British Journal of Social Work Advance Access published April 18, 2007 British Journal of Social Work (2007), 1 of 19 doi:10.1093/bjsw/bcm028
Unravelling Emotional, Behavioural and Educational Outcomes in a Longitudinal Study of Children in Foster-Care Elizabeth Fernandez Elizabeth Fernandez, BA, MA Madras, Ph.D. UNSW, conducts research and teaching in the areas of child protection, children in substitute care, children’s rights, field-based learning and cross-cultural studies. She is a Senior Lecturer at the School of Social Work of the University of New South Wales. Correspondence to Dr. Elizabeth Fernandez, School of Social Work, University of New South Wales, Sydney, NSW 2052, Australia. E-mail: E.Fernandez@unsw.edu.au
Summary The experience of out-of-home care has the potential to impact on children’s psycho-social outcomes in significant ways. This article highlights the interactive contribution of carers, teachers and children to the fostering experience. The paper reports on a strand of a longitudinal study of children in long-term foster-care. Using a mixed-methods, repeated-measures, multi-informant approach, it focuses on emotional, behavioural and educational outcomes. Children in the study were assessed by carers and teachers for competencies and problem behaviours using the Achenbach Child Behaviour Checklist and its companion, the Teacher Report Form. The results suggest high prevalence rates of Externalizing and Internalizing problems with demonstrated gains in terms of improved scores and adaptive functioning at subsequent assessments as they progressed in placements. While drawing attention to the adversities reflected in the children’s experience, the findings go some way in demonstrating the positive outcomes of care. One striking finding is the similarity between care children and controls in later assessments. Discussion of results and implications for practice centre on the need for a co-ordinated strategy for improved recognition and integrated responses to children’s psychological and educational needs that draw on resilience oriented interventions and target interrelated systems of service delivery. The findings have broad implications for practitioners concerned with psycho-social outcomes for children in care, and for researchers interested in integrating multiple perspectives in longitudinal research. Keywords: foster-care, outcomes, education, mental health
© The Author 2007. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.
2 of 19 Elizabeth Fernandez
The well-being of children in care presents a challenge to child welfare systems internationally. Increasing attention is being paid to their education, emotional health and behavioural development. Several studies have suggested they are significantly more likely to exhibit psychological problems than children in the general population (Clausen et al., 1998; Meltzer et al., 2003). Indications of emotional and behavioural concerns that are in the clinical range also come from studies on mental health service utilization by children and young people in care (Callaghan et al., 2003; Stahmer et al., 2005). High rates of disturbance are attributed to the interaction of pre-care adversities and negative in-care experiences (Stanley et al., 2005). A significant number of children come from deprived and disadvantaged backgrounds compounded by neglect, maltreatment and domestic violence. Evidence is also cited that children in care do respond to positive change in environments and develop satisfying attachments with new care-givers (Quinton et al., 1998). The phenomenon of children experiencing discontinuities in care is widely documented (Rowe et al., 1984; Fernandez, 1996; Sinclair et al., 2005). There is a distressing level of placement instability in foster-care as the numbers of emotionally disturbed children and adolescents with high support needs escalate. Emerging research demonstrates a strong relationship between placement instability and high mental health service usage by children in care (Newton et al., 2000; Rubin et al., 2006). Recent studies examining the complex relationship between placement disruption and children’s psycho-social problems note that children who experience multiple changes in care-givers tend to develop elevated emotional and behavioural problems, which, in turn, trigger placement breakdown (Stanley et al., 2005). Children with externalizing behaviours are particularly vulnerable to placement breakdown (McAuley and Trew, 2000; Newton et al., 2000). Children’s psychological needs are also evident in the educational context, as they impact on educational achievement and engagement with schooling. Studies undertaken internationally point to the educational deficits which children bring to the care experience (Jackson, 2001; Harker et al., 2004; Zetlin et al., 2005; Berridge, 2007). Among the factors uncovered by these studies are low educational attainment, poor attendance, overrepresentation in school exclusion, suspension, frequent school changes as a consequence of placement breakdown, low completion rates and high unemployment among those who age out of the system (Jackson, 2001; Harker et al., 2004; Zetlin et al., 2005; Pecora et al., 2006). In sum, research draws attention to the negative impact of pre-care experiences as well as the role of both care and educational systems. In relation to the latter, failure to prioritize education, low expectations and disruption in the care environment accompanied by disrupted schooling combine to place children in care at risk of educational disadvantage (Elliot, 2002; Harker et al., 2004). Previous research described here provides a useful context to examine findings from the research to be reported in this paper. The present study adopts a
Outcomes in a Study of Children in Foster-Care 3 of 19
longitudinal approach eliciting data from multiple informants and settings to establish a pattern of outcomes. This paper reports a component of a wider study and focuses on the initial four years of a longitudinal study.
Methodology The research involves an ongoing longitudinal study using a prospective, repeated measures design. Children and young people’s needs, strengths and difficulties and care-givers’ responses to these were assessed at different stages of the care process—at four months after entry to care, and at two-year intervals thereafter. Personal interviews with children over eight years of age, and caseworkers and foster-carers of children of all ages are the main sources of data. Quantitative and qualitative methods were combined to capture the process of interactions between children, caseworkers, carers and teachers and evaluate intermediate and long-term outcomes. To conceptualize the level of psycho-social need, the study incorporated standardized measures for which general population normative data are available. This included the Achenbach Child Behaviour Checklist (Achenbach, 1991) with versions designed to be completed by carers and teachers, results of which are analysed in this paper. In implementing this research, ethical protocols approved by the care organization and the university were followed.
Context of the research The site of research is Barnardos Australia—a major non-government child welfare provider receiving referrals from the statutory Department of Community Services. In Australia, child protection is the responsibility of State Departments of Child Welfare. Australia-wide, the number of children in care, on Care and Protection Orders, has been on the increase from 3.3 per 1,000 in 1997 to 4.6 per 1,000 in 2003 (Australian Institute of Health and Welfare, 2004). The provision of care in foster families is the predominant form of outof-home care and is delivered by both the statutory and non-government sectors. The sample included fifty-nine children from four to eighteen years placed in foster families through the Barnardos Find a Family Programme—a longterm foster-care service. The intent is permanent placement with a committed family in which the child can establish a secure psychological base (Schofield, 2002; Triseliotis, 2002) until adulthood. The sample included twenty-nine boys and thirty girls. Their ages ranged from four to fifteen, with an average age of 8.8 years. The ethnic composition of the children included Anglo-Australian (70 per cent), Indigenous Australian (2 per cent), European (17 per cent), Fijian, Tongan, Thai (9 per cent) and Sri Lankan (2 per cent). The children were placed with non-relative foster families, with a single exception, which involved a kinship placement.
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Among primary reasons for initial separation, the most frequently cited reason relating to birth mothers was drug or alcohol dependence (29 per cent). The mother’s mental health was a factor in 22 per cent of cases. Physical and sexual abuse and neglect accounted for 36 per cent. Birth father-related factors included abandonment of the child (39 per cent) and domestic violence (22 per cent). In 25 per cent, primary child-related factors, essentially emotional and behavioural concerns, were cited.
Children’s placement history Prior to their placement with the permanent foster-care program, 45 per cent of children had been placed in care through other agencies, while 37 per cent had prior placements through Barnardos Temporary Care Services. The children had a median of two prior placements; some children had five or more placements. Just under a third of the children had more than five placements in total. Placement stability was an important theme in children’s accounts of their experience in care. From the qualitative analysis of children’s views, their anxiety about moving on, as well as their perception of their behaviour as a factor related to being able to stay, was evident. Frequently, children internalized responsibility for breakdown: Never chuck a temper tantrum cause it gets you kicked out, I’ve like been in 12 homes now (male, aged thirteen years).
The schooling experience Placement histories had their impact on children’s educational experience. The most frequent problems reported by 50 per cent or more carers were discipline problems, attitude or motivational problems and poor academic performance. Approximately 20 per cent were reported to be behind their age-appropriate grade, suspension from school and unscheduled changes being citied as contributing factors. Based on carer accounts, 62 per cent of the children had had three or more unscheduled school changes. Children struggled to keep up with their peers, and were conscious of the disruption caused by their many moves. The children’s responses to the question ‘how many times have you changed school since leaving the home of your birth mum and dad?’ are informative: I don’t know. About three or four. It was pretty bad for my education (male, aged twelve years). I hate it . . . . Cause I love all my schools that I went to (female, aged eight years). About ten hundred times, cause I went to ten hundred schools (female, aged eight years).
Outcomes in a Study of Children in Foster-Care 5 of 19 I think she’s been to about nine different schools and this is the longest year and a half that she’s been in this school. I think that’s the longest she’s ever been in her life (carer).
In 78 per cent of cases, school-aged children changed schools when they moved into their current foster-care placement. Just under half of the carers (48 per cent) felt that the child was performing ‘very well’ at school, while the majority of the children were perceived to be coping ‘moderately’. Sixteen per cent, however, rated the child in their care as performing ‘not very well’ at school. Noting the qualitative data, it can be seen that carers recognize that if they are going to give the child the best chance at a good future, they have to be proactive in the child’s education: Well they’re just so far behind in their learning, they could barely read or write when they come here . . . so they’re way, way behind but with the extra support they’ve really come on well (carer).
Emotional and behavioural outcomes As part of the study, carers and teachers were asked to complete the Achenbach Child Behaviour Checklist (CBCL), which focuses on a child’s competencies and problem behaviours. The instruments are norm referenced, and provide an indication of a child’s likely behavioural and psychological difficulties through comparison with data collected by large samples of other same-aged and sexed children. An observational measure for children aged four to eighteen (Achenbach, 1991), it assesses 113 problem behaviours to provide three overall problem scores (Total problems, Internalizing and Externalizing) and eight further subscales. A key advantage of using the CBCL/4–18 is the availability of local and international comparison data. In this study, comparisons are made with the findings of the Australian Government’s Mental Health of Young People in Australia (MHYPA) (Sawyer et al., 2001), based on a national representative sample of children aged four to seventeen in the child and adolescent component of the National Survey of Mental Health and Well-being (Sawyer et al., 2001). Findings from the carer’s ratings of the CBCL are presented first, followed by teachers’ ratings, and thereafter a comparison of teacher and carer ratings.
Carers’ ratings on the Achenbach Child Behaviour Checklist The results in Table 1 provide an overview of the findings in the present study and comparisons with the Australian Mental Health Survey. In both cases, the statistic for comparison is the percentage of children falling in the clinical range of the survey, derived by using the percentage of children having ‘t-scores’
6 of 19 Elizabeth Fernandez Table 1 Children aged four to seventeen years in ‘clinical range’ of problems on CBCL, compared with the Mental Health of Young People in Australia (MHYPA) Survey All children Summary scales
2nd interview n = 55 %
Initial interview n = 53 %
MYPHA n = 3,870 %
Total problems Internalizing problems Externalizing problems
38.2 21.8 37.3
43.4 35.8 34.0
14.1 12.8 12.9
above the recommended cut-offs of 70 for the three summary scores, and 64 for the subscales. The data in Table 1 indicated that 43.4 per cent of the children aged over four were in the clinical range for the number of total problems, 35.8 per cent for internalizing problems and 34.0 per cent for externalizing problems. The clinical rate for ‘Total Problems’ is three times the Australian community sample. Internalizing and externalizing problems exceeded the MHYPA community norms. When the subscales were examined, carer ratings indicated that between 7.5 and 28 per cent demonstrated clinically significant problems. Attention problems, social problems, delinquent behaviour and anxiety and depression were frequently rated in the clinical range. The carers completed the CBCL as a part of the second interview two years later. As shown in Table 1, 38 per cent of children were in the clinical range of ‘total problems’, 22 per cent for internalizing problems and 37 per cent for externalizing problems. Comparison data of scores from Interviews 1 and 2 revealed the following trends:
•
Significant decreases between carer ratings at Interviews 1 and 2 on the internalizing t-scores (t = 2.07, df 50, p < 0.05) and the anxiety and depression subscale (t = 2.01, df 50, p < 0.05).
•
Using chi-square analyses, there was some indication that fewer children fell into the clinical range of ‘total problems’ at the second interview compared with the first interview, but this did not reach significance (K 2 = 3.2, df 1, p = 0.07).
•
Children’s ratings remained above the Australian normative data on all subscales and in terms of total problems and externalizing problems. Internalizing problems, however, had dropped.
Teachers’ ratings on the Achenbach Child Behaviour Checklist Teachers completed the Achenbach Teachers Report Form (TRF) (a companion to the CBCL) on two occasions. The TRF is norm referenced and assesses key problem subscales and overall problem scores, and includes an Adaptive
Outcomes in a Study of Children in Foster-Care 7 of 19
Functioning Scale that provides an assessment of norm referenced attributes. They include: Academic performance: Ratings of the child’s performance in academic subjects. Adaptive functioning: Four adaptive characteristics and the sum of the four characteristics: working hard; behaving appropriately; learning; being happy. Additionally, each child’s main teacher completed a checklist for another child in the class, matched for age and sex but who resided in their birth family. This formed a quasi, non-randomized control group.
TRF profiles Children in care The t-scores provide standardized scores for the children and are the most frequently reported statistic on the Achenbach rating scales. 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), whilst the average scores ranged from 52.6 (somatic complaints) to social problems (58.6) (Table 2). The breakdown by gender is also shown in Table 2, with the highest average scores for girls being social problems (mean 59.65) and for boys, aggression (mean 58.48). The children’s t-scores were also used to determine who was above a previously established clinical threshold, reflecting 13.9 per cent of children in the clinical range for the summary scores for internalizing problems
Table 2 t-scores for TRF problems at Assessment 1 All (n = 43)
Girls (n = 20)
Boys (n = 23)
Mean
s.d.
Max.
Mean
s.d.
Max.
Mean
s.d.
Max.
Internalizing problems Externalizing problems Total problems
53.35 56.72 56.40
8.67 9.19 8.95
80.00 84.00 80.00
54.15 56.10 57.10
9.38 10.35 9.72
80.00 72.00 77.00
52.65 57.26 55.78
8.16 8.26 8.39
70.00 84.00 80.00
Subscales Aggressive behaviour Anxiety and depression Attention problems Delinquent behaviour Social problems Somatic complaints Thought problems Withdrawn
58.21 56.81 57.47 56.35 58.63 52.56 54.63 53.91
8.22 6.24 5.91 6.98 7.49 5.79 6.98 4.87
91.00 77.00 73.00 78.00 81.00 77.00 78.00 67.00
57.90 56.65 58.75 57.50 59.65 53.40 54.55 55.40
7.53 6.52 5.38 7.52 7.23 7.13 6.24 5.21
72.00 77.00 67.00 70.00 81.00 77.00 67.00 67.00
58.48 56.96 56.35 55.35 57.74 51.83 54.70 52.61
8.93 6.13 6.23 6.48 7.76 4.33 7.71 4.26
91.00 74.00 73.00 78.00 74.00 64.00 78.00 66.00
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(greater than 63 on the teacher ratings), 20.9 per cent with externalizing problems and 16.2 per cent over threshold on ‘total problems’.
Control group children The problem t-scores for the children in the control group, including scores for boys and girls, are shown in Table 3. Compared with the children in care, only two significant differences were detected. First, the children in care had higher t-scores on aggressive behaviour (means = 58.2 for care and 54.3 control; p = 0.013) and, following on from this difference, the care group had higher t-scores for externalizing problems (means = 56.7 for care, 52.1 for control; p = 0.019). A curious finding in the sample of children selected by the teachers for comparison purposes was the high level of children in the clinical range of scores for internalizing problems. Twenty-five per cent of the children in the control group had scores which fell in the clinical range for internalizing problems (Table 3). This was evenly distributed between boys and girls. In relation to the subscales, however, few children had above clinical threshold scores. Overall, 91 per cent of the children had no subscale scores in the clinical range, with all girls in the normal range. Only two boys had one clinical problem each.
Adaptive functioning scales (TRF) Assessment 1 Children in care According to the t-scores, children in care had the highest average score for ‘working hard’ and the lowest for behaving appropriately (Table 4). By gender, Table 3 Control group t-scores for TRF problems at Assessment 1 All (n = 43)
Girls (n = 20)
Boys (n = 23)
Mean
s.d.
Max.
Mean
s.d.
Max.
Mean
s.d.
Max.
Internalizing problems Externalizing problems Total problems
56.37 52.14 55.09
8.48 7.51 7.34
68.00 66.00 68.00
55.15 52.85 55.45
9.20 8.07 8.34
68.00 66.00 66.00
57.43 51.52 54.78
7.86 7.10 6.53
68.00 64.00 68.00
Subscales Aggressive behaviour Anxiety and depression Attention problems Delinquent behaviour Social problems Somatic complaints Thought problems Withdrawn
55.61 59.19 56.33 55.01 56.53 51.21 53.02 55.95
6.81 7.28 5.12 7.89 6.02 2.99 5.94 5.48
70.00 71.00 68.00 83.00 70.00 64.00 70.00 68.00
54.85 58.50 56.65 55.30 56.50 51.55 51.75 55.15
5.38 6.89 5.34 6.22 5.95 2.76 5.45 5.73
66.00 71.00 68.00 69.00 70.00 57.00 70.00 68.00
56.65 56.04 50.91 53.00 53.17 57.31 56.57 53.78
5.27 5.02 3.20 8.01 3.33 5.43 6.21 4.23
70.00 65.00 64.00 83.00 59.00 64.00 68.00 66.00
Outcomes in a Study of Children in Foster-Care 9 of 19 Table 4 t-scores for adaptive functioning scales for children in care and control group Care children
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Control children
Mean
s.d.
Max.
Mean
s.d.
Max.
43.60 45.63 42.86 43.49 45.30 43.16
6.22 5.98 5.93 6.63 5.40 6.02
60.0 59.0 57.0 65.0 59.0 59.0
45.69 46.36 45.64 44.07 45.62 44.36
6.47 6.09 5.59 6.72 4.99 6.29
65.00 65.00 60.00 65.00 58.00 64.00
girls had their highest average ratings for working hard (mean = 44.85) and the boys, being happy (46.35) or working hard (46.5). A high score is indicative of better adaptive functioning.
Control group The adaptive scale t-scores for the children in the control group are summarized in Table 4. While a high score is indicative of greater adaptive functioning, all the average scores are below 50, with maximums up to 65. The highest mean t-score for the overall sample was for working hard. The percentiles offer a further guide as to where the children in care were in relation to the comparison group on the adaptive scales (Table 5). The percentiles indicate that:
•
on average, the children in care were in the lower third of the population across all these adaptive scales and, on the sum of the adaptive functioning, this was only just over the lower quartile (27 per cent);
• • •
for girls, academic performance was lowest, at the 21st percentile; for boys, behaving appropriately was at the 27th percentile; four children were rated in the 90th percentile for learning and two in the 80th percentile for academic performance.
Table 5 Percentiles for adaptive functioning scales for children in care and control group Care children (n = 43)
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Control children (n = 42)
Mean
s.d.
Max.
Mean
s.d.
Max.
29.09 34.98 26.93 28.42 33.74 27.67
19.78 19.82 18.48 20.58 17.86 19.04
84.0 81.0 76.0 93.0 81.0 81.0
35.31 37.40 34.83 30.31 34.36 30.86
20.75 19.94 18.98 21.23 17.01 20.13
93.00 93.00 84.00 93.00 79.00 92.00
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The control group children’s percentile means varied from a low of 30.31 for learning to a high of 37.40 for working hard (Table 5). The highest percentiles in the scales for this group ranged from the 79th percentile (happy) to the 93rd percentile, which cut across academic performance, working hard and learning.
Comparisons between the care and control samples The differences between the two groups in comparing the mean percentile ranks for the children with regard to academic performance and the sum of the four adaptive attributes show that girls in care appear to function at a lower average percentile to their non-care peers, while the boys’ samples appear more evenly matched. Statistically, there was evidence of only one significant difference between the children in care and the control children across the adaptive scales. In relation to the subscale ‘Behaving appropriately’, using paired t-tests, there was a mean difference of –2.7 (s.d. 8.2) (p = 0.038) between the children in care and their control child, with children in care having lower ratings.
Assessment 2 There were thirty-nine teacher reports completed on the children in care at Assessment 2 two years later. In all cases, a new teacher completed the children’s reports. Analysis of the summary statistics for the TRF behaviour problem t-scores at Assessment 2 for the children in care show that the mean scores across the various subscales all range within five points of the minimum (50) and fewer children were above the clinical threshold. There were no statistically significant differences between boys and girls in care except for attention problems, in which girls had a higher mean t-score than boys (p = 0.037).
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 four areas in the control group. The strongest changes for the control group surrounded the internalizing cluster, which was exceptionally high at Assessment 1. Conversely, the care children showed most change in the externalizing clusters. As this study is not randomized, nor are the teachers ‘blind’ to the status of the groups that they were assessing, a number of 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
Outcomes in a Study of Children in Foster-Care 11 of 19
constant for both groups. Some may be natural maturation, although the agerelated norms should also account for this effect. Finally, some of the effect may be attributed to the restorative effects of foster-care intervention.
Adaptive Functioning at Assessment 2 Children in care The TRF adaptive functioning ratings for the children in care are summarized in Table 6 (t-scores) and Table 7 (percentiles). Comparison data from Assessment 1 are provided as a guide, although statistical analyses of differences over time are based on paired t-tests for the t-score data. It is also important to note that with the adaptive scales, a higher score indicates better functioning. According to both the t-scores and percentiles, the childrenâ&#x20AC;&#x2122;s strengths were in relation to happiness and working hard. The paired t-tests confirmed that the apparent change in scores in Tables 6 and 7 were all significant. The children in care had improved in all areas of adaptive functioning. At Assessment 2, according to their teachers, as a group, they were functioning within the 50th percentile for their age and sex, with the most functional in the 90th percentile range.
Table 6 Adaptive scale t-scores for the care group at Assessment 2 Assessment 2 (n = 39)
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Assessment 1 (n = 43)
Mean
s.d.
Max.
Mean
s.d.
Max.
50.00 50.59 47.87 49.15 52.21 49.82
6.61 6.30 5.30 6.97 7.12 6.34
63.00 65.00 60.00 65.00 65.00 64.00
43.60 45.63 42.86 43.49 45.30 43.16
6.22 5.98 5.93 6.63 5.40 6.02
60.0 59.0 57.0 65.0 59.0 59.0
Table 7 Adaptive function subscale percentiles for children in care at Assessment 2 Assessment 2 (n = 38)
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Assessment 1 (n = 43)
Mean
s.d.
Max.
Mean
s.d.
Max.
50.50 52.03 42.28 47.23 57.85 49.82
21.99 21.09 18.80 22.85 23.70 21.40
90.00 93.00 84.00 93.00 93.00 92.00
29.09 34.98 26.93 28.42 33.74 27.67
19.78 19.82 18.48 20.58 17.86 19.04
84.0 81.0 76.0 93.0 81.0 81.0
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Control group The teacher ratings of the matched child, not in care, on the adaptive function subscales at Assessment 2 are summarized in Tables 8 and 9. These results prove interesting, with statistically significant changes in three of the subscales. In relation to the percentiles, there were significant improvements in academic performance and the cumulative variable, summing all items except academic performance. While there were some changes in working hard, behaving appropriately or happiness, the strengths for the control group were learning and academic performance, with the children as a group rated at just below the 50th percentile. A further significant difference between the two groups at Assessment 2 was for happiness, with children in care scoring, on average, 5.16 points higher.
Comparison of teacher/carer ratings on Achenbach Rating Scales The three summary scales from the CBCL4-18 and TRF5-18, internalizing problems, externalizing problems and total problems were examined to determine the extent of agreement between carers and teachers on the childrenâ&#x20AC;&#x2122;s behaviour. First, correlational analyses were used to compare the childrenâ&#x20AC;&#x2122;s t-scores on the three summary variables: Table 8 TRF adaptive function subscale t-scores for the control-group children at Assessment 2 Assessment 2 (n = 37)
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Assessment 1 (n = 42)
Mean
s.d.
Max.
Mean
s.d.
Max.
48.53 48.57 47.16 48.03 46.78 47.46
5.44 5.11 5.59 5.02 4.80 5.35
64.00 59.00 65.00 58.00 58.00 57.00
45.69 46.36 45.64 44.07 45.62 44.36
6.47 6.09 5.59 6.72 4.99 6.29
65.00 65.00 60.00 65.00 58.00 64.00
Table 9 TRF adaptive function subscale percentiles for control-group children at Assessment 2 Assessment 2 (n = 37)
Academic performance Working hard Behaving appropriately Learning Happy Sum working hard to happy
Assessment 1 (n = 42)
Mean
s.d.
Max.
Mean
s.d.
Max.
44.86 45.05 39.70 43.30 38.41 41.51
18.13 17.91 18.40 17.13 16.48 17.71
92.00 81.00 93.00 79.00 79.00 76.00
35.31 37.40 34.83 30.31 34.36 30.86
20.75 19.94 18.98 21.23 17.01 20.13
93.00 93.00 84.00 93.00 79.00 92.00
Outcomes in a Study of Children in Foster-Care 13 of 19
•
For the internalizing cluster of problems, all correlations were significant, but remained below 0.5. Correlations between the teachers at Assessment 1 and carers at both assessments appeared stronger than those with teachers at Assessment 2.
•
Correlations on the externalizing ratings were also all significant but there was stronger agreement at the second assessment, including the moderate correlation of 0.52 between carers and teachers at the second assessment.
•
Finally, for total problems like the externalizing cluster, the correlation between carer and teacher ratings was stronger with the teacher at the second assessment.
A second series of analyses were undertaken to assess the agreement on clinical classification of the children. On the internalizing cluster of problems, there was agreement on 74 per cent of children, with most agreement on non-clinical children, and only five children were rated at clinical levels by both teacher and carer. At Assessment 2, there was agreement on 79 per cent; however, there was no agreement on who showed clinically significant behaviour. In total, 23 per cent of children were rated at a clinical level, 16 per cent by carers and a different 7 per cent by teachers. In summary, there was significant agreement between the carers and teachers on the ratings of children; however, they were more likely to agree on the identification of children below clinical threshold problems than above. The most reliable trend was that carers would rate more children at above threshold levels than teachers, especially with regard to externalizing and total problems than internalizing. While this difference may be considered to be an indication that teachers were more conservative than the carers, or perhaps have a better idea of the normal range of behaviour, another explanation is that the structure of the classroom provides sufficient guidelines and rituals for the children to behave within non-clinical levels, and, in the absence of such structure, the carers observe a more problematic spectrum.
Key findings and implications for practice The majority of the children had experienced significant instability in their young lives. First separated from their families of origin at a median of six years of age, more than half had had multiple care placements prior to entering the Barnardos ‘Find a Family’ permanent foster-care programme. Despite the emphasis on ‘family for life’ underpinning the programme, some children experienced a fragile permanence as placements broke down. Placement moves were accompanied by change of schools and consequent broken peer and adult attachments. The children had particularly high levels of psychological need, with multiple and intertwined problems affecting their emotions, mood, behaviour and relational capacities. Significant problems with attention, social interactions,
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anxiety and aggression were identified, approximating estimates from other studies (Clausen et al., 1998; Stahmer et al., 2005). The study sample reflected similar levels of externalizing problems as other foster-care samples such as Newton et al. (2000). Comparisons of mental health outcomes of the general population in previous research provide clear evidence of elevated mental health problems in the care population. It is critical to understand why this is so and what responses are needed. Children in care experience a number of adversities which threaten their well-being. The combination of established factors, such as parental characteristics, maltreatment histories as well as experiences resulting from protective care interventions such as volatile placement trajectories, disrupted attachments and interrupted schooling experiences, influences emotional and behavioural outcomes (Stanley et al., 2005). Previous research has identified relationships between unstable placement careers and children’s emotional and behavioural problems (Newton et al., 2000; Rubin et al., 2006). While children’s behavioural problems may impact on stability of placements, it may be simplistic to overlook system-related deficits that jeopardize placement outcomes. Placement instability is the outcome of poor initial decisions and lack of support to foster-carers. Strengthening professional decision making to ensure children are less likely to move and investing in support of carers are important in improving stability. Planned monitoring of children at increased risk of instability in care, supported with additional professional services to deal with transitions and disrupted attachments, is crucial. Previous research has also shown stable care to have a positive impact on outcomes. James’s (2004) statistical simulations conducted to evaluate the expected effects of placement stability on outcomes predict a 22 and 17.8 per cent decrease in negative outcomes in mental health and education, respectively. The level of emotional and behavioural concerns warrants attention. There is a clear need for systems to identify children in need of professional support early and target necessary resources. Systematic gathering of foster-carers’ perceptions early in placement to identify vulnerabilities of children is important. Documenting carers’ experiences of and responses to children’s emotional and behavioural impairments will help in targeting timely resources to children in need of them most, while recognizing carers as integral to the professional service team (Sinclair et al., 2004). The contribution of carers is examined more fully in separate analyses. There are also implications for supporting carers in enhancing their relationship with troubled children. Implied in this is a range of training needs focused on enabling carers to understand the impact of maltreatment and care histories on children, and skilling foster parents in approaches needed for the sensitive management of children’s emotional and behavioural problems (Sargent and O’Brien, 2004). The study identified a range of concerns related to academic performance, motivational and discipline problems. Through eliciting teachers’ perspectives, there was the additional opportunity to include a quasi control group,
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by asking teachers to assess a second child matched by age and sex to the child in care. At the first assessment, both the children in care and peers in the control group exhibited a range of problems; however, there was evidence of a greater prevalence of problems in the care group. At the second assessment, there were no differences between the two groups on the problem subscales, which, in a restorative programme, is a positive finding. There were even stronger findings on the adaptive functioning scales, with the children in care showing significant improvements relative to peers in the comparison group across all subscales. According to the second assessment ratings, the children were functioning near the 50th percentile, based on the normal population. The control group showed some significant gains but without the same breadth or magnitude. Such positive trends are also reflected in the research of Heath et al. (2001) and Sinclair et al. (2005). Some of this change may be attributed to the effects of the foster-care intervention and specialist mental health services from which the children in care benefited as well as developing attachments to foster-carers. Evidence from children’s data about their relationship with carers suggests that they felt connected to their foster mothers (Fernandez, 2007), indicating that they got on ‘very well’ (63 per cent) or ‘quite well’ (26 per cent). When asked about perceptions of carers and what it was like being in the placement, most comments were positive, as below: I just like living here, cause I get to do some hammering and nailing if I want to . . . and its actually fun, and I get to do ironing, and its great! . . . She is kind, lovely beautiful, sweet, cute . . . like an angel (female, aged eight years). Good, everything is good. I want to stay here until I have money to buy a house (male, aged ten years).
The literature, while profiling problematic behaviours, pays little attention to strengths and competencies of children in care and the manifestation of difficulties across settings. Definitions of problem behaviour are influenced by context and social and cultural expectations of adults reporting such behaviour. These dynamics are reflected in this study and in the literature evaluating carers’ and teachers’ reporting of behaviour problems. In this respect, data on children’s psycho-social functioning from multiple informants helped to capture a more comprehensive picture of outcomes. Without dismissing concerns discussed earlier, the study found positive trends in outcome. The finding that children demonstrated improved outcomes in certain domains between the two waves of data collection suggests that they are benefiting from more stable care through permanent placement, and/or possibly from specialist services accessed while in care. Approximately 75 per cent of the children did not experience a change of placement during the period between Assessments 1 and 2, and 42 per cent were receiving psychological services. The finding that children’s sense of happiness improved over time is a positive finding, implying the potential of placement in care to provide a route to
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intervention for children with maltreating histories and a pathway into restorative services. The long-term care programme presumably afforded a context to develop a more secure base and sense of belonging (Schofield, 2002). The results from the teachers’ comparative assessments of the children in care and the comparison group lend support to resilience literature that views the school environment and the educational process as offering structure, boundaries and security to the children in care systems and furthering their well-being and self-efficacy. The satisfaction of educational needs brings benefits to children in other domains of development, including building self-esteem and resilience (Gilligan, 2001). Gilligan points to the importance of school in offering children positive role models as well as the benefits of ‘routines and rituals’, especially for children experiencing upheaval and adversity in their environment. Frequent changes, instability of care placements and the difficulties involved in starting new schools on a regular basis present significant challenges to children in care that have an impact on their educational outcomes (Jackson, 2001; Harker et al., 2004). Heath et al. (2001) found that children in long-term secure placements did better than children at home with social work support materially in terms of school attendance, and had greater involvement from their foster parents in school life. The research into outcomes for young people and children in care has, in recent years, turned to the ‘success stories’—the positive accounts of those children who, despite being in a group usually considered to be disadvantaged and ‘at risk’ of failure, have done well (Jackson et al., 2005). There were individual children in this study who were rated by teachers in the higher percentile ranges (Table 7) on academic performance and learning. The psychological resilience of these children has become a central tenet of discussion in this area (Gilligan, 2001; Jackson, 2001). So, too, has the concept of protective factors. Positive experience in school is considered to be a protective factor, especially for those children who are severely disadvantaged. Education, which can often be subsumed by welfare concerns, should be given a prominent focus in planning for children in care. Teachers have a key role to play in the enhancement of children’s outcomes and should be recognized in an expanded capacity by other professionals and systems working with children in a corporate parenting role. Schools and caseworkers may represent some continuity and stability to children in care, reducing in part some of the disruption they experience (Stanley et al., 2005). Much of the available literature also points to the negative impact of low expectations for the educational achievements of children in care. Harker et al. (2004) found in their research into children’s views on what would assist them in their studies that children want an adult to take interest and encourage them to do well in their school work. Education for children in care must become a priority for social workers and carers when addressing care plans and for governments’ social investment agenda to compensate for previous social disadvantage (Berridge, 2007).
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A strength of the study is that it generated data on the current experience of children and involved a prospective design. The voices of children added an important dimension to the study, bringing into the research their lived experience. Clearly, the children had individualistic views about the care experience, revealing different perceptions about their needs, strengths and difficulties (Fernandez, 2006). This underlines the importance of listening to children and respecting their capacity and right to self-expression (Gilligan, 2001). The limited size of the sample underlines the need for large-scale longitudinal research. Overall, the findings from this study indicate that despite concerns related to emotional and behavioural development, academic performance and placement instability early in their care, there was evidence of emerging gains in academic and emotional and behavioural outcomes as they progressed in their permanent care placements, supporting the optimistic trends noted in resilience studies in child development. Acknowledging that long-term and intended permanent placements are still liable to breakdown (Thoburn, 1990; Triseliotis, 2002; Sinclair et al., 2005), it is important that long-term fostering has an important niche in the repertoire of placement options for children, who may have a meaningful level of birth family connection but cannot return home, and who can benefit from a more secure psycho-social base with committed foster-carers. Drawing on a framework of resilience, child welfare practitioners could develop strategic interventions that promote children’s strengths and competence and enable them to recover from early adversity. Resilience-enhancing interventions may range from fostering children’s relationship-building skills to supporting carers in acknowledging and reinforcing children’s prosocial behaviours or finding turning points in their school experience through mentoring opportunities and positive peer and adult attachment relationships. Supporting carers in building sensitive and responsive relationships with children in their care and encouraging them to tap into children’s strengths is an important step in the resilience-building process. Good carer and teacher relationships can provide important buffers in helping children cope with changes and adversities they encounter. Equally important is the role of teachers and carers in the creation of roles, identities and strengths so that ‘being in care does not dominate the young person’s sense of self’ (Gilligan, 2001, p. 10). However, there is a danger that a framework of resilience may be used in public policy to withhold resources and supports based on the notion of individual responsibility, or to minimize children’s vulnerabilities. Apart from bolstering children’s resilience, policy and practice must strive to change the odds, whether this relates to placement breakdown or unscheduled school changes, social exclusion or inadequate preventative services. There is a need for a co-ordinated multidisciplinary response to address overlapping domains of need, such as education and mental health, and current policies must favour and target better health and education outcomes for children in care. Accepted: February 2007
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Acknowledgements The author thanks the children, carers and teachers who participated in multiple waves of data collection, and Tina Smith, senior manager, and the case workers at Barnardos’ Find a Family Programme for their involvement in the research. Thanks are also due to Michael Parle, Clinical Psychologist and Consultant, for his contribution to the analysis of the psychometric data. Funding from the Australian Research Council and the Ian Potter Foundation, Australia is gratefully acknowledged.