Challenges in identifying factors which determine the placement of children in care? An international review

Placing a child in out-of-home care is one of the most important decisions made by professionals in the child care system, with substantial social, psychological, educational, medical and economic consequences. This paper considers the challenges and difficulties of building statistical models of this decision by reviewing the available international evidence. Despite the large number of empirical investigations over a 50 year period, a consensus on the variables associated with this decision is hard to identify. In addition, the individual models have low explanatory and predictive power and should not be relied on to make placement decisions. A number of reasons for this poor performance are offered, and some ways forwards suggested. This paper also aims to facilitate the emergence of a coherent and integrated international literature from the disconnected and fragmented empirical studies. Rather than one placement problem, there are many slightly different problems, and therefore it is expected that a number of related sub-literatures will emerge, each concentrating on a particular definition of the placement problem.

Factors associated with the retention of HIV-infected children in care in Botswana

Lost to follow up (LTFU) in the care and treatment of HIV/AIDS represents a particularly problematic aspect when evaluating the success of treatment programs. Identifying modifiable factors that lead to LTFU would be important if we are to design effective retention interventions. The purpose of this study was to identify the challenges faced by children seeking care and treatment at a large HIV Clinic in Botswana. In order to identify those factors, we used mixed methods from different sources of information available at the Baylor Clinic. The first method involved a case-control study through which we interviewed a select representation of children 1-18 years who, at some point in time, have attended clinic at Baylor Clinic in Gaborone, Botswana. We document this in detail using the first journal article. We defined LTFU as patients who had not attended clinic for more than 6 months at the onset of the study; the comparison group was recruited from among those who have attended clinic at any point in the 6 months leading to the start of study. Factors were compared between the cases and controls. The second methodology involved conducting in-depth interviews with health providers to elicit their opinions and experiences dealing with patients at the at the Baylor clinic in general and the LTFU patients in particular. We document this methodology and its findings in the second journal article. ^ We found that most patients that are LTFU failed to engage with the clinic. Most of the LTFU made only one visit to the clinic (47.66%) as compared to less than 1% in the control group (P<0.01, 2-tailed Fisher's exact test). Among the interviewed patients, psychosocial factors such as stigma, religious beliefs, child rebellion and disclosure of HIV status concerns were characteristic of the LTFU population, but psychosocial issues were not cited among the comparison group. We also found that these psychosocial aspects of the patients point towards a bigger problem of mental health that needs to be addressed. Socioeconomic factors such as lack of transport, school-related activities and forgetting check-up dates were cited predominantly by the controls than cases. ^ From these findings, there is need to target interventions towards engaging pediatric patients at their initial clinic visit. Such interventions would focus on psychosocial support, as well as involving faith-based organizations in planning joint responses.^

Comparing long-term placements for young children in care: Does type of placement really matter?

This paper presents findings from the third phase of a longitudinal study, entitled Care Pathways and Outcomes, which has been tracking the placements and measuring outcomes for a population of children (n = 374) who were under the age of five and in care in Northern Ireland on the 31st March 2000. It explores how a sub-sample of these children at age nine to 14 years old were getting on in the placements provided for them, in comparative terms across five placement types: adoption; foster care; kinship foster care (with relatives); on Residence Order; and living with birth parents. This specifically focused on the development of attachment and self-concept from the perspective of the children, and behavioural and emotional function, and parenting stress, from the perspective of parents and carers. Findings showed no significant placement effect from the perspective of children, and a statistically weak, but descriptively compelling, effect from the perspective of parents. The findings challenge the notion of adoption as the gold standard in long-term placements, specifically from the perspective of children in terms of their parent/carer attachments and self-concept, and highlight what appears to be the central importance of placement longevity for delivering positive longer-term outcomes for these children, irrespective of placement type.

Problematic eating and food-related behaviours and excessive weight gain : why children in out-of-home care are at risk

Emerging evidence suggests that abuse and neglect in childhood may play a role in subsequent development of obesity. One population group particularly at risk is children and young people living in out-of-home care (OOHC). Given this population is already a vulnerable group, identifying potential mechanisms by which childhood abuse and neglect increases risk for obesity is essential. A possible explanation is that problematic eating and food-related behaviours (i.e., emotional eating, compulsive eating, overeating, binge eating, stealing or hoarding food) might mediate the association between adverse childhood experiences and obesity. Hence, the overall goal of this paper was to provide a narrative review of eating and food-related difficulties for children in care and their possible association with unhealthy and excessive weight gain. This review revealed a shortage of existing empirical papers and signalled particular need for further examination of the mediating effects of problematic eating.

Methodological issues for qualitative research with learning disabled children

This paper discusses key methodological issues for qualitative research with learning disabled children, based on the author's experience of involving learning disabled children in her doctoral study. The study was founded on the social model of disability and a sociological understanding of childhood that recognizes the abilities of disabled children as competent research participants. Issues that arose throughout the research process, from the early stages of gaining access to children, to communication challenges for interviewing learning disabled children, and the analysis and dissemination of data, are discussed. Within this context, this paper explores key methodological issues for researchers with regard to interviewing learning disabled children and actively involving them in qualitative research.

An examination of parental opinions regarding the inclusion of disabled students in regular education classes

This study investigated the opinions regarding inclusion of parents of both disabled and nondisabled elementary children from a large suburban county. An opinion survey combining Wilczenski's Attitudes Toward Inclusive Education Scale with additional questions was distributed to 1170 children from 24 schools. Three research questions focused on differences between mean parental responses as they related to the inclusion and disability status of the parent's child. Results from the 270 respondents indicated that parents with disabled children had more favorable opinions about inclusion than did those with nondisabled children. Parents with included children were more favorable toward inclusion than were parents whose children were not included. Parents with included disabled children were more accepting of inclusion than were those with nondisabled children in inclusive settings. Parents' answers differed depending on the type of disability being included. Regardless of their child's disability or inclusion status, the ranking for disability types from most acceptable for inclusion to least acceptable were: social, sensory, motor, academic and behavioral. Results across types of questions, including questions relating to acceptance and general inclusion issues, indicated consistently more favorable opinions of parents with disabled children, included children and disabled children in inclusive classes. Two additional research questions examined parental responses as they related to demographic characteristics of the parents and of the schools their children attended. Analysis of Variance found only one significant main effect for any parental demographic variable. This difference was for the number of parents' elementary children when comparing parents with and without disabled children. The only significant main effects of demographics of schools the parents' children attended were for the area of the county and for schools with differing percentages of severely disabled students when comparing responses of parents with disabled and nondisabled children. For all research questions, tests indicated low effect sizes and moderate to high power levels. These results, and the fact that means for all groups were in the middle range of response choices, indicate that there may be little practical significance to the overall results. Further studies should investigate the trends found in this study. ^

The participation of disabled children, young people and their parents in health and social care. Implications for policy and practice

No abstract available

Care-less spaces and identity construction:transition to secondary school for disabled children

There is a growing body of literature which marks out a feminist ethics of care and it is within this framework we understand transitions from primary to secondary school education can be challenging and care-less, especially for disabled children. By exploring the narratives of parents and professionals, we investigate transitions and self-identity, as a meaningful transition depends on the care-full spaces pupils inhabit. These education narratives are all in the context of privileging academic attainment and a culture of testing and examinations. Parents and professionals, as well as children are also surveyed. Until there are care-full education processes, marginalisation will remain, impacting on disabled children’s transition to secondary school and healthy identity construction. Moreover, if educational challenges are not addressed, their life chances are increasingly limited. Interdependent caring work enables engagement in a meaningful education and positive identity formation. In school and at home, care-full spaces are key in this process.