Foster Families: A Systematic Review of Intention and Retention Factors

Background: Compared to residential care, family foster care is the preferable type of alternative care for neglected or abused children as it provides a familiar context that supports children’s developmental needs. New foster families are needed to care for these children. Objective: This systematic review aims to provide a critical analysis of the literature, identifying factors that explain the intention to become and to continue as a foster family. This review was performed following the PRISMA checklist and guidelines, through a search conducted in the following databases (no restrictions were made): PsycArticles, PsycInfo, Psychology and Behavioral Sciences Collection, Academic Search Complete, ERIC, Scopus, and Web of Science. Study eligibility: The review includes empirical quantitative and/or qualitative studies in English, Portuguese, and Spanish, with community and/or foster parents’ samples and explores the factors for becoming and/or retention of foster parents. Results: Forty-nine studies were included. The results revealed that the intention to become a foster parent is largely influenced by motivational factors, personal and family characteristics, individual values and beliefs, social context influences, and perceived familiarity with the child protection system. The retention of foster families is closely related to factors within the child protection system, personal or family characteristics, foster child characteristics, and placement challenges. The relationship with agencies and professional support stands out as the most important factors. Limitations and Implications: This review did not include studies focused on children with specific needs and characteristics, and future research should consider the particular challenges of fostering this group. Practice implications of these findings for the recruitment, selection, and retention of foster families will be discussed.

     

Social Validity of a Training and Coaching Program for Parents of Children With Autism Spectrum Disorder on a Waiting List for Early Behavioral Intervention

Due to limited public resources, many children with autism spectrum disorder and their families must wait several months, if not years, to access early behavioral intervention (EBI) services. Service providers must thus develop alternative support models to assist families placed on waiting lists. The present study assessed the social validity of one such initiative, a training and coaching program for parents whose children had been put on a waiting list for EBI services. This program consisted of group training sessions on strategies to cope with their child’s disorder based on applied behavioral analysis and on one-hour, weekly follow-up meetings to support parents’ interventions with their child over the course of 12 months. Social validity was assessed through parental satisfaction with this program and their perception of its effects on themselves, the family, the child, and parental stress. The 94 participants were generally satisfied with the program overall, although they wished for more frequent and intensive interventions. They reported that the program had positive effects on their psychological well-being, their family’s quality of life, and their child’s behavior. However, parenting stress levels were found to have increased over the 12-month period. These results demonstrate that training and individually supporting parents can be beneficial for families of children with ASD who cannot have access to early behavioral intervention immediately upon receiving a diagnosis. Importantly, however, these lower-cost, parent-focused programs cannot be considered a substitute for more intensive and children-driven services.     

Parent–adolescent communication in foster,inter‐country adoptive,and biological Italian families: Gender and generational differences

There is a paucity of studies aimed at comparing how parents and children in different family structures cope with the challenges posed by the adolescence transition; in particular, there are few studies aimed at comparing adoptive and foster families. In order to partially fill this gap, the principal aims of the present study were to verify whether there are differences in parent–child communication among foster, intercountry adoptive, and biological families according to the adolescents' gender, and to compare the perceptions of parents and adolescents concerning parent–child communication. Data were elaborated on two levels: a generational level (adolescent's and his/her parents' perceptions among the three family groups) and a dyadic level (mother–child and father–child perceptions). The sample was composed of 276 Italian families with adolescents aged between 11 and 17 (81 foster, 98 international adoptive, and 97 biological families). Subjects (mothers, fathers, and children) filled out a questionnaire including the Parent–Adolescent Communication Scale (Barnes & Olson, 1985 ). Results highlighted that in foster families, parent–child communication showed more difficulties from both the adolescent's and the parents' point of view. Adoptive adolescents, however, reported a more positive communication with both their parents than did their peers living in biological and foster families. At a dyadic level, some differences emerged among the three groups. In biological families, a more pronounced distance emerged between parents and children. In adoptive families, father and adolescent shared more similar perceptions, whereas a significant discrepancy emerged between mother and child. A higher level of perceptual congruence between adolescents and parents was found in foster families. Gender differences were also seen: Mothers experienced a more open communication with their children than did fathers, and adolescents, and above all females, communicated better with their mothers than with their fathers in all three family groups.     

Motives for Fostering Children with Alcohol-Related Disabilities

A sample of 63 licensed foster parents was asked, “What motivates you to foster a child who has a fetal alcohol spectrum disorder?” The responses to this question were grouped together by licensed foster parents. The grouped data were subjected to multidimensional scaling and cluster analysis. Results indicated that foster parents were motivated to care for children with alcohol-related disabilities by witnessing positive changes in the children in their care, helping children focus on their strengths, using their own parenting experience, earning an income, assisting children who have disabilities, and helping children stay connected to their families and communities. Foster parents who foster children with alcohol-related disabilities foster for similar reasons to those who foster children with special needs in general. Differences between the literature on foster parent motives and study results were described. Foster parents who are caring for children with alcohol-related disabilities see their care as specialized, see their roles as long-term helpers facilitators to children, their birth families and home communities, and emphasize positive experiences of fostering.     

Latino Foster Parent Health Perceptions of Chronic Conditions: A Qualitative Exploration

Prior work using nationally representative data of children in the child welfare system suggested that Latino foster parents were less likely to identify children in their care as having chronic conditions. Hispanics comprise over one-fifth of children in foster care, the majority of whom have special health care needs, and there is a growing need to recruit qualified Latino families into the child welfare system. Little is known about Latino parents’ health perceptions regarding chronic conditions, and potential reasons for differing identification rates of children with special health care needs. We conducted 17 home-based, in-depth interviews with Latino foster parents to explore health perceptions and cultural beliefs for children in their care around the concept of chronic illness. We found that Latino foster parents’ understanding of conditions that occurred “over and over again” related to emotional and behavioral health problems. In contrast, their perception of “chronic” was associated with terminal, biological conditions that had limited treatment options, such as cancer, HIV, and hepatitis. Latino foster parents did not interpret the survey question on chronic illness as it was intended, and their view of recurrent conditions did not reflect chronic health conditions. Developing survey questions that are culturally sensitive should improve accuracy in assessing chronic health conditions for this high-risk population. Sensitivity to cultural interpretation for this high-needs population is vital to enhancing communication between families and health providers caring for children in foster care.     

Relationships among parental reports of child, parent, and family functioning.

Most children with psychosocial problems do not present for treatment in mental health settings. They are managed by primary care physicians. Children with psychosocial problems often have parents and/or families with psychosocial distress. The present study measured associations between parental reports of child, parent, and family functioning in individuals in the general population. Participants were 226 parents of children, aged 2-16 years, who presented for routine primary care. Parents reported on the psychosocial functioning of themselves, their child, and their family. All correlations of measures were significant, ranging from .55 to .23. Similar to data from psychiatric samples, the psychological functioning of children, parents, and families were significantly correlated. Unlike in psychiatric settings, child mental health problems were not as closely related to parent or family distress as parent and family distress were related to each other and to child behavior problems.     

Intrusive parenting,teacher sensitivity,and negative emotionality on the development of emotion regulation in early head start toddlers

Toddler emotion regulation develops within the context of relationships but is also influenced by toddlers’ individual characteristics. Drawing on transactional and differential susceptibility frameworks, this study examined direct and interactive associations of intrusive parenting, teacher sensitivity, and negative emotionality on toddler emotion regulation development in a sample of Early Head Start families utilizing center-based child care. Latent growth models indicated that, after controlling for a series of family and child care covariates, intrusive parenting at 14 months had diminishing effects on trajectories of emotion regulation across toddlerhood (14 to 36 months), whereas teacher sensitivity in child care was promotive for emotion regulation growth. Toddlers with high negative emotionality were not more susceptible to the effects of intrusive parenting or teacher sensitivity on emotion regulation development, however, results suggested emerging evidence for individual differences in the protective nature of teacher sensitivity in the context of high intrusion at home. Results are discussed in terms of their implications for informing parents and early care and education providers in nurturing relationships with the children who may be the most challenging to care for but may stand to make the greatest gains in emotion regulation development in quality caregiving settings.     

The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.     

Family Gender Role and Guilt in Spanish Dual-Earner Families

In dual-earner families the balance between work and family demands facilitates the development of guilt feelings when parents perceive a non-fulfillment of their responsibilities in childcare. Specifically, women who aspire to personal and professional development on the basis of more egalitarian gender role models must deal with the traditional stereotypes that maintain an intensive maternity mandate that prioritizes the family. On the other hand, for men the role change is primarily in the family setting with the development of a new father role more involved in the care of their children, which is not easily compatible with the more traditional breadwinner role. This study explored the feelings of guilt about parenting in 251 employed Spanish parents with children between 3 and 6 years of age, through the Scale of Guilt Feelings about Parenting, and its relationship with traditional stereotypes of maternal and family role. The scale addresses diverse situations pertaining to child rearing in which work requirements do not allow parents full availability for the care of their children. This availability is present in the model of intensive maternity and in the new father role model. Results indicate the presence of similar and high levels of guilt in fathers and mothers, although in men guilt is related to a non-traditional family role ideology, whereas in women guilt is related to a more traditional maternal role stereotype.     

Clinical application of attachment theory in permanency planning for children in foster care: The importance of continuity of care

Permanency planning is a critical issue facing all children in foster care. Foster children frequently suffer from developmental delays and severe behavior problems, often leading to repeated displacements that in turn increase the risk for attachment disorders. To prevent the emergence of such disturbances, an Attachment Clinic was developed in Montreal to offer consultation to Youth Protection workers. A specific problem has frequently been identified in this Clinic: Should a child who has developed a significant attachment to his or her foster parents return to the biological parents or stay in the foster family? The choice between the two families is even more difficult when the parenting competencies of the biological parents seem to have progressed while the child has developed secure attachments in the foster family. Clinical cases will be presented to illustrate such dilemmas. Concepts rooted in attachment theory have been very useful to understand such problems, and have led us to believe that children's best interests lie in the preservation of their attachment ties and that repeated ruptures of such ties constitute a severe trauma. Resistances of the milieu to our position will be discussed as well as the Court's decisions in light of Canadian jurisprudence.     

The attachments of children in foster care.

Subjects for this research were 52 foster children (mean ages 7 years, 11 months) and their natural and foster parents. Case history files provided information concerning reasons for placing the children in foster care. Foster parents completed the Parent/Child Reunion Inventory (Marcus, 1988) measuring the "quality of reunion behavior" following separation. Foster mothers also completed the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and measures of adult empathy were collected from both foster parents. Foster care workers rated the quality and intensity of attachment between the child and all parents. Finally, foster children were interviewed concerning their social supports, perception of affection from adults, and the quality of their relationships with adults and friends. Results showed that behavior and school achievement problems were predictable from measures of the quality of attachment with parents. The mean number of behavior problems of foster children were found to be midway between clinical and nonclinical norm groups. Children's perceptions of friends' behavior and degree of control over friends were related to their adjustment. Case history variables were also related to behavior problems and attachment.     

Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Sustainable Family Care for Children with Disabilities

The majority of parents want to continue caring for their sons and daughters with disabilities at home, and they are expected and actively encouraged to do so. Notwithstanding, and for reasons that are not well understood, a substantial number of parents seek to place their disabled son or daughter out-of-home. The aim of this study was to investigate the attitudes of parent-carers in Alberta, Canada, toward out-of-home placement. The primary objective was to identify factors that may explain why some families, and not others, seriously consider out-of-home placement as an option for their child. This knowledge is vital for developing social care policies and programs that support parents and promote sustainable family care for children with disabilities. A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the family life survey, which incorporated measures of child and family characteristics, sustainability of the daily routine, and out-of-home placement propensity. Results suggest that family placement propensity is inversely associated with the sustainability of the daily routine. Sustainability of the daily routine is, in turn, more strongly associated with social-ecological resources, including parental control-over-work and the adequacy of child care options, than with child characteristics, including activity limitations and behaviour problems. If families have the social-ecological resources they need to create and maintain a daily routine that is congruent with their values and goals, and with the needs, interests and competences of family members, then they are unlikely to give out-of-home placement any serious consideration.     

Support Needs and Satisfaction in Foster Care: Differences Between Foster Mothers and Foster Fathers

Family foster care is a vulnerable youth care intervention. The recruitment and retention of foster parents causes concerns. Offering support to foster mothers and foster fathers can augment the satisfaction and the intent of continuing fostering. Clearer understanding of the support needs of foster parents and their satisfaction with the foster care placement can lead to the identification of ways to improve the support offered. Although differences between foster mothers and foster fathers regarding their support needs and satisfaction can be expected, knowledge about these differences is nonexistent. Differences in support needs and satisfaction between 86 foster mothers and foster fathers who reported on 120 foster children were examined. No differences between foster mothers and foster fathers were found. Both foster parents had higher support needs regarding dealing with the birth parents compared to support needs in handling problem behavior of the foster child. For both foster mothers and foster fathers satisfaction with collaboration with the foster care worker, satisfaction with recognition experienced and satisfaction with reunification of the foster child, did not differ across these aspects. Satisfaction of foster parents can be increased by keeping in balance the rights and needs of birth parents and those of foster parents. Acknowledging that foster parents are experts on their foster child and consulting them on important decisions will also contribute significantly to their satisfaction.     

Matching adolescents with foster mothers and fathers: An evaluation of the role of temperament

We tested the notion that better foster care adjustment would be observed when the temperaments of mothers and fathers were matched with those of adolescent foster children. We hypothesized that families in which foster parents and foster children had high (easy) scores on subscales of the Revised Dimensions of Temperament Scale (DOTS-R) would also report higher family functioning and higher foster care adjustment than parents and children from families in which one or both family members had low (difficult) scores on these scales. The hypotheses were supported when the mothers and fathers family assessments were used but rejected when the observations of the case managers and adolescents were tested. Methodological and substantive explanations for the findings are discussed and recommendation for foster care practice and continuing research are provided.     

Foster Care Youth Share Stories of Trauma Before,During, and After Placement: Youth Voices for Building Trauma-Informed Systems of Care

Many research studies address child trauma experiences that take place before foster care placement. However, few studies focus on the types and patterns of trauma experiences that reportedly take place during and after foster care placement; that is, after entry into adult living. This study examined the testimony of 43 foster care youth who spoke to a listening panel comprised of state legislators, child welfare professionals, and university educators. Qualitative analyses of transcribed text data revealed 3 main themes. First, the youth reported experiencing trauma before, during, and after placement. Second, the youth described trauma events and situations that were chronic (i.e., intense, composite, or cumulative). Third, youth offered suggestions for reducing traumatic experiences for foster care youth. They recommended earlier family interventions, access to people who listen and care, improved parenting skills for foster parents, continuity of relationships, and opportunities for leadership for foster youth. Foster youth voices offer important suggestions for building, strengthening, and evaluating trauma-informed systems of care.     

The interaction approach to early intervention

A brief summary of research, supportive of the idea that quality of parent-infant interaction has a powerful effect on infant development, introduces an early intervention model based on that proposition. Also, central to the interaction model is the knowledge that (1) parent and infant both contribute to what happens between them and that (2) a multitude of factors, environmental and internal to parent and infant, affect the parent, the infant, and their interaction. Ten sets of principles and strategies that convey the essence of the interaction model constitute the core of this article. The principles and strategies address the importance of identifying sources of support and stress in the family, of developing relationships with both parents, and of supporting positive interactions between parents and the infant's siblings. The limitations of this model are also addressed, especially in cases where the parent is the primary risk factor. The infant's exposure to nurturing adults in quality day care programs and a more clinical approach with the parent and infant, such as Selma Fraiberg's model, may be more effective with such families.     

Comparing Maltreating and Foster Families in Italy

Maltreating and foster families belong to different research areas and have rarely been considered together. This exploratory study compared maltreating and foster families to demonstrate an integrated approach that overcomes the dichotomic view that often separates problematic families from those who have resources. This study had 81 participants: 48 maltreating parents and 33 foster parents and the children who were in foster care. We examined family functioning (FES), adult attachment styles (ASQ) and foster children’s strengths and difficulties (SDQ) in maltreating and foster families to examine the differences and similarities between families. Both types of families had significant differences on the FES and ASQ scales. Maltreating families had a stronger orientation to succeed and a family profile that was more orientated towards independence. Maltreating parents had higher scores on the scale that measured discomfort with closeness than foster families. However, both family types had a high level of confidence. Many foster children had SDQ scores that were in the borderline and problem categories. These components may promote a theoretical view of an integrated model for family and children’s problems that promotes children’s welfare and supports maltreating parents. Practitioners can build on parent’s strengths or protective factors and provide services to address less developed areas.     

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

When risky child and family circumstances cannot be resolved at home, (temporary) 24-h out-of-home placement of the child may be an alternative strategy. To identify specific placement risks and needs, care professionals must have information about the child and his or her family, care history, and social-cultural characteristics at admission to out-of-home care. However, to date information on case characteristics and particular their similarities and differences across the three main types of out-of-home settings (namely foster care, family-style group care, and residential care) is largely lacking. This review 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 modalities. A scoping review technique that provides a broad search strategy and ensures sufficient coverage of the available literature is used. Based on the 36 studies included, there is consensus that the majority of normally intelligent children in care demonstrate severe developmental and behavioral problems. However, the severeness as well as the kinds of defining characteristics present differ among the children in foster care, family-style group care, and residential care. The review also identifies several existing knowledge gaps regarding relevant risk factors. Future research is recommended to fill these gaps and determine the developmental pathway in relation to children’s risks and needs at admission. This will contribute to the development of an evidence-based risks and needs assessment tool that will enable care professionals to make informed referrals to a specific type of out-of-home care when such a placement is required.