Growing Up in Care A Longitudinal Study of Outcomes

1

• Growing Up in Care A Longitudinal Study of
  Outcomes
• Dr Elizabeth Fernandez
• School of Social Sciences and International
  Studies
• University of New South Wales
• e.fernandez_at_unsw.edu.au
• Care Matters Transforming Lives Improving
  Outcomes
• 8th International Looking After Children
  Conference
• Keble College, Oxford, UK 7-9 July 2008

2
The impact of the care experience on childrens
wellbeing

• Children come to the foster family setting as an
  already at risk group
• In relation to children's wellbeing in care
  research has identified a range of concerns
  including
• Instability in care placements (Barber
  Delfabbro, 2003 Fernandez, 1999 Pecora,
  Williams, Kesler Herings, 2003 Ryan and Testa,
  2004)
• Inability of care systems to ensure optimal
  educational outcomes (Jackson, 2000Dobel-Ober,
  Lawrence, Berridge Sinclair, 2003 Rosenfeld
  Richman, 2003 Zetlin, Weinberg Kimm, 2003)

3
The impact of the care experience on childrens
wellbeing

• Childrens vulnerability to physical and
  emotional difficulties while in care ( Flynn,
  Ghazal, Legault, Vandermeulen Petrick, 2004
  James, Landsverk, Slymen Leslie, 2004
• Risk of losing attachments to their biological
  families (Cleaver, 2000 Kufeldt et al, 2003)
• The Looking After Children Initiative (Ward,
  1995) emphasises key dimensions of optimum care
  to be expected from out of home care such as
  health, education, emotional and behavioural
  development and family and social relationships

4
The impact of the care experience on childrens
wellbeing

• Current research points to limitations of cross
  sectional studies in capturing developmental
  sequences
• Increasing recognition of the need to give a
  central place to the voices of children in
  research and practice (Gilligan, 2002 Newman,
  2003)
• Limited research that views outcome from
  different participants in the foster care process
  (Courtney, 2000 Kelly Gilligan, 2002)

5
The Research Aims

• To document the needs and experiences of children
  in care from the perspective of their carers,
  case workers, birth parents and children
  themselves
• To explore childrens perceptions of their
  developing relationships with foster families,
  and their established relationships with their
  birth family and significant others
• To analyse the perceived adjustment and
  psychosocial functioning of children over the
  study period and document placement and
  developmental outcomes

6
Data Collection

• Interviews were carried out at 4 months after
  entry to care and at 24 month intervals
  thereafter over 8 years
• Child interviews (8 18 yrs)
• Caseworkers (of children of all ages)
• Foster/adoptive carers (of children of all ages)
• Birth parents (of children of all ages)

7
Interviews Explored

• Conceptions of fostering
• Childs placement history
• Reasons for entry to care
• Relationship with the carer and foster siblings
• Relationship with the birth family
• Schooling experience
• Physical health
• Emotional and behavioural development
• Identity and self image
• Relationship with caseworker and agency

8
Data Collection (contd)

• Measures used in the study
• Looking after children AAR subscales (completed
  by caseworkers and children)
• Achenbach CBCL (completed by carers and
  caseworkers)
• Achenbach TRF (completed by teachers)
• Hare self esteem scale (completed by children)
• Interpersonal parent and peer attachment scale
  (completed by children)
• Attachment styles questionnaire (completed by
  carers)
• Foster care alliance scale (completed by children
  and carers)
• Strengths and Difficulties Questionnaire

9
Variables Analysed

• Variables from the childrens interviews analysed
  were
• placement variables (total number of placements
  and time in care
• contact with birth family members
• cohesion with foster family members.
• Feelings and emotions
• LAC 6 Subscales and relationship skills
• Variables from the caseworkers interviews
  analysed were
• academic progress,
• health,
• overall adjustment,
• satisfaction with how the placement is going
  overall.
• number of positive life events (total, total
  attachment events, total achievement events), and
  whether there is a stable foster placement
• length of time with the current carer
• assessment of carers parenting styles

10
About the Children

• 59 children participated in the study
• Boys 52
• Girls 48
• Ages ranged from 3 to 15
• 12 years was the most frequently occurring age
• Children are from Barnardos Find-a-Family Centre,
  an integrated service of permanent family care
  and adoption for hard to place children
  requiring long-term placement. Many have
  multiple failed placements prior to their
  Find-a-Family placement.

11
Childrens Conceptions of Fostering

• What is a foster home? "Places of refuge where
  people can stay, where you get looked after.
  Would you call this home a foster home? "No,
  this is my house. (male, 11 years)
• A person who acts like your mum and dad, I
  havent got my mum and dad or my brother or the
  pets that I had before. Thats why its not the
  same. Youre in somebody elses house and its
  not your real mum and dad but its the person
  thats looking after you for the moment.
  (female, 8 years)
• Um, I think it is alright. It is not that much
  different than living with a real parent. You
  still have your real parents but you have another
  family that supports you. They help you, they do
  what your real parents come, because they cant
  for whatever reason (female, 13 years)
• No a normal kid like everyone else. Because here
  it is like a real family. Some parents dont care
  about children, thats why I came into foster
  care. (male, 12 years)

12
Childrens Conceptions of Fostering (contd)

• The good things umm. I guess the good thing is
  like feeling you are part of the family but the
  bad thing is knowing that they are not you
  family, you know (female 15 years)
• For me its good, for me I like it cause Ive
  got good parents and good friends and Im just
  lucky (female,14 years
• Sort of because they miss their mum and they
  really want to go back to her, and they wont be
  able to see her for a long, long time, so they
  act differently because of this. But once they
  settle in they get fine, and then um they just
  forget about it and start moving on. (male, 9
  years)
• I dont know. I dont really know what its like
  to be a foster adult. I dont really know what
  its like to be a normal child (male, 17 years)

13
Care History

• Total placements
• A third of the children had more than 5
  placements in total including pre Barnardos care
  history
• The median number of placements was 4 placements
  and the average was 4.3 placements
• Time in care was strongly related to number of
  placements (r0.58, p0.000)
• Half the children have been in their current
  placement for four years or more
• The majority (71) of respondents are in non
  relative foster families and a further 19 are
  adopted

14
Change of Placement and Childrens Responses

• Many of the children interviewed had multiple
  carers over time. Childrens placements ranged
  from 2 to 7 foster homes. Many children were
  aware that they would eventually find a permanent
  foster placement, even though they were not sure
  how long their present placement would last
• (SIGH) well if I am very very, extremely good I
  might stay here and this might be my forever
  family but if um, if this isnt a good place I
  will have to move, which I dont want to
  (female, 8 years)
• (Until) I'm old enough to move out into a flat
  (female, 11years)
• Hard to make friends, and hard to keep contact
  with my old friends (female, 14 years)
• I feel sad at times, leaving my friends behind
  and moving to different schools, trying to make
  new friends (male, 16 years)

15
Change of Schools

• Three quarters of the children had experienced
  at least one
• change in schooling since their separation from
  their birth family
• More than half of the children had had three or
  more changes
• Heaps, probably about 5 or 6 times. I think I
  get stupider every time I have to move
  (female,14 yrs)
• Ive been to thousands of schools...about, 5 or
  6. I don't know (male, 11years)
• When asked to evaluate how they were doing at
  school, most children attempted to assess their
  own abilities.
• can't hardly readand plus I'm year 5 going in
  year 6can't even hardly read or do neat
  writing (female, 10 years)
• Um, playing and English. I'm not so good at my
  maths (female, 11years)
• Hand writing everything. Not everything in the
  world thoughI'm good at mostly everything
  (female, 8yrs)
• I feel sad at times, leaving my friends behind
  and moving to different schools, trying to make
  new friends (male, 16 years)
• Um I was going really well in school and the
  whole time I was in the top of classes. I enjoyed
  it and wish I had finished (female, 19 years)

16
Foster Parent Cohesion

• Forty-eight per cent of respondents indicated
  they got on 'very well' both with their foster
  mother and their foster father.
• All but one respondent indicated that they got on
  with their foster mother very well or quite
  well
• Almost 9 out of 10 respondents were positive
  about their relationship with their foster
  father, rating 'very well' or 'quite well
• Just over 1 in 10 respondents indicated that they
  got on with their foster father 'not very well'
• Eighty-six per cent of respondents were positive
  about their relationship with their foster
  sibling
• However nearly 1 in 10 respondents indicated that
  they got on with their foster sibling 'not very
  well'

17
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Childrens perceptions of cohesion

• The relationships with the foster mothers
  remained very positive, especially amongst boys
  and younger children
• Children who had a stronger level of maternal
  attachment were more likely to sustain highly
  cohesive relationships within the foster families
  
• The higher the cohesion with the foster mother
  the higher the cohesion with the foster father
  (r0.37, n40, p0.021)
• Age was significantly related to cohesion with
  the foster father (r0.5, p0.01) such that older
  children were less likely to report getting on
  very well with the foster father

19
Childrens perceptions of cohesion (contd)

• The childs cohesion with other children from the
  foster family, was significantly related to the
  childs number of placements
• Children who got on very well with the children
  of the foster family had significantly fewer
  placements than children who did not get on very
  well (p 0.018)
• There were significant relationships between the
  childs self reported relationship building
  skills and cohesion with the foster mother (r
  -.69, plt0.01) and the foster father (r -.63,
  plt0.05). The more perceived skills at Interview
  1, the more cohesive the relationships at
  Interview 2.

20
Cohesion with Foster Mother Foster Father

• In general the children manage to have good
  relationships with their carers. Some
  relationships are harmonious and others seem to
  be very good
• Q. What is it like living here, with (Carer)
• She is the best mum, and she looks after me and
  she takes me to school. He is the best dad and he
  works for my family to get money, so does mum and
  they make us live more (male, 11 years)
• They cuddle me and they say that they love me,
  they take care of me all the time. They take me
  to the doctors if I look sick. They give me food
  on a plate. They give me my room, my own room.
  They take me to friends houses and drop me off
  at school and pick me up and they say that they
  love me (male, 11 years)
• Good, everything is good. I want to stay here
  until I have money to buy a house. (male, 10
  years)

21
Cohesion (cont)

• She's (carer), understanding, she's nice. She
  helps me with lots of things. Shes just a very
  kind person she's got a nice heartsometimes I
  give a hug to (carer) before I go to bedI don't
  know what's the most important thing. When I go
  shopping with her, just me and her by ourselves
  we just talk you know. I like how we have time by
  ourselves sometimes (female, 17years)
• She, umm, she'll spend lots of time on me and
  she's really nice, andshe helps me with things
  when I need help...she always has the right
  advice to tell me...cause they treat me like Im
  part of the family so I think I am (female,
  10years)

22
The Inventory of Parent and Peer Attachment
(IPPA)

• The IPPA, was administered at Interviews 2 and 3
  to assess each childs level of attachment to his
  or her current foster mother, foster father and
  friends or peers.
• There are three subscales trust, communication
  and alienation and a total attachment score
• A higher score indicates greater attachment
• T-tests were used to compare the each childs
  scores at these two interviews on the IPPA three
  subscales trust, communication and alienation
  and a total attachment score.
• The analyses indicated statistically significant
  changes in the childrens ratings for maternal
  and peer attachment but not for paternal
  attachment

23
Changes in IPPA scores from Interview 2 to
Interview 3 for all children
24
The Inventory of Parent and Peer Attachment
(IPPA) (cont)

• Children reported better maternal attachment
  trust and communication, and overall peer
  attachment.
• Indicates that the children are feeling more
  settled in their relationships with their foster
  mother and the same aged children
• No progression or deterioration in the childrens
  feelings of attachment toward their foster father
  
• Boys reported improved scores on three maternal
  attachment scores, including alienation, trust
  and the total score. They also showed and
  significantly improved scores on all the peer
  attachment scores.

25
The Inventory of Parent and Peer Attachment
(IPPA) (cont)

• Younger children had stronger maternal trust and
  better peer communication at Interview 3.
• The teenage children had improved maternal
  alienation scores, better maternal trust and
  improved total maternal attachment scores.
  Additionally older children had significantly
  better peer communication scores. There were no
  changes in paternal attachment scores.

26
The Inventory of Parent and Peer Attachment
(IPPA) Summary of Changes

• The changes were in a positive direction and not
  signalling deterioration and lend some support to
  the benefits of the childrens time in care.
• Most encouragingly the strongest changes were
  observed for boys and for older children
• Older children and boys were catching up to the
  girls and younger children on some of these
  variables

27
Relationships between IPPA subscales

• Childrens responses to the maternal and peer
  subscales are closely inter-related
• Responses to the Paternal Attachment questions,
  however were only related to each other and not
  to the other two sets of subscales
• Childrens attachment to their peers and foster
  mothers were based on similar judgements but
  children thought in a different way when
  considering their attachment to their foster
  fathers

28
Frequency of Contact

• Birth Mothers and siblings were the most
  frequently contacted family members
• One child in 5 had contact with his or her birth
  mother at least fortnightly or monthly
• Nearly three-quarters of children (72) saw their
  birth mother at least once every 3 months
• A quarter had no contact at all
• Just over half (56) of the children had no
  contact at all with their birth father
• 28 saw their father between once a month and
  every few months or holidays

29
Frequency of Contact (cont)

• Grandparents were an occasional point of contact
• 26 of children confirmed contact with their
  maternal aunt
• 4 children in 10 had ongoing contact with their
  previous carers
• Nine in ten (90) respondents report that since
  the last interview they have had some contact
  with their siblings who are not living with them.
  One in four had contact either monthly or
  fortnightly with them

30
Childrens desired contact with their birth family
31
Childrens Contact with Birth Parents they say
that she's not a proper Mum. (male, 11yrs)

• Children throughout the interviews seem very
  connected to their birth mother. The children in
  the main have a desire to live with their mothers
  or would choose to confide in their birth mother
  if they were having any difficulties, although
  the foster mothers were also noted as a
  confidante.
• That she is still alive and I can talk to her. I
  have questions that want answers and sometimes we
  argue. Its all over again, feel sad for my mum,
  and when its time to depart, I re-live past a
  little (female, 18 year)
• Sometimes but most of the time not really.. Its
  hard that you have two families and you only get
  to see each family some of the time. And you
  dont know which to call mum, and they dont know
  which mum you are talking about and its hard
  (female, 12 years)
• Some children expressed clear and positive
  connections with their birth parents while also
  evaluating the positive aspects of the new home.
• I want to live with my mum but I like the school
  and that ...And mum couldn't pay for the school,
  so I'll live here, but I probably want to live
  with my mum (male, 12 years)

32
Childrens Contact with Birth Parents (cont)

• Q. How do you feel when you see her? (Birth
  Mother)
• HappyMmm, I dunno I just have this feelingMmm,
  nice, mmm happy, mmm that's about it (male,
  11years)
• Im always missing my mum. It doesn't happen
  that much now, cause I see her every month
  (male, 13years)
• I ask her a lot of questions, I ask her what was
  she like when she was little, what was I like
  when I was littleJust to see herShe realises
  what she's done and she tried to change but
  that's her (female, 17years)
• I feel happy and normal when I see him. I look
  forward to seeing him (female, 11 years)
• When I see her I am um, happy. Then at the same
  time, the way she is living and you know, she is
  also sick too. Mixed so happy and sad (female,
  19 years)

33
Childrens Contact with Birth Parents (cont)

• Compared to Interview 1, the significant change
  was an increase in childrens desire to see their
  fathers
• Many of the children expressed that they never
  see their birth fathers, they did however appear
  to be interested in seeing them and establishing
  a connection
• I'd like to see him (father) a lot more, heaps
  and heaps and heaps more times, it makes me feel
  happy (female, 8years)
• I dont have a real dad, I never did. I only
  have false dads (female, 8 years)
• Ive never had a first dad (male, 11years)
• Sometimes I do, I want to know about my dad
  because I dont know where he is from. People ask
  me where he is from and I just have to say I
  dont know. They say what do you mean you dont
  know? And im like I dont know (female, 16
  years)

34
Hare Self Esteem Scores (HSS) compared to
normative data
35
Childrens Self Esteem

• Childrens self esteem was assessed using the
  hare self esteem scale. Includes peer
  self-esteem, home self esteem and school
  self-esteem and a total score
• Girls and boys both had an average of 82
• Peer self esteem was negatively correlated with
  total number of placements, (r -0.42, p0.05) so
  that the more placements children had the lower
  their peer self esteem
• Age at entry to care was also found to be related
  to global self esteem (r0.37, p0.05). That
  is, children who went into care at an older age
  had higher self esteem at interview 2

36
Hare Self Esteem Scores, including gender
breakdown

• Girls were found to have remained stable from
  Interview 2 to Interview 3 on all the subscales
  and the total self esteem score
• Boys however had significantly higher home self
  esteem scores and total self esteem scores at
  Interview 3 compared to interview 2.
• This finding is encouraging given the small
  sample sizes and indicates that boys responded
  positively to the foster home environment.

37
Self esteem and Childrens care history

• From the childrens interviews it was apparent
  that being in care affected their self esteem.
  However, the children did also compare themselves
  to their peers for some reassurance.
• Its like we're second hand kids unless that's
  how all kids feel who are my age (female, 12
  years)
• When I see my friends with their parents I see
  nothing different...it just seems the same, like
  Ive got play stations and Nintendos, and being
  allowed to play and going to friends houses as
  well (male, 13years)
• Some people in my class don't even have a dad.
  And I get lots of stuff(female, 10years)

38
Identity and Self Image

• When children were asked what they most liked
  about themselves, many of the children appeared
  to have a positive response.
• Im a loving and caring person. And Im hopeful
  (male, 13years)
• Im creative, Im intelligent. I don't knowIm
  gentle, Im caring, Im nice to people (female,
  9 years)
• I don't know Im good at sporthappy most of the
  time, Im just happy (male, 12 years)
• If I do things I keep trying and trying. And if
  I cant do it I keep trying (male, 11years)
• Yes I think I have. I have respect for people.
  Im not as rude as I was. Sometimes I am more
  confident (female, 17 years)
• Q. Imagine you could change something about
  yourself, would you change anything?
• No, because my mum wouldnt recognise me.
  (male, 8 years)

39
Strong negative emotions experienced by children
at separation and in the 3 months prior to
Interview 3
40
Emotions experienced

• Most commonly experienced feeling across all
  categories was sadness
• Majority of boys also reported feeling worried
  (57)
• Majority of girls felt lonely (60)
• Girls were more likely to feel very angry than
  boys at the time of separation
• Younger children were more nervous
• Their overall distress included multiple emotions
  like being very worried, scared, angry and lonely
  simultaneously
• Children were significantly happier, less scared
  and more excited at interview 3

41
Looking After Children Assessment Action
Records
42
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43
Childrens scores on LAC subscales at Interview
1, 2 3

• Significant improvement in the childrens ratings
  of emotional problems
• Girls had significantly higher pro social scores
  which indicates a more positive social skill set
  than boys
• Girls also reported having more carer problems
  than boys
• Older children being were likely to have more
  conduct problems (r0.54, p0.003)

44
Relationship building skills reported by children
at Interview 1
45
(No Transcript)
46
Relationship skills

• At Interview 3, 11 skills were reported by more
  than 75 per cent of the children, an increase of
  six skills from Interview 1 and four from
  Interview 2
• At Interview 3 more children were reporting
  feelings of trust, confidence amongst their peers
  and less demanding with their carers
• Several behaviours did not improve very much from
  Interview 2 to 3 including comfort others who
  are upset, considerate of others feelings,
  not getting into fights, sharing, ability to
  make friends

47
LAC Scores and Cohesion

• A positive correlation exists between the number
  of reported relationship skills and the level of
  cohesion with the foster mother (r0.42, n42,
  p0.006) and the foster father (r0.38, n42,
  p0.014).
• Cohesion also relates to some LAC subscales
• The greater the foster mother cohesion the fewer
  relationship problems with carers (Carer
  Subscale r-0.41, n42, p0.006)
• The greater the foster father cohesion the fewer
  relationship problems with carers (Carer
  Subscale r-0.36, n42, p0.020), the fewer the
  conduct problems
• The nature of the relationship with the foster
  father at interview 1 appears to have had an
  important developmental influence on the
  children, so if there was very good cohesion the
  child increased their relationship skills by
  interview 2 3

48
Child Behaviour Checklist

• In the present study the CBCL 4-18 was used
• This is an observational measure for children
  aged 4 to 18 (Achenbach 1991) which assesses 113
  problem behaviours to provide information on 3
  overall problem scores
• Internalising Problems inhibited or
  over-controlled behaviour (I, II and III)
• Externalising Problems antisocial or
  under-controlled behaviour e.g., delinquency or
  aggression (IV and V)
• Total Problems Scale all mental health problems
  reported by parents or adolescents
• 8 Further Subscales

49
Children aged 4-17 years in clinical range of
problems on CBCL, compared to the Mental Health
of Young People in Australia (MHYPA) Survey
(n3870)
Comparisons are made with the findings of the
Australian governments mental health of young
people in Australia (2000), based on a national
representative sample
50
Carer Ratings on the Achenbach Child Behaviour
Checklist interview 1

• 43.4 of the children were in the clinical range
  for number of total problems,
• 35.8 for internalising problems
• 34.0 for externalising problems
• Clinical rate for Total Problems is three times
  the Australian community sample
• Internalising and externalising problems exceeded
  the MHYPA community norms

51
Carer Ratings on the Achenbach Child Behaviour
Checklist interview 2

• Between 7.5 and 28 demonstrated clinically
  significant problems on the subscales
• Attention problems, social problems, delinquent
  behaviour, anxiety and depression rated in the
  clinical range.
• 38 of children were in the clinical range of
  total problems
• 22 for internalising problems
• 37 for externalising problems

52
Comparison data of scores across Interviews

• Significant decreases detected between carer
  ratings at Interview 1 and 2 on the internalising
  scores (t2.07, df 50, plt0.05) and the anxiety
  and depression subscale (t2.01, df 50, plt 0.05)
• Fewer children fell into the clinical range of
  total problems at the second interview
• Ratings remained above the Australian normative
  data on all subscales total problems and
  externalising problems
• Internalising problems had dropped.

53
CBCL Teacher Report Form (TRF)

• Teachers of children in care were asked to
  complete the Achenbach teachers check-list, a
  companion to the child behaviour checklist
• The instrument is norm referenced and assesses
  key problem sub-scales and overall problem scores
  
• The TRF also includes an Adaptive Functioning
  Scale which include 5 ratings over two subscales
  on the childs positive attributes as displayed
  at School

54
TRF (contd)

• Academic Performance
• teachers ratings of the childs performance in
  academic subjects
• Adaptive Functioning
• Four adaptive characteristics and the sum of the
  four characteristics
• How hard the child is working
• How appropriately he/she is behaving
• How much he/she is learning
• How happy he/she is

55
Who were included in this part of the study?

• The TRF was completed for children aged between 5
  and 17, with an average age of 11.1 years (sd 3.1
  years)
• Additionally each childs main teacher completed
  a checklist for another child in the class,
  matched for age and sex but who resides in a
  birth family

56
Table T-scores for TRF Problems at Assessment 1
for Care and Comparison Groups
57
Table (contd)
58
Children in care

• The problem subscale scores have a minimum of 50,
  and a clinical cut off of 64
• The maximum scores for the children varied from
  67 (withdrawn) to 91 (for aggressive behaviour)
• The average scores ranged from 52.6 (somatic
  complaints) to 58.63 (social problems)
• the highest average scores for girls was social
  problems (mean 59.65) and for boys, aggression
  (mean 58.48)
• There were 14 children in the clinical range for
  the summary scores for internalising problems,
  (greater than 63 on the teacher ratings), 21
  with externalising problems and 177 over
  threshold on total problems

59
Comparison Group Children

• Compared to the children in care only two
  significant differences were detected
• Firstly the children in care had higher t-scores
  on aggressive behaviour (means 58.2 for care
  and 54.3 comparison P0.013)
• The care group had higher t-scores for
  externalising problems (means 56.7 for care,
  52.1 for comparison, p0.019)
• The comparison group had high level of children
  in the clinical range of scores for internalising
  problems
• 25of the children in the comparison group had
  scores which fell in the clinical range for
  internalising problems

60
Figure 11 Percentage of children in the clinical
range for TRF summary scales compared to the
sample of matched children, not in care
61
Table T-scores for adaptive functioning scales
for children in care and comparison group
A high score is indicative of more adaptive
functioning
62
Adaptive Functioning Scales (TRF)

• Children in care
• children in care had the highest average score
  for happiness and the lowest for behaving
  appropriately
• By gender, girls had their highest average
  ratings for working hard (mean 44.85)
• and the boys, being happy (46.35) or working hard
  (46.5)
• The highest percentiles in the scales for this
  group ranged from 73rd percentile (behaving
  appropriately) to the 93rd percentile (learning)
• Comparison group
• The comparison group childrens percentile means
  varied from a low of 30.31 for learning, to a
  high of 37.40 for working hard

63
Figure 13 Adaptive scale percentiles for
children in care and the matched children, not in
care for academic performance and the sum of the
adaptive scales
64
Comparisons between the care and comparison
samples

• Girls in care, appear to function at a lower
  average percentile to their non care peers
• Boys samples appear more evenly matched
• In relation to the subscale behaving
  appropriately children in care have lower
  ratings

65
Comparisons between the groups at assessment 2

• Both groups demonstrated significant changes in
  their TRF problem scores from the first
  assessments
• With regard to the summary scales, both groups
  showed significant reductions in the ratings
• In the subscales, the care group changed in six
  areas, as opposed to 4 areas in the comparison
  group
• The strongest changes for the comparison group
  surrounded the internalising cluster
• The care children showed most change in the
  externalising clusters

66
Summary

• Both the children in care and comparison group
  had arrange of problems detected
• Evidence of a greater prevalence of problems in
  the care group
• The high prevalence of internalising problems
  amongst the comparison group
• At the second assessment there were no
  differences between the two groups on the problem
  subscales, which, in a restorative program is a
  positive finding

67
Summary (contd)

• On the adaptive functioning scales, children in
  care showed significant improvements across all
  subscales
• Children in care were functioning near to the
  50th percentile, based on the normal population
• Comparison group showed some significant gains
  but without the same breadth or magnitude
• Some of this change may be attributed to the
  effects of restorative care and the Barnardos
  intervention

68
Comparisons between the groups at assessment 2
(contd)

• the teachers not blind to the status of the two
  children that they were assessing
• factors need to be considered when interpreting
  these data
• Some of these changes might be apportioned to
  different rating styles of the teachers at the
  different time points, but this is a constant for
  the two groups.
• Some may be natural maturation although the age
  related norms should also account for this
  effect.
• Finally some of the effects may be attributed to
  the effects of the Barnardos intervention

69
Teacher Carer Ratings on the Achenbach Rating
Scales

• There was significant agreement between the
  carers and teachers on the ratings of children
• They were more likely to agree on the
  identification of children below clinical
  threshold problems than above
• Carers would rate more children at above
  threshold levels than teachers, especially with
  regard to externalising and total problems

70
Teacher Carer Ratings on the Achenbach Rating
Scales (contd)

• This difference may be an indication that
  teachers were more conservative than the carers
• Have a better idea of the normal range of
  behaviour
• The structure of the classroom provides
  sufficient guidelines for the children to behave
  within non clinical levels
• In the absence of such structure, the carers
  observe more problematic spectrum

71
Caseworker Assessments Of Childs Adjustment

• Caseworkers were asked to rate how satisfied they
  were with the way things are going for the
  child on a 5-point scale where 1 is not at
  all satisfied and 5 is very satisfied
• Just over three-quarters are very satisfied
• 6 are not at all satisfied
• Greater average satisfaction ratings were
  recorded for younger (4.8) than older children
  t(35)1.95, p0.059.

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73
Caseworker Assessments Of Childs Adjustment
(cont)

• Caseworkers were asked to rate the childs
  adjustment on a 4-point scale where 1 poor and
  4 excellent.
• Caseworkers rated the childrens adjustment as
  excellent (40) or adequate (44).
• mixed (10) or poor (6) adjustment.
• Younger children were rated as having better
  adjustment than older children t(34)3.3,
  p0.002.

74
Adjustment to placement over time

• The proportion of children in placement with
  excellent adjustment grows with time
• 17.5 to 58.5 in year 3
• 54.5 in year 4
• Mixed or poor adjustment decreases from 42.5 in
  year 1 to 16 in year 8

75
Caseworkers ratings of childs academic progress

• Caseworkers were asked to rate the childs
  academic progress over the last 2 years.
  Three-quarters (75) were rated as progressing
  (very well 19) or (moderately well 55).
  Approximately a quarter (26) of children were
  rated as progressing not very well. There were
  no age or sex differences

76
Length of time with the current carer

• Those children who have been with their carers
  for at least 3 years have, on average, better
  academic adjustment and better overall adjustment
  t(45)-3.56, p0.001
• And better health t(44)1.98, p0.054

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78
Positive life events

• 94 of children had at least one of the five
  listed achievement life events
• 48 had had two or three such events
• 92 of children had at least one of the six
  listed attachment life events
• 52 had had two or three such events
• Caseworkers rated 90 of children as being in
  excellent (41) or very good (49) health

79
Positive Achievements

• Most frequently reported was having a stable
  foster placement (78)
• Three quarters of the children (76) were able to
  go on a trip or vacation
• Development of relationships with carers, new
  friends or birth family was also common,
  experienced by two thirds
• Many children experienced some level of
  educational achievement (52) or sporting
  achievement (42)

80
Positive life events

• The greater the total number of positive life
  events the better the academic adjustment
  (r0.42, p0.003), health (r0.38, p0.007), and
  the better the caseworkers overall adjustment
  assessment for the child (r0.34, p0.016)
• The greater the positive achievement life events
  the greater the academic adjustment (r0.58,
  plt0.001), health (r0.43, p0.002) and overall
  adjustment ratings (r0.38, p0.008)
• The greater the number of positive attachment
  life events the greater the health assessment
  (r0.38, p0.008)
• Having a stable foster placement is related to
  higher academic adjustment t(44)-3.50, p0.001),
  higher satisfaction with the placement
  t(48)-3.20, p0.002), health t(47)-4.94,
  plt0.001), and higher adjustment scores

81
Assessment of Parenting

• Caseworkers were asked to rate carers on a number
  of variables relating to parenting styles and
  skills
• the ability in relation to managing the child
  and disciplinary style were the more problematic
  areas noted
• Those with a younger child were more likely to be
  rated as never having a problem with disciplinary
  style or level of aggression in parenting (81)
  than were those with an older child (38)

82
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83
Parenting Variables

• Responsiveness
• Problems with the carers responsiveness was
  negatively related to the childs academic
  adjustment (?-0.49, p0.001)
• The caseworkers overall satisfaction with the
  placement (?-0.47, p0.001)
• The childs overall adjustment (?-0.65, plt0.001)
• And health (?-0.48, p0.001)
• Warmth
• Problems with the carers ability to express
  warmth towards the child was negatively related
  to the caseworkers overall satisfaction with the
  placement (?-0.50, plt0.001)
• the childs overall adjustment (?-0.55, plt0.001)
• And health (?-0.40, p0.005). There was no
  association with the childs ease of making
  friends or academic progress
• Sensitivity
• Problems with the carers ability to respond
  sensitively was negatively related to the childs
  academic adjustment (?-0.33, p0.023)
• The caseworkers overall satisfaction with the
  placement (?-0.59, plt0.001), the overall
  adjustment (?-0.64, plt0.001)
• The childs health (?-0.44, p0.002).

84
Parenting Variables (cont)

• Ability to manage child
• The carers ability in relation to managing the
  child was negatively related to the caseworkers
  overall satisfaction with the placement (?-0.30,
  p032)
• The childs overall adjustment (?-0.39, p0.006)
• And health (?-0.35, p0.014).
• Disciplinary Style / Level of Aggression
• The carers disciplinary style or level of
  aggression in parenting was negatively related to
  the childs academic adjustment (?-0.35,
  p0.015)
• The caseworkers overall satisfaction with the
  placement (?-0.45, p0.001)
• Overall adjustment (?-0.62, plt0.001)
• And health (?-0.59, plt0.001)
• Stressors on Carers
• Rating of the childs overall adjustment is
  higher on average in the absence of a stressor on
  carers that is related to the care of the child
  (t(47)-2.26, p0.029).

85
Summary and Implications

• Family and social relationships
• Children reported good levels of cohesion with
  foster carers at 3 interviews. Significant
  relationships emerged regarding the childrens
  judgment of their interpersonal skills and
  attachment with their foster parents
• Resources and training to enable carers and care
  systems to build on these strengths is stressed
• The nature of the relationship with the foster
  fathers appear to have had an important
  developmental influence on the children.
  Developing approaches to promote fuller
  involvement of fathers in fostering relationships
  are important to outcomes for children
• While acknowledging strong attachments with their
  foster parents children desired more contact with
  their family of origin.
• Contact remains a challenging and contentious
  issue (Cleaver, 2000) and carers must be
  supported in their dual task of building strong
  attachments with their foster children while
  responding to the childrens need for continuing
  connection with birth families

86
Summary and Implications

• Self concept and self esteem
• The childrens self esteem levels were lower than
  published normative data, reaffirming the
  childrens level of need.
• This result points to the need to assess more
  specific aspects of self esteem to better
  understand the needs of children in care.
• Consistent with a resilience orientation
  interventions may include fostering childrens
  relationship building skills and reinforcing
  their pro-social behaviours and self worth, or
  finding turning points in their schooling through
  mentoring and extracurricular opportunities and
  positive peer and adult attachment relationships.
  

87
Summary and Implications (cont)

• Childrens Emotional Needs
• Children had high levels of psychological need
• Problems with attention, social interactions,
  anxiety, aggression approximate estimates from
  other studies
• Findings underline the importance of recognising
  emotional and behavioural difficulties
  experienced by children in care early and
  identifying their impact on carers.
• Vulnerabilities and strengths of children based
  on gender, age, and care history indicate the
  need for individualised and differential
  responses from carers and caseworkers.
• Recognise adversities which threaten Childrens
  wellbeing in care such as, maltreatment
  histories, disrupted attachments, placement
  breakdown and interrupted schooling
• Support children at risk of psychological
  difficulties with therapeutic services

88
Summary and Implications (cont)

• Monitor children at increased risk of instability
  in care
• Externalising behaviours have been cited as a
  strong predictor of placement breakdown
  (Leathers, 2002)
• Strengthen professional decision making to ensure
  children are less likely to move
• Support carers in enhancing their relationship
  with troubled children
• Skill foster parents in approaches needed for the
  sensitive management of childrens emotional and
  behavioural problems
• Support carers and teachers through professional
  training to identify and work with vulnerable
  children to prevent the development of
  psychopathology

89
Focus on Strengths and Competencies of Children
in Care

• Childrens sense of happiness improved overtime
  is a positive finding implying placement in care
  provided a route to rehabilitative intervention
  for children with maltreating histories
• Permanent care afforded a context to develop a
  more secure base
• Being in care offered a pathway into restorative
  services
• School environment and the educational process
  can potentially offer structure, boundaries and
  security to the children in care systems

90
Focus on Strengths and Competencies of Children
in Care (cont)

• The importance of school in offering children
  positive role models and benefits of routines
  and rituals for children experiencing upheaval
  and adversity in their environment
  (Gilligan,1998)
• Research attributes positive school experience
  and achievement to happy adult behaviour
  (Rutter, Quinton et al. 1993)
• Instability of care placements and the
  difficulties involved in starting new schools on
  a regular basis present significant challenges to
  children in care

91
Resilience Enhancing Interventions

• Develop strategic interventions that promote
  childrens strengths and competence
• Foster childrens relationship building skills
• Support carers in acknowledging and reinforcing
  childrens prosocial behaviours
• Develop co-ordinated multidisciplinary response
  to address overlapping domains of need, such as
  education and mental health
• Encouraging child consumers right to self
  expression (Gilligan, 2002) and honouring
  childrens voices and knowledge in the
  development of child-centred policy and practice
  is stressed

92
Methodological and Ethical Considerations

• Justification of childrens involvement and value
  in being heard
• Benefits to participating children and future
  children
• Participation of children in the research process
  and stages of involvement
• Informed consent- who gives consent and how
• Determining competency to consent /participate
• Independent opportunity to consent/withdraw
  consent
• Role of gatekeepers in enabling/disabling
  consent/participation
• Providing information to professionals, carers,
  children to facilitate informed consent

93
Duty of Care Responsibility

• Providing a safe and confidential environment to
  express their views.
• Confidentiality and limits arising from child
  protection legislation.
• Protecting children from harm arising from the
  research process.
• Vulnerability in revisiting traumatic events.
• Potential for destabilizing care arrangements.
• Overexposure to research scrutiny.
• Ensuring processes for disengaging and debriefing
  from interviews.
• Availability of care professionals for referral
  to deal with the emotional impact of interviews

94
Publications related to the study

• Fernandez, E. (2007). Unravelling Emotional,
  Behavioural and Educational Outcomes in a
  Longitudinal Study of Children in Foster Care,
  British Journal of Social Work (in press).
  (Advance access doi 10.1093/bjsw/bcm028)
• Fernandez, E. (2007). How Children Experience
  Fostering Outcomes Participatory Research with
  Children, Child and Family Social Work (in press)
  (Advance access online November 2006). Vol 12, pp
  349-359.
• Fernandez, E. (2006) Growing up in care
  Resilience and care outcomes. Promoting
  resilience in child welfare. (Eds Flynn, R.J.,
  Dudding, P.M, and Barber, J.G.) University of
  Ottawa Press. Ch. 8. (pp 131-156)