Understanding Foster Placement Instability for Looked After Children: A Systematic Review and Narrative Synthesis of Quantitative and Qualitative Evidence

Ensuring the stability of foster placements for looked after children is a priority for social services. Many previous studies have highlighted the negative psychological, social and academic consequences of placement breakdown for foster children, but less is known about how services can effectively promote placement stability. A systematic review and narrative synthesis of research examining correlates of placement moves and breakdown were undertaken in order to inform practice in this area. Qualitative studies were included alongside quantitative research, providing additional insights into the processes that facilitate and impede placement stability. Correlates of increased placement instability with the strongest evidence included older age of children, externalising behaviour, longer total time in care, residential care as first placement setting, separation from siblings, foster-care versus kinship care and experience of multiple social workers. Key protective factors included placements with siblings, placements with older foster-carers, more experienced foster-carers with strong parenting skills, and placements where foster-carers provide opportunities for children to develop intellectually. Following from these findings, a conceptual framework is proposed that distinguishes vulnerability and protective factors as well as background and immediate factors. Implications for front line social work practice, including the development of manualised tools, are discussed.

[1]  E. Farmer,et al.  Contact with Family Members and its Impact on Adolescents and Their Foster , 2005 .

[2]  Rae R. Newton,et al.  Children and youth in foster care: distangling the relationship between problem behaviors and number of placements. , 2000, Child abuse & neglect.

[3]  Joseph Kogan,et al.  Placement Stability and Movement Trajectories , 2003, Social Service Review.

[4]  Jason Brown,et al.  Foster parent perceptions of placement breakdown , 2006 .

[5]  G. Schofield,et al.  Foster Carers' Perspectives on Permanence: A Focus Group Study , 2002 .

[6]  Elizabeth Fernandez Pathways in substitute care: Representation of placement careers of children using event history analysis , 1999 .

[7]  K. Gorey,et al.  Historical, Developmental, and Behavioral Factors Associated with Foster Care Challenges , 2004 .

[8]  R. Barth,et al.  Outcomes after child welfare services: Implications for the design of performance measures , 2000 .

[9]  Justeen Hyde,et al.  Adolescents' perspectives on placement moves and congregate settings: Complex and cumulative instabilities in out-of-home care , 2009 .

[10]  R. Barth,et al.  Placement stability for children in out-of-home care: a longitudinal analysis. , 2000, Child welfare.

[11]  T. Belin,et al.  Behavior Problems, Academic Skill Delays and School Failure Among School-Aged Children in Foster Care: Their Relationship to Placement Characteristics , 2000 .

[12]  S. Drapeau,et al.  Processes that contribute to resilience among youth in foster care. , 2007, Journal of adolescence.

[13]  Joseph P. Ryan,et al.  Placement and Permanency Outcomes for Children in Out-of-Home Care by Prior Inpatient Mental Health Treatment , 2009 .

[14]  M. Borland,et al.  Placement Outcomes for Children with Special Needs , 1991 .

[15]  A. Localio,et al.  The Impact of Placement Stability on Behavioral Well-being for Children in Foster Care , 2007, Pediatrics.

[16]  N. Peterson,et al.  Variables associated with disrupted placement in a select sample of abused and neglected children. , 1987, Child abuse & neglect.

[17]  J. T. Pardeck A profile of the child likely to experience unstable foster care. , 1985, Adolescence.

[18]  Robert E. Lee,et al.  Voices from the System: A Qualitative Study of Foster Children's Stories , 2003 .

[19]  B. V. D. Meulen,et al.  Typologies and Outcomes for Foster Children , 2005 .

[20]  J. Barber,et al.  Breakdown of foster care placement: carer perspectives and system factors , 2003 .

[21]  L. Cooper,et al.  The predictors of unsuccessful transition to foster care. , 2001, Journal of child psychology and psychiatry, and allied disciplines.

[22]  N. Gould Integrating Qualitative Evidence in Practice Guideline Development , 2010 .

[23]  C. Schuengel,et al.  Disruptions in foster care: A review and meta-analysis , 2007 .

[24]  J. Kraus Predicting Success of Foster Placements for School-Age Children , 1971 .

[25]  P. Delfabbro,et al.  The psychosocial functioning and family background of children experiencing significant placement instability in Australian out-of-home care , 2008 .

[26]  S. Palmer Placement stability and inclusive practice in foster care: An empirical study , 1996 .

[27]  Alfreda P. Iglehart,et al.  Kinship foster care: Placement, service, and outcome issues , 1994 .

[28]  I. Sinclair,et al.  Matches and Mismatches: The Contribution of Carers and Children to the Success of Foster Placements , 2003 .

[29]  B. Vinnerljung,et al.  Breakdown of teenage placements in Swedish foster and residential care , 2004 .

[30]  L. Leslie,et al.  Predictors of Placement Moves Among Children With and Without Emotional and Behavioral Disorders , 2007 .

[31]  Tina Miller,et al.  Finding qualitative research: an evaluation of search strategies , 2004, BMC medical research methodology.

[32]  S. Altshuler Children in Kinship Foster Care Speak Out: “We Think We're Doing Fine” , 1999 .

[33]  E. Farmer,et al.  Parenting fostered adolescents: skills and strategies , 2003 .

[34]  B. V. D. Meulen,et al.  Indicators for Placement in Foster Care , 2002 .

[35]  Jason Brown,et al.  Causes of Placement Breakdown for Foster Children Affected by Alcohol , 2007 .

[36]  S. J. Leathers,et al.  Placement disruption and negative placement outcomes among adolescents in long-term foster care: the role of behavior problems. , 2006, Child abuse & neglect.

[37]  G. Schofield Resilience and Family Placement: A Lifespan Perspective1 , 2001 .

[38]  H. Ward,et al.  Performance Targets and Stability of Placements for Children Long Looked after Away from Home. , 2001 .

[39]  C. Sellick From Famine to Feast. A Review of the Foster Care Research Literature , 2006 .

[40]  A. Faulkner,et al.  Promoting stability and continuity of care for looked after children: a survey and critical review , 2005 .

[41]  Yvonne A. Unrau Research on placement moves: Seeking the perspective of foster children , 2007 .

[42]  Susan F. Stone,et al.  The Prediction of Successful Foster Placement , 1983 .

[43]  N. Black,et al.  The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. , 1998, Journal of epidemiology and community health.

[44]  Lawrence Palinkas,et al.  Design Elements in Implementation Research: A Structured Review of Child Welfare and Child Mental Health Studies , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[45]  G. Cuddeback,et al.  Foster Parents’ Perceptions of Factors that Promote or Inhibit Successful Fostering , 2003 .

[46]  A. Beck Addressing the Mental Health Needs of Looked after Children Who Move Placement Frequently , 2006 .

[47]  H. Ward Patterns of instability: Moves within the care system, their reasons, contexts and consequences , 2009 .

[48]  J. Aldgate,et al.  Celebrating Success: What Helps Looked After Children Succeed , 2006 .

[49]  L. Earley,et al.  ‘One in, One Out’?: The Dilemma of having Multiple Children in Foster Placements , 2008 .

[50]  D. Hallas A model for successful foster child-foster parent relationships. , 2002, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[51]  Charles,et al.  ‘The past, the present, but never the future’: thematic representations of fostering disruption , 1999 .

[52]  Julie Glenndenning Children looked after in England (including adoption and care leavers) year ending 31 March 2013 , 2013 .

[53]  K. Trew,et al.  Children's adjustment over time in foster care: cross-informant agreement, stability and placement disruption , 2000 .

[54]  M. Stoolmiller,et al.  Who disrupts from placement in foster and kinship care? , 2006, Child abuse & neglect.

[55]  S. Biddle,et al.  Family correlates of breakfast consumption among children and adolescents. A systematic review , 2009, Appetite.

[56]  J. A. Walsh,et al.  Studies of the maintenance of subsidized foster placements in the Casey Family Program. , 1990, Child welfare.

[57]  S. J. Leathers Separation from siblings: Associations with placement adaptation and outcomes among adolescents in long-term foster care , 2005 .

[58]  Charles L. Usher,et al.  Placement Patterns in Foster Care , 1999, Social Service Review.

[59]  J. Landsverk,et al.  Placement movement in out-of-home care: patterns and predictors , 2004 .

[60]  M. Dixon-Woods,et al.  Including qualitative research in systematic reviews: opportunities and problems. , 2001, Journal of evaluation in clinical practice.

[61]  G. T. Swart,et al.  Risk and Protective Factors Affecting Children in Foster Care: A Pilot Study of the Role of Siblings* , 1992, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[62]  Sandy Oliver,et al.  An Emerging Framework for Including Different Types of Evidence in Systematic Reviews for Public Policy , 2005 .