Characteristics of Children in Foster Care, Family-Style Group Care, and Residential Care: A Scoping Review

Harmke Leloux-Opmeer; Chris Kuiper; Hanna Swaab; Evert Scholte

doi:10.1007/s10826-016-0418-5

Leloux-Opmeer, Harmke;Kuiper, Chris;Swaab, Hanna;Scholte, Evert;

2016-04-04 00:00:00

J Child Fam Stud (2016) 25:2357–2371 DOI 10.1007/s10826-016-0418-5 ORIGINAL PAPER Characteristics of Children in Foster Care, Family-Style Group Care, and Residential Care: A Scoping Review 1 1 2 3 • • • Harmke Leloux-Opmeer Chris Kuiper Hanna Swaab Evert Scholte Published online: 4 April 2016 The Author(s) 2016. This article is published with open access at Springerlink.com Abstract When risky child and family circumstances existing knowledge gaps regarding relevant risk factors. cannot be resolved at home, (temporary) 24-h out-of-home Future research is recommended to ﬁll these gaps and placement of the child may be an alternative strategy. To determine the developmental pathway in relation to chil- identify speciﬁc placement risks and needs, care profes- dren’s risks and needs at admission. This will contribute to sionals must have information about the child and his or the development of an evidence-based risks and needs her family, care history, and social-cultural characteristics assessment tool that will enable care professionals to make at admission to out-of-home care. However, to date infor- informed referrals to a speciﬁc type of out-of-home care mation on case characteristics and particular their simi- when such a placement is required. larities and differences across the three main types of out- of-home settings (namely foster care, family-style group Keywords Out-of-home care Characteristics Foster care, and residential care) is largely lacking. This review care Family-style group care Residential care compiles and compares characteristics of school-aged children of average intelligence and their families at the time of each child’s admission to one of the three care Introduction modalities. A scoping review technique that provides a broad search strategy and ensures sufﬁcient coverage of the The United Nations Convention on the Rights of the Child available literature is used. Based on the 36 studies inclu- states that every child has the right to live with his or her ded, there is consensus that the majority of normally parents or to stay in touch with them, unless this would intelligent children in care demonstrate severe develop- harm the child’s development (United Nations 1989). It mental and behavioral problems. However, the severeness also states that every child has the right to grow up in a as well as the kinds of deﬁning characteristics present supportive, protective, and caring environment that pro- differ among the children in foster care, family-style group motes his or her full potential. Positive child development care, and residential care. The review also identiﬁes several is sometimes compromised by development-threatening child characteristics, adverse family circumstances, or interactions between both areas. When these risky cir- & Harmke Leloux-Opmeer cumstances cannot be effectively addressed by appropriate [email protected] outpatient support, 24-h out-of-home placement of the Horizon Youth Care and Special Education, Mozartlaan 150, child is usually considered a meaningful strategy for 3055 KM Rotterdam, The Netherlands remediating the developmental risks (Bhatti-Sinclair and Department of Clinical Child and Adolescent Studies, Sutcliffe 2012; Huefner et al. 2010; Pinto and Maia 2013; Faculty of Social and Behavioural Sciences and Leiden Vanschoonlandt et al. 2013). Institute of Brain and Cognition, Leiden University, Leiden, Out-of-home (24-h) care consists of a continuum of The Netherlands intensive and restrictive care services, which range from Department of Clinical Child and Adolescent Studies, lower-level family-based settings (e.g. relative foster care) Faculty of Social and Behavioural Sciences, Leiden to family-style group care to several types of residential University, Leiden, The Netherlands 123 2358 J Child Fam Stud (2016) 25:2357–2371 treatment care (Huefner et al. 2010). Residential treatment factors and needs at the time of admission to a certain type centers in turn also reﬂect a continuum of services that vary of out-of-home care is to date largely unavailable or from open residential to secure residential to inpatient ambiguous (Barth 2002). psychiatric care (Barth 2002). Secure residential care This paper compiles and compares child, family, care seems to be especially preferred in juveniles with persistent history, and social-cultural characteristics at admission of aggressive behavior problems (Vermaes and Nijhof 2014), children who are placed in three of the main types of out- whereas inpatient psychiatric care is reserved for children of-home care (namely foster care, family-style group care, who additionally display psychotic or suicidal behavior and residential care). A scoping review technique is used to (Curtis et al. 2001; Huefner et al. 2010). In family-style (1) chart case characteristics of normally intelligent chil- group care, children live in home-like settings with live-in dren (aged 6–12 years) placed out-of-home in one of the workers (Lee and Thompson 2009). This kind of care can three main care modalities, (2) deﬁne similarities and dif- be viewed as an intermediate setting between foster and ferences among those characteristics, (3) determine the residential care (Barth 2002; Huefner et al. 2010; Rouvoet severity of the child and family’s problems, and (4) iden- 2009). tify the existing knowledge gaps within research on this In accordance with the United Nations Guidelines for particular population. The results of this scoping review the Alternative Care of Children (henceforth ‘‘UN guide- will help practitioners and policy makers to be aware of lines’’), foster care or other family-based settings are the speciﬁc risk factors and needs associated with children predominant types of care when out-of-home placement is placed out-of-home, which might promote positive child required (United Nations 2009, December 18). These set- development and reduce the risk of placement breakdowns. tings are considered to be most consistent with the best In addition, knowledge of these factors may contribute to interests and needs of the child (Courtney 1998; Doran and the increased demand for an evidence-based assessment Berliner 2001; Harder et al. 2013). However, little scien- tool to determine these speciﬁc risks and needs of disturbed tiﬁc evidence is available to support the recommendation to children; such as the Risk-Need-Responsivity model of place children in family-based settings such as foster care Andrews et al. (2011). (Bartelink 2013; Grietens 2012; Hussey and Guo 2002). In addition, one-third to one-half of foster children experience serious placement disruptions (Scholte, 1997; Van den Method Bergh and Weterings 2010; Van Manen 2011). These placement disruptions have negative impacts on children’s We considered a scoping review to be the most ﬁtting well-being and functioning. They also increase the risk of technique for answering our research question. Such a behavioral and emotional problems and heighten the like- review provides a broad search strategy that includes hand lihood of new (placement) breakdowns in subsequent foster searching through key journals, reference lists from the families (Doran and Berliner 2001; Newton et al. 2000; literature, and information from relevant organizations or Oosterman et al. 2007; Strijker et al. 2008). One of the existing networks (Arksey and O’Malley 2005). This main reasons for breakdowns in foster care is the child’s technique is generally used to summarize research ﬁndings level of externalizing behavior problems (Barber and and identify research gaps (Arksey and O’Malley 2005). Delfabbro 2002; Newton et al. 2000; Strijker et al. 2008; Hereto we used an adaptation of the developmental Vanschoonlandt et al. 2012). Several researchers have framework of Kerig et al. (2012). The framework of Kerig therefore suggested that children with certain speciﬁc et al. (2012) is based on a holistic and dynamic approach (treatment) needs are better off when they are placed that perceives a child’s development as being the result of directly in a more restricted treatment setting such as res- interaction between a series of successive developmental idential care (Barber et al. 2001; Butler and McPherson processes. Simultaneously, the child interacts with his or 2007; De Swart et al. 2012; Doran and Berliner 2001; her different contexts of development and deals with the Hussey and Guo 2002; Scholte 1997). Similarly, the UN attending risk and protective factors (Kerig et al. 2012). In guidelines state that residential care is applicable ‘‘for cases line with this framework, we distinguished ﬁve contexts of where such a setting is speciﬁcally appropriate, necessary development: (a) biological, (b) individual, (c) family, and constructive for the individual child concerned and in (d) care history, and (e) social-cultural. his/her best interests’’ (United Nations 2009, December 18, The following inclusion criteria were used. Studies had p. 5). This statement implies that individual and contextual to (a) focus primarily on child and family-related charac- characteristics at the time of admission will partly deter- teristics at admission that connect to the chosen develop- mine which setting across the continuum of out-of-home mental framework; (b) concern Western-oriented literature; care services is most appropriate. However, information on (c) be written in English or Dutch; (d) have a publication similarities and differences in a child’s attending risk date from 1990 onwards; (e) relate mainly to school-aged 123 J Child Fam Stud (2016) 25:2357–2371 2359 (i.e. 6–12 years) children; and (f) focus on a research type(s) of care-modality, sample size, and country of origin population that is comparable to the European population considered for each included primary empirical study. in terms of ethnicity. The review’s exclusion criteria were Three noteworthy comments can be made with regard to (a) studies concerning adopted children or children with the included articles. First, there was some overlap between intellectual disabilities; (b) studies related to crisis place- the datasets used for analysis in the reports of Strijker et al. ments, secure residential care, and inpatient psychiatric (2002, 2005); Hussey (2006); Hussey and Guo (2002); and care; (c) and graduate-level theses or dissertations. No Tarren-Sweeney (2008, 2013). We nevertheless decided to differences were made between articles about kinship include all of the articles, due to the different purposes of foster care (i.e. care by relatives) and non-kinship foster each study. Second, all of the foster care articles concerned care, due to the ambiguity of evidence in relation to the long-term foster care; the sole exception was the article of superior performance of either form of care (Wilson et al. Lee and Thompson (2008), which speciﬁcally related to 2004). treatment foster care. Finally, although we used the results We undertook systematic searches with a combination of Minnis e tal. (2006) for the description of several of search terms in the following electronic databases: characteristics, we excluded their results from our sum- CINAHL, ERIC, PsychInfo, and MEDLINE. Due to the mary table of case characteristics (Table 2). This was heterogeneity of the terminology in youth care studies, we because the mostly Caucasian ethnic composition of their used a broad scope of search terms to achieve sufﬁcient population is not comparable with the composition of the coverage of the available literature. Such an approach is European population. common when scoping reviews are conducted (Arksey and O’Malley 2005). First, to deﬁne the relevant case charac- teristics, we used the terms typolog*, epidemolog*, Results prevalence, proﬁle, baseline, characteristic, discriminat*, variable, cue, differ*, similar*, and compar*. Second, to In this section, the differences and similarities of children deﬁne the research population we used child*, infant, boy, at admission to foster care, family-style group care, and girl, juvenile, kid, youth, and toddler. Finally, to deﬁne residential care that were identiﬁed during the literature settings for out-of-home care we used residential, institu- review are discussed. Additionally, all reported deﬁning tional, foster, out-of-home, group home, shelter care, group characteristics are summarized in Table 2, where they are care, teaching family homes, family home, family-style arranged by both the ﬁve contexts of development and the group care, teaching family model, and family type home. three care modalities. Thereafter, the results were reﬁned to focus speciﬁcally on studies that considered school-aged children (i.e. Biological Context 6–12 years old) and used the following types of method- ology: systematic review, meta-analysis, literature review, Within the biological context, gender was frequently prospective study, follow-up study, and longitudinal study. mentioned as a deﬁning characteristic. In most studies, Additional articles were obtained using the snowball girls were more represented in foster care than boys method, in which we followed references of interest from (Armsden et al. 2000; James et al. 2012; Lee and relevant handbooks, key journals, and certain articles. Thompson 2008; Scholte 1997; Strijker et al. 2005, 2008; Similarly, we hand-searched the sites of relevant organi- Van den Bergh and Weterings 2010; Vanderfaeillie et al. zations that work in the ﬁeld of youth care, such as the 2013; Vanschoonlandt et al. 2013). Some researchers found Netherlands Youth Institute. a slightly higher percentage of boys, up to a maximum of We determined whether all of the articles identiﬁed 56 % (Holtan et al. 2005; Minnis et al. 2006; Wilson et al. through the literature search met the inclusion criteria 2004). Conversely, in family-style group care boys were based on their title, abstract, and key words. If they did, mostly represented (Gardeniers and De Vries 2011; Lee their full texts were imported into the ‘‘Endnote’’ biblio- and Thompson 2008; Van der Steege 2012). Here the graphic software package. We then used Microsoft Excel to reported percentages of boys varied from 54 to 62 %. record several literature data characteristics as the basis for However, very little evidence was found that the gender the ﬁnal selection of articles. The ﬁnal results of the search differences between foster care and family-style group care strategy, including the speciﬁc reasons for article exclu- are statistically signiﬁcant. Only Lee and Thompson (2008) sion, are displayed in a ﬂowchart (Fig. 1). Articles that reported a signiﬁcant difference in the number of boys in were only used to build the introduction or deﬁne speciﬁc these two categories. Finally, the vast majority of the terms are hereby excluded. In total, 36 articles met all of children in residential care were boys; the percentages the inclusion criteria when their full texts were considered. varied from 59 to 72 % (Hussey 2006; Hussey and Guo The accompanying Table 1 identiﬁes the considered 2002; James et al. 2012; Lee and Thompson 2008; Scholte 123 2360 J Child Fam Stud (2016) 25:2357–2371 Fig. 1 Flowchart showing the results of the search strategy 1997; Scholte and Van der Ploeg 2010). Nevertheless, placed out-of-home. However, they only included children neither James et al. (2012) nor Scholte (1997) found any aged 8 years and older in their research population, which statistically signiﬁcant differences between foster and res- might have increased the reported mean age of admission. idential care concerning gender differences. Lastly, the average age of admission for residentially With respect to age of admission, children in foster care placed children appear to be the highest of the three set- were on average between 7 and 11 years old (Barber and tings. The reported mean ages varied from 10 to 14 years Delfabbro 2009; Bernedo et al. 2014; James et al. 2012; (Hussey 2006; James et al. 2012; Scholte 1997; Scholte and Minnis et al. 2006; Strijker et al. 2008, 2002). Only Tarren- Van der Ploeg 2010). In comparison with foster children, Sweeney (2013) found an average age of 3.5 years at entry residentially placed children were reported to be signiﬁ- into care, although this presumably concerns the age at ﬁrst cantly older at admission (James et al. 2012; Scholte 1997). placement. In family-style group care, the mean age of Curtis et al. (2001) made the same conclusion based on admission varied from 10 to 12 years old (Gardeniers and their literature review. Only two studies speciﬁcally De Vries 2011; Van der Steege 2012). According to Lee reported age at the time of ﬁrst placement into out-of-home and Thompson (2008), children in family-style group care care: Yampolskaya et al. (2014) found an average age of were signiﬁcantly older than children in foster care when 6.4 years (SD = 5.4), while Hussey and Guo (2002) 123 J Child Fam Stud (2016) 25:2357–2371 2361 Table 1 Summary table of Study (publication year) Setting(s) N Country of origin study characteristics of included primary empirical studies Armsden et al. (2000) FC 362 USA (n = 29) Barber and Delfabbro (2009) FC 235 Australia Bernedo et al. (2014) FC 104 Spain Bhatti-Sinclair and Sutcliffe (2012) OCN 274,203 USA Esposito et al. (2013) OCN 2940 Canada Franze´n et al. (2008) FC, RC 3485 Sweden Gardeniers and De Vries (2011) FGC 162 The Netherlands Holtan et al. (2005) FC 135 Norway Hussey (2006) RC 306 USA Hussey and Guo (2002) RC 142 USA James et al. (2012) FC, RC 1191 USA Lee and Thompson (2008) FC, FGC 828 USA Minnis et al. (2006) FC 175 UK Newton et al. (2000) FC 514 USA Scholte (1997) FC, RC 81 The Netherlands Scholte and Van der Ploeg (2010) RC 123 The Netherlands Strijker and Knorth (2009) FC 419 The Netherlands Strijker et al. (2008) FC 419 The Netherlands Strijker et al. (2002) FC 120 The Netherlands Strijker et al. (2005) FC 91 The Netherlands Sullivan (2008) FC 2996 USA Tarren-Sweeney (2008) FC 347 Australia Tarren-Sweeney (2013) FC 347 Australia Van der Steege (2012) FGC 56 The Netherlands Vanderfaeillie et al. (2013) FC 49 Belgium Vanschoonlandt et al. (2012) FC 20 Belgium Vanschoonlandt et al. (2013) FC 212 Belgium Yampolskaya et al. (2014) OCN 33,092 USA Zima et al. (2000) FC, RC 330 USA FC foster care, FGC family-style group care, RC residential care, OCN out-of-home care, not otherwise speciﬁed Only information of the cohort ‘school-aged children (6–12)’ has been used reported an average of 4.9 (speciﬁcally for residentially health problems such as epilepsy and motor neurological placed children). It should be noted that the ambiguity in conditions, whereas both James et al. (2012) and Yam- reported ﬁgures is presumably due to differences in polskaya et al. (2014) used a broader deﬁnition like ‘‘the research methodology between the included studies. presence of any serious chronic physical health conditions A third deﬁning characteristic of children in care was that adversely impact the child’s daily functioning’’ their physical health. Yampolskaya et al. (2014) demon- (Yampolskaya et al. 2014, p. 196). strated that six percent of the children had physical health Lastly, some studies reported the average IQ of children problems. However, James et al. (2012) reported substan- in care. A meta-analysis of IQ delays in orphanages by Van tially more chronic health problems for children in both IJzendoorn (2008) showed a mean IQ of 84.4 (SD = 16.8), foster and residential care: they found that approximately which can be classiﬁed as ‘‘below average’’ intellectual one-third of the children have these problems. Likewise, functioning. Hussey and Guo (2002) also found a mean IQ Tarren-Sweeney (2008) indicated physical health problems of this order for residentially placed children (M = 82.5, in 30 % of the foster children. The comparability of the SD = 17.4). On the other hand, a longitudinal survey of ﬁndings related to physical health problems is limited by residentially placed children by Scholte and Van der Ploeg the heterogeneity of these problems’ deﬁnition. Tarren- (2010) showed a mean IQ of 90.2, which reﬂects lower Sweeney (2008) for example referred to speciﬁc physical levels of ‘‘average intelligence.’’ Unfortunately, no study 123 2362 J Child Fam Stud (2016) 25:2357–2371 Table 2 Summary table of Foster care Family-style group care Residential care deﬁning characteristics, arranged by context and setting Biological context Male gender/child (%) 38–56 54–62 59–72 Mean age of admission/child (years) 7.5–11.0 10.0–12.0 9.9–13.8 Chronic health problems/child (%) 27–30 7 38 Mean IQ/child unkn. unkn. 82.5–90.2 Individual context Emotional problems/child (%) 14–45 unkn. 39–57 Behavioral problems/child (%) 34–63 40–60 53–62 Attachment problems/child (%) 14–20 50 31–52 School/cognitive problems/child (%) 15–36 30–36 20–55 Use of medication/child (%) 36 unkn. 92 Family context Divorced/biological parents (%) 84 43 72–80 Deceased/parent (%) unkn. 27 unkn. (Physical/emotional) child abuse (%) 5–45 28–52 15–63 (Physical/emotional) child neglect (%) 21–78 39–41 29–69 Child sexual abuse (%) 6–29 17 11–46 Domestic violence (%) 32–41 31 16–18 Parental mental illness (%) 30–61 20–38 41–61 Parental substance abuse (%) 19–34 21 26–49 Parental incarceration (%) 26 16 12 Care history context Number of previous placements (mean) 1.3–3.4 2.0 4.3–6.6 Admission from birth home (%) 45–56 23 48–52 Child protective service custody (%) 57–59 65–82 66–73 Social-cultural context Peer problems (%) 8 29 46 Caucasian ethnic background (%) 51–58 60–93 49–77 Low income/poverty (%) 81 unkn. 83–95 When percentages or means varied, the range is given Unkn. = unknown Total IQ-score was found reporting the mean IQ of foster children and for out-of-home placement. In the literature, a frequently children placed in family-style group care. De Swart et al. mentioned risk factor was the presence of emotional (2012) conﬁrmed in their meta-analysis, that even to date problems. A recent study of Yampolskaya et al. (2014) remarkable few studies include IQ as moderator, whilst found that more than half (53 %) of the children in care had literature data have shown that this factor partly affects the such problems. With regard to foster care, the reported child’s cognitive abilities and learning style. However, a percentage of foster children with emotional problems retrospective study by Tarren-Sweeney (2008) concluded varied from 14 to 45 %, mostly as measured with the Child that nearly 23 % of foster children had an intellectual Behavior Checklist (CBCL) (Armsden et al. 2000; Bernedo disability. In general, available data indicate that a lower et al. 2014; James et al. 2012; Minnis et al. 2006; Scholte IQ is associated with higher levels of psychopathology 1997; Sullivan 2008; Tarren-Sweeney 2013; Vanderfaeillie (Hussey and Guo 2002; Tarren-Sweeney 2008). et al. 2013). Within residential care, this prevalence rate varied from 39 to 57 % (James et al. 2012; Scholte 1997; Individual Context Scholte and Van der Ploeg 2010). No information was found regarding emotional problems in children placed in According to Bhatti-Sinclair and Sutcliffe (2012), risk family-style group care. When comparing the number of factors within the individual context are the main reason children with emotional problems in foster and residential 123 J Child Fam Stud (2016) 25:2357–2371 2363 care, James et al. (2012) did not ﬁnd any statistically sig- family-style group care, attachment problems were repor- niﬁcant differences. However, Scholte (1997) demon- ted in 50 % of the children (Van der Steege 2012). Finally, strated that residentially placed children showed emotional Scholte and Van der Ploeg (2010) found signs of social and problems signiﬁcantly more often than foster children. emotional detachment in 31 % of the residentially placed Considering behavior problems, the number of foster children. In this study, the Social Emotional Detachment children with a score in the (borderline) clinical range on Questionnaire (in Dutch called VFO) was used (Scholte the externalizing problems scale of the CBCL covered a and Van der Ploeg 2007). They have similarly inventoried broad area, varying from 34 to 63 % (Armsden et al. 2000; the rate of children with insecure attachment patterns based Bernedo et al. 2014; James et al. 2012; Minnis et al. 2006; on the children’s case ﬁles and found a percentage of 52 % Tarren-Sweeney 2013; Vanderfaeillie et al. 2013; Van- (Scholte and Van der Ploeg 2010). Generally speaking, on schoonlandt et al. 2013). At least one-third of foster chil- average one-third of the children in care have attachment dren had these problems. In contrast, Scholte (1997) problems. This was also conﬁrmed in a meta-analysis by reported much lower scores on the different subscales Van IJzendoorn et al. (1999), who demonstrated that 38 % belonging to the externalizing problems scale, varying of the children (aged 0–4 years) in ‘‘normal’’ middle class, from 10 to 15 %. This difference is probably due to the nonclinical groups in North America showed insecure dating of the research. Last decades, more children with attachment patterns. severe psychosocial problems presumably have been A fourth relevant factor was the cognitive development admitted to foster care instead of being placed in more and related school performance. As noted previously, both restricted types of care [in accordance with the UN aspects are affected by the child’s intelligence (De Swart guidelines (2009, December 18)]. In family-style group et al. 2012). Problems in cognitive development and poor homes, 40–60 % of the children showed behavior prob- school performance seem to be the least common in foster lems, especially hyperactive and impulsive or deﬁant and care; at most one-third of the foster children had poor antisocial behavior (Van der Steege 2012). Lee and academic performance (Bernedo et al. 2014; James et al. Thompson (2008) found that children in family-style group 2012; Minnis et al. 2006; Scholte 1997; Tarren-Sweeney homes had (with statistical signiﬁcance) more behavior 2008). Likewise, according to Van der Steege (2012) found problems than those placed in treatment foster care. that approximately one-third of the children in family-style Finally, behavior problems were reported in more than half group care demonstrated cognitive problems such as social of the children at admission to residential care (James et al. skills problems and attention problems. With regard to 2012; Scholte 1997; Scholte and Van der Ploeg 2010). The residential care, the reported percentages of children with same studies also reported that residentially placed children cognitive problems showed more variability. One-ﬁfth to showed (with statistical signiﬁcance) more behavior prob- one-half of the children appeared to have school-related lems in comparison with foster children. As claimed by problems, such as poor school motivation or delays in Esposito et al. (2013), the degree of behavior problems language, cognition, or adaptive behavior (James et al. increases the risk of an out-of-home placement, in partic- 2012; Scholte 1997; Scholte and Van der Ploeg 2010). ular for older children. Zima et al. (2000) found a relationship between caregiver The behavior problems seem in part to be related to scores in the clinical range on the CBCL and a history of attachment problems (Newton et al. 2000; Vanschoonlandt suspension or expulsion. In total, they reported that 14 % et al. 2012). Therefore, the quality of the attachment of the children in care experienced at least one suspension development of children in care is a third relevant factor or expulsion (Zima et al. 2000). These researchers also within the individual context. A recent review of Pritchett reported that 23 % of the children in care had reading and et al. (2013) concluded that the severeness of attachment math skill delays and that 13 % repeated at least one grade problems was related to negative placement outcomes. (Zima et al. 2000). Unfortunately, no distinction was made Nevertheless, little detailed information was found con- between foster and residentially placed children. James cerning the prevalence of the attachment problems of et al. (2012) did not ﬁnd any signiﬁcant differences in children placed out-of-home. The deﬁnition of attachment cognitive development and school performance when problems also appeared to be very heterogeneous. Con- comparing residentially placed and foster children. In cerning foster care, Tarren-Sweeney (2013) found symp- contrast, Scholte (1997) found signiﬁcantly more school- toms in 20 % of the foster children that speciﬁcally related related problems in residentially placed children than in to complex attachment problems that were not reducible to foster children. Because different aspects of cognitive other psychiatric disorders. Strijker et al. (2008) reported a development and school performance were measured in the slightly lower percentage of 14 %, but they only included two studies, their results are not directly comparable. In foster children with an actual Diagnostic Manual of Mental general, both Pritchett et al. (2013) and De Swart et al. Disorder classiﬁcation for reactive attachment disorder. In (2012) state that little is known about the school 123 2364 J Child Fam Stud (2016) 25:2357–2371 performance, cognitive skills, and IQs of out-of-home emotional child abuse among foster children, physical placed children in relation to placement outcomes. Fur- abuse seems to be less common: up to one-third of them thermore, Pritchett et al. (2013) conclude that the existing have a history of this type of abuse. Regarding family-style literature shows conﬂicting results concerning whether risk group care, Van der Steege (2012) reported a similar per- factors in this area enhance the chance of negative place- centage of 28 % of children being physically or emotion- ment outcomes. ally abused. In contrast, Lee and Thompson (2008) stated Finally, a study of Tarren-Sweeney (2008) indicated that that 52 % of the children in family-style group care 36 % of foster children were prescribed any type of med- experienced physical or emotional abuse. Lastly, the per- ication; most common ones being mood-altering (‘‘psy- centage of residentially placed children with a history of chotropic’’) and asthma medications. For children in this type of abuse varied from 15 to 63 % (Hussey 2006; residential care, Hussey and Guo (2002) reported a very Hussey and Guo 2002; James et al. 2012; Lee and high percentage (92 %) of children using psychotropic Thompson 2008; Scholte and Van der Ploeg 2010). It is medication. No studies related to the use of medication in noteworthy that the Hussey and Guo’s (2002) reported family-style group care were found. percentage of 63 % was almost twice as high as other reported percentages for residentially placed children. This Family Context is possibly due to the speciﬁc research population in that study. Numbers concerning parental divorce were searched ﬁrst. Another common type of child abuse was physical or The percentage of divorced parents (43 %) in family-style emotional neglect. In short, the literature suggests that at group care reported by Van der Steege (2012) approxi- least one-quarter to one-third of out-of-home placed chil- mated the overall divorce rate in the Netherlands, which is dren experience neglect, although the presented percent- 37 % (Centraal Bureau voor de Statistiek 2013). Moreover, ages differ considerably. For foster children, in general 14 % of the children with divorced parents lived in a one-half to two-thirds of the children have been neglected stepfamily (Van der Steege 2012). The percentage of within their family of origin (Bernedo et al. 2014; James divorced parents in both foster and residential care is many et al. 2012; Lee and Thompson 2008; Strijker and Knorth times higher. In foster care, Scholte (1997) reported a 2009; Tarren-Sweeney 2008; Yampolskaya et al. 2014). percentage of 84 %. Similarly, in residential care the per- Only Vanschoonlandt et al. (2013) found a much lower centage of divorced parents was indicated as being between percentage of neglected foster children, namely 21 %. Lee 72 and 80 % (Scholte 1997; Scholte and Van der Ploeg and Thompson (2008) found that foster children had a 2010). It should be noted that all of the reported percent- history of neglect signiﬁcantly more often than children ages are based on Dutch research populations. Also related placed in family-style group care. When it comes to this to the family composition is the percentage deceased latter type of care, about 40 % of the children have expe- parents. Numbers were only found for family-style group rienced physical neglect, emotional neglect, or both within care. Van der Steege (2012) reported that 9 % of the their family of origin (Lee and Thompson 2008; Van der mothers and 18 % of the fathers of placed children were Steege 2012). In residential care, ﬁndings demonstrated deceased. percentages of neglected children that varied from 26 to Next to family composition, the degree of family 69 % (Hussey and Guo 2002; James et al. 2012; Lee and problems was a relevant deﬁning characteristic in children Thompson 2008; Scholte and Van der Ploeg 2010). Barber placed out-of-home. Complex and multiple family prob- and Delfabbro (2009) stated that in general terms, child lems are a main reason for out-of-home placement of neglect mainly occurs in young children. Both Barber and young children (aged 0–9 years) in particular (Esposito Delfabbro (2009) and Spinhoven et al. (2010) also found et al. 2013; Yampolskaya et al. 2014). A commonly that neglected children have an increased risk of other mentioned risk factor in this area was child abuse. Con- forms of child abuse. In addition, (emotionally) neglected cerning physical or emotional child abuse, approximately children are most vulnerable for lifetime mood disorders 5–45 % of foster children have a history of this type of like anxiety or depression in the future (Spinhoven et al. abuse (Bernedo et al. 2014; James et al. 2012; Lee and 2010). It therefore seems very important to be alert for Thompson 2008; Scholte 1997; Strijker et al. 2008; Tarren- signs of child neglect in the event of family problems. Sweeney 2008). Only Minnis et al. (2006) reported a much A third form of child abuse was child sexual abuse. In higher percentage of emotional child abuse in their Scottish foster care, most studies concluded that about 10 % of sample, namely 77 %. On the other hand, the reported foster children have been sexually abused in the past percentage of 5 % by Vanschoonlandt et al. (2013) was (Bernedo et al. 2014; James et al. 2012; Scholte 1997; actually very low in comparison to other studies concern- Strijker et al. 2008; Tarren-Sweeney 2008). At the same ing foster care. When distinguishing between physical and time, Minnis et al. (2006) and Lee and Thompson (2008) 123 J Child Fam Stud (2016) 25:2357–2371 2365 respectively found percentages of 28 and 29 % in relation parental substance abuse, in all three types of care at least to foster children. As far as children in family-style group one in ﬁve parents have alcohol or drug problems (Hussey care are concerned, very little information was found: only 2006; Hussey and Guo 2002; Lee and Thompson 2008; a study of Lee and Thompson (2008) reported a percentage Strijker et al. 2008; Yampolskaya et al. 2014). Hussey and of 17 %. This study additionally showed that foster chil- Guo (2002) even reported drug abuse in 49 % of the par- dren had a history of sexual abuse signiﬁcantly more often ents of children in residential care. Regarding parental than children placed in family-style group care. For resi- incarceration, Hussey and Guo (2002) demonstrated that dentially placed children, the percentage of those who have slightly more than 10 % of the residentially placed children experienced child sexual abuse in the past appears to be had an incarcerated parent. Lee and Thompson (2008) around 10 % (James et al. 2012; Scholte 1997; Scholte and found a similar percentage (16 %) of incarcerated parents Van der Ploeg 2010). Remarkably, Hussey (2006) reported for children in family-style group care and a (statistically that almost half of residentially placed children have been signiﬁcant) higher percentage for foster children (26 %). sexually abused, whereby girls were almost one and a half times more at risk (61 %) than boys. Care History Context Next to child abuse, domestic violence was also a rele- vant risk factor. In foster and family-style group care, To start with, the mean number of previous placements was domestic violence occurs within about one-third of the an important deﬁning characteristic. For the Netherlands, families of origin (Lee and Thompson 2008; Strijker et al. we found no literature related to the mean number of 2008; Tarren-Sweeney 2008; Yampolskaya et al. 2014). placements or repeated referrals to the three care modalities Lee and Thompson (2008) even reported percentages of concerned. A large study of Yampolskaya et al. (2014), 41 % for foster children and 31 % for children in family- however, suggested that almost a quarter of the children in style group care, with statistically signiﬁcant differences care have already experienced a previous placement, of between both percentages. As far as residentially placed which 29 % have been admitted at least four times since children are concerned, only Hussey and colleagues their ﬁrst referral to youth care. For foster children, some reported domestic violence ﬁgures. They concluded that studies reported a mean of 3.1–3.4 previous placements such violence occurs within about one-sixth of the families (Lee and Thompson 2008; Tarren-Sweeney 2013). Other of origin (Hussey 2006; Hussey and Guo 2002). studies related to foster care reported a lower mean of Furthermore, the presence of parental mental illness previous placements that lied between 1.3 and 1.8 (James could be identiﬁed as an important risk factor within the et al. 2012; Strijker et al. 2008). Concerning children in family context. In relation to all three types of care, at least family-style group care, Lee and Thompson (2008) con- one in three parents show mental illness (Hussey and Guo cluded that these children have experienced signiﬁcantly 2002; Lee and Thompson 2008; Scholte 1997; Scholte and fewer previous placements than foster children, speciﬁcally Van der Ploeg 2010; Strijker et al. 2008; Van der Steege 2.0 placements. Finally, previous placements in residential 2012). However, Scholte and Van der Ploeg (2010) care appear to be the highest, with an average of at least reported that a much higher percentage (61 %) of the four (Hussey 2006; Hussey and Guo 2002; James et al. parents (of residentially placed children) showed mental 2012). James et al. (2012) stated that residentially placed illness, whereby mothers clearly more often had these children experienced signiﬁcantly more placements than problems (49 %) than fathers (12 %). Likewise, ﬁndings of foster children. Minnis et al. (2006) demonstrated that 52 % of the bio- With regard to admission from birth home, almost half logical mothers (of foster children) showed mental illness. of the foster children were placed directly from their birth Lee and Thompson (2008) reported that the percentage of home into foster care during their ﬁrst out-of-home children in foster care with mentally ill biological parents placement (Barber and Delfabbro 2009; Holtan et al. 2005; (45 %) was signiﬁcantly higher than for children in family- Strijker et al. 2008). The former residences of the other half style group care (20 %). In comparing the percentages of of the foster children in these studies were not clearly mental illness between parents of children in foster and reported. Concerning children placed in family-style group residential care, Scholte (1997) found no signiﬁcant dif- care, ﬁndings of Gardeniers and De Vries (2011) demon- ferences. It should be noted that because of the differences strated that 23 % of these children entered from their birth in severeness and kinds of parental mental illness, com- home and that approximately the same percentage (22 %) parison between the three types of care is limited. In the entered from foster care. Most children (48 %) were placed same vein, this heterogeneity presumably have caused the into family-style group care from residential care (Garde- broad range in percentages of parental mental illness. niers and De Vries 2011). Lastly, about half of the children Lastly some literature data considered parental sub- entered residential care from their birth home (Scholte stance abuse and parental incarceration. With reference to 123 2366 J Child Fam Stud (2016) 25:2357–2371 1997; Scholte and Van der Ploeg 2010), although it could Ethnic background was also a factor that was mentioned not be determined from the study whether or not this rep- often. In general, about half of the children in care have a resented a ﬁrst out-of-home placement. Next to admission Caucasian ethnic background (Armsden et al. 2000; from birth home, Scholte (1997) reported that 20 % of the Yampolskaya et al. 2014). Nevertheless, the ﬁgures con- residentially placed children came from a foster family cerning ethnic background are hardly comparable due to setting while 28 % came from another residential both the heterogeneity of the deﬁned ethnic groups and the institution. diversity within those groups (Bhopal and Donaldson A ﬁnal deﬁning characteristic was the percentage of 1998). For example, ‘‘White’’ or ‘‘Caucasian’’ is often used children in child protective service custody. When a child in American literature; the relevant directive from the U.S. is at risk for abuse or neglect or has suffered serious Ofﬁce of Management and Budget includes people from physical or emotional damage, the child can be removed Europe, North Africa, and the Middle East in the deﬁnition from the custody of his or her parents or guardians by a of this term (Bhopal and Donaldson 1998). In contrast, the governmental agency (Arizona Ofﬁce of the Auditor governmental body of Statistics Netherlands considers General 2008). In foster care, the number of children in people from both North Africa and the Middle East to be child protective service custody appears to be the lowest; ‘‘non-Western’’ category (Centraal Bureau voor de Statis- the reported percentages varied from 57 to 59 % (Strijker tiek 2000). This non-Western category also includes people et al. 2002; Van den Bergh and Weterings 2010; Van- from Africa, Latin America, and Asia. Therefore, the per- schoonlandt et al. 2013). A distinction can be made centages related to ethnic background in our scoping between family supervision and a suspension of parental review should be considered as indicative. Several studies rights over the child. In the case of suspension, the child is reported that more than half of the American children in placed under the permanent legal guardianship of the foster care had a Caucasian ethnic background (James et al. government, and the caseworker has rights and responsi- 2012; Lee and Thompson 2008). In contrast, Minnis et al. bility for the care, custody, and control of the child (2006) reported that 99 % of foster children had a Cau- (DPHHS Human Resources Division 2010). When distin- casian ethnic background, but this percentage relates to a guishing between the two types of custody, Strijker et al. Scottish sample and thus is not directly comparable with (2002) reported that 19 % of foster children were under American foster children. With respect to residentially family supervision while 13 % were under permanent legal placed American children, almost half had a Caucasian guardianship. In family-home care, at least two-thirds of ethnic background (Hussey 2006; James et al. 2012). In the the children were in child protective service custody, Netherlands, Scholte and Van der Ploeg (2010) reported a mostly under family supervision (Gardeniers and De Vries slightly higher percentage of 77 % for residentially placed 2011; Lee and Thompson 2008; Van der Steege 2012). children. Lastly, a Caucasian ethnic background mostly Finally, approximately 75 % of the children in residential occurred in family-style group care both in the United care were in child protective service custody (Hussey 2006; States and the Netherlands (Gardeniers and De Vries 2011; Lee and Thompson 2008; Scholte and Van der Ploeg Lee and Thompson 2008; Van der Steege 2012). On the 2010). Similarly, a review of Frensch and Cameron (2002) other hand, Lee and Thompson (2008) found no statisti- also concluded that residentially placed children were cally signiﬁcant differences in ethnicity between foster mostly under child protective service custody. children and children in family-style group care. A ﬁnal factor within this context was social-economic Social-Cultural Context status. James et al. (2012) reported that over 80 % of the children in foster care lived in poverty, based on the A ﬁrst important factor in the social-cultural context was number of children with insurance through Medicaid peer relations. Results of Scholte (1997) showed that 8 % (which is an American social health care program for of foster children experienced problems in this area. He families and individuals with low income and limited also concluded that such problems were less likely to occur resources). Likewise, more than 80 % of the children in in foster care than in residential care, where a percentage of residential care had a low social-economic status (Hussey 46 % was found (Scholte 1997). Minnis et al. (2006) 2006; James et al. 2012). In a Swedish sample, Franze´n reported in contrast a much higher percentage of 63 % et al. (2008) reported lower percentages for out-of-home foster children with peer problems in their Scottish sample, placed children who are of primary school age. Over 12 % based on the Strengths and Difﬁculties Questionnaire. As of the mothers were at or below the poverty line. We found far as children in family-style group care are concerned, no results relating to the social-economic status of children Van der Steege (2012) reported that 29 % of the children in family-style group care. Overall, both Esposito et al. had peer problems. (2013) and Franze´n et al. (2008) concluded that adverse 123 J Child Fam Stud (2016) 25:2357–2371 2367 social-economic factors put young children at risk for out- Concerning the severity of child and family difﬁculties at of-home placement. admission, all appear to be most severe in residential care, with the exception of speciﬁc parental problems (such as parental mental illness, addiction, and incarceration). In Discussion addition, residentially placed children experience the highest number of previous placements, which seems to In general, family-based settings such as foster or family- reﬂect the tendency to view residential care as the treat- home care are considered to be the preferred type of care ment of ‘‘last resort’’ (Barth 2002; Huefner et al. 2010; when out-of-home placement is required (Courtney 1998; Nijhof et al. 2014). Our presumption that attachment Doran and Berliner 2001; United Nations 1989). At the problems mostly occur in residential care cannot be con- same time, the reviewed literature showed that at least one- ﬁrmed, due to an insufﬁciency of prevalence data regarding third of the children placed in family-based settings expe- the quality of attachment development. In contrast to res- rience serious placement disruptions (e.g. Scholte 1997; idential care, problematic family circumstances (and not Van den Bergh and Weterings 2010). Several researchers the individual problems of children) appear to be the main therefore suggest that residential care could sometimes be reason for placement in foster care. The high percentages in the best interests of the child (e.g. Butler and McPherson of parents with individual problems such as addiction and 2007; De Swart et al. 2012). This suggestion results in the mental illness suggest in particular that these problems challenge of determining when residential care must be temporarily preclude parents from offering their children a preferred (Frensch and Cameron 2002). However, to date healthy upbringing. Finally, ﬁndings indeed seem to indi- both evidence-based guidelines and assessment tools to cate that family-style group care can be considered an make informed decisions for a speciﬁc type of out-of-home intermediate type of care between foster care and resi- care are lacking (Barth 2002; Frensch and Cameron 2002; dential care, as noted previously (Barth 2002; Huefner Huefner et al. 2010). To develop such a scientiﬁcally et al. 2010; Rouvoet 2009). Most of the reported percent- supported instrument, insight is needed into the populations ages concerning child and family difﬁculties at admission referred to the three main care modalities (Barth 2002; of children in family-style group care were between the Frensch and Cameron 2002). The primary objective of this percentages reported for foster and residentially placed review was hence to determine similarities and differences children. In addition, children mostly appeared to enter in characteristics at admission of school-aged children who family-style group care from either foster or residential were placed in foster care, family-style group care, and care. residential care. In summarizing the ﬁndings, an initial tentative proﬁle Notwithstanding the large variation in reported ﬁgures, has emerged. Normally intelligent foster children could be available data indicated the following similarities and dif- characterized as young school-aged children whose most ferences in case characteristics. In relation to similarities, notable individual problems include chronic health prob- the literature data showed that the majority of normally lems as well as behavioral problems. They usually come intelligent children in all three care modalities suffer from from broken, poor families that frequently have histories of severe problems in the individual, family, or social context. neglect and domestic violence. Many parents appear to Second, several research gaps were found concerning case suffer from mental illness, addiction problems, or both, and characteristics at admission to all three types of care. As one of them would commonly be incarcerated. For children regards to the individual context, for example, remarkably in family-style group care with average intelligence, the little is known about intelligence and related cognitive most common ﬁnding was that data concerning their development. The prevalence of attachment problems also individual problems were insufﬁcient. However, the few remains largely unknown. However, both risk factors studies available suggest that attachment and behavioral appear to relate to placement outcomes (e.g. Pritchett et al. problems occur particularly frequently and that the children 2013; Tarren-Sweeney 2008). In the family context, ﬁg- would mostly have a Caucasian ethnic background. With ures on domestic violence and sexual abuse were regard to family issues, many children appear to suffer ambiguous or missing in particular. A ﬁnal research gap in from physical or emotional abuse and are mainly under all three care modalities concern care history (such as age civil law family supervision. Children placed in family- at admission and length of stay in care), which was also style group care usually come from another type of care. identiﬁed by De Swart et al. (2012). Nevertheless, care Finally, residentially placed children may be characterized history is strongly associated with negative placement as older school-aged male children with lower than average outcomes (e.g. Jones et al. 2011; Oosterman et al. 2007). IQs. Many of them seem to suffer from chronic health Meanwhile, available data also revealed various differ- problems and the reported ﬁgures indicate that many of ences among children in the three care modalities. them are on prescribed medication. Difﬁculties in peer 123 2368 J Child Fam Stud (2016) 25:2357–2371 relations and cognitive problems appear to be the most keywords for every type of care. However, we may have notable characteristics of residentially placed children, who missed particular keywords. Fourth, placement decisions also seem to frequently display severe emotional and are often dependent on policy of local child care systems or behavioral problems. The extent to which these social- child welfare workers placement preferences (Barth 2002; emotional problems relate to attachment problems remains Bhatti-Sinclair and Sutcliffe 2012; Curtis et al. 2001; unknown. Furthermore, residentially placed children tend Frensch and Cameron 2002; Huefner et al. 2010; James to come from broken, poor families that chieﬂy have his- et al. 2004), resource availability (Broeders et al. 2015; tories of child abuse, neglect, and sexual abuse. Many Frensch and Cameron 2002; Huefner et al. 2010), and the parents in these families seem to suffer from mental illness child’s ethnicity (Becker et al. 2007; Fernandez 1999). This and addiction. Literature data suggest that these children phenomenon has presumably caused large variance in are usually under permanent legal guardianship and have population characteristics and thus limited the generaliz- experienced an average of at least four placements before ability of research ﬁndings. Moreover, it also conﬁrms the they enter residential care. need for an evidence-based assessment tool for making The results of this review support arguments for the well-informed referral decisions. Lastly, no uniform deﬁ- development of an evidence-based assessment tool to make nition is available for some constructs (such as ethnic well-informed referral decisions when 24-h out-of-home background and attachment), which complicates compar- placement is needed. However, future (longitudinal) isons between relevant percentages. Such situations were research is required to relate intake characteristics to both explicitly indicated in the result section. short- and long-term placement outcomes (Curtis et al. Funding This study was funded by the Reformed Civil Orphanage 2001). Other determining factors for out-of-home care Rotterdam, the Netherlands. This foundation is fully independent and should also be considered when developing such an will not receive any beneﬁt from the research results. assessment tool, including living group climate (Strijbosch et al. 2015) and the professionalism of youth care workers Compliance with Ethical Standards (De Swart et al. 2012). The hope is that this all will Conﬂict of interest The authors declared no potential conﬂicts of eventually result in optimizing the effectiveness of pro- interests with respect to the authorship or publication of this article. vided care, given each child’s unique situation. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://crea Limitations tivecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give Some limitations should be noted regarding this scoping appropriate credit to the original author(s) and the source, provide a review. The ﬁrst relates to the broad search approach that link to the Creative Commons license, and indicate if changes were made. was used (and is characteristic of a scoping review). In this approach, a study’s substantive relevance is considered to be more important than the methodology used within it (Arksey and O’Malley 2005). However, we still considered References this technique to be the most appropriate for answering our Andrews, D. A., Bonta, J., & Wormith, J. S. (2011). The risk-need- research question. 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Characteristics of Children in Foster Care, Family-Style Group Care, and Residential Care: A Scoping Review

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Characteristics of Children in Foster Care, Family-Style Group Care, and Residential Care: A Scoping Review

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Characteristics of Children in Foster Care, Family-Style Group Care, and Residential Care: A Scoping Review

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