulnerable citizens - abused and neglected kids. Washington Monthly .<br />Levine, C. C. (2007). Reducing Transfers of Children in Family Foster Care Through Onsite Mental Health Interventions. Child Welfare, Vol. 86 #5 , 134-150.<br />Makin, J. H. (2000, February). AEI Outlook Series. Retrieved March 7, 2010, from American Enterprise Institute for Public Policy Research:<br />Marylee Allen, M. B. (Winter 2004). Safety and Stability for Foster Children: The Policy Context. Princeton Journal: Children, Families and Foster Care .<br />Murray, K. O. (2008, June 28). A Brief Legislative History of the Child Welfare System. Retrieved March 7, 2010, from Pew Commission on Children in Foster Care:<br />
  42. 42. Additional Sources<br />National Coalition for Child Protection and Reform. (2009, December 16). A Child Welfare Timeline. Retrieved March 7, 2010, from National Coalition for Child Protection and Reform:<br />Psychological Assessment Systems, Inc. (2010). CASI. Retrieved February 5, 2010, from CasiSystem, Inc.:<br />Rubin, D. M. (2007). The Impact of Placement Stability on Behavioral Well-being for Children in Foster Care. Pediatrics , 336-344.<br />Sigrid James, e. a. (2006). Children in Out-Of-Home Care: Entry Into Intensive or Restrictive Mental Health and Residential Care Placements. Journal of Emotional and Behavioral Disorders Vol. 14, #4 , 196-208.<br />Sisson, J. P. (2008). Children in Foster Care: Before, During and After Psychiatric Hospitalization. Child Welfare, Vol. 87 #4 , 79-99.<br />Steinberg, S. C. (2007). Birthfamilies as Permanency Resources for Children in Long-Term Foster Care. Child Welfare, Volume 86 #1 , 29-51.<br />Stephen M. Southwick, C. A. (2007). Mentors Enhance Resilience in At-Risk Children and Adolescents. Psychoanalytic Inquiry, Vol. 26 #4 , 577-584.<br />The New York Times. (2010). Fostering By State. Retrieved March 7, 2010, from Adoption/Foster Care:<br />
  43. 43. Additional Sources<br />U.S. Department of Health and Human Services. (2009, October 9). The AFCARS Report Preliminary FY 2008 . Retrieved March 6, 2010, from Administration of Children and Families, Children's Bureau:<br />U.S. Government. (1997, November 19). Adoption and Safe Families Act of 1997 P.L. 105-89. Retrieved March 7, 2010, from Child Welfare Information Gateway:<br />U.S. Government. (2009, February). Major Federal Legislation Concerned With Child Protection, Child Welfare and Adoptions. Retrieved March 7, 2010, from Child Welfare Information Gateway:<br />University of Oregon Department of History. (2007, July 11). Fostering and Foster Care. Retrieved March 7, 2010, from The Adoption History Project:<br />Washington, K. (2007). Sibling Placement in Foster Care: A Review of the Evidence. Child and Family Social Work , 426-433.<br />Woodward, J. F. (2010). Foster Care. Retrieved February 8, 2010, from Encyclopedia of Children's Health:<br />