Fostering healthy families: An exploration of the informal and formal support needs of foster caregivers

Children and Youth Services Review 110 (2020) 104760

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

Fostering healthy families: An exploration of the informal and formal support needs of foster caregivers

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Jacquelyn K. Mallettea, , Lindsey Almondb, Hannah Leonardc a

East Carolina University, Human Development and Family Science, 335 Rivers West, Mailstop 505, Greenville, NC, USA Auburn University, Alabama Healthy Marriage and Relationship Education Initiative, Department of Human Development and Family Studies, USA c East Carolina University, Human Development and Family Science, Greenville, NC, USA b

A B S T R A C T

This qualitative study examines the challenges foster caregivers face within their families and seeks to understand their formal and informal support systems so that future trainings may be created to provide for the specific and realistic needs of foster caregivers. Twelve licensed foster caregivers from North Carolina took part in 90 minute focus groups with semi-structured questions regarding relationship strengths and challenges, trainings, and support. Six themes were inductively coded from the data: quality of supports and people who understand, strain on family relationships, fear of removal, lack of support from systems, lack of applicable training, preparation and support for adoption; examples of each are provided. Increasing numbers of children in foster care, combined with a lack of available foster placements makes recruitment and retention a vital factor for those who train and work with foster caregivers; our research indicates a strong need for appropriate and applicable foster caregiver trainings, combined with support from both formal and informal systems.

1. Introduction Serving more than 400,000 displaced children, the foster system aims to protect children in the United States from abuse, neglect, and maltreatment (U.S. Department of Health and Human Services, 2019). Foster children are placed in the home of a foster caregiver or family who will provide for their needs until they are either reunited with their family, adopted, or placed with a family within the foster system. Foster caregivers account for the largest population who care for children who are displaced because of maltreatment (Geiger, Piel, & Julien-Chinn, 2017). Couples and individuals choose to foster for a variety of reasons including fondness for children, adding to their family, religious values, income boost, and a desire to help children in need (Baum, Crase, & Crase, 2001; Fisher, Van Ryzin, & Gunnar, 2011; Lietz, Julien-Chinn, Geiger, & Piel, 2016; Rodger, Cummings, & Leschied, 2006). However, foster families do not have the same rights and legal ties to their foster children as the child’s biological parents, potentially causing challenges and stressors (Miller-Ott, 2017). The addition of the new foster child may lead to foster caregivers feeling overwhelmed with new responsibilities (Lanigan & Burleson, 2017; Thompson, McPherson, & Marsland, 2016). To cope with the additional responsibilities, foster caregivers require social support, training, and a team of helpful professionals (Lanigan & Burleson, 2017; Piel, Geiger, Julien-Chinn, & Lietz, 2017). A helpful and supportive interdisciplinary team of professionals is

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essential to reducing stress, increasing satisfaction, and decreasing burnout for foster caregivers (Geiger et al., 2017; Greeno et al., 2016). Thus, the purpose of this qualitative study is to explore the influence of social and informal support needs of foster caregivers, as well as their formal social service and training experiences. This will enhance our understanding of strengths and challenges in their informal and formal support systems and allow for expansion of policy and programming aimed at foster caregivers in North Carolina that is targeted to their identified needs. 1.1. Supporting resilience in foster families Family resilience, which refers to the process by which family units are able to sustain, or even improve, family functioning despite the presence of multiple risk factors (Geiger et al., 2017), may help explain how foster families overcome the negative effects of risk and can enhance family function despite experiencing highly stressful challenges that often lead to breakup and discord (Cooley, Thompson, & Wojciak, 2017; Lietz et al., 2016). Longevity and the ability to maintain healthy family functioning, despite these challenges, suggests the construct of resilience offers an explanation regarding how some families are able to sustain effective fostering for years, despite the stressors associated with this important role (Geiger, Piel, Lietz, & Julien-Chinn, 2016). Emotional support is one way to enhance the process of resilience in families facing adversity (Geiger et al., 2017) and can be received

Corresponding author. E-mail addresses: [email protected] (J.K. Mallette), [email protected] (L. Almond).

https://doi.org/10.1016/j.childyouth.2020.104760 Received 30 August 2019; Received in revised form 7 January 2020; Accepted 8 January 2020 Available online 12 January 2020 0190-7409/ © 2020 Elsevier Ltd. All rights reserved.

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Although understudied within foster parents, external informal support networks (e.g., friends, extended family members, foster parent support groups) may also influence the health of their couple relationships. For example, in examination of non-fostering couples, those who share more friends (Amato, Booth, Johnson, & Rogers, 2007) and report greater social integration (Barton, Futris, & Neilsen, 2014) also report higher levels of couple relationship quality. When couples face challenges, those who turn to their external informal support networks report better outcomes than those who choose not to connect (Amato et al., 2007). Among foster caregivers, those who report more informal supports have higher levels of relationship efficacy and better quality couple and coparenting relationships (Richardson & Futris, 2019). Finally, for foster mothers, a stronger support system serves as a buffer against the negative influence of parenting stress on the coparenting relationship (Richardson, Futris, Mallette, & Campbell, 2018). Vanderfaeillie, Van Holen, De Maeyer, Gypen, and Belenger (2016) report foster fathers recognizing more strain from fostering, resulting in their need for higher support and less satisfaction. Approximately half of all marriages end in divorce, yet for data on fostering couples, the divorce rates and reasons have been neglected (Riggs & Blythe, 2017). Exploring the influence of informal supports on foster caregivers, as well as the impact of fostering on couple intimacy may highlight unique aspects regarding strengths and challenges for foster couples’ relationships, the importance of social support networks, and may provide support for inclusion of such topics in foster caregiver trainings.

through informal or formal sources. Informal social support (e.g., social networks, other foster parents, and family support) is typically differentiated between tangible resources such as goods and services, and emotional support (Piel et al., 2017). Tangible resources and emotional support have been identified as a protective factor which can be provided internally from within the family system as well as externally through outside sources within the environment (Piel et al., 2017). While informal support has been linked to reducing caregiver stress (Piel et al., 2017) and increasing placement stability (Brown, 2008; Buehler, Cox, & Cuddeback, 2003; Howell-Moroney, 2013), support from formal sources (e.g., services such as foster parent trainings, the caseworker, or the social service agency) has been linked to foster cargiver retention and satisfaction (Marcellus, 2010; Rodger et al., 2006). Specifically, foster parent training contributes to placement success, enhancing parenting efficacy, reducing parenting stress, and facilitating positive familial relationships (Fisher, Gunnar, Dozier, Bruce, & Pears, 2006; Fisher et al., 2011). 1.2. Navigating internal and external informal support systems Though foster caregivers may face challenges and stressors, most find it a rewarding act (Piel et al., 2017). Foster caregivers enjoy seeing positive changes in their foster children (Lietz et al., 2016). Many families also report their sense of familial closeness, including feelings of love, patience, and understanding are improved by their choice to foster (Thompson et al., 2016); individuals report more empathy, flexibility, and tolerance as well (Geiger et al., 2016). Choosing to foster provides families with both internal and external networks of support from other foster families, professional service providers, family, and friends (Piel et al., 2017). Informal social and emotional support has been identified as a component that contributes to foster family satisfaction and strongly influences their decision to continue fostering (Brown, 2008; Buehler et al., 2003; Geiger, Hayes, & Lietz, 2013; Howell-Moroney, 2013; MacGregor, Rodger, Cummings, & Leschied, 2006). For married or partnered foster caregivers, one potential source of internal informal support is the couple romantic relationship. Many couples experience various challenges throughout the duration of their relationship; the decision to foster is just one of these challenges. Not only must the family renegotiate roles, but the couple’s relationship may change with the addition of a foster child (Thompson et al., 2016). Children may exhibit challenging behaviors which may in turn spill over to the parents’ relationship, contributing to stress and conflict (Thompson et al., 2016). For foster caregivers, adding new children into their household can be a major transition. Similar to adoptive or blended families, foster families must learn to adapt to new roles, set boundaries, develop a new sense of family, and blend biological with nonbiological members (Lanigan & Burleson, 2017). Children in the foster care system converge with their new families having possibly experienced trauma, neglect, or abuse (Geiger et al., 2017). Though foster children can be a great source of joy, their emotional trauma and externalizing behaviors can influence the length of placement (Nelson & Horstman, 2017), as negative child behavior is reported as a top stressor amongst foster caregivers (Greeno et al., 2016). An added stressor for foster caregivers concerns including their foster children and trying to develop attachments with them (Lietz et al., 2016; MillerOtt, 2017). Not only might this cause friction between the couple, but may force a divide between their biological and blended foster family (Thompson et al., 2016), which can negatively impact the couple relationship. Although research in this area is limited for foster caregivers, empowerment gained through knowledge, support, and resources from informal sources (e.g., support from partner, foster parent support groups) may help caregivers feel more efficacious in their parenting role. When the child’s needs are met through confident parenting, secure attachments and stable routines are more likely, leading to fewer externalizing behaviors and a decrease in placement disruptions (Geiger et al., 2017; Semanchin Jones, Rittner, & Affronti, 2016).

1.3. Navigating formal supports – foster care systems and training Foster caregivers routinely navigate the care systems set in place for the child such as medical, mental, educational, and health, while working with a team to aid in foster children’s well-being and development (Geiger et al., 2016; Lietz et al., 2016). Foster caregivers desire to connect with, and be involved with the foster care system (Cooley et al., 2017) but often report challenges with the foster care system, and not feeling like an important part of the team as major contributors towards burnout and discontinuance of fostering (Cooley et al., 2017; Roman, 2016; Vanderfaeillie et al., 2016). For example, social workers play an important factor in foster caregivers’ continuance or discontinuance of fostering (Geiger et al., 2017); however, social workers and foster caregivers may have differing views of the role of foster caregivers, which contributes to a sense of worry that social workers do not trust or appreciate their work (Cooley et al., 2017; Lanigan & Burleson, 2017). When foster caregivers perceive that there is distrust or insufficient communication with their assigned social worker, it often leads to feeling unsupported, a percieved lack of recognition, or an unproductive relationship with their agency, challenges that are exacerbated by the technical aspects of fostering, such as low financial support and the complexity of the foster care system as a whole (Geiger et al., 2016; Hebert & Kulkin, 2016). Those interested in fostering are required to undergo both screening and training processes on in-depth parenting education, normative child development, and non-normative child development (Greeno et al., 2016; Riggs & Blythe, 2017). These trainings are intended to increase well-being, satisfaction, and continuance of fostering in families (Lanigan & Burleson, 2017); as well as help them prepare an appropriate environment for foster children (Riggs & Blythe, 2017). Training encourages the continuance of fostering and higher levels of satisfaction (Vanderfaeillie et al., 2016). Without proper training and support, foster caregivers may not be prepared to manage the transition and changes that fostering brings (Cooley et al., 2017). However, the trainings provided to potential foster caregivers are mandated by federal law, but are not always appropriate or supported by research (Solomon, Niec, & Schoonover, 2017). Approximately 30 h of training are mandatory in most states, though some require as few as 4 h before placement of a foster child (Greeno et al., 2016). Training is many times not validated by foster care agencies because of their belief that 2

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service training as well as enhancement of emotional support networks for families experiencing adversity. These necessary and targeted formal and informal supports could promote resilience and strengthen placement longevity and stability. Thus, we examined the following research questions: (1) From which sources of informal support systems do foster caregivers receive the most helpful and tangible support? (2) How do informal support networks impact family and/or couple relationships while foster caregiving? (2) What aspects of informal support networks are protective/stressful for their family and/or couple relationships? (3) From which sources of formal systems do foster caregivers receive the most helpful and tangible support? (4) What are the formal training needs of foster caregivers?

fostering does not require skill (Roman, 2016). Foster caregivers understand the importance of training and support to best adapt to their new family system (Lanigan & Burleson, 2017) but often feel that the training and support they receive from Social Services does not encourage positive growth (Cooley et al., 2017). Lanigan and Burleson (2017) found foster caregivers desired specific training on how to be realistic in their expectations during the transition to fostering. Foster caregivers also recognize the need for specialized training to successfully care for their foster child (Nash & Flynn, 2016), and communicated a desire to be provided more information about the specific child they take in (Cooley et al., 2017). Foster caregivers also report a desire for training on navigating Social Services and the foster care system (Greeno et al., 2016). Many policies regarding fostering and adoption can be difficult to find and understand (Cooley et al., 2017). Discussing these policies, challenges, and concerns with social workers without fear of being looked down upon, allows foster caregivers to form better connections with their interdisciplinary foster team (Piel et al., 2017). Social workers who have helped build confidence and abilities incorporated training based on mastering the new responsibilities and stress (Greeno et al., 2016). One aspect of training that families feel is inadequate, is the unspecified aspect of training to their personal family and romantic lives. Though time consuming, foster caregivers report wanting training that takes into account the individual circumstances of their lives, location, children, and other contextual factors (Geiger et al., 2016; Piel et al., 2017). One specific contextual factor foster caregivers feel unprepared for, based off their training, is caring for a child who is at increased risk for behavioral problems, emotional problems, or trauma (Lanigan & Burleson, 2017; Solomon et al., 2017). Foster caregivers who feel they have been adequately prepared to handle these behaviors will be more likely to feel a connection with their foster child, potentially leading to continued fostering (Semanchin Jones et al., 2016; Solomon et al., 2017). Relatedly, one study identified that at least half of all long term foster caregivers in their sample experienced feelings of grief after losing a foster child (Hebert & Kulkin, 2016). The thought of their foster child being removed from their care has been reported as a major stressor amongst foster caregivers (Hebert & Kulkin, 2016); this situation can be negatively intensified if a new placement or reunification of the child comes earlier than expected (Riggs & Willsmore, 2012). Foster caregivers report feeling unprepared with their training for how to cope with a new placement or reunification of a foster child (Hebert & Kulkin, 2016), and report not being provided much counselling afterwards, making the change more difficult (Riggs & Willsmore, 2012). Feelings of ambiguous loss after the placement or reunification of foster children does not always allow for foster caregivers’ grief to be acknowledged or supported. When the foster care system and social workers do provide supports for foster caregivers during transfers in placement, foster caregivers have an easier time dealing with their grief and are more likely to continue fostering (Hebert & Kulkin, 2016).

3. Methods 3.1. Sample and recruitment The sample consisted of foster caregivers licensed in the state of North Carolina (N = 12). Foster caregivers were recruited from three counties in Eastern North Carolina. Flyers were distributed to social workers at local social service agencies, who gave them out to foster caregivers during mandatory meetings, and were provided to local foster parent support groups. Most of the foster caregiver participants were female (n = 10; 83.3%). The caregivers ranged in age from 26 to 75, with an average age of 41.73 years (SD = 13.55). 58.3% of the foster caregiver participants were married (n = 7), one was dating (8.3%), and 33.3% reported being uninvolved romantically (n = 4). For those in romantic relationships, the length of their relationships ranged from six months to 21.83 years, with an average relationship length of 11.6 years (SD = 7.94 years). The majority identified as white (n = 8; 66.7%) with the remainder identifying as African-American (n = 4; 33.3%). Most (n = 10; 83.3%) of the caregivers had completed some college or a 4 year college degree; one had a high school diploma (8.3%), and one had an associates degree (8.3%). Ten of the caregivers worked outside of the home either part- or full-time (83.3%), one was retired (8.3%), and one was disabled and unable to work outside of the home (8.3%). Household income of the caregivers ranged from $25,000 to over $100,000, with the majority (n = 7; 58.3%) falling in the $40,000–$75,000 range. 3.2. Data collection and interview questions Three focus groups were held over six months time in two counties from which all participants resided. The focus groups ranged in size with two, six, and four foster caregivers, respectively. Foster caregiver participants were provided with a $30 gift card incentive for participation. Focus groups were recorded with a video recorder that captured audio and video simultaneously. The facilitator utilized a semi-structured approach; the facilitator had a list of baseline questions to ask the participants, but also allowed the conversation to develop organically. We had a set of questions that included their experiences with their formal supports as well as their internal and external informal supports. For external supports, they were asked about their formal support systems, such as social workers and the foster care system, as well as their experiences with mandated foster licensing trainings as well as what would be helpful additions for trainings. In order to identify their experiences with internal and external informal supports, participants were asked about aspects of their families that make fostering more successful or difficult. They were then asked to identify specific parenting strengths/challenges, and experiences with romantic relationships while fostering (whether or not they were currently in a couple relationship).

2. Current study Many foster caregivers discontinue fostering within a year (Geiger et al., 2016), with the average length of fostering being between 8 and 14 months (Geiger et al., 2017). Research indicates that even if foster caregivers have a high overall satisfaction, having a strong dissatisfaction in just one area can contribute to discontinuance of fostering (Vanderfaeillie et al., 2016). Exploring foster caregivers’ experiences with formalized services and trainings may help professionals to prepare future trainings that are in line with the needs of foster caregivers. In addition, exploration of internal and external infomal support systems for foster families is underdevelopod in prior research. Therefore, understanding the familial challenges faced by foster families and how support from informal networks influences their foster caregiving could provide support for inclusion of these topics in pre-

3.3. Data analysis The research team transcribed each focus group and used a 6-phase 3

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a foster parent support group both in person and on Facebook. The particpants explained that the support group has been invaluable to them and allows them to feel free to discuss questions, comments, and concerns pertaining to everyday fostering life. This method is a judgement-free zone where foster caregivers feel comfortable to ask and answer questions without reprimand.

thematic analysis (Braun & Clarke, 2006) to identify, code, and uncover themes in the data. The main phases of this thematic analysis are to (1) become familiar with the data, (2) generate initial codes, (3) search for themes, (4) review themes, (5) name themes, and (6) relate the themes back to the research questions to produce a scholarly report. The triangulation of data in this thematic analysis method produces a more comprehensive set of findings, which adds to the trustworthiness of our findings (Noble & Smith, 2015). In addition, to enhance the precision in which our findings accurately reflected the data, our semistructured audio recording allowed for repeated data analysis in which we could revisit the data to check emerging themes in order to ensure accuracy of participants’ accounts (Noble & Smith, 2015). Last, to ensure credibility, we included verbatim descriptions of the experiences of our participants to support our findings (Slevin & Sines, 1999). During the transcription process, the authors (1) became familiar with the data and began creating meanings from the translation of spoken text into written text (Braun & Clarke, 2006). Following all finalized transcription, the team (2) identified and organized a list of initial interesting ideas, which were coded. Two coders then sorted and combined codes to (3) develop main themes. The team (4) reviewed the themes to determine how representative they were of our data set. Data were coded using an integrated approach (Bradley, Curry, & Devers, 2007), in which we used our research questions as a deductive organizing framework for overarching codes, but also included inductive development of sub-codes within the data to reduce bias (Braun & Clarke, 2006). Upon deciding our final themes, we (5) defined and described each one to capture the essence of the theme. The data were then reanalyzed by the research team to ensure each code was themed accurately with essential notes and were (6) related back to the research questions.

When I go to the Facebook group a lot of times when we have questions or concerns we can just post it out there because it’s now just literally foster caregivers, no social workers, no anything, it’s just us. So if it’s straight up, this kid is on my nerves what do I do type deal or can’t potty train or some things of that nature you have different people chiming in not looking at you like you’re a bad parent or you don’t know what you’re doing and they’re looking at you’re like exactly what you are; you are a foster parent so it’s totally different. Having a group, or support network, that had firsthand experience with fostering was something foster caregivers within the focus group were greatly appreciative of: “Having someone to understand what we’re going through because our parents all day long can come and help and our friends can come and help but having that network of people that truly understands how hard it is.” 4.2. Strain on family relationships Participants shared that fostering a child is a large responsibility that is generally life changing and has an impact on familial relationships, including couple relationships and extended family relationships. It comes with many doctors’ visits, social work appointments, and paperwork. There is much that goes into fostering that many times foster caregivers don’t feel able to, or are not allowed, to tell their families. A caregiver mentioned that she often keeps the more negative aspects of foster caregiving from her family members because “my family is learning, but sometimes I don’t want them to learn all that. I don’t want them to worry.” Within a romantic relationship, foster caregivers reported not having enough time for intimacy with the responsibilities of having a child. Many of these responsibilities seem to fall on the mother figure (in heterosexual relationships) more frequently than the father figure. Multiple participants reported feelings of unequal distribution of parenting, but did not always report dissatisfaction with this arrangement. For example, one foster mother expressed that “I can’t expect him to wear the same hats I wear; it wouldn’t work that way. He would have checked out.” Within partnerships where the foster child was in the home before the partnership began, foster caregivers have noticed a challenge remembering to include the other partner in the information about the child: “I forget that he needs to be a part of the decision making process.” Due to this, foster caregivers expressed a desire to have some aspect of relationship education included in their foster caregiver training. When asked about training for current or future relationships, one caregiver replied that “there’s definitely nothing in there about when you’re bringing someone else into the relationship.” And when asked whether fostering changes the couple relationship a foster mother responded, “Oh, yes,” and her husband replied, “and if you say it doesn’t, you’re lying.”

4. Results and specific participant quotes Foster caregivers explained their experiences with informal and formal support networks and how those networks influenced their foster families. Six themes were inductively coded from the data and examples of each are provided below. Two themes on internal and external informal supports included: (1) Quality of Supports and People who Understand, and (2) Strain on Family Relationships. Four themes on formal sources of support included: (1) Information and Understanding Provided by Formal Systems, (2) Fear of Removal, (3) Lack of Applicable Training, and (4) Preparation and Support for Adoption. 4.1. Quality of supports and people who understand A common theme amongst the participants was that if their sources of internal and external informal support truly understood the challenges of foster parenting, this would improve the quality of their support. For participants who were in a romantic relationship, having their partner provide little comforts or take care of everyday needs was an important aspect of support foster caregivers felt they needed. Regardless of their romantic relationship status, many participants agreed family was one of the major forms of support for their fostering. A non-partnered caregiver explained that “I’m single so I couldn’t really do it without my family’s support like my parents and sister-in-law and brother.” A supportive and nurturing relationship with close friends and family allowed these foster caregivers to better handle the stressors related to fostering. One participant recalled an instrumental role her father played creating a special bond with her foster daughter:

4.3. Information and understanding provided by formal systems Participants discussed different formalized support sources in their lives and a common theme emergeed that whether those various resources were actually supportive depended on the knowledge they had about the process of foster caregiving and the amount of information that was provided to them as caregivers. A few main resources listed by participants were the social workers, guardian ad litems, and the Department of Social Services (DSS). Many foster caregivers reported feelings of social workers and guardian ad litems being unaware of the

The therapist suggested that my dad taking and spending more time with her [foster child] and taking her on dates and getting to know her better and letting her choose things, it would help replace the memories with him [biological father] with more positive memories with my dad would help her feel close to another man. Some of the foster caregivers were familiar with each other through 4

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Similar to their fear that their foster child may be removed suddenly from their care, foster caregivers fear asking questions or inadvertently saying the wrong thing. One caregiver expressed “Sometimes I’m scared to ask our social worker because I think they’re typing something or it’s negative to me. I don’t feel like I can be completely honest.” Participants in the focus groups felt as if there their comfort level asking questions was dependent on their comfort level and relationship with their social worker.

required trainings that foster caregivers attend, such as MAPP (Model Approach to Partnerships in Parenting) classes. A caregiver speaking about the importance of formal support stated that, “I think the social workers and people involved with the agencies need a better understanding of how we operate and how our minds work.” Another stated: I think the biggest problem is that there is no training for the social worker or guardian on how to deal with the foster family. You say some things to social workers and they’re like, “Do what?” I’m like, “Yeah, we learned that in MAPP class.” They’re like, “What’s MAPP class?” The class we take to get licensed? They should know that. They should get the same information.

It’s just a weird dynamic where some of the social workers really care and some just don’t at all. It’s such a weird thing and you don’t want to say the wrong thing. Sometimes I’m like, they think I’m a bad foster parent and I just don’t care about her. [They think] that’s what my opinion is about her.

Some foster caregivers reported occupying additional roles, such as respite caregivers. As either foster caregivers or respite caregivers, caregivers require a certain amount of information about the child. This can occasionally be difficult with the sensitivity of providing information dealing with a foster child. However, much of the common information caregivers requested included allergies, likes, and dislikes. Participants described their frustration with not receiving this information in advance of child placement. For example, a respite provider explained that “They didn’t tell us ours was lactose intolerant and we didn’t know for two months and I was like I don’t understand what’s wrong is he sick I don’t get it.” When engaged and well informed, foster caregivers support the notion of every foster child having a guardian ad litem. Foster caregivers suggested that guardian ad litems may be a useful support or link between foster caregivers and social workers.

Often their feelings of lack of support were not attributed to their specific social worker, but to DSS in general. For example, several foster caregivers reported pushback from DSS for creating a foster parent Facebook support group and advocating for their foster children. They can say anything they want about me, and I’ve seen the politics of it. I know they’ll do and say anything if it’s what they want to remove a kid. You find yourself walking on eggshells for your kids’ sake. Even after a fostering case moved to adoption, foster caregivers felt a need to be mindful around DSS and the social workers. Fear of being perceived negatively by the social workers was commonly reported throughout various topics of discussion. Foster caregivers reported using extra caution to ensure that DSS or social workers would accept their adoption paperwork. The idea was also echoed that foster caregivers who adopted were glad to be distanced from the foster care system and away from the duties associated with fostering.

If there’s one thing to advocate for that would probably make a difference, it would be a guardian ad litem paid position through the state that would be their only job…because there’s a chance people would do it longer if that was their job and those were their responsibilities. Right now it’s a non-paid, voluntary position and they are more constant than the social workers.

When I adopted my daughter, one of the most exciting things was no more paperwork. No more social worker to answer to. No more charting medications. That was so exciting. Every time there was a visit, it was a reminder that he was not ultimately mine.

4.4. Fear of removal and retribution from the foster care system 4.5. Preparation and support for adoption Foster caregivers expressed multiple fears regarding the removal of their foster child as well as worries about retribution from their social worker or DSS. Foster caregiving can include uncertainty in the stability of a placement, as well as lack of knowledge of the timing for transfers in placement or reunification plans. Foster caregivers know that they (rightly) do not have the same parental rights as biological parents, but this lead to a feeling that they must be hyper aware of their parenting choices at all times.

An unexpected theme that emerged within the topic of support from formal systems was that of the desire for preparation and support for adoption from social workers, the foster care system, and during mandated trainings. Approximately half of our participants reported originally fostering with the intent to adopt. Going into fostering though, some of our participants and people known to the participants had mistaken ideas about what fostering would entail. These foster caregivers had a desire to foster a child because adoption is an expensive method; however they did not consider the trauma foster children may have endured and the services children may need to regain a sense of normalcy. When discussing reasons for fostering and misconceptions about foster caregiving, one participant indicated that “When I could not go anywhere with the adoption because an adoption costs way too much, we said we want to foster to adopt.” The other half of our participants reported no initial intent to adopt, though many of them ended up adopting. They recalled how adoption is not a topic of conversation during training, nor feeling supported once they decided to initiate the adoption process. Many of the foster caregivers agreed that adoption is almost a taboo word amongst social workers: “I really think they’re lacking how to handle the foster parent when these changes go on, when things move to adoption social workers are still, ‘don’t say the word adoption.’” The first goal of foster care is always to reunite the child and biological/adoptive parent if the parents are willing and able to provide a safe and stable environment for the child. Foster caregivers reported that this lead to a sense of partiality towards the biological parent that placed a strain on the foster parent-child relationship. For example, a participant said, “they want you to love them like they’re your

You better be on your P’s and Q’s. They could take them at any minute. It doesn’t take but one thing. The fact that we don’t have any rights in it, things like that make it frustrating, and emotional. Due to this fear and hyper-awareness, foster caregivers reported feeling unable to express any concerns, or questions they have to the social workers or DSS. For example, one caregiver stated that “It’s hard to express your grievances, for fear they’ll come take the kid.” Another caregiver described a specific parenting challenge they faced but said “We didn’t want to tell the social worker that, because we didn’t want to seem like we didn’t want the kid.” There are many policies, laws, and rules associated with being a foster caregiver. As mentioned previously, foster caregivers do not always feel well supported in their training to understand these rules to abide by. When they have questions pertaining to these policies, or feel they should speak out against things that they believe are not right, they may not feel protected from having the foster child removed. A foster caregiver who was in the process of starting an association of foster caregivers to address some of these concerns expressed “In the back of my mind it’s, are they going to do something to sabotage our placement because we’re trying to start a foster parent association.” 5

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especially when at first they told us he [foster child] was straight up adoption.”

biological kid, but they don’t want you to fight for them like they’re your biological kid.” One participant remarked on how her foster child still had biological parent visitations even after the case had moved to adoption and the visits had been shown to be destructive for the child. Overall, foster caregivers who had adopted or were moving towards adoption expressed that adoption allows for a sense of security for the child that the foster caregiver cannot otherwise count on.

5. Discussion Foster children spend an average of two years in the foster care system before they are reunited with their biological parents (Roman, 2016). Foster caregivers often do more than just provide stability for a child in need; many are also advocates, mentors to biological parents, and thoughtful guardians who form attachments (Hebert & Kulkin, 2016). To mitigate the stress of foster caregiving, foster caregivers are often encouraged to utilize various supports such as training, social networks, and professional resources (Cooley et al., 2017). Social support from family, friends, neighbors, service providers, and others is listed by foster mothers as an essential factor in coping with the challenges of fostering (Lietz et al., 2016), while access to supports may promote resilience and better familial outcomes (Fuentes‐Peláez, Balsells, Fernández, Vaquero, & Amorós, 2016; Lietz et al., 2016). Unfortunately, many foster caregivers perceive their supports as unfulfilling and insufficient (Cooley et al., 2017), and there is a gap in understanding the functionality of support systems for foster caregivers. The current study utilized a qualitative design to determine the informal and formal support needs of a sample of foster caregivers in North Carolina. In focus groups, participants explained how changes to their family structure, fears about their foster children being removed from their care, and lack of clarity about expectations, the adoption processes, and their role in care, has led to feelings of stress and often strain on their personal relationships. Themes about internal and external informal support systems emerged around topics of quality, understanding, and strains on family relationships. Themes about formal networks emerged around topics of fear about the system and ways that formal networks can better support foster caregivers through provision of information and knowledge, support for adoption, and overall more applicable trainings that are specifally focused on what foster caregivers will actually encounter. Prior examinations of the relationship between parenting stress and parenting relationships indicates that formal and informal support systems may play a buffering role (Richardson et al., 2018) and thus it is important to understand how existing informal and formal supports function for foster caregivers, as well as reported gaps in such support. Our sample of foster caregivers did indicate certain challenges uniquely attributed to caring for foster children, along with certain training and support needs. One often expressed theme was one of fear or worry. Caregivers were concerned that their foster child would be removed from their care, feared that they were not caring for their child appropriately, and worried that there were restrictions or rules that they were inadvertently missing due to a lack of applicable training topics. These findings were in line with past examinations of foster caregivers who expressed challenges (Roman, 2016) with children’s behavior, knowing how to appropriately care for their foster child, understanding the child welfare system or foster agency, establishing a bond with their foster child, and combining biological and foster family members (Cooley et al., 2017; Geiger et al., 2016; Lietz et al., 2016; Miller-Ott, 2017). Considering the magnitude of these challenges, foster caregivers tend to be at risk for burnout and discontinuance of fostering. This was also stated among our sample of foster caregivers, who expressed that sometimes the lack of privacy due to social workers and others doing home visits, the rules and regulations that have to be followed, and the grief of losing children when they return to their biological parents or are placed in a new foster home were so challenging that they often felt as though they may not be able to continue. One father who was taking a break from fostering after his last child was reintegrated with their birth family expressed that they often feel that they have to perform like ‘robots,’ whereby they are trained to nurture and love the children in their care, but are not expected to experience sad feelings when those children have to leave their home.

I want permanency for him because if something were to happen to me, he goes back into the system and nothing breaks my heart more than think that because my family isn’t licensed or doesn’t have the right to him, that he would go back into the system. 4.6. Lack of applicable training While discussing formalized and required trainings, participants felt some aspects of training were useful, but that overall there was a lack of training that was actually applicable to their experiences as foster parents. Specifically, they felt that trainings needed to be more detailed, expanded, and universally known. Specifically, foster caregivers felt prepared to care for a child with trauma, stating that training discussed signs to look for and ways to approach them. For those who had previously not been parents, trainings also provided some basic parenting skills. I feel like some of the things I’ve learned, I’ve been able to implement. As far as understanding a child who’s gone through trauma, you know things like that. With not having children in the home I think it’s been helpful for me. Although useful, the basic parenting skills taught during their state specific trainings did not always cover material about how to make a connection with the foster child. Foster caregivers wished to have increased training that provided this information, as well as further training specific to situations they may face as a foster parent. The topic of trainings not being applicable to daily fostering life was universally echoed amongst all participants. For example, one participant stated that “nothing I learned in MAPP class has been applicable to my experience in two years as a foster parent,” and every other participant nodded in agreement. In addition, they desired for their trainings to be more encompassing of the specific situations they may experience. Example topics included child behavioral outbursts, addiction symptoms, grief and relationship counseling, information on the procedures associated with fostering such as court dates, medical processes, and social worker visits. As one foster caregiver explained, “I feel the MAPP class should be more realistic; it gives you a very good rose-colored glass view into things.” Another aspect of training foster caregivers particularly wanted addressed was information about what services they were given and how to utilize them. Some of the foster caregivers voiced their frustration with not being provided information on how their stipend, WIC, or Medicaid services worked; some reported not being told they had WIC or Medicaid until well after the placement of their foster child. This information seemed to be desired through face-to-face communication during trainings, as well as an additional PDF-formatted resource to which to refer. Foster caregivers wanted to be able to know how, when, and where they would be able to use these resources for their child: “It would be great if there was a class on Medicaid and WIC. But give me a piece of paper with some numbers. Something, give me something!” Lastly, foster caregivers described desiring resources and training for how to deal with changes in familial relationships and on dealing with the grief associated with transfers to new placements or reunification with the biological parent(s). One participant said that they did not receive counseling of any kind during training, placement, or after a placement had ended: “They are definitely not training us on support or counseling. Nothing to say, “okay this was a huge loss,” 6

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reaction to unanticipated situations they may encounter. Several couples reported an unequal distribution of parenting tasks in our sample, but found this to have been a natural process that unfolded as needed. However, among the couples in our sample, there was a consensus that the stress of fostering hinders intimacy and healthy relationship functioning. For this reason, married couples felt unprepared for the strain on their marital relationship and had little knowledge about how to develop and/or maintain healthy relationship behaviors. Due to these factors, married participants felt that inclusion of knowledge of how fostering may disrupt the marital relationship, as well as some skills on how to maintain intimacy would be useful. Among single/dating participants, it was noted that fostering brings up awkward conversations with potential romantic partners, in which they must discuss required state background checks, as well as ways that the new partner are legally allowed to interact with the children in care. A dating participant mentioned that the pressure of these conversations has cut short several potential romantic partnerships. Because of these factors, single and dating foster caregivers agreed that they would have appreciated training on how to develop romantic relationships and bring new romantic partners into the family.

5.1. Working with many formal systems Although foster caregivers may have access to informal and formal supports, they consider positive, close relationships with social workers and other support systems as most beneficial during difficult times (Brown, Anderson, & Rodgers, 2016). Unfortunately if those relationships are strained, our results indicate that foster caregivers become disenchanted or distrustful with the process and begin to distance themselves or conceal some of their true support needs or fears. Foster caregivers respect social workers for the difficult task of removing and placing children, and want to have positive reciprocal working relationships. One stated suggestion was for social workers to have the same training that they do, or knowledge of the covered topics so they feel that they are on the same page about how to care for the children. Foster caregivers sometimes felt that they were caring for a child in the way that they were trained to do, but that their assigned social worker had differing opinions or methods about that care. Also, foster caregivers suggested “cheat sheets,” or a one page document that would give quick information about a child, such as food allergies, known behavioral triggers, nicknames, or helpful resources. Newer foster caregivers agreed that being provided with a list of local usable resources would ease some nervousness around feeling unprepared or uncertain about the responsibilities of their new role. Foster caregivers work with many individuals: their foster child, social workers, and possibly the child’s biological parent. Though social workers are an important part of the team, the foster caregivers interact with all aspects of the foster care system and their specific child the most (Cooley et al., 2017). Additionally, roles and relationships change with the addition of a foster child; therefore, researchers and agencies supporting these individuals need to better understand the impact of both the new and old emblematic meanings attached to these roles as they change for foster caregivers (Thompson et al., 2016). Social service providers may benefit from understanding how the foundation of empathy supports resilience in foster families and be encouraged to support and acknowledge the importance of affective response, affective mentalizing, self-other awareness, perspective-taking, and emotion regulation within foster families (Geiger et al., 2016).

5.3. Limitations The implications of this study must be considered within its limitations. The qualitative design provided an exploratory perspective to an underdeveloped area of research into informal social and family support needs as well as formal system and training support needs of foster caregivers. Although the qualitative design does not allow for generalization to all foster caregivers, or those outside of Eastern North Carolina, the knowledge obtained can inform future foster trainings and research studies. Future quantitative designs can focus on data around the identified themes to get information from a wider, more diverse group of foster caregivers. In addition, if additional trainings are developed, longitudinal designs that examine pre- and post-testing could help to determine the effectiveness of these trainings in improving and adding to specific knowledge, skills, attitudes, and behaviors. Unfortunately, we could not report a reliable sample response rate as we were unable to track how many foster caregivers actually attended meetings across Eastern North Carolina and thus would have been exposed to the recruitment flyer. This potentially further limits the accuracy and generalizability of our findings. Lastly, these focus groups combined both married and unmarried foster caregiver participants, and we did not ask them about their sexual orientation, which did not allow for in-depth information specific to differentiation of parenting based on relationship status. Examination of changes during fostering specific to married caregivers would allow for more exploration of how fostering both adds to and inhibits certain characteristics of the marital relationship (e.g. positivity, intimacy, communication, conflict management); whereas examinations specific to single or dating caregivers could elucidate how single caregivers can best add new partners into their family system.

5.2. Fostering positive informal support systems Fostering is a unique experience that can heighten the stress on family relationships and lead to potential marital dissolution (Lietz et al., 2016). It is increasingly important for couples and coparents to have realistic expectations and keep a strong partnership while transitioning to fostering, or adding a new foster child to their existing family (Lanigan & Burleson, 2017). Creating healthy relationships between foster caregivers can promote child adjustment and resilience (Nelson & Horstman, 2017). As one example, relationship education for couples who are fostering can have meaning for the couple and their family. Though relationship education programs and marital quality for parents have been previously studied, many researchers or programs focus on populations that are primarily Caucasian, middle class, married, and have children under five years old (Ooms & Wilson, 2004). Many times foster caregivers’ relationship experiences are influenced by the foster care system’s ideals about whether or not to offer relational support to the family or couple (Riggs & Blythe, 2017). Foster caregiving necessitates negotiation of the coparental care of their biological and foster children. In our sample, foster mothers were more likely to take on the primary caregiving role, which sometimes added stress to the parent-parent system. Similar to literature on the transition to parenthood (Lanigan & Burleson, 2017), foster caregivers make decisions about parenting responsibilities and move towards establishing a parent identity. Unique to foster caregiving situations, however, is the timing. In most placement situations, foster caregivers have little or no preparation for the new child that will enter their home and many of these decisional tasks have to happen on the spot, or in

5.4. Future directions and conclusion Foster caregivers may benefit from learning how to identify strong sources of formal and informal support in their life and being able to communicate their needs to increase the helpfulness of their support networks. A module regarding building a helpful support network may be useful to new foster caregivers in the initial, required training. Finally, common formal support networks for foster caregivers (e.g. foster parent associations, faith communities, and child welfare agencies) may examine their policies and training to consider how best to serve foster caregivers, and design policies and procedures with this information in mind. Increasing numbers of children in foster care, combined with a lack of available foster placements makes recruitment and retention a vital factor for those who train and work with foster 7

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caregivers, and our research indicates a strong need for appropriate and applicable foster caregiver trainings, combined with support from both formal and informal systems.

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CRediT authorship contribution statement Jacquelyn K. Mallette: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Writing - original draft, Writing - review & editing. Lindsey Almond: Formal analysis, Writing - original draft, Writing review & editing. Hannah Leonard: Writing - review & editing. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding source Fostering Healthy Relationships. College of Health and Human Performance, East Carolina University. There is no grant number associated with this funding as it was acquired through an internal university startup grant. References Amato, P. R., Booth, A., Johnson, D. R., & Rogers, S. J. (2007). Alone together: How marriage in America is changing. Cambridge, MA: Harvard University Press. Barton, A. W., Futris, T. G., & Neilsen, R. B. (2014). With a little help from our friends: Couple social integration in marriage. Journal of Family Psychology, 28(6), 986–991. https://doi.org/10.1037/fam0000038. Baum, A. C., Crase, S. J., & Crase, K. L. (2001). Influences on the decision to become or not become a foster parent. Families in Society, 82(2), 202–213. Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. Brown, J. D. (2008). Foster parents' perceptions of factors needed for successful foster placements. Journal of Child & Family Studies, 17, 538–554. https://doi.org/10.1007/ s10826-007-9172-z. Brown, J. D., Anderson, L., & Rodgers, J. (2016). Resource workers’ relationships with foster parents. Journal of Child and Family Studies, 25(1), 336–344. Buehler, C., Cox, M. E., & Cuddeback, G. (2003). Foster parent's perceptions of factors that promote or inhibit effective fostering. Qualitative Social Work, 2, 61–83. Cooley, M. E., Thompson, H. M., & Wojciak, A. S. (2017). Risk, resilience, and complexity: Experiences of foster parents. Children and Youth Services Review. https://doi.org/10. 1016/j.childyouth.2017.02.030. Fisher, P. A., Gunnar, M. R., Dozier, M., Bruce, J., & Pears, K. C. (2006). Effects of therapeutic interventions for foster children on behavioral problems, caregiver attachment, and stress regulatory neural systems. Annals of the New York Academy of Sciences, 1094(1), 215–225. Fisher, P. A., Van Ryzin, & Gunnar, M. R. (2011). Mitigating HPA axis dysregulation associated with placement changes in foster care. Psychoneuroendocrinology, 36(4), 531–539. Fuentes‐Peláez, N., Balsells, M.À., Fernández, J., Vaquero, E., & Amorós, P. (2016). The social support in kinship foster care: A way to enhance resilience. Child & Family Social Work, 21(4), 581–590. Geiger, J. M., Hayes, M. J., & Lietz, C. A. (2013). Should I stay or should I go? A mixed methods study examining the factors influencing foster parents’ decisions to continue or discontinue providing foster care. Children and Youth Services Review, 35(9), 1356–1365. Geiger, J. M., Piel, M. H., & Julien-Chinn, F. J. (2017). Improving relationships in child welfare practice: Perspectives of foster care providers. Child & Adolescent Social Work Journal, 34(1), 23–33. https://doi.org/10.1007/s10560-016-0471-3. Geiger, J. M., Piel, M. H., Lietz, C. A., & Julien-Chinn, F. J. (2016). Empathy as an essential foundation to successful foster parenting. Journal of Child and Family Studies, 25(12), 3771–3779. https://doi.org/10.1007/s10826-016-0529-z.

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