Post-permanency discontinuity: A longitudinal examination of outcomes for foster youth after adoption or guardianship

Children and Youth Services Review 70 (2016) 419–427

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Post-permanency discontinuity: A longitudinal examination of outcomes for foster youth after adoption or guardianship Nancy Rolock, Ph.D. a,⁎, Kevin R. White, Ph.D. b a b

Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Avenue, Milwaukee, WI 53211, United States School of Social Work, East Carolina University, 116 Rivers Building, Greenville, NC 27858, United States

a r t i c l e

i n f o

Article history: Received 23 August 2016 Received in revised form 13 October 2016 Accepted 13 October 2016 Available online 14 October 2016 Keywords: Adoption Guardianship Discontinuity Post-permanence Chil welfare Survival analysis

a b s t r a c t For over two decades, federal policies and case practices in child welfare have shifted to prioritize legal permanence for children in foster care, and increasing numbers of children have been placed in permanent adoptive or guardianship homes. Despite this change, little research has examined the long-term stability of legally permanent adoptive and guardianship homes for former foster youth. This study used child welfare administrative records to track a population of 51,576 children in Illinois who exited foster care through adoption or guardianship for ten years or until the age of majority. Univariate and bivariate analyses were conducted to describe the population, and a multivariable Cox proportional hazards model was estimated to examine the relationship between child age and discontinuity, controlling for several pre-placement characteristics. Results indicated that the vast majority (87%) of children did not experience post-permanency discontinuity. In addition, African American children and children who had more moves in foster care had a higher hazard of discontinuity, while children placed with siblings and children who spent three or more years in foster care had a lower hazard of discontinuity. Study findings also indicated that prevention efforts should be targeted at families with adolescents. This study contributes significantly to the scant literature on long-term outcomes for adoptive and guardianship families, and suggests several areas for future research. © 2016 Elsevier Ltd. All rights reserved.

1. Background and rationale Federal policies and local practices have shifted over the past two decades, from a system focused on ensuring the safety of children in out-of-home care, to one where the safe achievement of legal permanence is also a targeted outcome for children in foster care (e.g., Adoption and Safe Families Act of 1997, 1997; Fostering Connections to Success and Increasing Adoptions Act of 2008, 2008). The results of this shift can be seen in Fig. 1. Between 2000 and 2013 the number of children in IV-E subsidized foster care decreased by approximately half (from 288,000 to 159,000), while the number in IV-E subsidized adoptive homes nearly doubled (from 228,000 to 446,800; Committee on Ways and Means of the U.S. House of Representatives, 2014). Nationally in 2013 there were 2.8 children living in federally-assisted adoptive and guardianship homes for every child living in foster care, yet little is known about the long-term success of these placements (Committee on Ways and Means of the U.S. House of Representatives, 2014). Federal policies have prioritized the movement of children from state custody into legal permanence (e.g., adoption and guardianship) with the ⁎ Corresponding author. E-mail addresses: [email protected] (N. Rolock), [email protected] (K.R. White).

http://dx.doi.org/10.1016/j.childyouth.2016.10.025 0190-7409/© 2016 Elsevier Ltd. All rights reserved.

presumption they would live ‘happily ever after’ (Hanna, Tokarski, Matera, & Fong, 2011). However, current research has highlighted lingering reservations about whether legal permanence endures (Samuels, 2008; Scott, Lee, Harrell, & Smith-West, 2013; Pérez, 2014). The U.S. Children's Bureau, the federal agency that oversees foster care in the United States, provides clear direction that additional research is needed to better understand long-term outcomes for children and families after adoption or guardianship. However, research on post-permanency families is limited. In particular, little is known about the longterm stability of adoption or guardianship placements, and risk factors associated with poor well-being outcomes. Tracking the post-permanency experiences of children previously involved with the child welfare system is not common practice in most child welfare agencies. One difficulty in tracking these children is that their names and social security numbers often change after adoption and child welfare systems deliberately do not link pre- and postadoption identities (Child Welfare Information Gateway, 2012). This is further complicated because in some states no historical data are maintained regarding adoption subsidies, as new information is entered into the data system and old data is deleted or overwritten (Barth, Wildfire, Lee, & Gibbs, 2002). Finally, as noted above, there is no agreed-upon language for describing the post-permanency experiences of youth

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Fig. 1. IV-E Funded caseload from 1984 to 2013. The number of children in IV-E subsidized foster care relative to the number of children in IV-E subsidized adoptive or guardianship homes.

formerly in foster care. In this study, discontinuity is used to refer to children who have experienced instability post-adoption or guardianship (Rolock, 2015). Furthermore, for children who leave their legally permanent (adoptive or guardianship) homes prior to becoming adults, there is no consensus regarding the terminology for describing these situations. Previous studies have used a variety of terms to discuss placement changes for children in adoptive or guardianship homes. The terms dissolution, post-adoption placement and displacement have all been used to describe placements where children experience instability after the adoption or guardianship has finalized (Festinger, 2002; Festinger & Maza, 2009; Goerge, Howard, Yu, & Radomsky, 1997; McDonald, Propp, & Murphy, 2001); discontinuity is a broad term that includes all of these types of these post-permanency instability (Rolock, 2015; Testa, Snyder, Wu, Rolock, & Liao, 2014; White, 2016). Disruption is another frequently used term, but is typically used to refer to placements for children in foster care that are intended to result in an adoption or guardianship finalization, but end prior to finalization (Barth, Gibbs, & Siebenaler, 2001; Coakley & Berrick, 2008; Rosenthal, 1993; Smith, Howard, Garnier, & Ryan, 2006). In this study, we use the term post-permanency discontinuity to refer to children who have experienced instability after adoption or guardianship. Discontinuity is determined by an examination of administrative data. For children who have achieved legal permanence through adoption or guardianship, discontinuity is defined as (1) reentry of children into foster care, or (2) an adoption or guardianship subsidy payment is terminated prior to the child reaching the age of majority (Rolock, 2015). Discontinuity includes reentry plus the subsidy ending category and is therefore a conservative test of our hypothesis because it includes any instance of an interruption of care that can be tracked through administrative data. A point of clarification is required to explain the subsidy payment ending category. A subsidy may end because the child is placed with a relative, the child is returned to the care of his or her biological parent after a guardianship is vacated, the caregiver is no longer caring for the child, or for some other reason. The inability to understand and distinguish between these variations is an inherent limitation of this study. However, prior research on discontinuity found that about half (47%) of the children who experienced discontinuity also experienced the death of their caregiver. For the remaining cases, most (61%) were returned to state guardianship, 31% were returned to their biological parent(s), and the remaining had a new private guardian assigned (Rolock & Testa, 2006). It should also be noted that the youth may move out of the home, the subsidy continues because the agency has not been notified; these cases would not be included in our discontinuity estimates. There are also situations where children may move around among the homes of

extended family members after discharge to adoption or guardianship, and there is no record of this movement in the administrative data. However, there may be some question regarding the extent to which these types of placement changes would be problematic for children and youth, and generally, comparable to more disruptive types of discontinuity, such as foster care reentry. A recent study found that young adults reported that they experienced discontinuity, but there was no record administrative record, either because the young adult was over the age of 18, or the living situation was not reported to the child welfare system (Rolock & Pérez, 2016). Therefore, our definition of discontinuity is imperfect, but it is the best estimate of discontinuity available when using administrative data. Furthermore, recent media reports have focused attention on the needs of families after adoption has been finalized that are not captured in any data systems, by identifying ‘unregulated child custody transfers’. Also referred to as ‘rehoming’, these transfers are used by adoptive parents to relinquish custody of adopted children to another family without legal oversight or formal child welfare system involvement (McIntyre, 2016; Twohey, 2013). A Government Accountability Office report (GAO, 2015) found that a common reason behind these transfers was the families were unable to access the services they needed. While many of these children were adopted internationally, some of the reported cases involved children who had previously been involved in a child welfare system. These reports highlighted the need for services for families after legal permanence through adoption or guardianship has been achieved. However, identifying the families most likely to struggle after legal permanence is important in order to target limited state resources at those families most in need. Extant research has documented some factors associated with adoption disruption (placements that are intended to result in adoption but break down prior to finalization) or adoption dissolution (breakdowns that occur after finalization). For instance, adoptive placements are more likely to disrupt for older children compared to younger children. A review of the literature found that the child's age at the time of the placement was associated with adoption disruption, with higher disruption rates associated with children who were older at the time of placement (Rosenthal, 1993). Additional studies confirmed this finding, suggesting that a child's age at the time of placement is the most predictive characteristic of adoption disruption (Berry & Barth, 1990; Jones & LaLiberte, 2010). In addition to the age of the child at the time of the adoption, Smith and Howard (1991) found that children removed at an older age were more likely to disrupt. Some studies have found demographic factors other than age, such as race and gender have been associated with adoption disruption, with males and African-American children more likely to experience disruption (Coakley & Berrick, 2008; Smith et al., 2006).

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Another factor that has receive much attention in the extant literature is the impact of placement with siblings. Although these studies have generally shown mixed results, several studies have found sibling placement to be associated with adoption breakdown (Barth, Berry, Yoshikami, & Carson, 1988; Rosenthal, Schmidt, & Conner, 1988; Smith et al., 2006). For instance, one study found that siblings were more likely to have at least one sibling move if there were other children in the home (Barth et al., 1988), and another study found the relationship between sibling placement and risk of adoption dissolution or disruption (not distinguished in the study) was moderated by the age of the child. For children aged 8.7 and younger, sibling placement was associated with increased risk of disruption, yet for children over 8.7 years old, sibling placement was associated with decreased risk of disruption. In general, the literature on risk and protective factors related to post-permanency discontinuity is scant, as well as hampered by significant limitations related to research designs and methods, and the majority of these previous studies are decades old. This study attempts to fill this research gap by using population-level data and survival analysis to examine pre-permanency characteristics associated with discontinuity, a time-to-event outcome. Identifying pre-permanency characteristics associated with discontinuity would help program developers and practitioners target prevention efforts at those children and families most at risk for placement instability. While many policy makers and practitioners believe that the movement of children from foster care to adoptive and guardianship homes represent an improvement, little research has examined the long-term outcomes of these families. Most previous research has focused on outcomes 18 to 24 months post-permanence (Child Welfare Information Gateway, 2012; Festinger, 2002; Fuller et al., 2006; McDonald et al., 2001; Koh & Rolock, 2010). This study examines the population of children who exited foster care through adoption or guardianship in Illinois, a large Midwestern state. Child welfare administrative data records of 51,576 children who exited foster care in Illinois through adoption or guardianship between 1998 and 2010 are analyzed, and their outcomes are tracked through December 31, 2014, or the age of majority, whichever came first. 2. Methods 2.1. Data and measures 2.1.1. Population data The Illinois Integrated Database (IDB) is a longitudinal relational database that relies on probabilistic record linkage to match child records across Illinois Department of Child and Family Services (IDCFS) administrative data systems. Data in the IDCFS are collected for all children involved with the Illinois child welfare system and compiled and maintained by Chapin Hall at the University of Chicago. For children who have been adopted through IDCFS, their names and identifying information often change during the transition from state custody to adoption. IDCFS maintains a file that links pre- and post-adoption case identification numbers; this data is not part of the IDB. For this study, the link file was cleaned and linked to the IDB. Data for children who exited through guardianship did not require this additional step as their identifying information do not change when they exit foster care. The population used in this study included all children (N = 51,576) who had been adopted or taken into legal guardianship in Illinois between fiscal years 1998 and 2010 inclusive and were under the age of 17 at the time of legal permanence. If multiple permanencies were achieved, the first permanency was selected. Unlike most studies that have tracked shorter-term outcomes for children after adoption or guardianship, outcomes for children in this study were tracked through December 31, 2014, or the age of majority, whichever came first, using IDCFS administrative data. Therefore, children were tracked for a minimum of ten years, or until 18 years of age, which could be up to 15 years post-finalization.

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2.1.2. Outcome variable: post-permanency discontinuity For children who have achieved legal permanence through adoption or guardianship, discontinuity is defined as (1) reentry of children into foster care, or (2) an adoption or guardianship subsidy payment is terminated prior to the child reaching the age of majority (Rolock, 2015). 2.1.3. Covariates Outcomes for children after foster care may be impacted by their experiences while in foster care. Furthermore, identifying pre-permanency characteristics that are predictive of discontinuity may assist child welfare practitioners interested in prevention efforts. In this study several pre-permanency variables were included in the multivariate analysis including: child's age at entry into foster care, age at the time of legal permanence, stability in foster care, and sibling placement. Child's race and gender were also included in multivariable models as control variables. 2.1.3.1. Long-term foster care. A variable was created that counted the time a child spent in foster care. Children who spent three or more years in foster care were coded as 1, less than three years in care was coded as 0. 2.1.3.2. Child's age at legal permanence. The child's age at the time of legal permanence (adoption or guardianship) was also examined. We grouped the child's age into groups of three years (birth through 2; 3 through 5, etc.), and used the youngest children (children whose adoption or guardianship was finalized prior to the age of three) as the reference group. These groupings allow for examination of outcomes based on developmental categories (e.g, infants, preschool age children, and adolescents). 2.1.3.3. Number of placements while in foster care. Based on standard practices used in Illinois, and federal guidelines (e.g., Adoption and Foster Care Analysis and Reporting System), the following types of placement settings were excluded from the count: temporary stays in hospitals, camps, respite care, run away episodes, and institutional placements. However, any of the following were considered to be distinct placements: shelter care, foster care, kinship care, treatment foster care, group homes, residential treatment, and independent living placements. 2.1.3.4. Placement with siblings. To test the possible impact of placement with siblings, this study used a point in time variable that coded children who, at the time of finalization, were living with at least one of their siblings in foster care. Children who had no siblings in foster care, or were not living with any of their siblings at the time of finalization, were the comparison group. 2.2. Analytic plan There were three stages to this study. First, descriptive analyses were conducted using a population of children who achieved legal permanence in Illinois between 1998 and 2010, including those children who experienced post-permanency discontinuity. This descriptive data is lacking in many states, and understanding the prevalence and characteristics of this population can provide a reference to help other states evaluate their own post-permanency populations. Second, survival analyses were implemented to examine the impact of age on the hazards of experiencing post-permanency discontinuity, controlling for race, gender, and pre-permanency characteristics. Survival analysis was employed to account for the time-varying nature of the data, and to estimate the hazard of post-permanency instability. Survival analysis is useful when the time to event has yet to occur for some cases. This method utilizes information on censored cases (those cases where discontinuity has not occurred, but may in the future) to inform the analysis, while controlling for effects of independent variables (Allison,

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2010). This is important because the length of time since finalization is relevant to their long-term outcomes. In this study, a multivariable Cox proportional hazards model was estimated. A significant advantage of Cox regression is that no assumptions are required regarding the functional form of the baseline hazard function, as long as censoring is non-informative and covariate effects change the hazard curve proportionally over time (Guo, 2010; Royston, 2001). Finally, a sensitivity analysis was conducted to examine if results were contingent on how conservatively discontinuity, the primary outcome of interest, was measured. As previously noted, post-permanency discontinuity includes reentry into foster care and the premature ending of an adoption or guardianship subsidy payment. Thus, the same analysis discussed above was repeated using a more conservative definition of discontinuity (i.e., an administrative record that indicated foster care reentry) and results were compared to those obtained using the less conservative definition of discontinuity.

3. Results To provide a sense of how the frequency of adoptions and guardianships have changed over the course of the study period, Fig. 2 shows the number of children who exited foster care through adoption or guardianship by year of finalization. Between 1998 and 1999, the number of children who exited foster care through adoption or guardianship almost doubled. During this same period of time exits from foster care decreased each year, reaching an average of approximately 2000 annual exits from foster care to adoption or guardianship since 2006 (see Fig. 2). A profile of the population of children who exited foster care through adoption or guardianship in Illinois between 1998 and 2010, inclusive, is included as Table 1. Percentages are shown for the total population, as well as by discontinuity status. The vast majority (87%) of children did not experience post-permanency discontinuity. Children who exited foster care were predominately African-American (73%), and African-American children experienced more discontinuity (14%), as compared to children in other racial groups (10–11%). The vast majority of children spent three or more years in foster care (long-term foster care, LTFC; 78%), and a slightly higher proportion of children who were in LTFC also experienced discontinuity (14%) as compared to children who were not in LTFC (11%). The mean age at the time of legal permanence for the entire population was 7.5 (SD = 4.0). Children who experienced discontinuity were very similar, on average, to those who did not experience discontinuity in regard to age at the time of legal permanence (M = 7.4 SD = 3.6 vs. M = 7.5, SD = 4.1 years old respectively).

Table 1 Profile of children who exited to permanence through adoption or guardianship in Illinois, 1998–2010. ALL

Discontinuity

No Discontinuity

Number Percent Number Percent Number Percent 51,576 100% 6781 13% 44,795 87% Race or Ethnicity African-American Hispanic Other races or ethnicities White

37,668 2195 923

73% 4% 2%

5392 209 98

14% 10% 11%

32,276 1986 825

86% 90% 89%

10,790

21%

1082

10%

9708

90%

25,600 25,976

50% 50%

3421 3360

13% 13%

22,179 22,616

87% 87%

11,183 40,393

22% 78%

1272 5509

11% 14%

9911 34,884

89% 86%

5264

10%

469

9%

4795

91%

13,920

27%

1907

14%

12,013

86%

12,012

23%

1839

15%

10,173

85%

10,209

20%

1542

15%

8667

85%

10,171 7.5

20% (4.0)

1024 7.4

10% (3.6)

9147 7.5

90% (4.1)

Placements while in Foster Care Mean (SD) 1.6

(2.0)

1.8

2.2

1.6

2.0

39,295

76%

5071

13%

34,224

87%

12,281

24%

1710

14%

10,571

86%

Gender Female Male Time in foster care Less than 3 years Three or more years (long-term foster care) Age at permanence Birth through two years old Three through five years old Six through eight years old Nine through eleven years old Twelve and older Mean (SD) – for entire population

Sibling placement Placed with sibling(s) in care Not placed with sibling in care

Note: Test of statistical significance were not conducted because these data represent a population rather than a sample.

Sibling placement. The majority of children were placed with at least one sibling at the time of finalization (76%), with little difference observed between children who experienced discontinuity and children who did not.

Fig. 2. Number of children who exited foster care each year to adoptive or guardianship homes.

N. Rolock, K.R. White / Children and Youth Services Review 70 (2016) 419–427

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numbers and percentages are cumulative; the 676 children who experienced discontinuity by 10 years post-finalization from the 1998 exit cohort are inclusive of the 364 who experienced discontinuity by 5 years and the 132 children who experienced discontinuity by 2 years postfinalization.

Number of moves while in foster care. The mean number of moves in foster care was 1.6 (SD = 2.0), with little difference observed between children who experienced discontinuity and those who did not. 3.1. Post-permanency discontinuity

3.4. Age at finalization

Children were tracked from the time of adoption or guardianship finalization until they experienced discontinuity, or reached the age of 18. Results examining all children who exited foster care through adoption or guardianship between 1998 and 2010 (N = 51,576) found that 13% (N = 6781) of children experienced post-permanency discontinuity. Of the 6781 children who experienced discontinuity, 53% reentered foster care, and 47% experienced a premature subsidy closure (prior to the child's 18th birthday). A sensitivity analysis examine outcomes for only children who reentered foster care. These results are summarized at the end of this section.

The relationship between the age of the child at the time of adoption or guardianship and post-permanency discontinuity was also explored. As shown in Fig. 5, approximately 9% of children who achieved permanence as infants (prior to their third birthday) experienced post-permanency discontinuity. Slightly higher proportions (12 to 16%) were observed for children who achieved legal permanence between the ages of three and thirteen, inclusive. However, for children who achieved legal permanence in later years there was less opportunity for long-term follow-up, as administrative data records end when the child reaches 18 years of age.

3.2. Age at the time of discontinuity

3.5. Multivariate analysis results

For children who experienced discontinuity, their mean age at time of discontinuity was 13.2, SD = 3.3 years old. When examined by age at the time of discontinuity, an increase is observed as the child ages, with 15% of discontinuity occurring when the child is between the ages of 9 and 11 years old, 29% during the early teen-aged years (12–14) and 45% at the age of 15 or older. As depicted in the histogram (Fig. 3), discontinuity increases dramatically as children enter their teen-aged years.

Survival analysis was employed to account for the time-varying nature of the data, and to produce hazards of instability for study participants. These results are reported in Table 2. We found that AfricanAmerican children were 39% (HR = 1.39; 95% CI = 1.31, 1.48) more likely to experience discontinuity, controlling for the other covariates in the model. Little differences were observed by gender (HR = 1.04; 95% CI = 0.99, 1.09). A curvilinear relationship was observed for the child's age at the time of legal permanence. Using the youngest children as the reference group (children whose adoption or guardianship was finalized prior to their third birthday), we found that children who finalized between the ages of 3 and 5, 6–8, and 9–11 had similar hazards (HR = 1.62; 95% CI = 1.44, 1.82; HR = 1.79; 95% CI = 1.58, 2.02 and 1.74; 95% CI = 1.53, 1.97, respectively), and the hazards decreased to 1.15 (95% CI = 1.01, 1.31) for the oldest age group (i.e., youth who achieved permanence at the age of 12 or older). However, the decrease for the oldest age group required additional analysis. Given that these data were only available through the youths' 18th birthday, this oldest group had a truncated follow-up time compared to children who experienced permanency at a younger age. To gain a better understanding of these results, these data were stratified by age at permanence and hazard curves examined for each of the age at permanence strata (results not shown). The cumulative hazard for discontinuity for the oldest age stratum (12 or older) was similar to that of the 9 to eleven year old

3.3. Time since permanence Discontinuity outcomes were also examined by time since permanence. These outcomes are reported for three time periods post-finalization: 2, 5 and 10 years post-adoption or guardianship. Broadly, the results for children, regardless of the year of exit from foster care to adoption or guardianship, found that at 2, 3, and 10 years after legal permanency, 2%, 6%, and 12% of children, respectively, had experienced discontinuity. Fig. 4 depicts the annual proportion of children who experienced discontinuity, based on the year of exit from foster care. For instance, in 1998, Fig. 1 states that 5996 children exited foster care through adoption or guardianship in Illinois. Of these children 132 (2%) experienced discontinuity 2 years post-finalization (by 2000). By 5 years post-finalization (in 2003), a total of 364 children (6%) experienced discontinuity, and by 10 years (by 2008) post-finalization, 676 (11%) children had experienced post-permanency discontinuity. These

Age at Discontinuity 1,400 1,200 1,000 800 600 400 200 1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Fig. 3. This histogram represents the age of the child at the time they experienced post-permanency discontinuity.

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Fig. 4. Percent of children who experienced discontinuity. Using exit cohorts as the denominator (in Fig. 1), the percentage of children who experienced discontinuity two, five and ten years post-permanency (adoption or guardianship) are plotted. These are cumulative percentages.

stratum, and somewhat steeper than the cumulative hazard curves for other strata. For example, at 5 years post-permanency, the cumulative hazard of discontinuity for the 12 and older stratum was close to 0.10 and the cumulative hazard for the 6–8 year old stratum at 5 years post-permanency was about 0.05. These results suggests that if the follow-up time was extended for the group with the oldest age at time of the permanency, their hazard of discontinuity would be similar to that of the 9–11 year old group or possibly even higher. Three additional pre-permanency characteristics were explored: Time in foster care, number of placements in foster care, and placement with siblings at the time of permanence. Children who spent 3 or more years in foster care (long-term foster care) were 14% less likely to experience discontinuity than children who spent less than three years in foster care (HR = 0.86; 95% CI = 0.79, 0.92). However, the number of placements a child had while in foster care was associated with only slightly larger hazards, (HR = 1.05; 95% CI =1.04, 1.07). Finally, if children were placed with at least one sibling at the time of legal permanence, they had lower odds of experiencing post-permanency discontinuity (HR = 0.85; 95% CI = 0.81, 0.90).

3.6. Sensitivity analysis In order to test the sensitivity of the results to the type of outcome measured, survival analysis was repeated using a more restrictive definition of discontinuity: an administrative record that indicated foster care reentry. Results were consistent with those already presented. Reentry at 2, 5, and 10 years after legal permanency was 1%, 4%, and 6% of children, respectively. The survival analysis found similar results (see Table 3 below), with the only noteworthy difference in the hazard ratios for the age at permanence variables. While a similar pattern emerged, the hazards for experiencing post-permanency discontinuity for children between the ages of six through eight and nine through eleven years old increased (HR = 2.07; 95% CI = 1.73, 2.48 and HR = 2.19; 95% CI = 1.82, 2.63, respectively). 4. Discussion This is a population-based long-term examination of outcomes for all children who achieved legal permanence through the child welfare

Fig. 5. Discontinuity by age at finalization. The x-axis represents the age of the child at the time finalization and the y-axis is the percentage of children who experienced post-permanency discontinuity by time since finalization.

N. Rolock, K.R. White / Children and Youth Services Review 70 (2016) 419–427 Table 2 Survival analysis results.

African-American Female Age at permanence Birth through two years old (reference group) Three through five years old Six through eight year olds Nine through eleven years old Twelve years old and older Long-term foster care Number of placement moves in foster care Placed with siblings

Hazard Ratio

95% CI

1.39 1.04

1.31 0.99

1.48 1.09

1.00 1.62 1.79 1.74 1.15 0.86 1.05 0.85

1.44 1.58 1.53 1.01 0.79 1.04 0.81

1.82 2.02 1.97 1.31 0.92 1.07 0.90

Comparison: Male, not African American, achieved permanence prior to the age of 3, in foster care less than 3 years, no placement moves, placed with no siblings.

system in one large Midwestern state, Illinois. The population used in this study included all children (N = 51,576) who had been adopted or taken into legal guardianship in Illinois between fiscal years 1998 and 2010 inclusive and were under the age of 17 at the time of legal permanence. Unlike most studies that have tracked shorter-term outcomes for children after adoption or guardianship, outcomes for children in this study were tracked through December 31, 2014, or the age of majority, whichever came first, using IDCFS administrative data. The primary outcome of interest in this study was post-permanency discontinuity, defined as the re-entry into foster care, or the premature ending of an adoption or guardianship subsidy prior to the age of majority. The vast majority (87%) of children did not experience post-permanency discontinuity. This finding is consistent with previous studies which suggest that, generally, most children in finalized adoptions and guardianships (about 85% or more) do not experience subsequent placement changes, at least within limited observation windows (i.e., within a few years of finalization; White, 2016). A unique contribution from this study is the length of follow-up time. Most studies follow children for up to 24 months post adoption or guardianship finalization, and therefore miss the majority of the post-permanency discontinuity. This study was able to track children for up to 10 years post-finalization. Examining outcomes over a long period of time resulted in remarkably similar findings across the two decades of data, despite the fluctuation in the underlying numbers of children exiting foster care through adoption or guardianship: At 2 years post-finalization, 2% had experienced discontinuity. By 5 years post-finalization 6% had experienced discontinuity, and by 10 years post-finalization, 11% of children had experienced post-permanency discontinuity. The stability of these outcomes seems to be unaffected by the fluctuation in the overall numbers of children who exited foster care each year. With tight state budgets, the provision of services to the population of children who have finalized adoptions or guardianship is something that many states struggle to fund. The stability of these findings, however, should help states who are trying to target services at families who may be at risk for postTable 3 Sensitivity Analysis: Survival analysis using reentry only.

African-American Female Age at permanence Birth through two years old (reference group) Three through five years old Six through eight year olds Nine through eleven years old Twelve years old and older Long-term foster care Number of placement moves in foster care Placed with siblings

Hazard Ratio

95% CI

1.42 0.99

1.31 0.92

1.55 1.05

1.00 1.78 2.07 2.19 1.42 0.90 1.08 0.76

1.50 1.73 1.82 1.17 0.80 1.07 0.71

2.13 2.48 2.63 1.71 1.00 1.10 0.82

Comparison: Male, not African American, achieved permanence prior to the age of 3, in foster care less than 3 years, no placement moves, placed with no siblings.

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permanency discontinuity. These results suggest that the proportion of children who experience discontinuity is a small group. If preventative services can be targeted at those families most at risk for post-permanency discontinuity, limited resources can be targeted at those most in need. However, while these results allow us to understand the experiences of children in Illinois, it is unclear how generalizable these findings are to other states or jurisdictions. Illinois has a long history of funding for post-adoption services, and was one of the early adopters of subsidized guardianship. Other jurisdictions may place different restrictions on families who adopt or assume guardianship of children in foster care, or may not have the services and supports available to families in Illinois post-finalization. As such, these findings may not be generalizable to families in other jurisdictions. Additional research is needed to understand the long-term outcomes of children who exit foster care through adoption or guardianship. Multivariable survival analysis was conducted to account for the time-varying nature of discontinuity. Results indicate that the hazard rates for African-American children are much higher than for children of other races or ethnicities (HR = 1.39). However, the data do not allow us to understand why they are at higher risk, and this finding may be due to unmeasured covariates. Extant research has documented that African-American families are not only more likely to experience stressful social conditions, such as poverty and disadvantaged schools, but they are also more likely to be disproportionally represented in the child welfare system (Crosson-Tower, 2013; Drake, Lee, & Jonson-Reid, 2009; USDHHS, 2012). Thus, the finding in this study of a higher hazard for discontinuity adds to the research evidence of disadvantaged conditions for African American youth involved with child welfare services. However, relationships between child race and child welfare outcomes are complex (Drake et al., 2009) and additional research is required to help understand the conditions under which African American children experience higher discontinuity after permanency (e.g., with higher poverty, in neighborhoods with disadvantaged schools, etc.). A multivariate analysis was conducted to help provide a better understanding of pre-permanency characteristics that are associated with post-permanency discontinuity. Characteristics that are known at the time of adoption or guardianship finalization may be used in prevention efforts to target at the subset of children and families most at risk for post-permanency discontinuity. This study examined several pre-permanency characteristics: number of placements while in foster care, placement with siblings at the time of permanence, length of time in foster care, and age at the time of legal permanence. These four characteristics are known at the time of legal permanence and are easily tracked by child welfare administrative data systems. The number of placements a child had while in foster care was associated with marginally higher odds of discontinuity, with a 5% additional risk of discontinuity for each additional placement. In addition, children who spent three or more years in foster care had lower odds of experiencing post-permanency discontinuity than children who spent less time in care. This suggests that pre-permanency stability may not be a strong predictor of post-permanency discontinuity. Children placed with at least one sibling at the time of legal permanence had about 15% lower hazard of experiencing discontinuity as compared to those not placed with at least one sibling. This finding is consistent with extant research on the importance of maintaining sibling bonds. Sibling relationships have been found to be a significant source of support throughout the life cycle and associated with increased stability for children in foster care, although caveats in the results suggest that these findings are not universal (Brown & Seita, 2009; Hegar & Rosenthal, 2011; Herrick & Piccus, 2005; Maas & Engler, 1959; Shlonsky, Bellamy, Elkins, & Ashare, 2005). An alternative explanation for the finding related to sibling placement may be that families who are willing or able to adopt or assume guardianship of sibling groups are somehow different than those families who are not willing or able to accept sibling groups, and this unmeasured characteristic accounted for the difference found

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between sibling and non-sibling groups in the multivariate survival model in this study. The length of time children spent in foster care was also associated with post-permanency discontinuity. Children who spent 3 or more years in foster care (long-term foster care) were 14% less likely to experience discontinuity than children who spent less than three years in foster care. Thus, children who experienced longer stays in foster care, and thus, more contact with the child welfare system would have lower hazards of discontinuity. This finding may reflect that families who receive more support and guidance from child welfare agencies (e.g., case management, mental health, and other services) are more prepared for post-permanency than those with less support and guidance from child welfare agencies. Indeed, there is significant evidence from previous research that children in pre-adoptive families who receive more preparation and support for permanency experience more placement stability (Barth & Miller, 2000; White, 2016). We did not examine the length of time children lived with their adoptive parents or guardians. It may be that an increased length of time together prepermanence resulted in a higher level of bonding and attachment within the family unit that also resulted in a higher level of post-permanency stability. In this study, children who achieved permanence as infants (prior to their third birthday) had the lowest odds of discontinuity. However, for purposes of interventions aimed at prevention, the current age of the child may be the most compelling characteristic. Bivariate statistics examining the age at the time of discontinuity showed a mean age of discontinuity was 13.2, and an increase was observed in the proportion of children who experienced discontinuity as the children aged into their teen years. These findings suggest that prevention efforts may be best focused on children as they become teens. Services to families after adoption or guardianship have been finalized are typically provided as a result of a family reaching out for services, often at a point in time when the need for services has reached a crisis point (Testa, 2004; USDHHS, 2012). However, a key challenge facing the child welfare system of the 21st century is how to address the well-being of children and families who are no longer formally involved with the child welfare system. As noted above, this challenge was brought to the forefront of media attention to the issue of ‘unregulated child custody transfers’ or rehoming, which involves adoptive parents using the black market to transfer custody of their adoptive child (see McIntyre, 2016; Twohey, 2013). The desperation of the adoptive families profiled in these stories point to the need for services to be provided prior to a family reaching the point of crisis, without fear of criminal or financial repercussions as a result of reaching out for help (U.S. Government Accountability Office, 2015). There is a need for these services to be offered preventatively, because services offered when the family is at the point of crisis may be too late. Furthermore, scarce state and federal dollars to address the needs of these families suggest the need for targeted prevention efforts for those most at risk for postpermanency discontinuity. This study highlights some of the possible predictors of post-permanency discontinuity. Results suggest that African American children, and children with more moves in foster care, may be at greater risk for discontinuity. Further, children placed with siblings and children who spend more time receiving support in foster care prior to finalization may experience lower risk for discontinuity. Study results also indicate that child welfare prevention services should probably be targeted to post-permanency families with pre-teens or teen-agers because older youth are at higher risk for discontinuity. However, more research is needed to clarify which pre-permanency characteristics increase risk for discontinuity after controlling for relevant child, family, and service characteristics and accounting for potential contextual, or moderating, factors such as race or socioeconomic status. Interventions will be needed in the near future as child welfare agencies widen their scope of interest, and increasing numbers of foster youth are placed in permanent homes with adoptive and guardianship families.

5. Implications While the use of administrative data is a strength of this study, it is also limits the conclusions that can be drawn from results. One study limitation related to the use of administrative data is that data items were collected during the course of routine service delivery, and were not driven by theoretical or research considerations. Thus, variables were limited to those that were available in the administrative dataset. Furthermore, the information available on the post-finalization experiences of children and youth formerly in foster care was quite limited. Therefore, we relied on assumptions and proxies for some of the items we were interested in studying. This includes, for instance, our measure of sibling placement. While we were able to tell that a child was living with at least one sibling at the time of finalization, we did not know if all siblings were adopted or living in guardianship with the same caregiver. We also lacked any assessment of the relationship between the youth and adoptive parent or guardian, which would provide a better understanding of the enduring nature of these relationships, and we relied on administrative data to examine discontinuity which, as previously noted, may not capture all types of discontinuity. As a final caveat, a recent study of young adults with foster care histories found a 75% match between the administrative data records on post-permanency discontinuity and the accounts of the young adults about their experiences, although this was a small sample (Rolock & Pérez, 2016). Therefore, a more complete picture of post-permanency relationships could be obtained if the opinions of multiple reporters were surveyed, such as the youth, their parents or guardians, and other family members. Despite these limitations, this study has implications for policy and practice. Because state administrative data was used, this study included a large number of participants. Further, unlike most post-permanency studies, this study followed outcomes for children for a minimum of 10 years or until they reached the age of majority; it also examined a broad definition of discontinuity. Finally, by using administrative data, this study also examined data that is readily available to state child welfare administrators. Therefore, if administrators want to consider targeting prevention efforts at those most in need of services and supports after adoption or guardianship, this study can be used to guide decisions about which families might be most at risk for post-permanency discontinuity, and limited resources can be targeted at those families most in need. References Adoption and Safe Families Act of 1997 (1997). Pub. 105-89 § 42 U.S.C. 1305. Allison, P. D. (2010). Survival analysis using the SAS system: A practical guide (2nd Edition ). Cary, NC: SAS Publishing. Barth, R. P., & Miller, J. M. (2000). Building effective post-adoption services: What is the empirical foundation? Family Relations, 49(4), 447–455 (www.jstor.org/stable/ 585840). Barth, R. P., Berry, M., Yoshikami, R., & Carson, M. L. (1988). Predicting adoption disruption. Social Work, 33(3), 227–233. http://dx.doi.org/10.1093/sw/33.3.227. Barth, R. P., Gibbs, D. A., & Siebenaler, K. (2001). Literature review: Assessing the field of post-adoption service: Family needs, program models and evaluation issues. Research Triangle Park, NC: Research Triangle Institute. Barth, R. P., Wildfire, J., Lee, C. K., & Gibbs, D. (2002). Analysis of secondary data assessing the field of post-adoption services: Family needs, program needs, and evaluation issues. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Berry, M., & Barth, R. P. (1990). A study of disrupted adoptive placements of adolescents. Child Welfare, 69(3), 209–225. Brown, W. K., & Seita, J. R. (2009). Growing up in the care of strangers: The experiences, insights and recommendations of eleven former foster kids. Tallahassee, FL: William Gladden Foundation Press. Child Welfare Information Gateway (2012). Adoption disruption and dissolution. Washington, DC: U.S. Department of Health and Human Services, Children's Bureau. Coakley, J. F., & Berrick, J. D. (2008). Research review: In a rush to permanency: Preventing adoption disruption. Child & Family Social Work, 13(1), 101–112. http://dx.doi.org/10. 1111/j.1365-2206.2006.00468.x. Committee on Ways and Means (CWM) of the U.S. House of Representatives (2014e). 2014 Green book: Background material and data on the programs within the jurisdiction of the Committee on Ways and Means. http://greenbook.waysandmeans. house.gov

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