Factors for Failures in Foster Care Placements

INTRODUCTION

At any point in time, an estimate of 60,000 children and adolescents are available in the system waiting on the local authorities for provision of quality care. Out of this number of children, an approximate of two thirds are fostered (Sinclair, 2005). This was also reported by the Fostering Network’s survey which revealed a drastic shortfall of over 10,00 foster carers in the United Kingdom (Tapsfield and Collier, 2005).

This growing trend in the number of children entering the care system in this era differs from the trend in the early eighties. Similarly, there is a paradigm shift in the reason why children enter the care system in the 21^st century compared to early centuries. Parental misfortune, child’s truancy, and flouting of the law are cogent reasons child enter the care system but more children are entering the system nowadays due to abuse.

Furthermore, adolescent’s failure to cope with their family due to belligerent attitude and independence assertion remain critical factors contributing to the growing trend in number of children entering the care system. In the words of Sinclair (2005), there is a gap between the number of carers and children and adolescent entering the care system. Thus, these looked after children remains a source of concern for carers considering the different reasons they enter the care and the challenges in deciding which children to give care.

The inadequate number of carers in the system signifies the necessity for existing placements to success so as to provide succor for the growing needs in the system. Therefore, this study investigates some of the factors contributing to the failure of existing foster placements purposely secured for adolescents. Also, the study offers evidence-based policy which can avert future placement disruption.

MOTIVATION FOR THE CHOICE OF SUBJECT

It has been discovered that placement disruption is a major reason children exit a particular foster placement to another. While this breakdown applies to all children regardless of their age, the reality shows that it is prevalent among children aged 11 to 16 years.  Rowe (in Farmer, Moyers & Lipscombe,2004) asserted that foster placement for adolescents ends more quickly than foster for younger children in the ratio of 2 to 1. This observed pattern instigates the need to investigate the causes of adolescent’s placement breakdown with the ultimate goal of proffering long-term policy which will reverse this trend in the near future.

In the same vein, it has been found that Adolescents in foster care are more susceptible to behavioural problems. Consequently, the propensity for conflict and instability in their foster home is increased by these behavioural problems. Placement breakdown is also likely. Indeed, more placement changes are experienced by adolescents in care compared to younger children and are not likely to leave foster care for a permanent placement. It has been found that placement disruptions can bring about a high likelihood for short and long term physical and mental health and behaviour ( Oosterman, Schuengel, Slot, Bullens and Doreeijers, 2007).

Thus, this study is motivated by the established adolescents’ increased risk for problem beahiours and placement breakdown. It seeks to explore effective ways through which supervising social workers can achieve placement stability for adolescent children (13-16) and ensure their overall well being in foster care.

PROBLEM FORMULATION

Problem formulation creates the context and backdrop through which readers can understand the inquiryand stance of the researcher Fouché (2002). Empirically, there is a consensus in the literature that children long for stability because of the effects a disruption might exert on their well-being and self-worth (SCIE, 2005). For instance, an interview with an adolescent by Barrow Cadbury Trust (Barrow Cadbury, 2005) indicated that the adolescent undergoes torturous moment anytime he is placed in a foster home. The adolescent asserted that he is very anxious about how the placement will work out having experience series of ejection from former placement. After being accepted into the foster placement, he is ejected again from the house after a couple of weeks and this fuels his longingness for stability. Findings showed that the adolescent final abode was a Young Offenders Institution.

Placement instability is directly attributed to the incessant collapse of adolescent placements and findings showed that nearly half of the breakdown occurs before the age of eighteen (SCIE, 2005). For a placement to be stable, fosters carers saddled with the responsibility of caring for the children must be retained especially children who cannot cope with living their parents. The growth of foster carer as solution for ending placement failure was proved as 66% children in the UK care system live with foster family. The service of the foster carer becomes more needed in this time considering the twenty percent surge in the number of looked after children (Farmer et al., 2004).

From the researcher’s standpoint, lack of cordial relationship between carers and children is the leading cause of placement breakdown in most cases. This sour relationship causes children to move from one foster placements to another thus interrupting the children’s sense of stability and security. However, the factors contributing to placement breakdown have not been sufficiently investigated thus necessitating a rational investigation to underscore other salient factors.

While every individual investigation into the causes of placement breakdown will differs due to the difference in methods, geography, sample size, and type of sample investigated, the researcher still recognized the possibility of repeating some earlier findings which are considered important regardless the case of placement breakdown being investigated.

Therefore, the research question can be developed based on the problem formulation and generally, the study seeks to answer the question “what are the causal factors that contribute to foster placement breakdowns?”. This question would enable the researcher concentrate on key aspect of placement breakdown instead of reviewing every empirical thought on the subject matter.

AIM AND OBJECTIVES

In the words of Fouché (2002), the aim specifies the ultimate goal that must be achieved while objectives enumerate that which must be taken to achieve the aim. The following are the aims and objectives of this study:

Aim: To examine effective ways of promoting placement stability of adolescent children (13-16 years) in foster care by supervising social workers in the United Kingdom.

Objectives of the Study:

The researcher had the following objectives for this study;

• To examine  current measures taken by supervising social workers towards ensuring placement stability such as careful assessment of physical, developmental and cognitive functioning of adolescent children,
• To identify of gaps between provider abilities and child needs,
• To examine timely provision of specialized services to address adolescent children areas of need among others.
• To assess the strength and weaknesses of measures taken to promote placement stability
• To proffering better and more effective ways of ensuring placement stability of Adolescent Children in the United Kingdom.

 

RESEARCH APPROACH

The study employed a Systematic Literature Review design to achieve the objective of the study.

A systematic review involves sifting relevant findings from previous studies which relate to clearly formulated research questions. Systematic literature review utilizes meticulous approach to search, categorize, select, and assessed findings previously published in early literature.

The systematic review only uses studies that satisfy selection criteria and reasonably support popular ‘evidence’ in the area of studies.

In executing this study, the researcher conducted a literature search of internet-based databases to identify previous studies that have investigated placement stability among adolescents in the UK. In the search process, the researcher complies with the specification of PRISMA – Preferred Reporting Items for Systematic reviews and Meta-Analyses (Moher et al, 2009). The study focuses on six databases during the search and these include (i) WEB OF SCIENCE, (ii) PsychInfo, (iii) MEDLINE, (iv) CINAHL, (v) ASSIA, and (vi) Social Services Abstracts.

The searches were limited to catalogue of scholarly work published in English between the year 1971 and March 2012. The researcher didn’t include all the references available within this time span but only titles that relates to children in care. This is followed by sanity-check of titles and abstracts by a single reviewer (RP), advised by other authors on the inclusion and exclusion criteria. Journal articles included in the final index of literature reported original data which promotes placement stability.

The search terms were modified severally in order to find related scholarly works. More terms were derived from relevant articles that were identified from previous search. The key words and sub-section headings in such relevant articles were used as search terms for more articles. The search was done in conjunction with a University librarian repute for special skills in such area.

Three terms used in the search process are 1. Adopt* or foster* 2.  “Placement stability” or rehabilitation or permanency and 3. effective*. The search terms were first used individual and jointly (1 and 2 and 3).

The study also searches for the scholarly works of authors whose findings are insightful from key relevant papers. Additionally, the researcher also sought the knowledge of experts in children care on key papers in the areas for such scholarly work to be included. The consultation with the experts was considered important due to the high volume of unrelated and irrelevant articles in the areas of children in care. The findings of scholarly work published within the timeframe of the study and that emphasize on children in care were reviewed using a data extraction sheet.

This choice of this method is justified based the systematic process involved as well as the rigour in selecting existing scholarly work in the area of children in care. Since these scholarly works serves as data for this study, it is important that the reliability and validity of such studies are established through a meticulous approach.

DEFINITIONS OF TERMS AND KEY CONCEPTS

The clarification of certain terms and core concepts are necessary in this study. Terms and core concepts clarified in this study include;

Looked after child

In a situation where a local authority provides accommodation for a child, it can be said that the local authority is “looking after” the child. The concept of applies to both children whoare subject to court orders and those who are not. Parental responsibilities of any person or local authority are not affected by provision of accommodation. In a situation where the local authority is empowered by a court order to a child in care, the local authority shares parental responsibility with the parents and have control over the child.   A ‘care order’ is a concept used to refer to such a court order. The local authority will automatically look after and provide accommodation for a child subject to a care order (Brayne and Carr, 2003). For the purpose of this study, reference will be made to “looked after child” and not to “looked after adolescent”. This is because “ looked after child” is a statutory term and is inclusive of all children in the care system, inclusive of adolescents.

Foster carer

Foster carers (alos known as foster parents) refers to people deemed suitable and selected by the local authority for the purpose of provision of accommodation and maintenance for a child being looked after (Brayne and Carr, 2003).

Child and adolescent

As much as possible, the term adolescent was used, albeit the use of ‘child’ was more apt, as the author’s meaning might have been changed by the use of adolescents. In a situation where the term child is used, this is inclusive of adolescent, but where adolescent is used, it makes reference particularly to a group of children within the age range of 11 and 16 (Sinclair and Wislon, 2003)

Drift and permanence

It is important to ensure that drift does not occur when caring for children. Considering the fact that a child has already experienced disruption by being removed from his known home, there is a need to ensure that such a child finds permanence in the fastest possible time. The provision of this permanence occurs by coming back home or undergoing long-term foster care or adoption.

As soon as a child enters care, he goes into a short-term placement due to the fact that there is there is no planning for moves from homes. This implies that short-term placements are provided by foster carers for children who need to move out of their family home for whatever reason, usually in a rush. By implication, the child may not remain with the foster carer long term, although they usually do (Fisher et al, 2005)

Social worker

In the course of this study, when making reference to the social worker saddled wit the responsibility of the adolescent and his care plan, the study will make use of the term adolescent’s social worker. This is done to avoid confusion between the adolescent’s social worker and the foster carer’s own social worker (Bryane and Carr, 2003)

Supervising social worker

The supervising social worker is the foster carers’ social worker whose responsibility is in providing support for the foster carers in their caring role, ensuring that all the child’s needs are met in the placement. There often seems to be confusion about this role, both amongst professionals and foster carers. The supervising social worker’s main role is not to be the advocate or representative of the foster carer, but to support the carer in providing quality care to the child (Bryane and Carr, 2003).

 

LITERATURE REVIEW

LITERATURE REVIEW

This review entails an examination of contributory factors to placement stability, placement disruptions and attachment resilience. It considers factors which help foster carers achieve the goal of ensuring that difficult placements do not end in disruptions.

Placement Success

There have been varying views as to what constitutes placement success, depending on whose perspective the issue of placement success is being considered. Successful placement can be said to have been achieved for the adolescent if permanence is established or when there is an improvement in the outcome of the adolescent, then placement success can be said to have been achieved. There have been calls to explore a broader perspective of placement success (Sinclair, Wilson and Gibbs, 2005).

Achieving Placement Stability for Fostered Adolescent

There are some factors associated with placement stability for adolescents. Some of these factors are factors associated with the adolescents and the family they come from, the type and quality of placement they have and the type of welfare services and systems made available to them. There is a need for the supervising social worker to take cognisance of these factors to achieve placement stability for the adolescent.

Child and Family of Origin Characteristics

When an adolescent has behavioural problems such as mental health issues, he/she is likely to experience placement disruptions (Webster et al,.2000). Thus, there is a need for the supervising social worker to ensure that the development and cognitive health of adolescents are examined to ensure that they are able to achieve placement stability for them. Other behavioural problems such as delinquency among adolescents have also been found to have implication for placement disruption (Eggertsen , 2008).

The reason why adolescent adolescents left their family of origin has been found to be a contributory factor to placement stability (Osterling, D’Andrade & Hines, 2009). Adolescents who experienced physical or sexual abuse from their family of origin are at an increased risk of placement disruption compared to those who never had such experiences.  This finding has implication for interventions for achieving effective placement stability among adolescents and underscores the need for the supervision social worker physical, development and cognitive function of adolescents as experiences from their family of origin can have an effect on them.

Despite the fact that unpleasant experiences such as physical and sexual abuse at family of origin could affect placement stability among adolescent, the odds can be reduce if appropriate measures are taken and interventions introduced. For instance, it has been found that when adolescent are given the opportunity to share past experiences in their family of origin and how their birth relationships were, then there is a higher likelihood of having placement stability and less placement disruption. This is especially so when such adolescents are able to share such experiences with a trusted adult in the foster care. Thus, there is a need for careers to be receptive to adolescents need and make out time for them to share their past histories and difficulties in an atmosphere of trust, love and acceptance.  When the carers make out time for such interactions, there is a fostering of bond between carers and the adolescents. This helps in sharing confidence and help adolescents to better deal with past pain experiences and integrated better in to their new home.

Characteristics of Placement

Studies have identified some placement characteristics that may influence placement stability or disruption as the case may be. Some the characteristics considered are foster parents’ roles, kin and non-kin placements, timing and number of placement moves and the number of times the adolescents get welfare referrals.

With respect to foster parents’ role, it has been found that the characteristics and attributes of foster parents have implication for placement stability for adolescents. Adolescents who stay with foster parents who are stable and involved emotionally with the foster care are more likely to experience placement stability than those adolescents with foster parents who are unstable and emotionally uninvolved in their care. Also, it has been found that adolescents with foster parents who are trained, prepared and supported to deal with children with special needs are more likely to experience placement stability (Redding, Fried and Britner, 2000). It is important to consider the adolescents’ temperament, temperament of their parents and their parents’ expectations in matching them with foster families. This has been also found to have positive implications for placement stability.

A living arrangement where a child is made to live with and be in the care an adult he/she is related with other than his/her parents is known as kinship care. The arrangement could be arranged privately or initiated publicly owing to the child welfare system’s involvement (Geen, 2004). Studies have examined the  kin and non-kin placement with respect to placement stability. A study by Webster et al. (2000) found that children experience more placement moves when placed out of their home. However, the placement moves is increased for those who are not in a kinship care compared to those who are in a kinship care. Testa (2008) found that the likelihood for increased placement stability decreases for adolescents in kinship care after one year. However, several other studies have found that placement in kinship care has increases the likelihood of staying longer in care (Courtney & Park, 1996; Smith, Rudolph & Swords, 2002; Vogel, 1999), and this consequently leads to placement stability (Webster, 2000).

One on the reasons adduced for the longer stay associated with kinship care is that while kinship care providers may not be willing to initiate adoption of the child in care, they have been reported to be more willing to take responsibility of the care of the child until they are ‘old enough’ and considering the fact that they are family, they consider this arrangement as good as adoption (Rubin et al, 2007).

Another placement characteristic that has been found to have implication for placement stability is the personal experiences of adolescents within the child welfare system. Adolescents who were placed with siblings and later placed in homes without siblings have been found to experience increased placement moves (Leathers, 2005). Rubin et al (2007) established that adolescents who had not been involved in with child welfare in the past are more likely to experience placement stability compared to those who have had prior involvement with child welfare. Additionally, Webster (2000) found that if adolescents are move more than once in their first year of in care, they are likely to experience placement disruption in their future care.

Systems Factor of Placement Stability

Placement stability with respect to factors within the wider child welfare system has been examined by scholars. Ryan, Garnier, Zyphur and Zhai (2006) found that mandates of policies or systems inform 70% of placement moves. Some of these moves involve moving from short term facilities or long-term one, funding issues and kinship placements. Also,   placement instability has been associated to turnover of caseworkers. Factors linked to this high turnover include low salary, administrative workload, increased caseload, lack of supervisory support and low levels of training. On the other hand, some factors associated with placement stability include are provision of subsidies for adoption placements and guardianship and the employment of graduate-level training caseworkers (Testa, 2002).

Gaps between Providers’ Abilities and Child Need

It is important that providers of care are able to meet the adolescents’ needs. Where there is a gap in between providers’ abilities and child needs, the adolescents in care may be at risk of placement stability. Foster carers must be able to cope with the temperament and behavioural tendencies of adolescents in their care. This will augur well for placement stability for adolescents. However, where carers are unable to cope or deal with temperament or behaviours of adolescents in their care, then there is likely to be issues of placement disruptions for the adolescents.

Beyond issues of behavioural tendencies, there are also the aspects of health of the adolescents. Foster carers must be equipped to cope and deal with the health issues of adolescent in their care, especially those with mental challenges. It has been reported that there have been cases abound where children have taken ill and died after placement due to the lack of knowledge of the social workers nor foster parents to the children’s immediate health needs. An appreciation of the health care needs of adolescents will inform effort to ensure placement stability as frequent moves are contributory to little or no continuity with care received from different physicians by adolescents.

Also with respect to health care needs of adolescents, it has been reported that some child welfare agencies are lacking in the provision of policy mandates with respect to health care of children in foster care. Most times, caseworkers may depend on the sound judgment of foster parents in determining when children are in need of health and mental health care. However, foster parents lack the legal backing to provide consent for children to be treated. In some cases, there may be a need to contact biological parents to give direct consent for health, developmental and mental health care received by their child while in placement, bring about potential hindrance to much needed health services.

The Role of Supervising Social Worker

A necessary component for effective foster care for adolescents is an effective working relationship between all members of the team around the adolescent in foster care. This should be inclusive of the supervising social worker showing empathy towards the foster carer and sometimes challenging him/her. Studies have revealed that most foster carers express a better working relationship with their supervising social worker compared to their foster child’s social worker (Sinclair et al, 2004).

The supervising social worker (SSW) is provided to every foster carers. This supervising social worker is responsible for the supervison, support and ongoing assessment of the foster carer. For the fostering service of local authority, the SSW and the child’s social worker work for the same authority. However, the SSW works in a with separate management and supervison in a different section.

Statutorily, the carer is expected to contact the SSW for guidance, advice and information sharing about the fostered adolescent. The SSW is then expected to facilitate a meaningful professional relationship information sharing and open communication, with a view to mmeting the adolescents’ needs and support for the carers emotional and practical needs.

The National Minimum Standards (NMS) require The fostering service is required by the National Minimum Standards to be supportive to carers to the end of ensuring they provide fostered adolescents with care that meet their needs, take account of the wishes and feelings of fostered adolescents, ensure the safety of fostered adolescents, promote their individual care, promote their health, promote their education and prepare them for independence.

The SSW is saddled with the core responsibility of ensuring that the National Minimum Standards (NMS) are put to practice. Because the way through which this core role of the SSW is to be achieved is not spelt out in detail in the standards, the SSW is expected to adhere to adhere to the procedure and policies of their organization. Key responsibilities expected of the SSW are to coordinate the emotional and practical support needed by foster carers, provision of advice, information and guidance for carers and their families, look out for and support foster carers’ development and learning needs, see to standards of care, make sure foster carers comply with policies and procedure, liaise with adolescent social workers ensure that their working partnership with foster carers is supported,  liaise with other professionals and be supportive of their working partnership with foster carers, be supportive of carers’ own children, and be responsive to comments, concerns and allegations and carry out annual reviews of foster carers’ approval.

SSWs are expected to make regular visits to foster homes. As much as the NMS does not specify the frequency of visits, the SSW is expected to take decision on frequency of visists based on need; what is going on with the adolescent, the foster family, and how complex the carers’ issue is.

Specialised Needs for Adolescent in Foster Care

A major chunk of the unmet health needs of adolescent in foster care are entrenched in their intricate history of trauma and complicated by their low access to the right health care services. Restricted access to health care and unmet health needs is experienced before placement and most time persists afterwards.

Essentially, psychosocial issues are fallouts of family dysfunction and this is the experience of most, if not all adolescents in foster care. Thus, there is a need to address the psycho-social issues of adolescents in foster care and failure to do this may have negative implications in the future. As much as there has been an inadequate study of long-term outcome of foster care, there is evidence that there have been experience of high rates of mental health problems, homelessness, low educational attainment, unemployment, and post traumatic disorder among young adults who stayed in foster care as adolescents.

Although not much is known as to how younger children who left foster care before adolescent, through kinship-care placement, adoption or reunification with parents, turn out, evidence abound that placement in long-term stable foster/kinship care is more favourable to adolescent compared to being confounded with unstable placements.

The neurobiology of developing brain is endangered by early childhood trauma/toxic stress, more so if constant and unremitting and not mitigated by nurturing, responsive caregiving. Poor emotional regulation, hyperactivity, aggression, impulsivity, attention and attachment problems and being unable to associate mood and thought have been correlated with early childhood trauma, which can progress into adolescence. Unresponsive and chaotic caregiving prior to foster care have implications for insecure attachment disorders manifesting as hypervigilance, indiscriminate friendliness and social withdrawal.

Normally, children undergo a complete mental health evaluation, inclusive of trauma assessment, upon entering foster care. Although mental health screening at entry to care is important to assess for acute mental health needs and suicide risk, a complete evaluation is best suited after the child has settled in and acquainted with his new environment and visitation with family. If there is a need for treatment after evaluation, it should incorporate the right therapy, inclusive of trauma-informed care, with the right education and support of the adolescent’s caregiver and caseworker.   There is a dearth of mental health professionals with the right training in trauma-informed therapies. Also, funding is not adequate to ensure access by adolescents whom access to these interventions will prove beneficial.

 

METHODOLOGY

THEORETICAL FRAMEWORK

Theories are proven and valid principles which offers insights into the occurrence of certain phenomena. In general, theories are systematic synthesis of interrelated facts which provide acceptable explication for social happenings. They are fundamental tenets that shed more light on the subject of a researcher’s inquiry. Theories enable the researcher to analyze issues from an objective standpoint. Theories contain a set of assumptions which serves as the basis for developing a hypothesis to test the connection between different variables. This study would employ the attachment theory and social learning theory as the basic framework for explaining placement stability among adolescents in the UK.

Attachment Theory

Attachment theory is a psychological framework that explains the intricacies of interpersonal relationship among distinct individuals both in the short term and long term. Rather than being a holistic proposition on human relationship, the theory only investigates specific aspects of human relationship. The theory offers insights on the response of human beings to hurt, separation from loved ones, and threat in a relationship.

For infant to succeed emotionally and socially, they need to be attached to a caregiver committed to developing a quality relationship with them. The differences in the quality of relationship between infants and care giver influence the emotional and social development of the infant. As infant, they becomecloser with a familiar caregiver and when they are frightened by any occurrence, the derive security from the caregiver they are attached to. John Bowlby asserted that infant’s development of affinity with caregivers is connected to evolutionary pressure which makes infant to survive when faced dangers.

The supreme tenet of attachment theory is that infant must cultivate a relationship with at least one caregiver in order to be stable socially and emotionally. This relationship between the infant and the caregiver enables the infant to regulate their feelings and respond to the caregiver. An infant’s attachment figure can be the father, mother, or individuals who attend to the emotional and social need of the child.

When the attachment figure is present, the infant can freely explore the environment with the assurance that his “safe base” will respond when face with dangers. Although there are times when the caregiver is occupied and exhausted, a sensitive caregiver will always seek avenues to manage the distraction and attend to the emotional needs and social interaction of the infant.

In scenario when a caregiver is not sensitive and responsive to the interactions of the infants, a different dimension of affinity is established and it holds great implications for the development of the infant. Since infants cannot exit this type of caregiving relationship, they try to manage themselves and this will influence their attachment pattern later in life but may not affect the expectations about a relationship when grown up. In the findings of Mary Ainsworth, a developmental psychologist, in the 1960s and 1970s, she found out that exhibition of a different patterns of attachment in a child can be traced to their early experience in a caregiving environment.

Social Learning Theory

Social learning theory offers a practical model to understanding learning and social behavior. The theory proposed that individuals can acquired new behavior from observation and imitation. Since learning is a cognitive process that occur in a social context, the theory asserted that learning can take place by observation and instruction even without direct reinforcement.

Besides the observation of behavior, learning can also be initiated by observing receipt of rewards and punishment, a process termed vicarious reinforcement. When a specific behavior is frequently rewarded, such behavior is expected to continue and if a specific behavior is repeatedly punished, it will likely cease. The theory broadens existing traditional theories which established that behavior is learned by reinforcement.

Social learning theory unified the behavioral and cognitive theories of learning to develop a robust model which could offer detailed explanation on the range of learning experiences taking place in the real world.

The key tenets of social theory learning as outlined by Bandura and Walters (1963, 1977) is stated as follows:

1. Learning is not totally behavioral; rather, it is a mental process initiated within a social setting.
2. Learning can take place through direct observation of behavior and its consequences (vicarious reinforcement).
3. Learning takes places through direct observation, extracting information from such observations, and deciding about the outcome of the behavior (observational learning or modeling). Hence, learning can take places without a noticeable transformationof behavior.
4. While reinforcement is an integral part of the learning process, it is not totally responsible for learning.
5. The learner is an active receiver of information. Cognition, environment, and behavior are all interwoven (reciprocal determinism).

Method

This study employed international best practices in conducting systematic review by complying with the procedures specified by the NHS Centre for Reviews and Dissemination (2008). This methodical order for conducting the review is enumerated in Figure 1 representing only the first stage in the study. The second stage explored the development of social work practice employing evidences provided in the review.

Search strategy

Basically, searches were done through electronic bibliographic databases from Embase, PsycINFO, SwetsWise, OVID Social policy and practice,Web of Knowledge and Applied SocialSciences Index and Abstracts (ASSI),Medline, Scopus,and Article First (OCLC).The terms searched for LAC include (foster or (looked after) or (substitute care)). For a more robust search, the researcher combined these LAC related terms with other placement-related words related like (instability or stability or stable or unstable or disrupt or drift or breakdown or permanent or move).

For the qualitative study, the researcher utilized the following search terms: ((foster or (looked after) or (substitute care) and (qualitative or (grounded theory) or interview or (observation  method). The reason the researcher conducted a separate search for qualitative studies was because of the observed inconsistency in the method of indexing qualitative scholarly work in bibliographic databases (Shaw et al., 2004). All searches conducted were limited to scholarly work conducted in English language between the year 19700 and June 2010. Similarly, the researcher cross-referenced the search results with other reviews in the area of children care to verify the eligibility of the citation in the review.

Study selection

The quantitative studies review in this study were ensure to meet the following criteria:

(i) the population studied in such works included a larger percentage of adolescent children  in foster-care (mixed samples of adolescent children who were placed in other types of placement. For example, studies that uses a sample of adolescent children in residential care were included if findings in such studies were reported separately for a subsample of foster children in the study); (ii) use placement instability as a controlled variable that captures incidence of placement disruptions or placement moves; and (iii) a cohort (prospective or retrospective) or cross-sectional research method was employed in analyzing the relationship between placement instability and control variables used in the study. The study didn’t restrict the literature search for the following: age of LAC, country where the study originated from, and method of data analysis (univariate, bivariate or multivariate). Studies that analyzed the effects of service interventions on placement results were not included in the review but studies that analyzed the nexus between non-interventions factors and placement disruptions were included in the review.

For the qualitative studies, the following criteria were used in selecting scholarly works for review: (i) respondents interviewed in the study comprises LAC, foster-carers and their children, and social workersthat works directly with foster placements; (ii) the study engaged respondents on their experiences and outcomes of foster placements; (iii) the qualitative reviews were analyzed using an explicit method of qualitative analysis.

Quality assessment

This study appraised the quality of the quantitative scholarly works using a Downs and Black’s (1998) checklist which was developed for evaluating the quality of healthcare studies. The checklist analyzed the quality of a scholarly work using twenty-four items segmented into five domains: study design, internal validity, external validity, statistical rigour and practical significance to the target population (i.e. children in UK foster-care). The checklist uses a rating system to provide descriptive data on the strength and rigour of the reviewed studies, although there was no cut-off mark for the inclusion of a study in the entire review.

For the qualitative research work reviewed, the researcher employed a quality evaluation framework based on the works of Spencer et al.’s (2003). The strength of a qualitative studies was evaluated using four criteria: relevance to target population and overall contribution to body of knowledge, strength of study design, accuracy of data collection method and analysis, and reliability of findings overtime. The qualitative studies included in this reviewed were ensure to meet the inclusion criteria without further restriction considering the scarcity of peer-reviewed qualitative research works in the areas of placement stability. Therefore, the quality framework of Spencer et al (2003) only indicate the strength of studies included in the study but not as a threshold for reviewing an article.

For both quantitative and qualitative studies, the quality evaluations were done by the researcher and the inter-rater reliability of (quantitative tool, r =0.73; qualitative tool, r = 0.85) was accepted.

Data synthesis and analysis

This study utilized a narrative synthesis approach to express ideas, compare findings, and integrates findings from qualitative and quantitative studies using figures, text, and tables (Popay et al., 2006).

At the initial stage of analysis, different themes were used to categorize factors that influence placement instability into main and subs. Vote counting method Pearson et al. (2009) was used to further inspect each category in order to ensure they were consistent and aligns with overall findings.

The relationship between a factor subcategory and placement instability is deemed to be positive or negative if 60 per cent of the studies depict such relationship. Similarly, relationship between a factor subcategory and placement outcome is considered ‘inconsistent’ if 34 – 59 per cent of relevant studies establish such relationship. The relationship is also labeled ‘nonexistent’ when less than one-third of the studies established such relationship between placement outcome and a factor.

The relationship between a factor category and placement instability is said to be a ‘strong’ one when(i) the 60–100 per cent studies established such and criteria satisfied; (ii) the correlation was established using multivariate data analysis in at least one or more studies; and (iii) a minimum of a research work utilized placement disruption as the outcome variable captured in the study. Thus, the strong association classification emphasizes the importance of a rigorous statistical analysis considering the fact that frequency of placement moves may be subject to measurement bias (Ward et al., 2001).

Qualitative findings was classified based on related themes and the relationship between the themes and key variables were established using the qualitative themes and theme emanating from quantitative data.

RESULTS

Number and quality of included studies

After the screening of citations and abstracts, 172 scholarly works were gathered of which forty-one were used in the synthesis process. Quality of quantitative papers ranged between 12 to 19 from a total of 24 (mean =16) while qualitative research works ranged between 11 to 31 from a total of 35 (mean = 23).

The researcher excluded studies that scores 8 primarily because of the inadequate method of qualitative analysis as this didn’t pass the inclusion criteria. While majority of the research works employed a sound and defensible sample design and study approach, much attention was not devoted to negative cases, outliers or other exceptions in the study. The researcher ensured that the qualitative studies reviewed reported coherent findings in tandem with the data used.

Characteristics of included studies

The total sample size for all the studies reviewed was n =12,128, while sample size in individual study ranges between 16 to 2,571 (mean n = 724).

The number of studies that used frequency of placements movements or incidence of placement disruption as dependent variables were nineteen each. Only a study was found to use both indices as dependent variables.

The total sample size for the literature reviewed for the qualitative study was n = 458,while individual samples has sample size which ranges between two to fifty-three (mean n =37).

Synthesis of findings

Generally, sixty-two factor subcategories were recognized and classified into five thematic areas. The thematic areas are child, birth parent, carer, relationship and placement. These categorizations were used to present the findings in both qualitative and quantitative studies.

Child factors

Demographics

Among the demographic factors, age emerge as the extensively research factor with emphasis on older age as factor that causes more placement instability. The researcher established a positive relationship between placement moves and breakdown in nine studies using multivariate statistics to confirm the association. The association between placement instability and other demographic factors were found to be very weak and low.

Placement history

There was a positive correlation between history of unstable placement and future placement instability. Evidence from the qualitative studies showed that placement breakdown makes a child to ‘give u’, feel ‘disconnected’ and ‘detached’, and ‘withdraw’ from people. This is further aggravated by lack of social networks and connection to the child’s school. Although, some children were optimistic about future placement despite exiting an uncomfortable and unhappy foster placement.Parental reluctance to care for a child and problem behavior were factors that influence the probability of placement breakdown.

Birth parent factors

There was weak evidence for birth parent factor and placement instability in all the studies reviewed. Only two of seven studies that examine this relationship established a positive relationship between parental substance abuse and placement instability. One study also confirmed a significant association between placement instability and birth parents’ socioeconomic penury. Dearth of birth mother and criminal activity were found to significantly influence placement stability.

Child–birth parent contact

The evidence for birth parent contact and placement instability nexus was inconsistent although two studies established a relationship between placement breakdown and frequent contact with birth parents. Conversely, a second study established relationship between birth parent contact and placement stability. Furthermore, a second study didn’t find any supporting evidence for a relationship between birth parent contact and placement outcome. This makes the relationship between birth parent contact and placement instability to be inconsistent. Evidence from qualitative studies showed that harmony only exist between birth parents and foster carers immediately foster carerobtain legal parental responsibility.

Placement factors

Kinship versus foster-care

Many of the studies reviewed lend support to negative relationship between placement instability and kinship placements while non-relative foster care was found to lead to placement stability when compared to kinship placements. Evidence from qualitative findings showed that kinship carers feel oblige to care for the child unconditionally without any string attached. They considered the care as a binding duty to their relative.

Separation from siblings

Child’s separation from siblings was found to promote placement instability as qualitative studies confirm that the child feels unsecure when disconnected and far from their siblings and parents. Findings showed that the children miss the presence of their parents and their siblings. Older children who cares for their younger siblings before being absorbed in a foster care do feel that their siblings need their care thus making them uncomfortable. Also, some qualitative studies traced placement between to conflict between the child and fostered siblings.

Presence of carer’s children/other foster children

Unravelling the relationship between placement breakdown, presence of carer’s children, and presence of other foster children is considered knotty. The relationship hinges on the age of the LAC and the status of other children (whether they are foster carer’s own children or other foster children).

Four studies established a positive relationship between the presence of carers’ children and instability, and a negative relationship between placement instability and presence of other foster children. One qualitative study attributed placement disruption to tension between a carer’s child and a new foster child, birthsibling or another foster child. Due to the variety of the stress undergone by the foster carers biological children, a placement may becomeinstability.

Carer factors

Child-centred motivation was found to contribute to placement success but motivation like providing a company carer’s other children may prove problematic as established by Buehler et al. (2003). Furthermore, carers who expect gratitude from foster children in form of a ‘gift’ may feel disappointed when the child didn’t appreciate them in the way they expected (Butler and Charles, 1999).

Personal qualities

Nearly all the reviewed quantitative studies established a variety of personal characteristics which relates directly to placement outcome. Carers who sets boundaries and tolerate the children emotionally recorded more successful placement. Furthermore, discipline, flexibility, and persistency were other qualities of successful carers. Inspiring the children about their academic life and learning lifelong skills are also pillars that build a stable placement. Also, acts of kindness and affection toward the child are qualities desired by children for a successful foster placement. Qualitative studies also showed that academic performance of foster children in school boost their confidence which makes them to have more stable placement. Thus, when carers and social workers expects the foster child to perform excellently, the child does perform and the stable becomes stable.

Relationship factors

Carer–child relationship

Commitment of both the child and carers in terms of communication and attachment greatly affect the stability of a placement while poor acclimatization of the child fuels placement instability. In the same vein, inability of the foster child to meet carer’s expectations also contribute to placement instability. Similarly, inability of the carer to cope with child behavior lead to the abrupt end of placement. Approach to parenting and absence of animosity toward the child in the foster home promotes stability. Good communication also strengthens the relationship between the child and carer thus minimizing the failure of a placement.

Social worker relationships

Changes in social workers influence the stability of placement and this was established in different studies. Qualitative studies show that a harmonious and cordial relationship with a social worker is considered effective in ensuring the stability of a placement both by carers and the children. However, more frequent contact between the foster children and social worker as well as harmonious accord between them tends to exert negatively influence on placement stability.

For the carers, they were of the opinion that they could abruptly terminate a placement especially when they find the social workers unsupportive during crises, mischievous, meddlesome, and non-informing the carers about decision that concerns the child. Also, when children are carry along in making crucial decisions that concerns them, findings showed that there are only fewer placement movement. Also, when carers are abreast with adequate information before placements, risk of instability is greatly reduced.

DISCUSSION

This study employed a systematic method in reviewing and integrating a host of existing studies in order to glean superlative insight that will inform practice. From the review, a host of factors that relates to child, birth parent, carer, placement and relationship were identified and the role each of the factors play in relation to foster placements stability/instability were mapped out.

More evidences were found for the following factors older age; externalizing behaviour; duration of child in care; residential care as first placement setting; distance/separation from siblings; location of care (if outside area of origin), type of care settings (foster-care versus kinship care); poor integration into foster care family, and experience of different social workers.

Protective factors that facilitate the success of a placement include the skills, disposition, expectation, and qualities of the carers as well as the siblings of the child.

Findings from the study corroborates existing reviews in the literature which have identified various vulnerability and protective factors that influence placement stability (Holland et al., 2005; Munro and Hardy, 2007; Oosterman et al., 2007; Pardeck, 1985; Sellick et al., 2006;

, 2005; Wilson et al., 2004).

Since the study employed a comprehensive inclusion and exclusion criteria, this study contributes and adds to the body of knowledge in the area of children in care. Considering the richness of the methodological approaches and quality of international research that the review was based upon, the researcher is convinced of the quality of the contribution to the body of knowledge and the findings aligns with other large scale data studies like Sinclair et al.’s (2005) whose influential monograph Foster Placements: Why They Succeed and Why They Fail demonstrate findings that tally with the study.

Findings from Sinclair’s (2005) showed that placement stability is ensured when boundary is set and carer respond positively to the problem behavior exhibited by a child. These findings align with key themes that surface from our analysis thus boosting and augmenting the external validity of the findings of this study.   Also, Sinclair et al (2005) shows that children’s aggression and other externalizing difficulties negatively leads to placement breakdown/disruption. The findings of Sinclair et al (2005) on the concept of ‘fit’ – which implies how easy it is for a child to feel among other children in the family and how the child perceives his/her treatment relative to other children within the family also emanates from this study.

Strengths and limitations of the study

This study has conducted a robust and holistic investigation of adolescent children in care using an exhaustive review of both qualitative and quantitative evidence that relates to adolescent child, carer, and social worker perspectives on the subject of inquiry. By rigorously sifting salient facts and findings from qualitative and quantitative scholarly works, the study has been able to situate the major findings in the right context in order to ensure that exact findings are applied to the right situation and solution are proffered in the real world.

Generally, the application of the primary research studies in other climes is limited as most reviewed scholarly works are carried out in the UK and USA.

Implications for practice

Findings showed that for a proper care planning, vital stability factors as well as specific identified in the study must be dully addressed and considered. The translation of the researcher evidence into actionable insight which would facilitate smooth practice is ongoing and the stage involve the formulation, design, piloting, and propagation of evident-based tools which can aid social workers to successfully make efficient, actionable formulation, and care plans for placement that appears unstable and at the verge of collapsing.

Research recommendations

While efforts have been concentrated on developing a working model of placement instability in this study, there is a need for more in-depth analysis and report on the fundamental processes supporting the effects of vulnerability and protective factors. For instance, there is scarcity of works on individuals that deals with the placement of adolescent children and the reasons why they are prone to placement instability.

There is an explicit need for more rigorous work to provide practical insights on approach to understanding, evaluating and implementing evidence-based tools to enhance stability. On this premise, the researcher is convinced that the effectiveness of evidence-based practice tools would be enhanced by social workers evaluation and acceptability. The involvement of other key stakeholders in the process of developing the practice tools will broaden the metrics as well as indices and strengthen the capability of the practice tools in combating real world complexities.

For initial match to be ideal, the CAMHS should be involved in initial diagnosis care plan and interventions continuous in the LAC journey. There is a need for CAMHS to train foster carers as specialist therapeutic carers in complex behaviours involving trauma seperation and loss. Also, supervising social workers should identify training needs of foster carers as a major requirement according to NMS standards.

Conclusions

Evidence showed that a range of risk and protective factors are connected to placement instability and awareness of these factors couple with their effect on placement success is crucial for social worker to discharge their duties to the carer and children simultaneously. The study identified that it is crucial that all available evidences are considered in developing a sustaining approach to practice in the area of children in care. The study considered dynamic interaction to mirror the real world instead of developing a mix and balance between risk and protective influences thus making the model static and nonresponding to different situationsin the real world.

Considering the intricate and multifaceted characteristics of the client group, findings from this study provide social workers with an organized but flexible approach which would guide them in care planning and placement service improvement. Findings from the study would be effective for social workers to develop and generate hypotheses which would serve as benchmark for interventions having identified the relationship between requisite knowledge of clients and evidence-based instability factors.

 

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