Relationship between type of placement and competencies and problem behavior of adolescents in long-term foster care

Children and Youth Services Review 29 (2007) 216 – 225 www.elsevier.com/locate/childyouth

Relationship between type of placement and competencies and problem behavior of adolescents in long-term foster care Jelena A. Marinkovic ⁎, Dusan Backovic Department of Hygiene and Medical Ecology, Section for Human Growth and Development, Medical School, Belgrade University, Serbia Received 2 May 2006; received in revised form 6 August 2006; accepted 8 August 2006 Available online 14 September 2006

Abstract Children entering foster care are a high risk population for socio-emotional, behavioral, and psychological problems. The problems may persist in spite of environmental improvements. The aim of the presented study was to explore the impact of placement type on competence and problem behavior of adolescents in long-term foster care. The study included all children deprived of parental care residing in Belgrade, Serbia, 12 to 17 years old, and living in out-of-home care for at least 1 year prior to study start. Competencies and problem behavior were assessed with Youth Self-Report (YSR). Children living in foster homes scored lower on competence and higher on all problem scales than children living in foster families. The type of placement had significant main effect on scores on activity competence and thought problem scales. Discussion of these results tried to explain observed differences in terms of differences in the family and placement histories of the studied groups. © 2006 Elsevier Ltd. All rights reserved. Keywords: Foster care; Adolescents; Placement type; Youth Self-Report

1. Introduction During the last two decades, Serbia faced complex and dramatic events and changes. From socialism and one-party system, it entered transition period and multiparty system. War was going on in the close surrounding causing a huge number of refugees coming to Serbia. All this led to major economic disturbances such as high inflation, rise of unemployment rate and consequently ⁎ Corresponding author. Bulevar Mihaila Pupina 141/117 11 000 Belgrade, Serbia. Tel.: +381 63 87 76 283. E-mail address: [email protected] (J.A. Marinkovic). 0190-7409/$ - see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2006.08.004

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increased part of population living below poverty. It is not surprising that all kinds of social pathology have become more frequent in such social surrounding, leading to increased number of children deprived of parental care. There are 1928 children residing in group foster homes and additional 2100 in foster families in Serbia according to data from August 2001. Out of this number, 567 children are living in group foster homes and 217 in foster families in the Belgrade territory (Lukic-Havelka & Seratlic, 2002). 1.1. Child welfare system in Serbia In Serbia, the social care of children deprived of parental care is organized through Social Work Centers. These centers are the basic units of social welfare system and they are organized in each municipality. Each center has an expert team engaged in work with children deprived of parental care. An expert team comprises of a social worker, psychologist, pedagogue, and legal representative. Long-term foster care has two forms: foster families and specialized institutions for children deprived of parental care—group foster homes. These two types of placement are not antagonized or mutually excluding. A child can be moved from foster home to foster family and vice versa, according to its needs. In everyday practice, each case is evaluated individually and depending on child's needs and actual circumstances, an expert team, having in mind the best interests of the child, makes the decision about placement type. When it is identified that a child is endangered by familial circumstances (direct approach of one of the parents to the Social Work Center, report from relatives, neighbors, teachers or school psychologists, or bringing a child because of street bagging or drifting), the first step of the expert team is to assess the possibility for a child to stay in its own family. The expert team acts towards improvement of family circumstances with advisory work and other types of social support including financial support. If this fails, a child is removed from its family and, from this point forward, the child is under custody of the expert team. The expert team decides about the type of placement, assesses eligibility of potential foster parents, prepares the child and future foster parents for placement, cooperates with professionals working in group foster homes, supervises everything that is happening during the placement, and at the same time tries to help biological parents to resolve problems that caused the placement. 1.2. Literature review It is well documented that children in foster care are a high risk population in the terms of socio-emotional, behavioral, and psychological problems. The rate of psychological problems is significantly higher than 10–20%, which has been estimated in community populations, and is higher than the estimates for youth living below poverty (Farmer et al., 2001). Previous studies reported that one-half to three-fourths of children entering foster care exhibit behavior or social competence problems (Clausen, Landsverk, Ganger, Chadwick, & Litrownik, 1998; Dimigen, De Priore, Butler, Evans, Ferguson, & Swan, 1999; Halfon, Mendonca, & Berkovitz, 1995; Harman, Childs, & Kelleher, 2000; Pilowsky, 1995; Simms, Dubowitz, & Szilagyi, 2000). Entering foster care system presents a significant psychological challenge; children must cope with the effects of traumatic events precipitating their entry into foster care, face a temporary or permanent loss of their parent(s), experience additional trauma of being isolated from familiar surrounding (schools, friends, siblings), and adjust to new families and living situations. Psychological problems may persist in spite of major environmental improvements, and as several studies suggested, foster

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youth with mental health problems continue to exhibit mental health problems in adulthood (Buehler, Orme, Post, & Patterson, 2000; Courtney, Piliaviu, Grogan-Kaylor, & Nesmith, 2002). A number of studies tried to give better insight in factors influencing children's psychological functioning. As the most important, the following emerged: type of placement, age when the child was removed from inadequate biological family, placement stability, and the type of maltreatment a child was suffering. Previous studies reported that children in foster care institutions had more mental health problems than children living in foster families (Keller et al., 2001; Leslie, Hurlburt, Landsverk, Barth, & Slymen, 2004; McCann, James, Wilson, & Dunn, 1996; Zima, Bussing, Yang, & Belin, 2000). The findings of Holloway (1997) and Scholte (1997) are consistent in conclusion, that placement outcome is better if the children entered care at earlier age. Several studies emphasized that volatile placement histories contributed negatively to psychological functioning of foster children (Newton, Litrownik, & Landsverk, 2000; Rubin et al., 2004; Zima et al., 2000). Available evidence suggests that maltreatment history influence mental health services use. Children who experienced physical or sexual abuse were more likely to use mental health service (Garland, Landsverk, Hough & Ellis-Macleoud, 1996; Leslie et al., 2004; Shin, 2005). Leslie et al. (2000) reported that children who were placed in care due to caretaker absence used less mental health services than children who were placed due to other reasons. Interplay between the mentioned factors is common. Most of the published studies investigated mental health needs of the children in out-of-home care across a wide age range. Our study focused on adolescents for two reasons: (a) adolescence is psychologically challenging period and mental health needs and problems of adolescents may be significantly different from those of younger children; (b) adolescents are reaching the age when they are no longer entitled to services within child welfare system, therefore mental health status of adolescents in care shows overall success of services previously provided. The aim of the presented study was exploring influence of type of placement and reason for placement and their interaction on competencies and problem behaviors of adolescents living in log-term foster care. We hypothesized that the children placed in group foster homes exhibit more problem behaviors as compared with their peers placed in foster families. 2. Methods 2.1. Participants Study included all children deprived of parental care who had records in Belgrade City Social Welfare Coordinating Center, 12 to 17 years old, and living in out-of-home care for at least 1 year prior to the beginning of the study. Children with IQ below 70 who attended schools for children with special needs were excluded. This exclusion was necessary because the implemented test was not standardized for this specific population. The exclusion was also needed in order to match studied groups as much as possible (all children with mental retardation were residing in foster homes). The group living in foster families consisted of 41 adolescents (22 male and 19 female), mean age 14.66, SD = 1.39. All were living in non-relative foster families. The group living in foster homes consisted of 43 adolescents (16 male and 27 female), mean age 14.99, SD = 1.37. 2.2. Measures Competencies and problem behaviors were assessed by Achenbach Youth Self-Report (YSR) (Achenbach, 1991). The YSR was designed in 1989 and revised in 1991 by Achenbach.

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It has been reported to have good validity and international consistency, with Cronbach α 0.70 (Achenbach, 1991; Broberg et al., 2001; Verhulst, Prince, Vervuut-Poot, & deJong, 1989). YSR assesses competencies and behavior problems for ages 11–18. Competencies are measured by social competency and activity. High scores indicate high competency. The problem section consists of 119 items. Answers are rated on a three-point scale. Problem items are scored on eight syndrome scales: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. Three of the problem scales constitute derived scale “internalizing” (withdrawn, somatic complaints, and anxious/depressed) and two scales constitute scale “externalizing” (delinquent behavior and aggressive behavior). High scores indicate a high degree of behavior problems. The scoring system used in this study follows the instruction in the YSR manual and is in agreement with previous studies in which YSR was used. 2.3. Procedure Data on biological families of adolescents deprived of parental care and their placement history were obtained from files that are kept by expert teams in Social Work Centers. These files contain all relevant information concerning biological families, reasons for placement and placement changes, as well as any other problems that the child might have while in care. Reasons for placement are defined by case social worker and are categorized as follows: socio-economic circumstances, no available caretaker, abandonment, neglect, and physical or sexual abuse. Category “no available caretaker” included the following cases: parents' absence because of long hospitalization due to psychiatric or physical illness, single parent's incarceration or death. Abandonment is defined as unknown whereabouts of the parents and neglect as child endangerment by neglecting its physical, emotional, medical, or educational needs. In our sample, there were no cases of physical or sexual abuse. Participants completed YSR questionnaire in their place of residence in the presence of researcher. There was no time limit and the participants were encouraged to ask for clarification if they did not understand any of the items in the questionnaire. This study was approved by Boards of Belgrade City Social Welfare Coordinating Center and group foster home institutions as well as Research Committee of School of Medicine, Belgrade University. Each adolescent gave an informed consent. 2.4. Data analysis SPSS software package for Windows (version 9.0) was used for data analysis. According to type and distribution of data, studied groups were compared using the following statistical methods: chi-square, Student's t-test, and Mann–Whitney's U-test. Differences between studied groups in frequencies of non parametric variables were assessed by chi-square; difference in the means of years spent in care (parametric variable that was normally distributed) was assessed by t-test; difference in the means of age at entering care (parametric variable that was not normally distributed) was assessed by Mann–Whitney's U-test. Effects of placement type and reason for placement on the mean values of T-scores for each scale of YSR were assessed by using two-way between-subjects ANOVA procedure. Since there was significant difference between studied groups in age when they were removed from their biological families, all ANOVAs were conducted with this variable as a covariate.

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3. Results Family and placement histories of the studied groups are presented in Table 1. More than half (51.2%) of adolescents living in foster families has never lived with their biological parents while in the group living in foster homes there are only 11.6% such adolescents (χ2 = 15.393, p = 0.001). The parents of adolescents living in foster families more frequently had common-law marriages or have never lived together (73.2% vs. 41.9%, χ2 = 8.402, p = 0.004). Alcoholism is very often identified in the biological families of adolescents deprived of parental care, but groups do not differ significantly in the respect of this problem (19.5% parents of adolescents from foster families and 25.6% parents of adolescents living in foster homes; χ2 = 0.442, p = 0.506). Adolescents living in foster families entered care at earlier age (1.29 vs. 7.29). In this group, 51.2% of adolescents were removed from their biological families before their first birthday, while in the group residing in foster homes there are only 9.3% such cases. Mann–Whitney procedure reviled that this is a significant difference (Mann–Whitney U = 158.000, p = 0.001). The group living in foster families has been in care for longer period (11.45 years vs. 5.07 years, t = 11.945, p = 0.001). These two groups differ in the number of placement changes, as well. The majority of children living in foster families have one placement change (82.9%). More placement changes are less common (two changes 4.9% and three changes 2.4%). In this group, 9.8% of adolescents did not have placement change while in care. In the group living in foster homes, the majority of children have no placement change (60.5%). But, within the subgroup that has placement changes, two changes are more common then in the group living in foster families (20.9%), while the percentage of adolescents who had three placement changes is equally small (2.3%). This represents a significant difference (χ2 = 38.342, p = 0.001). In both studied groups, only small percentage of adolescents has any kind of contact (regular or occasional) with their biological parents (17.1% in foster families and 27.9% in foster homes). Regarding this variable difference between studied groups is not significant (χ2 = 1.407, p = 0.235). In the group of adolescents living in foster families, the most common reason for being in care is abandonment and it accounts for 39.0% of the placements (Table 2). The second most common reason is neglect (34.1%). In the group of adolescents living in foster homes, the most common Table 1 Family and placement history

Never lived with biological parents Parents were not married Alcoholism Age at entering care (years) Time spent in care (years) Placement 0 changes 1 2 3 Have contact with birth parents ⁎Mann–Whitney, ⁎⁎t-test, ⁎⁎⁎χ2.

Foster families

Foster homes

p

21 (51.2%) 30 (73.2%) 8 (19.5%) 1.29 ± 1.69 0–7 11.45 ± 2.07 7–16 4 (9.8%) 34 (82.9%) 2 (4.9%) 1 (2.4%) 7 (17.1%)

5 (11.6%) 18 (41.9%) 11 (25.6%) 7.27 ± 4.05 0–15 5.07 ± 2.76 1–10 26 (60.5%) 7 (16.3%) 9 (20.9%) 1 (2.3%) 12 (27.9%)

0.001⁎⁎⁎ 0.004⁎⁎⁎ 0.506⁎⁎⁎ 0.001⁎ 0.001⁎⁎

0.001⁎⁎⁎ 0.235⁎⁎⁎

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Table 2 Reason for placement

Socio-economical No available caretaker Abandonment Neglect Objective reasons Parents

Foster families

Foster homes

pa

4 (9.8%) 7 (17.1%) 16 (39.0%) 14 (34.1%) 11 (26.8%) 30 (73.2%)

2 (4.7%) 18 (41.9%) 10 (23.3%) 13 (30.2%) 20 (46.5%) 23 (53.5%)

0.364 0.013 0.118 0.701 0.062

a 2

x.

reason for entering care is no available caretaker, accounting for 41.9% of the placements, followed by neglect (30.2%). Concerning reasons for placement, statistically significant difference appears only in the category “no available caretaker” which is more frequent in the group living in foster homes than in the group living in foster families (41.9% and 17.1%, respectively, χ2 = 6.169, p = 0.013). If the reasons for placement are roughly divided into reasons that are the consequence of objective circumstances (socio-economic reasons and no available caretaker) and reasons that are parent(s) related (abandonment and neglect), then parent(s) related reasons are more frequent in the group of adolescents living in foster families (73.2% vs. 53.5%), but this difference does not reach statistical significance (χ2 = 3.492, p = 0.062). Adolescents living in foster homes scored worse on all scales of YSR than adolescents living in foster families (Table 3). The type of placement has significant main effect on mean scores on activity competency scale (F1,79 = 12.199, p = 0.001) and thought problem scale (F1,79 = 10.992, Table 3 Two-factor between-subjects ANOVA with mean T-scores on YSR scales as dependent variables

Competency in activities Social competency Withdrawn Somatic complaints a Anxious/ depressed Social problems Thought problems Attention problems Delinquent behavior Aggressive behavior Internalizing a Externalizing a

Foster families Foster (objective) families (parents)

Foster homes (objective)

Foster homes Placement (parents) type (p)

Placement reason (p)

Type X reason (p)

42.91

44.30

36.05

39.22

0.001

0.197

0.457

47.27

47.37

44.35

46.13

0.505

0.640

0.691

54.09 52.45

57.67 52.27

58.25 56.05

56.74 57.00

0.649 0.073

0.836 0.703

0.721 0.357

53.73

56.10

58.80

56.78

0.888

0.859

0.237

56.00

54.83

56.30

54.39

0.308

0.306

0.984

51.09

51.53

54.00

56.96

0.001

0.128

0.316

54.18

56.60

57.45

57.04

0.485

0.559

0.639

51.73

52.30

58.25

57.30

0.072

0.934

0.778

52.27

51.23

55.75

54.52

0.065

0.365

0.960

49.54 44.18

50.57 46.03

57.15 53.90

56.04 53.17

0.310 0.061

0.970 0.800

0.839 0.705

Variables where age at placement have significant effect.

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p = 0.001). Reason for placement does not show significant effect on any scale of YSR. Interaction of the type of placement and reason for placement does not have significant effect on any scale of YSR. Age when a child was removed from its biological family has significant effect on scores on scales somatic complaints (F1,79 = 8.918, p = 0.004) and internalizing (F1,79 = 4.188, p = 0.044). On both scales, mean scores are higher if the children were older when removed from their biological families. 4. Discussion The main goal of this study was to assess competencies and problem behaviors of adolescents deprived of parental care and to increase our understanding of factors that influence the outcome. Placement type had significant main effect on competency in activities. Adolescents living in foster homes scored lower on this scale and explanation for this should be looked for in the organization of these institutions. Structured organization of the institutions prevents children from developing and pursuing their individual talents and interests. Some activities are organized within the institutions, but if the children are not interested in them, they do not have to participate, and in that case, they would not have any extra-curricular activity. Adolescents living in group foster homes, scored higher on all problem scales. These results confirm the findings of McCann et al. (1996) that psychopathological tendencies are more frequent among children living in residential institutions than among children living in foster families. Nevertheless, it is possible that differences in scores in our sample are not the reflection of placement type per se, but the reflection of other confounding variables. The findings of our study reviled some significant differences in personal and placement histories of the studied groups of adolescents. The most apparent difference is that adolescents living in foster families are placed in care at younger age. Age at placement showed significant effect on two scales, somatic complaints and internalizing, and scores were consistently higher as the child was removed later. The other is the number of placement changes. Most of the adolescents in foster families have only one placement change. They were removed from their biological families as toddles, placed in a shelter, and then in the foster family in which they have lived for a long period without changes. On the other hand, in the group of adolescents living in group foster homes, there are more children without any placement change, but among those who had changes, more changes are more common. In whole, it could be said that children living in foster families have had more stable placements. In the previous studies, both, age when a child is removed from its biological family, and placement stability, have been identified as significant predictors of behavior problems of children in care (Halfon et al., 1995; Leslie et al., 2000; Newton et al., 2000). The findings of our study, as well as the findings of several other studies (Kalland & Sinkkonen, 2001; Olivan Gonzalvo, 1999; Takayama, Wolfe, & Coulter, 1998), show that the majority of children deprived of parental care are in care because of abandonment and neglect. In the group of children living in foster families, the most common reason for placement is abandonment. The fact that these children are placed in care younger and more often have parents who are not married could lead to the conclusion that single parents exhibit incompetence in taking care of their children earlier, while in married couples this is postponed until problems accumulate and lead to complete family disorganization. This has another important implication; Occurrence of family break down is a strong stressor for the child who had somewhat functional family. Because, no matter how severe problems are, families provide children with a sense of belonging and a unique identity, that do not disappear with the break down of the family.

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Moreover, children are often overwhelmed by a whole spectrum of mixed emotions; blaming themselves and feeling guilty, wishing to return to their parents even if they were abusive, feeling helpless, insecure, and uncertain about their future. All these features of personal and placement histories can be related to attachment issues. Children removed from their biological families at earlier age have chance to develop trusting relationship with their caregiver who represent a parent figure for them. If this placement is stabile, the children can form secure attachments. Not only that adolescents living in foster families were younger at placement, but also a high proportion of them have never lived with their biological parents. For them, foster family is the only family that they have ever had and foster parents are parent figures to whom they can relate. Children in group foster homes have less chance to develop close relationship with an individual who will make a lasting commitment to them. This is so, mostly due to the organization of these institutions. Namely, group foster homes are institutions where a large number of children reside and they are divided according to their age into groups of 20–30, and each group is guided and supervised by a professional working in the institution. It is easy to realize that each professional takes care of too many children and that some psychological needs of the children cannot be meet properly. It is well documented that insecure attachments can create a variety of psychological problems, such as difficulties in interpersonal relationships, impaired affect regulation, internalizing, and externalizing behavior problems (Armsden, McCauley, Greenberg, Burke, & Mitchell, 1990; Greenberg, Speltz, & DeKlyen, 1993; Nakash-Eisikovits, Dutra, & Westen, 2002; Rubin et al., 2004). In our study, reason for placement did not show significant main effect or interaction with the type of placement. It seems contrary to findings of other studies, which pointed out that maltreatment a child had suffered is significant predictor of behavioral problems. However, other authors' findings suggest that only physical and sexual abuse have significant influence on psychological problems and mental health services use (Garland et al., 1996; Leslie et al., 2004). Since in our sample there were no such cases, it is expected that effect on behavior problems was not identified. In one other work, Leslie et al. (2000) did not detect any effect of reason for placement on mental health services use, except that caretaker absence was correlated with less services use. Our study has several limitations. The use of self-reported questionnaire, such as YSR is not perfect, but since our aim was not defining the prevalence of mental health problems in studied groups, but differences between them, YSR as a proxy measure can be accepted. The most important limitation is a relatively small sample size. However, the studied adolescents were the whole population of adolescents deprived of parental care residing in Belgrade. Research that would include adolescents residing in other cities in Serbia would give better insight in situation on the national scale. Until such a study is undertaken, this study gives some practical and research guidance. In order to isolate factors that influence the psychosocial functioning of the children deprived of parental care future studies should be designed in such a manner that makes studied groups as uniform as possible. An international multi-centric study would be of the enormous value, as it would give us a chance to measure influence of the factors that are connected to the welfare system characteristics and separate them from the factors that are connected to child/family characteristics. Presented study has some practical implications. The expert teams of Social Work Centers should be more proactive and collaborate with other Social Services more closely in order to detect children who are in need for Child Welfare Services as soon as the need occurs, and to act more promptly so the adverse influences would not be unnecessary prolonged. The promotion of foster parenting should be stronger and permanent and potential foster parents should be encouraged to take into care older children, as it is shown that placements in foster families is more stable and better for overall children's functioning.

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