Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors

Children and Youth Services Review 35 (2013) 587–593

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Children and Youth Services Review journal homepage: www.elsevier.com/locate/childyouth

Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors Johan Vanderfaeillie a,⁎, Frank Van Holen a, b, Femke Vanschoonlandt a, Marijke Robberechts a, Tim Stroobants a a b

Vrije Universiteit Brussel, Faculty of Psychology and Educational Sciences, Department of Clinical and Lifespan Psychology, Brussels, Belgium Opvang vzw, Belgium

a r t i c l e

i n f o

Article history: Received 27 September 2012 Received in revised form 17 December 2012 Accepted 17 December 2012 Available online 20 January 2013 Keywords: Family foster care Behavioral problems Longitudinal research

a b s t r a c t Due to prior experiences of trauma and abuse, many foster children have behavioral problems. The placement of the child in a family foster home is expected to reduce the behavioral problems. However, this expectation is seldom met and mostly behavioral problems increase or remain stable during placement. Research on the development of behavioral problems in foster children is scarce. Moreover, most of the research results are situated on a group level, which obscures the development of problem behavior on a case level. This study investigated the development of problem behavior of 49 foster children on a case level and the association of global, contextual, familial and child factors with the increase or decrease of problem behavior. Over a two year period 18 foster children had more, 23 just as much and 8 less problem behavior. An increase was associated with the use of more negative parenting strategies by the foster mothers. A decrease was related to the use of supportive parenting. Support of foster parents aiming at reducing the use of negative discipline practices and promoting the use of supportive parenting may have a positive effect on the development of foster children. © 2013 Elsevier Ltd. All rights reserved.

1. Introduction

1.1. The development of problem behavior in foster children

When children cannot grow up in their own family because their safety cannot be warranted (e.g. due to abuse), an out-of-home placement may be required. Due to prior experiences of trauma and abuse, many children in care, family foster homes as well as residential care, have behavioral problems (Armsden, Pecora, Payne, & Szatkiewicz, 2000; Harder, Knorth, & Zandberg, 2006; Strijker & Zandberg, 2001; Van Holen, Vanderfaeillie, & Trogh, 2007). Nowadays when a child is in need of out-of-home care, foster family care is increasingly the first option of choice. A foster family offers more continuity in relationships than, for example, a group home (Van IJzendoorn, 2010). Foster care placements aim at protecting foster children, providing them with a nurturing and warm home and stimulating their development. Given that family foster care becomes increasingly important in child welfare, it is important to gain insight into how foster children develop and what factors influence their development. In this longitudinal study, the development of problem behavior of foster children was investigated over a two year period and the association of global, contextual, family and child factors with an increase or decrease of problem behavior is examined.

Social workers and foster parents often expect that problem behavior in foster children will decrease and prosocial behavior will increase once in care. However, this expectation is rarely realized. Only in a few studies regular foster parents reported a negligible to small (db .30) reduction in problem behavior shortly after the start of the foster placement (Barber & Delfabbro, 2003, 2005; Wilson, 2006). Moreover, this small positive development did not continue, and psychosocial functioning of the foster children stabilized within four months. Most research found problem behavior in foster children, as reported by foster parents, remained stable or increased during the foster care placement (e.g. Chamberlain, Moreland, & Reid, 1992; Fisher, Gunnar, Chamberlain, & Reid, 2000; Nilsen, 2007). For example, a recent Dutch study (Van Oijen, 2010) of 78 foster children in long-term family foster care found over a period of 1.5 year a significant increase in delinquent and aggressive behavior, and in social problems and thought problems. A Flemish study (Van Holen et al., 2007) of 49 long-term foster children found that the average raw Total Problem CBCL-score increased over a period of two years. Consequently the percentage of foster children with a deviant Total Problem CBCL-score (borderline and clinical scores taken together) increased from 24% to 40%. Moreover, these results were obtained after dropout of the foster children with the most behavioral problems. As did foster parents, foster care workers neither reported a reduction in problem behavior. In an Australian study the CBCL Internalizing, Externalizing and Total Problem scores did not differ significantly from the respective beginning scores

⁎ Corresponding author at: Vrije Universiteit Brussel, Faculty of Psychology and Educational Sciences, Department of Clinical and Lifespan Psychology, Pleinlaan 2, 1050 Brussels, Belgium. E-mail address: [email protected] (J. Vanderfaeillie). 0190-7409/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.childyouth.2012.12.012

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after three years (Fernandez, 2009). Results obtained from self-reporting by foster children are less clear. They revealed an increase (Farmer, Moyers, & Lipscome, 2004), no change (Van Oijen, 2010) and a decrease (Fernandez, 2009). A criticism on most of these research results is that they are situated at group level. Because of this, it remains unclear how problem behavior develops on a case level. We only know of two studies that addressed this question. Strijker and Zandberg (2001) reported that around 20% of foster children showed more behavioral problems and problem behavior decreased (not necessarily to a normal level) among 13% after 1.5 years of placement. Van Oijen (2010) found that problem behavior increased among 28% of the foster children. Only in 9% the foster parents reported a decrease. They reported also a much greater increase of externalizing problem behavior than of internalizing problem behavior. The increase led in 12% of foster children to a change in ‘problem status’. Those with an original ‘normal’ CBCL Total Problem score had a borderline or clinical score after 18 months. Among 5%, a decrease led to a change from borderline or clinical score to a normal score. From the above findings, we can conclude that problem behavior does not always decrease during the foster care placement. Among a large group of foster children, problem behavior increases. Among only a very small number of foster children, problem behavior decreases. Insight into what makes one foster child progress and another foster child function worse is important.

attitude towards corporal punishment and pay less attention to the specific needs of the children in care (Orme & Buehler, 2001). Although parenting by foster parents plays a central role in the development of foster children, factors relating to the placement also can influence the development of problem behavior. In itself, the foster care placement can be traumatic due to the separation from the child's primary carers and thus can contribute to the development of problem behavior. Replacing foster children can also contribute to the development of problem behavior (Newton, Litrownik, & Landsverk, 2000). For movements result in relationship breakdown and unstable living and upbringing conditions. Lastly, international studies found that kinship foster children show less problem behavior than non-kinship foster children (Holtan, Ronning, Handegard, & Sourander, 2005). In this study, we describe a longitudinal research over a two year period into the development of problem behavior in foster children. This study is unique because it examines the development at case level. We also examined if global (education level of foster mother), contextual (placement-related factors such as the number of previous placements, length of placement, kind of placement, and referrer), family (parenting stress and parenting behavior) and child factors (gender, age, and problem behavior at the start of the study) were associated with an increase or decrease in problem behavior.

1.2. Influencing factors

2.1. Procedure and participants

The development of problem behavior among non-foster children is determined by multiple factors. Global factors (e.g. socio-economic situation), contextual factors (e.g. relationships with family members in the wider context), family factors and child factors all play a role (Yahav, 2006). Family factors can be distinguished as distal factors (e.g. perceived parenting stress) and proximal factors (e.g. parenting behavior) (Dekovic, Janssens, & Van As, 2003). In terms of global, contextual and distal family factors, the development of problem behavior is associated to low education, single parent families and parenting stress (Dekovic et al., 2003; Gorman-Smith, Tolan, Zelli, & Huesmann, 1996; Hoff-Ginsberg & Tardif, 1995). Regarding parenting behavior, lack of rules, inadequate supervision, inappropriate discipline, unpredictable outbursts and ignoring problem behavior, all result in an increase in problem behavior (Gardner, 1989; Patterson, 1982; Patterson, DeBaryshe, & Ramsey, 1989). Positive engagement, reinforcement of desired behavior, authoritative discipline, supervision, teaching rules and promoting autonomy lead to a decrease in problem behavior (Sanders, Markie-Dadds, Tully, & Bor, 2000). Research into child factors found that boys have more and more serious externalizing problem behavior, and that the severity increases with age (Wicks-Nelson & Israel, 2009). Research into factors influencing the development of problem behavior of foster children is limited. A first important factor is the parenting of foster parents. Less supportive parenting, such as less reinforcement and supervision, and more negative control and inconsistent discipline by the foster parents are associated with an increase in problem behavior (Fisher et al., 2000; Vanderfaeillie, Van Holen, Trogh, & Andries, 2012). Training foster parents to deal with problem behavior in positive way leads to a decrease (Chamberlain et al., 1992; Fisher et al., 2000). Conversely, more problem behavior results in higher parenting stress, which in turn is related to a less effective parenting (Vanderfaeillie et al., 2012). The quality of foster parents' parenting behavior is also related to their educational level and the kind of the placement. Better-educated foster parents provide higher quality parenting. In comparison with non-kinship foster parents, kinship foster parents 1 have a more positive

In 2004, all foster parents with a foster child aged six to twelve years who had lived at least six months with the foster family (n=96) of one foster care agency with several branches throughout Flanders were asked to participate in the study. Seventy-seven foster mothers participated in the first data wave collection (response=80%) and completed a Child Behavior Checklist (CBCL). Data on the non-response group could not be collected. Given the fact that the majority of the respondents were female, it was decided to limit the sample to foster mothers. In 2006, twelve placements were terminated (8 breakdowns and 4 reunions). Forty-nine of the remaining 65 foster mothers participated in the second data wave collection and filled in a CBCL, a Nijmegen Questionnaire for the Parenting Situation and a Ghent Parental Behavior Scale (response = 75%). Of the 49 foster mothers, 37 were married or cohabiting and 12 were single. Thirty-seven placements were non-kinship placements and 12 were kinship placements. At the start of the study, the average age of the foster mothers was 48.9 years (sd = 9.2, min = 29 and max = 67). Eleven foster mothers had a higher educational degree. The remaining foster mothers had a diploma from higher secondary education (n = 20), lower secondary education (n = 12) or primary education (n = 4). We had no information about the educational level of two foster mothers. The foster children (31 girls and 18 boys) had an average age of 9.3 years (sd=1.7). Length of placement at the start of the study varied across the sample. Foster children had stayed on average 4.8 years (sd= 3.0, min =1, max=11) in the foster family. Thirty-three foster children were placed in foster care by a Committee for Special Youth Care and 16 by a juvenile court.

1 Kinship foster parents have a relation with the foster child prior to the placement (e.g. family, friends). Non-kinship foster parents have no connection to the child prior to the placement.

2. Methods

2.2. Non-response group The non-response group comprised 28 foster mothers: 16 refused to participate and 12 placements were terminated (8 breakdowns and 4 reunions). Response and non-response groups differed as to the gender of the foster child (χ 2 = 4.13, p b .05), referring authority (Committee for Special Youth Care versus juvenile court) (χ 2 = 5.73, p b .05), and severity of emotional and behavioral problems. The dropout rate was higher among boys, among children placed in foster care by court order and among children with more behavioral

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problems (internalizing problems (U=441.5, pb .05), externalizing problems (U=406.5, pb .05), Total Problem score (U=375.0, pb .01)). Response and non-response groups did not differ in foster mother's age (U=547.50, p =.46), foster child's age (U=626.00, p=.52) and length of placement (U=543.00, p=.13). 2.3. Measures 2.3.1. Child Behavior Checklist/6-18 (CBCL) Problem behavior as experienced by the foster mothers was measured using the CBCL/6-18 (Achenbach & Rescorla, 2001). The CBCL consists of a competence section and a problem-related section. Only the problem-related section was used. It consists of 118 questions answered on a three-point scale (0 = absolutely not, 1 = a little or sometimes, 2 = often or always). The scoring of questions results in a Total Problem score, an Internalizing and an Externalizing score, and eight problem scale scores. We only used the Internalizing and Externalizing scores and the Total Problem score as (general) indexes for internalizing, externalizing and global problem behavior. In order to identify normal from deviant scores, cut-off scores were used. The authors of the CBCL suggest using a T-score of ≥60 to discriminate between children with and without problems (i.e. the cut-off score for borderline range). The reliability and validity of the CBCL are regarded as good (Achenbach & Rescorla, 2001). 2.3.2. Nijmegen Questionnaire for the Parenting Situation (NQPS) Parenting stress of foster mothers was measured using the Nijmegen Questionnaire for the Parenting Situation (Wels & Robbroeckx, 1996). This self-reporting questionnaire measures parenting stress experienced in parenting a target child with items scored on a five-point scale. The present study only used four scales referred to as the core of parenting stress by the NQPS-authors (Not feeling able to cope, Experiencing problems in parenting the child, Desiring changes and Experiencing the child as a burden). We refer to the sum score of the four scales as the parenting stress score (28 items, α=.95). The reliability and validity of the NQPS are considered sufficient (Evers, van Vliet-Mulder, & Groot, 2000). 2.3.3. Ghent Parental Behavior Scale (GPBS) Parenting behavior of foster mothers was measured using the GPBS (Van Leeuwen & Vermulst, 2004). With 45 items this self-reporting questionnaire measures specific parenting behaviors. Parents score how often they engage in specific parenting behaviors on a five-point scale (1 = almost never, to 5 = almost always). The items are grouped in nine sub-scales: Positive Parenting (problem solving and involvement with the child) (11 items, α=.83); Monitoring (supervising the child) (5 items, α=.65); Rules (teaching the child appropriate behavior) (6 items, α=.76); Discipline (punishment of the child when s/he misbehaves) (6 items, α=.80); Inconsistent discipline (punishment in a inconsistent way) (3 items, α=.60); Harsh Punishment (corporal punishment and verbal blaming) (4 items, α=.62); Ignoring (ignoring unwanted behavior) (4 items, α=.61); Material Rewarding (rewarding with gifts or money) (3 items, α=.71) and Autonomy (stimulation of autonomous behavior) (3 items, α=.58). Three scales (Positive Parenting, Rules and Autonomy) can be grouped in the Supportive Parenting Scale (20 items, α=.86). Three others scales (Discipline, Harsh Punishment and Ignoring) form the Negative Control Scale (14 items, α= .69). The GBPS is sufficiently reliable and valid (Van Leeuwen & Vermulst, 2004). 2.4. Data and statistical analysis The development of problem behavior in each individual child was examined by calculating a Reliable Change Index (RCI) for each CBCL scale (Internalizing, Externalizing and Total Problem score). The RCI is a measure that can be used to determine if a change is statistically significant or due to change. A RCI is the difference between the raw

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scores obtained in 2004 and those obtained in 2006 on a specific CBCL scale divided by the standard of error of the difference of this scale. It is accepted to consider a RCI greater than 1.64 or smaller than −1.64 as statistically significant (Van Yperen & Veerman, 2008). However, statistically significant changes are not always clinically relevant. To determine whether statistically significant changes were clinically relevant, the CBCL T-scores were used. A significantly and clinically relevant change is a RCI score greater than 1.64 or smaller than − 1.64 where respectively a transition from a deviant score (T-score ≥ 60) to a normal score (T-score b 60) or vice versa was made. The association of child variables (age, gender, and problem behavior in 2004), family factors (parenting behavior of foster mother and family stress), contextual factors (length of placement, kind of placement (kinship versus non-kinship placement), referrer (juvenile court versus Committee of Special Youth Care), and number of previous placements) and global factors (educational level foster mother) with a significant increase or decrease in problem behavior at case level were examined using Mann–Whitney U tests (data on interval/ordinal level) and Fisher exact tests (nominal data). In a first series of analyses, the categories of the dependent variable were an increase in problem behavior (RCI b − 1.64) versus a decrease and stabilization in problem behavior (RCI ≥ − 1.64). In a second series of analyses, the categories were a decrease in problem behavior (RCI > 1.64) versus an increase and stabilization in problem behavior (RCI ≤ 1.64). Effect sizes were expressed with r. An r smaller than .10 is trivial, between .10 and .30 small, between .30 and .50 moderate, and greater than .50, large (Cohen, 1988).

3. Results 3.1. Development of problem behavior At the start of the study, 7 foster children had a deviant Internalizing score, 8 a deviant Externalizing score, and 12 a deviant Total Problem score. Two years later, 9 foster children had a deviant Internalizing score, 15 a deviant Externalizing score, and 20 a deviant Total Problem score. The number of foster children with a deviant Internalizing score grew by 2, the number with a deviant Externalizing score by 7, and the number with a deviant Total Problem score grew by 8. Depending on the scale, after two years, 4 to 8 foster children had significantly fewer behavioral problems, 23 to 36 the same, and 8 to 18 foster children more behavioral problems (see Table 1). Of the 4 to 8 foster children who showed improvement, only one child made clinically relevant progress. This foster child evolved from a deviant Internalizing score at the first measurement moment to a normal Internalizing score at the second measurement moment (see Table 2). If we only take into consideration the foster children who deteriorated, 5 foster children had significantly and clinically more relevant internalizing behavioral problems after two years, 5 more externalizing behavioral problems and 8 more behavioral problems overall (see Table 3).

Table 1 Numbers of foster children showing improvement, no development or deterioration on the CBCL scales.

Internalizing Externalizing Total problem score

Improvement RCI > 1.64

No development 1.64 ≥ RCI ≥−1.64

Deterioration RCI b −1.64

N

5 4 8

36 30 23

8 15 18

49 49 49

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Table 2 Overview of changes in problem status of foster children developing positively. Scores T2 Normal Internalizing T1 Externalizing T1 Total Problem score T1

Normal Deviant Normal Deviant Normal Deviant

2 1 2 0 6 0

Deviant 0 2 0 2 0 2

Total 2 3 2 2 6 2

3.2. Variables associated with increased problem behavior 3.2.1. Increase in problem behavior (overall) Of proximal family factors, positive parenting (U = 180.50, p b .05, r = .29) was negatively and the factors discipline (U = 179.00, p b .05, r = .30), harsh punishment (U = 115.50, p b .001, r = .64) and negative control (U = 133.00, p b .01, r = .43) were positively associated with a statistically significant increase in problem behavior. As distal family factor, parenting stress was positively related to the development of problem behavior (U = 139.00, p b .01, r = .42). No child or contextual factor was associated with an increase in problem behavior. Nor, as a global factor, was the educational level of the foster mother associated with an increase of problem behavior (see Table 4). 3.2.2. Increase in internalizing problem behavior Internalizing problem behavior increased more among boys than girls (FE = .04). Proximal family factors harsh punishment (U = 82.50, p b .01, r = .42), inconsistent discipline (U = 62.00, p b .01, r = .40) and negative control (U = 74.00, p b .05, r = .35) were positively associated with an increase in internalizing problem behavior. Parenting stress was also positively associated with an increase in internalizing problem behavior (U = 53.00, p b .01, r = .43). The other child, family, contextual and global factors were not associated with an increase in internalizing problem behavior. 3.2.3. Increase in externalizing problem behavior Of the proximal family factors, the GPBS scales positive parenting (U=161.50, pb .05, r=.29) and discipline (U=164.50, pb .05, r=.28) were respectively negatively and positively related to an increase in externalizing problem behavior. Parenting stress was also positively related to an increase in externalizing problem behavior (U=135.00, pb .01, r =.37). No child, contextual or global factor was associated with an increase in externalizing problem behavior. 3.3. Variables associated with a decrease in problem behavior 3.3.1. Decrease in problem behavior (global) The proximal family factor, supportive parental behavior (U=83.00, pb .05, r=.31), and the distal family factor, parenting stress (U=86.00, pb .05, r=.30), were respectively positively and negatively associated with a decrease in problem behavior. No other child, family, contextual or global factor was associated with a decrease in problem behavior (see Table 5). Table 3 Overview of changes in problem status of foster children developing negatively. Scores T2

Internalizing T1 Externalizing T1 Total Problem score T1

Normal Deviant Normal Deviant Normal Deviant

Table 4 Overview of factors associated and strength of the association with an increase of problem behavior.

Normal

Deviant

Total

1 0 6 0 6 0

5 2 5 4 8 4

6 2 11 4 14 4

Child factors Age Gender Problem score T1 Familial factors Parenting behavior PP MON RUL DISC IncDISC HaPUN IGN REW AUT SUP NC ParentStress Contextual factors Length placement Kind placement Referrer Previous placements Global factor Educational level FM

Total Problem score

Internalizing

Externalizing

0 0 0

0 + boys 0

0 0 0

−r = .29 0 0 +r = .30 0 +r = .64 0 0 0 0 +r = .43 +r = .42

0 0 0 0 +r = .40 +r = .42 0 0 0 0 +r = .35 +r = .43

−r = .29 0 0 +r = .28 0 0 0 0 0 0 0 +r = .37

0 0 0 0

0 0 0 0

0 0 0 0

0

0

0

+ = positive relation, − = negative relation, 0 = no statistically significant relation, PP = Positive Parenting, MON = Monitoring, RUL = Rules, DISC = Discipline, IncDISC = Inconsistent Discipline, HaPUN = Harsh Punishment, ING = Ignoring, REW = Material Rewarding, AUT = Autonomy, SUP = Supportive Parenting, NC = Negative Control, ParentStress = Parenting stress, FM = Foster mother

3.3.2. Decrease in internalizing problem behavior The CBCL internalizing score on T1 (U=19.50, pb .001, r=.43) and the length of the placement (U=49.00, pb .05, r =.29) were associated Table 5 Overview of factors associated and strength of the association with a decrease of problem behavior.

Child factors Age Gender Problem score T1 Familial factors Parenting behavior PP MON RUL DISC IncDISC HaPUN IGN REW AUT SUP NC ParentStress Contextual factors Length placement Kind placement Referrer previous placements Global factor Educational level FM

Total Problem score

Internalizing

Externalizing

0 0 0

0 0 −r = .43

0 0 −r = .32

0 0 0 0 0 0 0 0 0 +r = .31 0 −r = .30

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0

−r = .29 0 0 0

0 0 0 0

0

0

+r = .36

+ = positive relation, − = negative relation, 0 = no statistically significant relation, PP = Positive Parenting, MON = Monitoring, RUL = Rules, DISC = Discipline, IncDISC = Inconsistent Discipline, HaPUN = Harsh Punishment, ING = Ignoring, REW = Material Rewarding, AUT = Autonomy, SUP = Supportive Parenting, NC = Negative Control, ParentStress = Parenting stress, FM = Foster mother

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with a statistically significant decrease in internalizing problem behavior. Foster children whose internalizing problem behavior decreased had a higher CBCL internalizing score on T1 and were placed in foster care for shorter lengths of time. No other child, family, contextual or global factor was associated with a decrease in internalizing problem behavior. 3.3.3. Decrease in externalizing problem behavior The CBCL externalizing score on T1 (U=29.50, pb .05, r=.32) and the educational level of the foster mother (U=24.00, pb .05, r=.36) were associated with a significant decrease in externalizing problem behavior. Foster children whose externalizing problem behavior decreased, had a higher CBCL externalizing score on T1 and a foster mother with a lower educational level. No other child, family, contextual or global factor was associated with a decrease in externalized problem behavior. 4. Discussion Foster care is an intervention that offers support to the foster child and his/her parents. Boosting the development of the foster child – including a reduction in problem behavior – is often a target. Little is known about the development of problem behavior among foster children. If foster care is to contribute to the development of foster children, more needs to be understood about the role parenting in foster families and other important foster care-related factors play. In this study, we examined at case level to what extent foster children positively or negatively developed over a period of two years and which global, contextual, family (distal and proximal), and child factors were associated with an increase or decrease in problem behavior. When interpreting the findings the reader should bear in mind that a cross-sectional sample of foster children was followed for two years. Consequently, the length of the foster placement of the foster children followed, varied across the sample. Some foster children were only placed for a short time (e.g. one year) while others lived already a long period in the foster family at the start of the study. In accordance with the literature, after a period of two years, 18 foster children (37%) had more (global) behavioral problems, and 23 foster children (47%) had the same level of behavioral problems. Only eight foster children (16%) had fewer behavioral problems. In cases showing an increase, this was clinically relevant for more than half of the foster children. The number of foster children with a deviant Total Problem score evolved from 12 to 18 children. A decrease in (global) behavioral problems was not clinically relevant for any of the foster children. An increase in problem behavior is not only more common than a decrease, it is also often more severe. The increase and/or stabilization of behavioral problems over a period of two years raises questions about the effectiveness of foster care and the parenting in foster families. In only 16% of the foster children did problem behavior decrease, while the estimated decrease in problem behavior among young people living in residential care is between 25% and 60% (Knorth, 2005). Factors relating to the child, the foster family and the context of the foster care placement may contribute to the development of problem behavior. This study mainly found evidence of the importance of family factors (parenting behavior and parenting stress) for an increase of (global) problem behavior. Indeed, no child, contextual or global factor was associated with an increase. Parenting behaviors such as harsh punishment, negative control, and positive parenting were all associated with an increase in problem behavior. When foster parents use more negative parenting strategies and no longer have a positive relationship with the foster child, problem behavior increases. In addition, the size of the effect suggests that negative parenting strategies have a greater influence than the absence of a positive relationship. Because of the correlational design of the study, causality is not known and the above relationship also can be interpreted contrariwise. Compared with studies of non-foster children (Stoolmiller, 2001) and professional carers (Harder et al., 2006), the findings may indicate

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that foster carers use more negative control and less positive parenting strategies for children with more behavioral problems. Making a distinction between internalizing and externalizing problem behavior, an increase in internalizing problem behavior was more strongly associated with negative parenting practices (severe punishment and inconsistent discipline) than an increase in externalizing problem behavior. This could indicate that the use of these parenting strategies with foster children mainly contributed to an increase in internalizing problems. Conversely, this association can suggest that internalizing problem behavior made foster mothers more insecure, which is why they resorted to more (inconsistent and harsh) punishment. This uncertainty may result from the fact that foster parents are poorly prepared for dealing with internalizing behavioral problems (Van Holen et al., 2007). This latter interpretation is in line with the finding that parenting stress was associated with an increase in internalizing problem behavior. Conversely, the relationship between an increase in internalizing problem behavior and parenting stress suggests that parenting stress – mediated or not – contributed to an increase in internalizing problem behavior. In studies of non-foster children, discontent and disillusionment of mothers about the interaction with their child are specifically associated with more internalizing problem behavior in the child (Costa, Weems, Pellerin, & Dalton, 2006). An increase in externalizing problem behavior was less associated with parenting behavior (only with the GPBS discipline and the positive parenting scale). This could indicate that (an increase of) externalizing problem behavior is less associated with the upbringing by foster parents. Other factors, such as the placement per se but also genetic factors may contribute to the development of problem behavior in children who are not brought up by their parents. The small(er) association between an increase in externalizing problem behavior and parenting behavior may even suggest an adequate parenting by foster parents and that foster parents can take a distance from the problem behavior in their foster child. Genetic factors not only contribute to the development of problem behavior, they also lead to more harsh and inconsistent punishment and less warm parenting (Ge et al., 1996). The moderately positive association of parenting stress with an increase in externalizing problem behavior shows that this does not leave foster parents untouched. It has already been demonstrated that an increase in problem behavior is associated with more parenting stress (Fisher et al., 2000). In comparison with an increase in problem behavior, fewer factors were associated with a decrease. Parenting behavior was also less associated with an improvement. Only the supportive parenting scale was strongly associated with a decrease in (global) problem behavior. Being involved with the foster child, teaching him/her rules and stimulating his/her autonomy can contribute to a decrease in problem behavior. Conversely, this association may indicate that it is easier for foster parents to practice the abovementioned parenting behavior with a foster child whose problem behavior is lessening. This interpretation is also consistent with the finding that parenting stress is lower with foster children whose problem behavior is decreasing than with foster children whose problem behavior remains stable or increases. That parenting behavior is less associated with an improvement in psychosocial functioning may indicate that parenting by foster parents is not “specific” enough. Previous studies of the parenting behavior of foster parents found that most foster parents provide “average” parenting and that the parenting of 10% to 25% of foster parents is inadequate (Orme & Buehler, 2001; Vanderfaeillie et al., 2012). Similar results were also found among professional carers. Confronted by problem behavior they attempt to limit and correct this behavior. Children who are more difficult receive less positive attention and encouragement than easier children (Harder et al., 2006). A more tapering or specific upbringing might ultimately lead to a reduction of problem behavior in more foster children. Earlier research found indeed that foster carers had a major influence on outcomes. Foster carers that were caring, accepting, encouraging, clear in their expectations, not easily upset by the child's failures, capable of seeing things from the child's view, doing things with the child which he or

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she might be expected to like, and that were child-oriented, had more successful placements. On the contrary, rejection of the foster child was associated with increasing problem behavior (Sinclair, Wilson, & Gibbs, 2005). The fact that higher T1 scores were related to a decrease may be due to the fact that foster children with more behavioral problems have greater room for improvement. This improvement is barely clinically relevant. The association between a decrease in internalizing problem behavior and a shorter placement is more difficult to interpret. In a first instance, a placement in a secure family environment with involved foster parents can result in a decrease in internalizing problems. With foster children who have been placed for longer, this decrease has already occurred so the effect can no longer be observed. Another possible explanation is that shorter placements offer the foster child greater prospects of a reunion with their parents. Rightly or wrongly, this expectation may result in a decrease in internalizing problem behavior. Since we do not have visibility on the expectations or perspectives of the foster child, it is difficult to determine which explanation is most valid. The results of this study have important implications for practice. Firstly, they show that improvement in psychosocial functioning of foster children during a foster care placement only occurs in a limited number of cases. With most foster children, problem behavior remains stable or increases. The results also underline the importance of parenting behavior of foster parents. An increase in problem behavior was mainly associated with the parenting behavior of foster mothers. And surprisingly, so was the association between internalizing problem behavior and negative parenting strategies. Preparing foster parents to deal with internalizing problem behavior is therefore important. This behavior is less immediately visible and often attracts less attention. The finding that a decrease in problem behavior was less strongly associated with parenting behavior (only the CBCL Total Problem scale and the GPBS composite supportive parenting scale) than with an increase in problem behavior, raises the question of whether parenting by foster parents needs to be more specific or specialized. At the same time it must be acknowledged that even high-quality substitute parenting may not easily produce substantial change, and that support to children and foster carers is likely to be needed (Biehal, Ellison, Baker, & Sinclair, 2010). Finally, the absence of a relation between the length of placement and an increase in problem behavior might indicate that even when there has been progress, children may slip back at different stages in a placement. So, even for apparently stable long-term placements, support is necessary. This study has some limitations. The longitudinal design, accompanied by the high dropout rate of participants resulted in a small, biased study group. The study period of two years was rather short. Following foster children over a longer period and conducting a survey of all stakeholders involved in terminated or prematurely ended placements, might paint a more complete picture of the development of behavioral problems in foster care. Foster children were not followed from the beginning of their placement, which means that a decrease in problem behavior could have already occurred before the study that we were unable to measure. All the information was collected via self-reporting questionnaires completed by foster mothers. Using the same information source and methodology can color the results and artificially increase the level of association between the constructs. Differences in selection and support offered by the foster care agencies may hinder generalization of the results. Finally, only long-term placements were studied. 5. Conclusion The expectation that behavioral problems of foster children decrease or continue to decrease during a foster care placement is not justified. Among most foster children, behavioral problems increase or remain stable. Only a limited number of foster children show a decrease in problem behavior. The increase in behavioral problems is mainly associated with the use of negative parenting strategies by foster parents. A decrease is associated with more supportive parenting behavior. Support for foster parents focusing on reducing the use of negative parenting strategies

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