SUBSTANCE ABUSE AND CHILD WELFARE PRACTICE

Foster Care, Removal and Reunification

This webpage identifies the major literature in the field of substance abuse and child welfare practice: foster care, removal and reunification. The time frame is from January 2000 through December 2014.

Barber, J. G., & Delfabbro, P. H. (2009). The profile and progress of neglected and abused children in long-term foster care. Child Abuse & Neglect, 33(7), pp. 421-428.

This study compared the profile of neglected and abused children in the Australian foster care system as well as differences between maltreatment types in relation to parental contact, reunification and psychosocial progress in care. The case files of 235 children entering foster care were examined and their social workers were administered standardized questionnaires at the point of intake. Neglected children were younger than non-neglected children, more likely to have a physical or mental disability, more likely to experience multiple forms of maltreatment and less likely to pose conduct problems for carers. Neglected children were more likely than non-neglected children to experience a decline in parental contact over time, and were less likely to be reunified with their families of origin. There was minimal difference between neglected and non-neglected in their psychosocial progress while in care. Aboriginal children were more likely to be reunified than non-Aboriginal children when neglect was attributable to transient factors (parental incapacity) but the reverse was true for non-neglected children. The fact that neglected children more often require a second form of maltreatment before being removed from home suggests that children's services workers are less inclined to remove children for neglect than for other forms of maltreatment. As a consequence, those neglected children who are in care tend to come from more dysfunctional families than non-neglected children do, as evidenced by the relatively poorer parental contact and reunification results of neglected children. Neglected children differ systematically from non-neglected children and suffer relative disadvantage in relation to multiple forms of maltreatment, parental contact, and reunification. The fact that declines in parental contact among neglected children in care occurred only when indirect contact was provided suggests that, wherever possible, care plans should include face-to-face visits and overnight stays rather than being restricted to less direct forms of contact. The difference in the success of reunification according to type of neglect (chronic or transient) also suggests that parental intervention programs need to focus their efforts on chronic factors rather than transient parental factors.

Berrick, J. D., Cohen, E., & Anthony, E. (2011). Partnering with parents: Promising approaches to improve reunification outcomes for children in foster care. Journal of Family Strengths, 11(1), Article 14. Available at: http://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?article=1011&context=jfs

Family reunification is one of the central tenants of the child welfare system, yet research supporting effective practices to promote safe reunifications is limited. As a departure from previous initiatives, the Parent Partner (PP) program enlists as staff mothers and fathers who have experienced child removal, services, and reunification. This study examines outcomes for children served by the PP program. The experimental group includes 236 children whose parents were served by a Parent Partner and a matched comparison group of 55 children whose parents were served by the public child welfare agency in 2004, before the Parent Partner program was established. Cases were examined 12 months following case opening to determine reunification status. Results from the outcome study indicate that reunification may be more likely for children whose parents were served by Parent Partners. Although there are limitations to the data, findings from this study suggest that the Parent Partner model may hold promise as a child welfare intervention designed to support reunification.

Blome, W. W. (2009). Association between foster care and substance abuse risk factors and treatment outcomes. Journal of Child & Adolescent Substance Abuse, 18(3), pp. 257-273.

The child welfare and substance abuse systems are integrally linked through the children and families they both serve. There is a dearth of knowledge, however, on how children who have experienced foster care fare when they are treated for substance abuse issues as adults. This article presents an exploratory study using the Alcohol and Drug Services Study (ADSS) data set. To pursue a set of exploratory questions, adults in substance abuse treatment who were formerly in foster care were matched with a group who had not experienced substitute care. Their experiences before and after treatment were compared. This article presents the methodological and substantive findings.

Brook, J. (2009). In McDonald T., McDonald T. (Eds.), Impact of parental substance abuse on the stability of family reunifications from foster care. Children & Youth Services Review. 31(2), pp. 193-198.

This study examined the likelihood of reentry into foster care following reunification for children whose primary caretakers were stratified into groups based on the type of substance abuse cited as a primary reason for the initial removal: those with alcohol only involvement, those with drug only involvement, those with both alcohol and other drug involvement, and those with no alcohol or drug involvement. Event history analysis showed that children whose reasons for initial placement in foster included caretakers with both alcohol and drug involvement were much more likely to reenter care following reunification than any of the other three groups. However, drug or alcohol involvement as the initial reason for removal was also associated with higher risk of reentry.

Bullock, R. & Gaehl, E. (2012). Children in care: A long-term follow-up of criminality and mortality. Children and Youth Services Review, 34(9), pp. 1947-1955. DOI: 10.1016/j.childyouth.2012.06.003

This article looks at the criminal careers and mortality rates of children in care in England in 1980, two cohorts were selected for the study one consists of long-stay children in care for at least two years and another group who left care within five weeks. The aim of the study was to identify risk factors and learn about behavioral continuity and discontinuity. The rates for the subsequent offending of children presenting delinquency and other difficult behavior, especially irregular school attendance, and who stay long in care is 2.7 times higher than for those coming into care because of neglect and abuse and 1.6 times higher than for those coming into care due to family breakdown. There was no evidence that being in care per se reduces or increases the risk of offending, as criminal behavior is not constant and the risks associated with it vary over time with much depending on the child's predisposition, life events and the quality of interventions received.

Bryson, S. A., Akin, B. A., Blasé, K. A., McDonald, T., & Walker, S. (2014). Selecting an EBP to reduce long-term foster care: lessons from a university-child welfare partnership. Journal of Evidence-Based Social Work, 11(1-2), pp. 208-221. DOI: 10.1080/15433714.2013.850325

This article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor and tailoring the model to the practice context. Additionally, the authors look to and detail each step of the process using aspects of implementation science.

Carison, B. E., Smith, C., Matto, H., & Eversman, M. (2008). Reunification with children in the context of maternal recovery from drug abuse. Families in Society, 89(2), pp. 253-263.

Little is known about mothers' experiences of reunification with children in the context of recovery from drug abuse. Using a stress and coping framework, this qualitative study interviewed 6 mothers and 11 service providers from substance abuse and child welfare agencies regarding reunification experiences. Analysis of themes indicated that multiple parenting stressors and lack of resources and supports complicate women's abilities to manage parenting pressures upon reunification. Maternal readiness for reunification was an important theme; returning children prematurely heightens risk for poor outcomes, especially if insufficient services are in place to support children's return home. The stress of dealing with child protective services and multiple service systems was another theme. Implications for service provision to mothers and families are discussed.

Carlson, B. E., Matto, H., Smith, C., & Eversman, M. (2006). A pilot study of reunification following drug abuse treatment: Recovering the mother role. Journal of Drug Issues, 36(4), pp. 877-902.

This qualitative study explored the experiences of women in recovery from drug abuse who had resumed parenting their children after child placement. Six mothers and 11 service providers from substance abuse treatment and child welfare agencies were interviewed about their perceptions of the experience of being reunified with one's children following substance abuse treatment. Findings revealed that mothers have intense emotional reactions to having children placed, which can motivate recovery but also be a source of stress. A variety of supports were identified as necessary to prepare mothers for resuming care of children beyond substance abuse treatment including counseling, child care, financial support, and parenting education. Reunification, however desirable, was described as overwhelming and fraught with parenting challenges, such as effective limit setting with children. Numerous challenges and barriers to successful reunification were identified, such as stigmatization in the child welfare system. The authors state that the results suggest the need for continuity and coordination in service delivery that targets several key areas of skill development for substance-abusing mothers following initial treatment and post-reunification with children. This would require coordinated, effective collaborations between treatment providers, the child protective system, and community-based child welfare providers.

Cheng, T. C. (2010). Factors associated with reunification: A longitudinal analysis of long-term foster care. Children and Youth Services Review, 32(10), 1311-1316.

Longitudinal analysis and a secondary sample of 411 children were used to examine how child welfare worker engagement with families and parent receipt of needed services shaped the outcomes for children in long-term foster care. The data came from the National Survey of Child and Adolescent Well-Being. Multinomial logistic regression showed reunification to be likeliest for neglected children who had caseworkers deeply involved with their families; whose families needed housing and financial assistance but not domestic violence services, specifically; and who were provided appropriately matched services. Adoption was likeliest for neglected children who had caseworkers deeply involved with their families; whose families needed substance-abuse services but not housing services; whose families had a high risk of re-reporting; whose parents were married; who were White and relatively young; and who had experienced foster care for relatively longer periods. Implications for services and training are discussed.

Dorsey, S., Kerns, S. E. U., Trupin, E. W., Conover, K. L., & Berliner, L. (2012). Child welfare caseworkers as service brokers for youth in foster care: findings from project focus. Child Maltreatment, 17(1), pp. 22-31.

This study examines caseworker-level outcomes of Project Focus, a caseworker training and consultation model designed to improve emotional and behavioral outcomes for youth in foster care through increased linkages with EBPs. Project Focus was tested through a small, randomized trial involving four child welfare offices. Caseworkers in the Project Focus intervention group demonstrated an increased awareness of EBPs and a trend toward increased ability to identify appropriate EBP referrals for particular mental health problems but did not have significantly different rates of actual referral to EBPs. Dose of consultation was associated with general awareness of EBPs. Implications for practice and outcomes for youth are discussed.

Grant, T., Huggins, J., Graham, J.C., Ernst, C., Whitney, N., & Wilson, D. (2011). Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not. Children and Youth Services Review, 33(11), pp. 2176-2185. DOI: 10.1016/ j.childyouth.2011.07.001

The sample is 458 substance-abusing mothers enrolled in long-term case management. Final custody status was among four categories based on parenting continuity. At program exit 60% of the mothers were caring for their index child. These mothers had more service needs met, more time abstinent from substances, support. Mothers who lost custody had more serious psychiatric issues, fewer service needs met. Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met.

Grella, C. E., Needell, B., Shi, Y., & Hser, Y. (2009). Do drug treatment services predict reunification outcomes of mothers and their children in child welfare? Journal of Substance Abuse Treatment, 36(3), pp. 278-293.

This article examines the predictors of child reunification among mothers who participated in a statewide treatment outcome study. Data were integrated from multiple sources to determine the contributions of characteristics of mothers (n = 1,115), their children (n = 2,299), and treatment programs (n = 43) on reunification outcomes. Hierarchical linear modeling was used to determine the fixed and random effects of mother, child, and program characteristics. Mothers with more employment and psychiatric problems were less likely to be reunified with their children; completion of 90 or more days in treatment approximately doubled their likelihood of reunification. Mothers who were treated in programs providing a “high” level of family-related or education/employment services were approximately twice as likely to reunify with their children as those who were treated in programs with “low” levels of these services.

Haight, W., T. Ostler, et al. (2007). A child's-eye view of parent methamphetamine abuse: Implications for helping foster families to succeed. Children and Youth Services Review, 29(1), pp. 1-15.

This report focuses on the experiences and perspectives of rural, Midwestern children aged 7-14 years who were involved with the public child welfare system because of their parents' methamphetamine abuse. Eighteen children participated in semi-structured, in-depth interviews focusing on their families of origin. Children reported exposure not only to their parents' and non-kin adults' methamphetamine and other substance abuse, but to a constellation of activities related to drug use or drug seeking behavior including violence within their homes and other criminal behavior. Children responded to the contexts in which they were reared in a variety of ways including accepting or actively resisting socialization messages that normalized substance abuse. The majority of children described involvement with law enforcement and child welfare as a "sad" and "scary" time in their families. Far from embracing their placement within safe and stable families, many children continued to express sadness, distress and resistance to legal and child welfare interventions even after months in foster care. Implications for facilitating the adjustment of children to foster care and beyond are discussed including providing foster parents with support and information about the contexts in which children have been reared and children's understanding of those contexts in order that they may interpret and respond to challenges that may emerge.

Harris-McKoy, D., Meyer, A. S., McWey, L., & Henderson, T. L. (2014). Substance use, policy, and foster care. Journal of Family Issues, 35(1), pp. 1298.

In this article, the authors analyze the impact The Adoption and Safe Families Act (ASFA) has had on parents struggling with alcohol or other drug problems, who are also appealing the termination of their parental rights (TPR). In the study, the authors analyzed court cases from Virginia, Florida, Louisiana, and Georgia involving parental appeals of TPRs pre- and post-ASFA. According to the findings, decisions to uphold TPRs for parents with AOD issues were more frequent post-ASFA.

Hohman, M. M., & Butt, R. L. (2001). How soon is too soon? Addiction recovery and family reunification. Child Welfare, 80(1), pp. 53-67.

This article describes the addiction recovery process and stages of recovery, the behaviors and attitudes that indicate recovery, and how recovery impacts parenting. This information is crucial for child welfare workers involved in decision making regarding family reunification. Two models of recovery, one from alcoholism and one from cocaine addiction, are reviewed. In addition, issues encountered in recovery, particularly for women for discussed. Case examples and discussion demonstrate how child welfare workers can apply these models in determining the appropriateness of reunification.

Hong, S., & Piescher, K. (2012). The role of supportive housing in homeless children’s well-being: an investigation of child welfare and education outcomes. Children and Youth Services Review, 34(8), pp. 1440-1447.

This study seeks to understand the impact of supportive housing services on homeless children’s well-being over time, including the academic functioning and child protection involvement of homeless children. Significantly positive effects of recipients of supportive housing services were found in school mobility, school attendance, and math achievement. The proportion of children with child protection involvement for the supportive housing group sharply decreased over time. Recommendations for policy and future research are made; study limitations are addressed.

Huang, H., Ryan, J. P. (2011). Trying to come home: substance exposed infants, mothers, and family reunification. Children and Youth Services Review. 33(1), pp. 322-329.

This article presents the findings of a study of 160 mothers and their substance exposed infants focusing on the relationship between treatment modalities (residential and outpatient), recovery from substance abuse and family reunification. Results show that there are benefits to residential treatment in terms of progress and family reunification, but only when residential services were delivered in combination with transitional services.

Koh, E., Rolock, N., Cross, T. P., & Eblen-Manning, J. (2014). What explains instability in foster care? Comparison of a matched sample of children with stable and unstable placements. Children and Youth Services Review, 37(1), pp. 36-45.

This study investigates what characteristics explain placement instability for children in foster care; it also examines specific reasons for placement changes for a group of children who experienced multiple placements. Findings from this study show that the following three components that contribute to placement stability for children in foster care: a) a caregiver's commitment to a child's legal permanence; b) the absence of a child's mental health diagnosis; and c) placements with a relative caregiver. The findings of the study also illustrate that while system- or policy related reasons explain the largest proportion of placement changes for children's earlier stay in foster care, a majority of placement changes are related to foster family or behavior-related reasons over time.

Leathers, S. J., Spielfogel, J. E., Gleeson, J. P., & Rolock, N. (2012). Behavior problems, foster home integration, and evidence-based behavioral interventions: What predicts adoption of foster children? Children and Youth Services Review, 34(5), pp. 891-899. DOI: 10.1016/ j.childyouth.2012.01.017

This article is based on the results of a pilot study focused on testing associations between behavior problems, foster home integration, an evidence-based foster parent intervention, and adoption likelihood. According to the findings, externalizing behavior problems had a negative effect on both integration and adoption, and foster home integration had an independent positive effect on adoption. Internalizing behavior problems (e.g., depression/anxiety) were not related to adoption or integration. The study provides further evidence of the negative effect of externalizing behavior problems on adoption.

Linares, L. O., Li, M., & Shrout, P. E. (2012). Child training for physical aggression? Lessons from foster care. Children and Youth Services Review, 34(12), pp. 2416-2422.

In this article, the authors valuated the effectiveness of a child-focused adaptation of the Incredible Years Child Training (CT) program to reduce physical aggression. Participants were assigned to the CT program or usual care. Post-intervention results showed that physical aggression decreased over time for both groups and results show that the CT group did not experience better outcomes than those in the Usual Care group. However, children in the Usual Care showed more improvement the overtime in good self-control and physical aggression than those in the CT program. Teacher ratings remained unchanged for both groups.

Linsk, N., Mason, S., Fendrich, M., Bass, M., Prubhughate, P., & Brown, A. (2009). “No matter what I do they still want their family”: Stressors for African American grandparents and other relatives. Journal of Family Social Work, 12(1), pp. 25-43.

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.

Maliszewski, G., & Brown, C. (2014). Familism, substance abuse, and sexual risk among foster care alumni. Children and Youth Services Review, 36(1), pp. 206-212.

This study examined the relations among family connectedness, substance abuse, and sexual risk for young adults of at-risk environments, looking specifically at foster care alumni. Findings of the study suggest that there was significant associations found between the quality of young adults’ relationships with family members and their sexual risk intentions and substance abuse behaviors. The authors suggest that findings could inform clinical practice by helping their clients develop and maintain positive family relationships.

Marcellus, L. (2008). (Ad) ministering love: Providing family foster care to infants with prenatal substance exposure. Qualitative Health Research, 18(9), pp. 1220-1230.

A significant percentage of children in foster care in North America are younger than 1 year of age and are in foster care because of parental substance use and other social challenges. Infants might present with specific health and behavioral issues that are challenging to manage within the foster family home environment; foster families require specialized skills and knowledge to manage these issues. In this article, the author describes a constructivist grounded theory of the process of becoming and providing family foster caregiving in the context of caring for infants with prenatal alcohol and/or drug exposure. The basic social process of (ad) ministering love was identified. The author further describes the three phases of this process and the core concepts within each phase.

Marcenko, M.O., Lyons, S. J. & Courtney, M. (2011). Mothers’ experiences, resources and needs: The context for reunification. Children and Youth Services Review, 33(3), pp. 431-438. DOI: 10.1016/j.childyouth.2010.06.020

This paper extends prior scholarship regarding the characteristics of mothers involved with the child welfare system In-person interviews were conducted with a statewide sample of 747 mothers, 318 with children remaining in home and 429 with children in care, to examine their socio-demographic and psychosocial characteristic as well as service needs Mothers were mostly impoverished, struggling to meet basic needs, and coping with early trauma, mental health problems, substance abuse and domestic violence. Almost half reported an annual income of less than $10,000 and 70% were unemployed, but few received public benefits with the exception of food stamps. Mothers with child in care experienced greater economic hardship than mothers whose children remained in home. The implications of the finds are discussed.

Marsh, J. C., Ryan, J. P., Choi, S., & Testa, M. F. (2006). Integrated services for families with multiple problems: Obstacles to family reunification. Children and Youth Services Review, 28(9), pp. 1074-1087.

The current study focuses on families in the child welfare system with co-occurring problems and the impact of such problems on the likelihood of reunification. The current study contributes to the literature on service integration by examining whether it is necessary to go beyond assessment and service access to insure families make progress in each co-occurring problem area to achieve reunification. The sample is comprised of 724 substance-abusing families enrolled in the Illinois Title IV-E Alcohol and Other Drug Abuse (AODA) Waiver Demonstration. Data on client progress consisted of provider ratings completed quarterly to track progress related to problems of substance abuse, domestic violence, housing and mental health. The findings indicate that progress in resolving co-occurring problem areas increases the likelihood of achieving family reunification. Thus, the provision of the child welfare service model alone is insufficient. In order for child welfare systems to increase reunification rates, services must target the specific needs of individual families and assist them in achieving progress within co-occurring problem areas. Successful integrated service programs must identify the range of specific problems that clients are dealing with and insure that they address and resolve these problems in order to increase the likelihood of family reunification.

Merritt, D. H., & Klein, S. (2014). Do early care and education services improve language development for maltreated children? Evidence from a national child welfare sample. Child Abuse & Neglect. In Press.

This article presents findings from a study which used data from a nationally representative survey of children in the U.S. child welfare system, the National Survey of Child and Adolescent Well-Being II, to assess whether young CWS-supervised children who were enrolled in high quality early care and education (ECE) had better language development outcomes 18 months later than those not enrolled in ECE. The findings suggest that ECE participation predicted better scores at follow-up.

McWey, L. M., Henderson, T. L., & Alexander, J. B. (2008). Parental rights and the foster care system: A glimpse of decision making in Virginia. Journal of Family Issues, 29(8), pp. 1031-1050.

Using ecological theory and a mixed-methods approach, the authors examined family-court interactions for foster care decisions made in Virginia across three policy periods: 1980 to 1993, 1994 to 1997, and 1997 to present (N= 95). For the first and last policy periods, quantitative analyses revealed significant differences in the rates at which parental rights were terminated. Differences also existed in termination rates for parents with mental health issues and limited IQs but not for parents with substance abuse issues or those with special-needs children. The best-interests-of-the-child standard and clear and convincing evidence were the primary legal principles used to determine whether to terminate parental rights or to reunify families. Suggestions were made to enhance the understanding of family professionals.

Miller, K.A., Fisher, P.A., Fetrow, B., & Jordan, K. (2006). Trouble on the journey home: Reunification failures in foster care. Children and Youth Services Review, 28(3), pp. 260-274.

This article examined parent, child, family, environmental, and service utilization factors hypothesized to be associated with reunification failure. The sample for the study included foster children who, at reunification with their birth parents, ranged in age from 4-7 years. All participants were reunified with at least one parent. Among the variables found to significantly differentiate between failed and successful reunifications were parental utilization of substance abuse treatment, child utilization of special educational services, child utilization of individual, family, or group therapy, overall parenting skill level, appropriate use of discipline, and quality of neighborhood. The authors discuss the implications of these results for policies aimed at increasing the success rate of reunifications following foster care.

Miller, K. M., Cahn, K., Anderson-Nathe, B., Cause, A. G., & Bender, R. (2013). Individual and systemic/structural bias in child welfare decision making: Implications for children and families of color. Children and Youth Services Review, 35, pp. 1634-1642.

This article summarizes the results of the Child Welfare Equity Task Force which looked at ways in which to engage child welfare and collaborating system decision makers in a subjective interpretative analysis of the practice context for Oregon’s child welfare administrative data which reflected the existence of racial disproportionality and disparity. Thematic analysis yielded eleven themes from the participant focus groups, four of which clustered around individual and structural/systemic bias and are examined in this paper: visibility bias; cultural bias and insensitivity; personal influences on determination of minimally adequate care; and foster and adoptive parent recruitment and licensing practices. Participants offered recommendations to improve outcomes for children and families of color in light of these observations: increase awareness of bias, create checks and balances in decision-making, contract with and hire culturally and racially diverse professionals, and increase funding for training.

Pelton, L. H. (2008). An examination of the reasons for child removal in Clark County, Nevada. Children & Youth Services Review, 30(7), pp. 787-799.

The factors precipitating child placement were examined in two randomly selected samples of protective custody cases that were brought before the family court in Clark County, Nevada during a one-year period. Methamphetamine use, homelessness, lack of resources, and physical abuse were factors frequently prompting placement. Homelessness was as prevalent in cases not involving meth or other drug use as in those that did. Police were involved in a large proportion of the cases, in these cases; children were more frequently placed in foster care facilities. In many cases, the arrest and incarceration of parents on outstanding warrants unrelated to the immediate safety of the children precipitated the need for placement. Parents frequently received counseling for their substance abuse and other issues, but were rarely offered concrete assistance or any significant help with housing. The reallocation of resources from Child Haven, the emergency placement congregate care facility in which most children were initially placed, to the provision of direct assistance with housing and other concrete services, is recommended and discussed.

Pilowsky, D.J., & Wu, L.T. (2006). Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care. Journal of Adolescent Health, 38(4), pp. 351-358.

The purpose of this study was to ascertain the prevalence of psychiatric symptoms and substance use disorders among adolescents with a lifetime history of foster care placement, using data from a nationally representative sample of U.S. adolescents. Study subjects were adolescents aged 12-17 years in the public use file of the 2000 National Household on Drug Abuse (n = 19,430, including 464 adolescents with history of foster care placement). Psychiatric symptoms and substance use disorders were ascertained through direct interviewing of adolescents. Results indicated that adolescents involved with foster care had more past-year psychiatric symptoms, and especially more conduct symptoms, and past-year substance use disorders than those never placed in foster care. Adolescents involved with foster care were about four times more likely to have attempted suicide in the preceding 12, and about five times more likely to receive a drug dependence diagnosis in the same period The authors concluded that adolescents involved with foster care have a higher prevalence of psychiatric symptoms and drug use disorders than those never placed in foster care.

Raphel, S. (2008). Kinship care and the situation for grandparents. Journal of Child and Adolescent Psychiatric Nursing, 21(2), pp. 118-120.

Kinship care. What is it? What is needed? What is being done? A totally new swing in child welfare is before us. In 1996, 2.5 million U.S. families were maintained by grandparent(s) who had one or more grandchildren living with them. According to census records, this number increased 30% in the decade ending 2000. The grandparent(s) provide a safety net to children inside and outside the Social Welfare System in cases where parents struggle with substance abuse, incarceration, mental illness, economic hardship, divorce, domestic violence, and other issues leading to their absence as primary caregivers for their children. Although this informal, private or voluntary arrangement has many advantages for the child, there are fewer resources available to the kin caregiver. Kinship care arrangements tend to be complex. Some families find themselves in both formal and informal situations with related children. Many caregivers are still raising their own children or caring for elder parents. Evaluating the quality of kinship care involves many views. The quality indicators are appropriate behavior, school performance, happiness, and the caregiver's experience with raising other children.

Rees, C. A., & Selwyn, J. (2009). Non-infant adoption from care: Lessons for safeguarding children. Child: Care, Health & Development, 35(4), pp. 561-567.

The aim of this study is to explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. A cohort of 130 children was identified for whom adoption was recommended in 1991-1996 at a mean age of 5.7 years (range 3-11). All were in local authority care for child protection reasons. Background information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent-Child Communication Scale were completed. Results all but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty-six percent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty-seven percent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional “phoniness” and rejection affected closeness. At follow-up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty-eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional responsibilities in supporting it need to be acknowledged and adequately resourced. Dysfunctional hypothalamus-pituitary-adrenal axis programming may contribute to persisting difficulties. Supporting substitute care should be considered integral to safeguarding children.

Rischel, C. W., Morris, T. L., Colyer, C., & Gurley-Calvez, T. (2014). Preventing the residential placement of young children: A multidisciplinary investigation of challenges and opportunities in a rural state. Children and Youth Services Review, 37(1), pp. 9-14.

This study identifies systemic factors contributing to the residential placement of young children and opportunities for service improvement in a rural state. Key informant interviews and surveys were used to synthesize a broad array of professional perspectives. Remarkable consensus across multiple groups suggests that young children are best served in a family setting. The authors argue that children and families would be best served by shifting resources from residential placement options toward prevention and early intervention.

Saunders, C., Hetling, A., Ovwigho, P. C., & Born, C. E. (2012). Children without parents in the TANF caseload: thinking beyond the child-only label. Children and Youth Services Review, 34(1), pp. 1024-1034.

This article compares and contrasts the demographics of parental and relative caregiver cases, analyzing the differences between cases with and without adults receiving benefits. The findings suggest that relative caregivers have service needs that are different from those of parents and may be more disadvantaged than child-only cases.

Simmel, C. (2012). Highlighting adolescents’ involvement with the child welfare system: a review of recent trends, policy developments, and related research. Children and Youth Services Review, 34(1), pp. 1197-1207

The purpose of this article is to provide a review of the literature on issues pertinent to adolescents involved with the child welfare system. The authors point out gaps in the literature and review policies pertinent to this population. Recommendations made include providing better services to this population.

Smith, B.D. (2003). How parental drug use and drug treatment compliance relate to family reunification. Child Welfare, 82(3), pp. 335-365.

This study assesses the relationships among parental drug use, drug treatment compliance, and reunification from substitute care. Parental drug use and treatment compliance have been presented as justification for a new emphasis in child welfare policy and practice, especially due to the shorter permanency timelines. Using in-person survey data and state administrative data, the study finds that drug treatment compliance is associated with faster reunification, even when accounting for ongoing drug use and three parenting measures. The findings are consistent with a conceptual framework suggesting that certain client actions, such as drug treatment compliance, may serve as markers that substantially affect client outcomes. This study contributes to the growing body of empirical literature on the correlates of reunification, including parents’ treatment compliance.

Smith, D. K., Johnson, A. B., Pears, K. C., Fisher, P. A., & DeGarmo, D. S. (2007). Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use. Child Maltreatment, 12(2), pp. 150-160. DOI: 10.1177/1077559507300129

This article presents findings from a study looking at 1) the effects of prenatal and postnatal parental alcohol and drug use and 2) maternal and paternal substance use as predictors of child maltreatment and Foster care placement transition in a simple of Foster care children. Results show that prenatal maternal alcohol use predicted child maltreatment and the combined prenatal maternal alcohol and drug use predicted Foster care placement transitions.

Svoboda, D. V., Shaw, T. V., Barth, R. P., & Bright, C. L. (2012). Pregnancy and parenting among youth in foster care: A Review. Children and Youth Services Review. 34(5), pp. 867-875. DOI: 10.1016/j.childyouth.2012.01.023

This review reports the findings related to prevalence, risk factors, and protective factors for pregnancy and parenting among youth in foster care. Youth report their motivations for parenting and barriers to preventing pregnancy. Child welfare workers and administrators report lack of policy and practice guidance related to pregnancy prevention and reproductive healthcare for youth in foster care. The authors argue that inclusion of family planning and pregnancy prevention should become part of the discussion to ensure child well-being for children in foster care.

Tarren-Sweeney, M. (2013). An investigation of complex attachment – and trauma-related symptomatology among children in foster and kinship care. Child Psychiatry and Human Development, 44(1), pp. 747-741.

This article presents findings from an investigation into the nature, patterns and complexity of mental health symptomatology of children in foster and kinship care. Findings indicate that social and interpersonal relationship difficulties are often presented in children in care, including anxiety as a component of felt insecurity, and attention-deficit hyperactivity is often manifested along with other difficulties.

Taylor, O. D. (2011). Children of substance-abusing or substance-dependent parents. Journal of Human Behavior in the Social Environment, 21(7), pp. 727-743. DOI: 10.1080/0911359.2011.615683

Children of substance abusing or dependent parents are suffering a tremendous hardship. According to the Office of Applied Studies, an estimated 6 million children live with a parent who abuses alcohol or other drugs. These children are being removed from their natural home environments at alarming rates. Of the 80% of the children within the child welfare system because of a substance abusing or substance dependent parent, an estimated 50% are reunified with their recovering parents and return home. However, the other children are loss in a costly child welfare system of uncertainty.

Uliando, A., & Mellor, D. (2012). Maltreatment of children in out-of-home care: A review of associated factors and outcomes. Children and Youth Services Review, 34(12), pp. 2280-2286.

This article provides an overview of the types of maltreatment in out-of-home care and examines the impact of this maltreatment on children’s functioning. It discusses maltreatment by individual perpetrators such as carers or other children, and maltreatment inflicted through policies, processes and decisions made within the child protection system. The impacts of maltreatment in out-of-home care on children are reviewed, and the child, worker and system factors that contribute to maltreatment of children in care are discussed.

Vanderploeg, J. J., C. M. Connell, et al. (2007). The impact of parental alcohol or drug removals on foster care placement experiences: A matched comparison group study. Child Maltreatment, 12(2), pp. 125-136.

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Vanschoonlandt, F., Vanderfaeillie, J., Van Holen, F., De Maeyer, S. & Andries, C. (2012). Kinship and non-kinship foster care: Differences in contact with parents and foster child’s mental health problems. Children and Youth Services Review, 34(8), pp. 1533-1539.

This article aims to compare kinship and non-kinship foster placements in regards to contact with/attitude of parents and the mental health of foster children. According to the authors, non-kinship foster placements fare better on different aspects of contact with/attitude of parents than kinship foster placements. Foster children in kinship foster placements have less behavioral problems than non-kinship foster children. The researchers draw attention the number of previous out-of-home placements as the most important predictive factor for behavioral problems.

Wells, K., & Marcenko, M. O. (2011). Introduction to the special issue: Mothers of children in foster care. Children and Youth Services Review, 33(3), pp. 419-423. DOI: 10.1016/j.childyouth.2010.06.022

This article introduces the special issue of Children and Youth Services Review devoted to single mothers with children in foster care. It delineates the policy context in which mothers are operating; examines reasons for mothers' temporary loss of custody of their children, a loss that occurs when their children are placed in foster care; presents expectations of mothers once they enter the public child welfare system; and summarizes empirical and theoretical papers included in the volume intended to advance policy and practice for this population. Taken together, these papers reflect one over-arching theme—the need to re-orient child welfare policy and practice so that the rehabilitation, health, and well-being of mothers is one of the central aims.

White, C. R., O'Brien, K., White, J., Pecora, P. J., & Phillips, C. M. (2008). Alcohol and drug use among alumni of foster care: Decreasing dependency through improvement of foster care experiences. Journal of Behavioral Health Services & Research, 35(4), pp. 419-434.

The Northwest Foster Care Alumni Study examined the effects of family foster care on adult substance dependencies. The study focused on young adults (N = 479) who were served by a private (Casey Family Programs) or public foster care agency in Washington and Oregon states. This paper describes (1) prevalence rates of alcohol dependence and drug dependence, (2) the relation between risk factors and experiences in foster care and adult substance dependencies, and (3) statistical simulations showing how adult substance dependency rates may be reduced through improvement of the foster care experience. The rate of alcohol dependence within the past 12 months (3.6%) among alumni was not significantly different from that of the general population; the rate of drug dependence within the past 12 months (8.0%) was significantly higher among alumni. Optimization of foster care experiences (i.e., improving care) was associated with significant reductions in the estimated prevalence of these two dependencies.

Woolgar, M. (2013). The practical implications of the emerging findings in the neurobiology of maltreatment for looked after and adopted children: recognizing the diversity of outcomes. Adoption & Fostering, 37(1), pp. 237

This article presents findings from a literature review on the most recent research on the neurobiological consequences of maltreatment, by focusing on the impact on children’s brain development, physiology and genetics. The article also provides two cases studies in which neurobiological science was used for the detriment of child placements. Authors argue that neurobiological research should be used carefully.

Wulczyn, F., Ernst, M., & Fisher, P. (2011). Who are the infants in out-of-home care? An epidemiological and developmental snapshot. Chicago: Chapin Hall at the University of Chicago.

This brief examines five key domains in which infants in out-of-home population differ from older children including 1) incidence of first-time out-of-home placements; 2) duration in care; 3) experiences in care: 4) characteristics and; 5) vulnerability for delayed development.

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