Outcomes of Kinship Care Placement

1
Outcomes of Kinship Care Placement

• Donna Harrington, Ph.D.
• University of Maryland School of Social Work
• 23rd Annual UC Davis Western Regional
• Child Abuse and Neglect Conference
• Sacramento, CA, September 13-15, 2004

2
Workshop Goals

• Define kinship care placements
• Discuss rates of kinship care placements
• Review research on outcomes
• Discuss limitations of research
• Describe a few recent studies in detail
• Discuss subsidized guardianship initiatives
• Availability
• Outcomes

3
Participants

• What types of settings do participants work in?
• Child welfare
• Medical
• Other
• What type of work do participants do?
• Clinical
• Research
• Administration
• Experience with kinship care?

4
What is Kinship Care?

• Living with a relative because parents are unable
  to take care of the child
• Formal placement arranged by a child welfare
  agency
• Informal arranged within the family without
  involvement of a child welfare agency
• Relative may include fictive kin, who are close
  to the child, but not related by blood

5
Informal Kinship Care

• Much more common than formal
• Only a few studies have examined, therefore
  little is known (Cuddeback, 2004)
• Ehrle and Geen (2002) children in formal and
  informal kinship care were similar
• Both experiencing greater hardships than children
  in non-kinship foster care

6
Why Kinship Care is Needed

• Children may be unable to live with their parents
  because of
• Death
• Incarceration
• Maltreatment
• Mental illness
• Substance abuse
• Illness, including HIV/AIDS
• Other

7
Numbers

• 2000 US Census 5.6 million children reside with
  grandparents or other relatives
• 26 of children in out-of-home care lived with
  relatives (Harden, et al., 2004, based on
  Adoption and Foster Care Analysis and Reporting
  System AFCARS data)
• Kinship care is fastest growing type of
  out-of-home placement
• In a number of states more children are entering
  kinship care than foster care

8
Numbers from National Survey of Americas Families

• 1999 2.3 million children did not live with
  their parents (Billing, et al., 2002)
• 90 of those children lived with a relative
• Most arrangements are made privately within the
  family
• March 2002 almost 2.2 million children living
  with a relative (Fields Casper, 2001, in
  Carpenter Clyman, 2004)
• 10 times the number in traditional foster care
• 3 of children live in kinship care

9
Changes in NSAF Numbers

• 1997 1.8 million children living with relatives
• Increase primarily due to informal (i.e. outside
  the child welfare system) placements
• 1.3 million in 1997
• 1.8 million in 1999
• Formal placements stable around 400,000
  (Billing, et al., 2002)

10
Increased Use of Kinship Care in the Public Child
Welfare System

• Changing reimbursement policies that permit
  relatives to receive foster care payments
• Increasing foster care caseloads
• Decreasing numbers of foster parents
• Increasing emphasis on maintaining family ties
  (Iglehart, 2004)

11
Placement Rates

• In Baltimore, up to 75 of children in
  out-of-home care are placed with relatives
• In New York City, approximately 50 of children
  in out-of-home care are placed with relatives
• (Kolomer, 2000)

12
Placement with Relatives

• Separation from parents can be traumatic
• Trauma may be minimized by placement with
  relatives
• Often experience significant economic hardship or
  poverty
• Unknown whether risk of living in poverty on
  development moderated by benefits of living with
  relative
• (Billing, et al., 2002)

13
Theoretical Advantages ofKinship Care

• Continuity of family identify and knowledge
• Access to relatives other than kinship caregiver
• Continuity of ethnic, religious, and racial
• Caregivers familiarity of child based on
  pre-existing relationships
• (Cuddeback, 2004, based on Hegar, 1999)

14
Pros and Cons

• Some of these findings raise concern it is
  important to examine whether the theoretical
  advantages of placing a child in kinship family
  foster care outweigh some of the disadvantages
  characteristic of kinship placement (i.e. lower
  socioeconomic status, fewer resources, less
  training and support) (Cuddeback, 2004, p. 625)

15
Perceptions of Kinship Care

• Child welfare professionals have reported
• Generally children are better off being fostered
  by kin
• Kinship care children have a stronger sense of
  belonging
• Have more continuity in their lives
• Level of care and parenting in kinship homes is
  generally good (Cuddeback, 2004)

16
Perceptions of Kinship Care continued

• Child welfare professionals also report
• Kinship foster care families are more difficult
  to supervise
• Require more time to assess
• Make case plans harder to enforce
• Are more likely to delay reunification
• Less likely to be able to meet health and
  educational needs (Cuddeback, 2004)

17
Disproportionate Placement of African American
Children in KC

• Kinship care is consistent with values and
  family patterns that are firmly etched in
  African-American history and child welfare
  workers use kinship placements to fill the need
  for culturally relevant placements (Iglehart,
  2004, p. 613)

18
From Exclusion to Overinclusion

• 1995 African American children approximately
  15 of US child population
• Almost 30 founded allegations of abuse and
  neglect
• 41 of child welfare population
• 49 of out-of-home placements
• (Smith Devore, 2004)

19
From Exclusion to Overinclusion continued

• Historically African American children excluded
  from child welfare system
• Orphaned children absorbed into the community
  by other adults who took over the parenting
  role in keeping with kinship care patterns
  familiar in their African cultures (Smith
  Devore, 2004, p. 429)
• Mid 1800s and early 1900s white run charity
  organizations, mutual aid societies, and
  settlement houses ignored, segregated, or served
  African Americans during special hours

20
From Exclusion to Overinclusion continued

• Exclusion continued through the Progressive Era
  reform movement
• Slight change occurred post World War II as the
  Black presence became more evident in the urban
  centers of the North. Greater strides toward
  inclusion were accomplished as a response to the
  racial unrest in many cities (Smith Devore,
  2004)

21
From Exclusion to Overinclusion continued

• By 1950s, civil rights activity expanding, number
  of children of color in child welfare system
  increased
• Increase due to three factors (Billingsley
  Giovannoni, 1972, cited in Smith Devore, 2004)
• Large numbers black families migrate to north
• Civil rights movement integration focus
• Decreasing poverty among white children formal
  system increasingly caring for poor minority
  children

22
From Exclusion to Overinclusion continued

• African American children greater risk for
  mandated abuse and neglect reporting
• Currently two tiered system
• Formally licensed and trained relatives receiving
  foster care payment rates
• Unlicensed relatives receiving TANF payments
• Often also receive fewer agency support services
• Some may not receive any financial support

23
From Exclusion to Overinclusion continued

• Financial concerns in child welfare system
• Kinship care is usually less costly
• On average TANF payments are 50 lower than
  foster care rates (Smith Devore, 2004)
• Throughout welfare reform of late 1990s
  preference for kinship care placements continued
• ASFA (1997) affirmed place of relatives in
  providing child welfare services

24
From Exclusion to Overinclusion continued

• ASFA required shortened time frame to achieve
  permanence
• Termination of Parental Rights (TPR) for all
  children in foster care for 15 out of last 22
  months
• TPR petition not required if child placed with a
  relative

25
From Exclusion to Overinclusion Policy
Implications (Smith Devore, 2004)

• Policy to address minimum standards of care
  which are grounded in cultural values about
  parenting and child rearing (p. 442)
• Realistic standards
• Not based on Euro-American middle class values

26
From Exclusion to Overinclusion Policy
Implications (Smith Devore, 2004) continued

• Policies valuing the cultural tradition of a
  reliance on extended family (blood and fictive
  kin) need to be developed to reduce the
  unnecessary placement of African American and
  other children of color (p. 442)

27
From Exclusion to Overinclusion Policy
Implications (Smith Devore, 2004) continued

• Acknowledge that poor children tend to have poor
  relatives (p. 442)
• Provide more equitable financial and service
  support
• Require evaluation of culturally competent
  practice (p. 442)

28
Federal Licensing Guidelines

• January 2000 USDHHS issued guidelines
  instructing states to use the same requirements
  for relative foster homes as they do for
  non-relative foster homes to obtain Title IV-E
  reimbursement for care of children placed with
  kin (Barbell Freundlich, 2001)

29
Kinship Caregivers

• Some research suggests that kinship caregivers
  might foster less effectively, and that kinship
  caregivers receive less support, services, and
  training and have fewer resources than
  non-kinship caregivers (Cuddeback, 2004, pp.
  623-624)
• May contribute to differences in outcomes

30
Caregiver Demographics

• Compared with non kinship caregivers, kinship
  caregivers are more likely to be
• African American
• Older
• Single
• Less educated
• Unemployed
• Lower socioeconomic status

31
Grandparents raising Grandchildren

• Compared with grandparents not caring for their
  grandchildren
• Report more limitations of daily activities
• Increased depression
• Lower levels of marital satisfaction
• Poorer health
• Some evidence that benefit from support groups
  (Cuddeback, 2004)

32
Harden, et al. (2004)

• Comparison of kinship (n 50) and foster (n
  51) care parents
• African American 96 kinship, 80 foster
• Mean age of caregivers 56.2 ( 10.2) years
  kinship, 44.9 ( 9.4) years foster
• Caring for 2.7 ( 1.7) children
• Recruited in Washington and Baltimore from child
  welfare agencies

33
Harden, et al. (2004) Results

• Kinship caregivers reported
• Less warmth/respect
• More strictness/overprotectiveness
• More parent-child conflict/anger
• Fewer social resources
• Fewer married and more widowed
• Fewer with other adult present (32 v. 63)
• More with income lt 20,000 (62 v. 18)

34
Harden, et al. (2004) Results continued

• Kinship caregivers reported
• Fewer own home (50 v. 82)
• Fewer employed (32 v. 66)
• Fewer high school graduate (64 v. 87)
• More with chronic illness (50 v. 20)
• More medical treatment (50 v. 14)
• More hospitalized gt 1 time (80 v. 51)
• More prescribed medication (60 v. 27)

35
Harden, et al. (2004) Discussion

• Kinship care providers reported parenting
  attitudes that have been associated with
  deleterious child outcomes in other studies of
  parenting However, the parenting findings were
  clearly related to the background characteristics
  of this sample, in particular the older age and
  single parent status of the kinship care
  providers (p. 666).

36
Harden, et al. (2004) Discussion continued

• In general, results of this study corroborated
  other evidence that kinship parents have fewer
  social and economic resources, and poorer health,
  than traditional foster parents (p. 666)
• Children reared in high-risk contexts have a
  higher probability of poor outcomes, such as
  academic underachievment, deficits in social
  competence, and mental health difficulties (p.
  667)

37
Kinship Homes

• Compared with non kinship homes
• More crowded
• Worse general structural condition
• Not as clean, safe, or pleasant
• More likely to have acknowledged past violence in
  the home
• Expressed concerns about other adults in home
  using drugs or alcohol
• Neighborhoods rated less well (Cuddeback, 2004)

38
Placement Stability

• Compared with non kinship care, children in
  kinship care
• Have more stable placements
• Have fewer prior placements
• Limited evidence remain in care longer
• Limited evidence less likely to reenter care
• Better contact with birth parents

39
Permanency Outcomes

• Some evidence that kinship families less likely
  to adopt or accept legal custody
• Unclear if less likely to adopt because child
  welfare professionals less likely to discuss this
  option or other reasons

40
Reluctance to Adopt

• Relatives may decline adoption because of blood
  ties and cultural reasons (Burnette, 1997)
• Relatives may not be reluctant to adopt if
• Provided with accurate information
• Assured of receiving ongoing subsidy payments and
  continued role of birth parents
• Option to keep childrens birth names after
  adoption (Geen Berrick, 2002 Testa Shook,
  2002)

41
Comparison with Children in General Population

• Children in kinship care function less well
• More behavior problems
• More problems with homework
• Below average scores in reading, math, cognitive
  functioning, problem solving, reasoning, and
  listening comprehension, but above average in
  oral expression
• Similar to children in non-kinship care and
  maltreated children not in care (Cuddeback, 2004)

42
Behavioral and EmotionalWell-Being

• 13 of 6-17 year olds living with relatives
  exhibit high levels of problems
• Higher than the 7 of those living with parents
• Within poverty groups (lt200 Federal Poverty
  Level), no difference in rates
• 14 children in relative care
• 11 in parent care (Billing, et al., 2002)

43
Carpenter and Clyman (2004)

• Adult physical and emotional wellbeing
• Nationally representative sample of women with a
  history of living in kinship care
• 1995 National Survey of Family Growth
• Subsample of 18 to 44 year olds

44
Carpenter and Clyman (2004) continued

• Sample
• Kinship care group women who lived with any
  relative, without either biological parent, for
  at least one month (n 471)
• Comparison group lived with at least one
  biological parent throughout childhood (n 8289)
• Excluded women who had been in foster care or
  group homes at any time in childhood

45
Carpenter and Clyman (2004) Results

• Kinship group
• More likely African American (29.2 v. 13.2)
• Less likely complete high school (79.2 v. 88.8)
• More likely obese (25.1 v. 18.4)
• More likely current smokers (40.5 v. 28.1)
• More likely poor (124 FPL v. 191 FPL)

46
Carpenter and Clyman (2004) Results

• Kinship group
• More likely unwanted first sexual experience
  (13.1 v. 8.4)
• Women in the kinship group exhibited higher
  rates of worse physical and emotional wellbeing
  than in the comparison group, across all of the
  outcomes of interest (p. 680)

47
Carpenter and Clyman (2004) Results
Multivariate Analyses

• After controlling for other predictor variables
  (e.g. age, smoking, obesity, etc.) kinship care
  was not a significant predictor of poor health
  status or limited life activities
• Kinship group remained more likely to have
  experienced extended period of anxiety even after
  control variables

48
Carpenter and Clyman (2004) Results
Multivariate Analyses

• Kinship care group women more than twice as
  likely to report general unhappiness with life,
  even after adjusting for periods of anxiety and
  poor health

49
School Performance

• Compared with the general population, children in
  kinship care
• Fewer attendance problems
• Fewer suspensions and expulsions
• Less likely to be working at or above grade level
  (Cuddeback, 2004, based on Dubowitz study)
• Other studies find no differences in educational
  performance for kinship and non-kinship care
  children

50
School Suspensions or Expulsions

• 26 of 12-17 year olds living with relative
  suspended or expelled during survey year
• Twice as high as the 13 of those living with
  parents
• Within poverty group, 31 of those living with
  relatives v. 21 of those living with parents
  (Billing, et al., 2002, based on National Study
  of Americas Families NSAF)

51
Skipping School

• 22 of those living with relatives skipped school
• Compared with 16 of those living with parents
• Within poverty group, equally likely (21) to
  skip school whether living with parents or
  relatives (Billing, et al., 2002, based on NSAF)

52
Why the Inconsistencyin School Findings?

• Dubowitz study cross-sectional study of Baltimore
  children in kinship care
• No comparison group
• Early 1990s
• Billing reporting findings from National Study of
  Americas Families
• Probability sample, not kinship care focused
• Data collected 1997 and 1999

53
Physical Health

• 14 of children living with relatives with a
  limiting condition compared with 7 of those
  living with a parent
• 7 in poor/fair health compared with 4 of those
  living with a parent
• Within poverty group, higher limiting condition
  (17 v. 11), but similar in poor/fair health (9
  v. 8) (Billing, et al., 2002)

54
Physical Health continued

• Other studies have not found differences in
  health status of children in kinship and non
  kinship care and children in the general
  population (Cuddeback, 2004, p. 631)

55
Sexual Risks (Carpenter, et al., 2001)

• First intercourse 6 months younger for kinship
  care group than comparison group
• Foster care did not differ from comparison
• Earlier first pregnancy
• Kinship care 8.6 mos earlier than comparison
• Foster care 11.3 mos earlier than comparison
• Increased odds of more than 3 sexual partners
  (1.4-1.7) than comparison group

56
Summary of National Survey of Americas Families
Findings (Billing, et al., 2002)

• Children living with relatives fare worse than
  children living with parents on most measures of
  behavioral, emotional, and physical well-being
  (p. 4)
• Not necessarily surprising
• Separation from parents
• Many experienced abuse and/or neglect
• Poverty

57
General Findings from NSAF

• Significant barriers to well-being faced by
  children living with relatives rather than
  parents
• Children living with low-income relatives fare
  worse on some measures of well-being compared
  with children living with low-income parents, but
  on others they are doing just as well (Billing,
  et al., 2002, p. 1)

58
Impact of Poverty

• On several measures, children in low-income
  relative care and parent care fare similarly
  well. They have comparable levels of behavioral
  and emotional problems and activity involvement,
  and are equally likely to skip school. They also
  fare similarly in terms of physical health
  status (Billing, et al., 2002, p. 5)

59
Outcomes General Findings

• The research regarding outcomes of kinship vs.
  non-kinship foster care is limited and
  inconclusive and should be interpreted with
  caution as these studies are based upon
  self-reports of small non-probability samples of
  unknown generalizability (Cuddeback, 2004, p.
  628)

60
Title IV-E WaiverDemonstration Projects

• Revisions of the Social Security Act in 1994
  paved the way for child welfare demonstration
  projects that waive certain federal legislative
  and regulatory requirements under Titles IV-E and
  IV-B (Geen Berrick, 2002)
• Several states that received waivers implemented
  programs to support kinship care (i.e. the
  subsidized guardianship projects)

61
Subsidized Guardianship Objectives

• Acknowledge value and role of kinship caregivers
• Recognition that relatives need financial
  assistance to be successful (Needell, et al.,
  2001)
• Provide caregivers with parental authority
• Legal decisions concerning their relative
  children
• Release child from agencys custody without
  terminating parental rights (Jackson, 1996
  Barbell Freundlich, 2001)

62
Subsidized Guardianship Projects

• 35 states have some form of subsidized
  guardianship option for relative caregivers
• 3 (NJ, MO, MT) have 2 separate subsidized
  guardianship programs serving different groups of
  children
• Total of 38 subsidized guardianship programs
  nationally
• 7 states (DL, IL, MD, MT, NM, NC, OR) have
  Title IV-E waivers to test the effectiveness of
  the subsidized guardianship projects
• 19 states use state funds for the programs 12
  use TANF funds and 3 use other federal funds
• (Allen, Bissell, Miller, 2003)

63
Marylands Subsidized Guardianship Demonstration
Findings

• Eligibility for guardianship subsidy
  significantly increases the rate at which kinship
  care children exit the foster care system
• Effect was stronger in Cohort 2 than in Cohort 1,
  probably due to implementation changes
• Eligibility for guardianship subsidy did not
  significantly affect rate at which restricted
  foster care children exit the foster care system
• 300/month subsidy higher than kinship care rate
  of approximately 200/month, but lower than
  restricted foster care rate of 550/month

64
Marylands Subsidized Guardianship Demonstration
Findings continued

• When differences in outcomes were found (e.g.
  case exit rates), the differences favored the
  experimental group and the subsidy appears to be
  cost effective, suggesting that it is a good
  permanency option to make available to relative
  caregivers, especially those in the kinship care
  group

65
Marylands Subsidized Guardianship Demonstration
Cost Effectiveness

• For all groups cost savings to families
• For all groups except the cohort 1 restricted
  foster care group, cost savings to society (i.e.
  government and families combined)
• For the cohort 1 restricted foster care group,
  the net costs of the GAP Program to society were
  essentially zero

66
Methodological Issues inKinship Care Research

• Lack of differentiation between paid kinship care
  and foster care in child welfare studies
• Most studies focus on children while in care
• Of the few long-term outcome studies, sample
  sizes are small and comparison groups lacking
  (Carpenter Clyman, 2004)

67
Conclusion

• Few studies address formal kinship care, and
  virtually none address informal kinship care
  (Carpenter Clyman, 2004, p. 674)
• Because of these methodological issues and the
  paucity of information available to date on
  kinship care populations, the long-term physical
  and emotional outcomes of adults who have lived
  in kinship care has not been adequately studied
  (Carpenter Clyman, 2004, p. 674)

68
Conclusion continued

• Kinship foster care has become part of the
  public child welfare system and the knowledge
  base for this practice has not been able to keep
  pace with its utilization (Iglehart, 2004, p.
  619)

69
Do We Know Anything?

• Yes children in kinship care experience a number
  of situations that we know are associated with
  poor outcomes, therefore, it is likely that they
  are at risk for these same poor outcomes
• Not clear that outcomes are worse than foster
  care, but all children in out-of-home placements
  should receive screenings

70
References

• Allen, M., Bissell, M, Miller, J. L. (2003).
  Expanding permanency options for children A
  guide to subsidized guardianship programs.
  Washington, DC Childrens Defense Fund and
  Cornerstone Consulting Group.
• Barbell, K., Freundlich, M. (2001). Foster care
  today. Washington D.C Casey Family Programs.
• Billing, A., Ehrle, J., Kortenkamp, K. (2002).
  Children cared for by relatives What do we know
  about their well-being? New Federalism National
  Survey of Americas Families. The Urban
  Institute, Series B, No. B-46, May 2002, pp. 1-7.
• Carpenter, S. C., Clyman, R. B. (2004). The
  long-term emotional and physical wellbeing of
  women who have lived in kinship care. Children
  and Youth Services Review, 26, 673-686.
• Carpenter, S. C., Clyman, R. B., Davidson, A. J.,
  Steiner, J. F. (2001). The association of
  foster care or kinship care with adolescent
  sexual behavior and first pregnancy. Pediatrics,
  108 (3), retrieved online at http//www.pediatrics
  .org/cgi/content/full/108/3/e46

71
References continued

• Cuddeback, G. S. (2004). Kinship family foster
  care A methodological and substantive synthesis
  of research. Children and Youth Services Review,
  26, 623-639.
• Garland, A. F., Landsverk, J. A., Lau, A. S.
  (2003). Racial/ethnic disparities in mental
  health service use among children in foster care.
  Children and Youth Services Review, 25, 491-507.
• Geen, R. Berrick, J.D. (2001) Kinship care
  An evolving service delivery option. Children
  and Youth Services Review, 24, 1-14.
• Harden, B. J., Clyman, R. B., Kriebel, D. K.,
  Lyons, M. E. (2004). Kith and kin care Parental
  attitudes and resources of foster and relative
  caregivers. Children and Youth Services Review,
  26, 657-671.
• Iglehart, A. P. (2004). Kinship foster care
  Filling the gaps in theory, research, and
  practice. Children and Youth Services Review,
  26, 613-621.
• Jackson, S.M. (1996) The kinship triad A service
  delivery model. Child Welfare, 75, 583-599.
• Kerman, B., Wildfire, J., Barth, R. P. (2002).
  Outcomes for young adults who experienced foster
  care. Children and Youth Services Review, 24,
  319-344.

72
References continued

• Kolomer, S.R. (2000). Kinship foster care and its
  impact on grandmother care givers. Journal of
  Gerontological Social Work, 33, 85-102.
• Needell, B., Shlonsky, A., Dawson, W. C.
  (2001). KSS and Kin Gap University, state
  county, and advocate partnership for kinship care
  policy in California. University of California,
  Berkley.
• Smith, C. J., Devore, W. (2004). African
  American children in the child welfare and
  kinship system From exclusion to over inclusion.
  Children and Youth Services Review, 26, 427-446.
• Testa, M. F. (2002). Subsidized guardianship
  Testing an idea whose time has finally come.
  Social Work Research, 26, 145-158.
• Testa, M. F., Shook, K. S. (2002). The gift of
  kinship foster care. Children Youth Services
  Review, 24(1/2), 79-108.
• For more information on Marylands Subsidized
  Guardianship Demonstration, please visit
  www.rhycenter.umaryland.edu