A COMPILATION OF BEST PRACTICE RECOMMENDATIONS COLLECTED FROM RESEARCH PROJECTS REPORTED FROM

2004-2009 IN THE UNITED STATES, WITH SUPPLEMENTARY INFORMATION FROM

OTHER SOURCES INCLUDING GOVERNMENT STATISTICS AND REPORTS

Best Practices in Out-Of-Home Foster Care

Placements

Out-of-Home Foster Care Placements•A brief overview of the facts including

causes and participants

Out-of-home placements refer to any living situation for a child removed from the legal home (biological or adoptive family) and include primarily foster homes and group homes, both public and private

Children are removed, generally by Child Protective Services, from homes with abuse or neglect, unsafe conditions or other risk factors

Group Homes Foster Homes

Similar to a hospital or boarding school in that full time skilled care is provided continually on rotating shifts

School is often provided onsite Counseling and therapeutic services are

provided onsite Considered to be a more restrictive

environment Designed for children with complex

needs or those not functioning well in traditional foster homes

Often used for hard-to-place and older children especially those who have experienced prior multiple placements

Segregates children by gender, age and type of disability, often separating sibling groups

Residential home with a family trained in foster care

Children attend neighborhood schools alongside their peers

Counseling and therapeutic services are provided in home when needed and when available, some services may be provided at school

Considered to be a less restrictive environment

Designed for children in care who do not present a danger to themselves or others

Can function as respite care, emergency care, short and long term care, as well as pre-adoptive homes

Can often accommodate sibling groups Can also include kinship placements

Types of Out-Of-Home Care

Problems In Out-Of-Home Placements

Separation of sibling groups leading to decreased contact with siblings resulting in deteriorated relationships

Instability in placements resulting in multiple movements leading to increased behavioral and psychiatric problems

Inconsistency of access to services: psychiatric, medical, academic, and others impairing quality of care

Decreased contact with stability forces including positive biological family relationships as well as contacts with clergy, teachers, and mentors

Best Practices Background Information

Foster care as an institution of social welfare has only been used in the United States since the mid twentieth century and as a result, there are few longitudinal studies on its effectiveness.

There is little documentation on best practices in out-of-home care other than that which is mandated through such legislation as the Adoption Assistance and Child Welfare Act of 1980 and the Adoption and Safe Families Act of 1997.

Professional research has revealed interesting trends and correlations between successful out-of-home placements and certain present factors, which can be viewed as potential best practices if duplicated in other situations

Best Practices Overview

Pre-screen foster home availability for suitability matches with placement children

Provide consistency of quality medical, dental, psychiatric, academic and early intervention services

Recruit and match mentor figures to incoming placements Reduce turnover in social services staffing Minimize multiple placements or movements Increased involvement in case planning by child, biological

family, foster family and social services members Decrease time in out-of-home placement Encourage and support attachment bonding Consider biological family bonds as well as foster family bonds

when arranging permanency placements with special note given to child age and time of placement ratios

Pre-screen foster home availability for suitability matches with placement children

Research shows that matching foster children to homes similar in cultural practices, native language, socioeconomic status and personality results in better transitions.

When possible, keep children in the same community: same school, same church/place of worship, and same support network to help children maintain early connections for stability and attachment

SUGGESTED APPLICATION OF BEST PRACTICE: Pre-screening and Matching

Use basic demographics information such as home address and school district assignment, as well as racial, cultural and religious background information to connect waiting foster homes with new admittance cases into foster care

Use proven standardized testing such as the CASI-FC to help identify “foster children from birth to age 19 who are at risk for more than two placements within 12 months, consistent with federal outcomes and accountability standards” (The Child & Adolescent Screening Inventory 2010) and then implement support strategies to offset risks

Conduct pre-placement interviews between the child entering foster care and the potential foster family to insure basic compatibility, and have an alternate family prepared if the first placement is not suitable

Provide consistency of quality medical, dental, psychiatric, academic and early intervention services

Research proves that children in foster care are less likely to receive necessary medical care and are more likely to suffer educational setbacks

Continuity of care in these five key areas encourages progress during the out-of-home placement and can contribute to the confidence and positive development of the child in care

Failure to care for these five key areas can result in children who display problem behaviors due to low self-esteem, insecurity, physical or psychological pain, or as the result of bullying from peers because of deficiencies in these areas. These types of problems are often linked to placement failures and numerous successive placements or graduated care needs to more restrictive environments.

SUGGESTED APPLICATION OF BEST PRACTICE:Continuity of Medical/Dental/Academic/Psychological Care

Centralize and computerize records to link the child’s practitioner notes with the foster care file, and maintain an online data entry system for foster caregivers to give real-time updates on children in care, with automatic email updates sent to social workers and case coordinators, to reduce backlog time in filing systems and approval systems as well as prevent lost paperwork

Require immediate reviews of all children entering care or changing placements by a case coordinator who then arranges with the foster family for changes in all required services including medical and therapeutic

Conduct entrance examinations to identify urgent needs, including a psychological assessment for behavioral or academic needs as well as dental and medical needs

Recruit and match mentor figures to incoming placements

Mentoring is very effective, especially amongst African-American teens in care

Mentoring allows the child in care to have a neutral contact (someone not involved in the foster care process like a therapist, social worker, foster parent, biological parent, guardian ad litem) with an objective perspective who can offer advice on success in school, work and normal relationships, giving the child in care an opportunity to focus on things within his/her power to control such as ethics, effort and attitude

SUGGESTED APPLICATION OF BEST PRACTICE:

Identify & Match Mentors to Children in Care

Arrange cooperative relationships with mentor groups such as Big Brothers Big Sisters or civic groups for ongoing tandem programs linking incoming placements or existing high risk placements with suitable mentors

Survey community support such as fellow church members of the child or biological family, neighbors or other non-relative family members with an existing relationship with the child for interest in mentoring the child through the out-of-home placement period

Reduce turnover in social services staffing

Children who maintain a continuous connection to a social worker often report lower levels of anxiety and display fewer emotional and behavioral issues in school and at home

Foster parents report a higher sense of satisfaction when they have an ongoing relationship with a social worker they feel is interested and invested in their circumstance and the children in their care, improving the overall attitude in the foster home

SUGGESTED APPLICATION OF BEST PRACTICE:

Reduce Social Work Staff Turnover

Hire sufficient staff to avoid caseworker overload Implement support programs to help workers with paperwork

requirements, visit supervision and other routine tasks Accommodate flexibility in scheduling so that home visits,

court dates and traveling time are worked around other time requirements

Monitor employees and respond to feedback regarding potential changes to help improve the workplace

Observe staff for signs of pending burnout and offer intervention if noted

Focus on team building and emotional support especially through difficult cases

Minimize multiple placements or movements

Children in foster care for longer than 12 months typically experience more than one placement. As the time in care increases, statistically so do the number of placements. Every disrupted placement equates to disrupted attachment in the emotional development of the child, which is tied to increasing levels of behavioral and emotional dysfunction.

Children with special needs, children with sibling groups, children under the age of 5 and children over the age of 13, especially boys, are the most likely to be moved due to circumstances related to the child’s needs rather than the retirement or relocation of the foster parents

Minimize multiple placements or movements

(continued)

Some placement changes cannot be avoided, such as in the death of a foster care provider or when a provider is transferred out-of-jurisdiction due to a spouse’s employment.

Use of contracts to ensure foster home stability can be effective, as can pre-screening foster home candidates for potential longevity

Providing wrap-around in-home services can assist foster homes in caring for children with high ranges of issues.

Establishing respite plans are also effective in minimizing placement abruptions

SUGGESTED BEST PRACTICE APPLICATION:Minimize Multiple Placements

Identify children at risk for multiple placement through earlier screening tests and implement support practices to help alleviate concerns

Match the child’s behavior, personality and needs with a family suitably trained and prepared for them

Contract with foster families and agencies providing financial incentives for remaining with the assigned client through the entire placement period

Involve the foster family in the child’s treatments, welcoming their input and taking their concerns seriously

Give immediate response to the foster family’s concerns and needs in regards to the child’s behavior

Be sensitive to the foster family’s time, resources and personal needs

Provide respite services with easy-to-use guidelines and encourage its use especially with problematic cases

Increased involvement in case planning by child, biological family, foster family and social services members

The benefits of full involvement by the members of the case include allowing the child to have input on their future, giving ownership and empowerment to that child client, a key principle of social work

Encouraging participation from all members of the foster and biological families as well as the support staff allows the team to better decide what is needed to reach permanency for the case

SUGGESTED APPLICATION OF BEST PRACTICE:Full Team and Child Involvement in Planning

Notify the entire team in writing 10 days prior to scheduled events, earlier if notice is available

Attempt to schedule meetings during a time conducive to full attendance (after school for children, after work in the early evenings for foster and biological families)

When the full team is not available to attend, solicit involvement through email or other communication, which can be presented at the meeting

Allow the child in care to have input over what decisions are made. Even if the child does not get what is asked for (such as a return to an unsafe home), the opportunity to speak and defend his or her request builds empowerment

Decrease time in out-of-home placement

It is important to note that “out-of-home” placement refers to the time in foster care, not time out of the biological home. Placement in an adoptive home is not considered “out-of-home”

The goals of the majority of the legislation on foster care and adoption passed over the previous four decades include expediency in reaching permanence.

Specifically, the ASFA of 1997 mandates that after 15 of 22 prior months in foster care, the state must file for termination of parental rights if reunification has not occurred.

Concurrent planning is also required by several pieces of recent legislation, in an effort to decrease foster placement time

Decrease time in out-of-home placement

(continued)

Shorter stays in foster care allow the child to remain focused on either reunifying with the biological family (continuing existing attachment) or to begin transitioning to attachment to the potential adoptive family, whereas longer stays in out-of-home situations cause bonded attachments to the foster parents that can cause emotional setbacks if disruption occurs

Shorter times in out-of-home placements also reduce the risks of multiple placements and disruptions

SUGGESTED APPLICATION OF BEST PRACTICE:

Reduce Time Spent in Out-Of-Home Care

Follow federal laws governing 15/22 month rule and concurrent planning

Solicit involvement from potential adoptive families including relative placements and encourage contact once the 15 month timeframe has passed

Fully involve the biological family in the reunification process simultaneously with the concurrent planning, giving them full support and access to services than can facilitate a prompt reunification

Complete all court-required paperwork efficiently and promptly to avoid unnecessary delays in the court process

Keep attorneys, families, team members and child informed of the status of the case on a regular basis so to avoid unnecessary rescheduling of hearings

Encourage and support attachment bonding

Attachment cycles are a relatively new aspect to consider in terms of psychological and behavioral issues, although psychology leaders such as Erik Erikson have studied the concept for years

In many situations for child removal by CPS, there exists poor attachment models: Insecure attachment, where the child is rejected by a caretaker, Resistant attachment, where the child’s needs are met inconsistently, and Disorganized attachment, which occurs in abuse situations as well as any situation in which the child fears the caretaker

Poor attachment patterns are tied to a multitude of disruptive behaviors and psychological disorders and are often a strong indicator of future problems with social and relationship circumstances

Encourage and support attachment bonding

(continued)

Research shows that children with healthy attachments to their biological families continue with positive strides even when removed into out-of-home care

Children with secure attachment fare better during trials and challenges in life because they have a support in place. Because their needs were met consistently in early childhood, they do not view the world distrustfully.

Many foster children display behaviors that discourage healthy attachment, such as violence, rejection and withdrawal. Foster parents need special training to help overcome these issues, as do the biological family in regards to reunification

SUGGESTED APPLICATION OF BEST PRACTICE:

Encouraging healthy attachments

Provide foster parents with quality and in-depth training in attachment cycles, both the psychological aspect as well as suggested methods of building attachment so that they have a full understanding of its importance

Provide foster parents, upon placement of a child, with an overview of the age-appropriate milestones of the child as well as the actual developmental level of the child, so that they do not have unrealistic expectations

Train foster parents of older children in how to encourage healthy attachment after infancy and how to address signs of insecure, disorganized and resistant attachment

In biological families, develop and implement a basic psychological parenting class that focuses not on simple skills like cooking and cleaning, but on healthy and secure attachment, positive reinforcements and relationships, presented on a 5th grade level.

Consider biological and foster family bonds when arranging permanency placements with special note given to child age and time of placement ratios

Current standards guide social workers towards reunification with the biological family, assuming that the bonds of DNA supersede other ties, however, research indicates that this is not always in the best interest of the child

Previous case law has negated any rights the foster family may have on behalf of the child in foster care and does not take into consideration the bond the child in care may have developed with the foster family and their support network despite length of time in care and age of the child upon placement

Consider biological and foster family bonds when arranging permanency placements with special note given to child age and time of placement ratios

(continued)

Recent studies have shown that disrupting a secure attachment with the foster family can be as destructive as the initial removal of the child from the biological home, especially if the child is very young upon the removal and subsequent placement

Considering the “best interests” of the child in terms of health and security need to include an assessment of attachment and security with the foster family (or relative placement) especially if the time of placement has been greater than the recommended 18 months

SUGGESTED APPLICATION OF BEST PRACTICE:

Consider Foster and Biological Family Attachment

Utilize psychological screenings to determine attachment levels and types with potential permanency options, looking at the types and depth of relationships with foster or biological siblings, grandparents and parents in both the foster and biological homes

Minimize out-of-home placement lengths and follow ASFA requirements on requesting termination of parental rights at 15/22 months

Place young children entering care into concurrent planning homes- those open to adoption if reunification does not occur

Emphasize the importance of timely and consistent response to the parenting plan when working with the biological family

Present the “health” aspect of the court’s plan as including the mental and emotional health as well as the physical health

When reunification is warranted, but the child in care presents a secure attachment to the foster family, encourage ongoing contact and support between the foster and biological family to smooth the transition for the child

EXPECTATIONS OF RISK REDUCTION THROUGH USE OF SUCCESSFUL

EXPERIENCED BASED PRACTICE FINDINGS

Effects of Best Practice Implementation

Best Practice ResultsStandard Practice Results

Attached children with healthy emotional connections able to weather trials using healthy relationship-based coping mechanisms

Better results when reunified or fewer movements while in placement

Insecurely attached children who resort to unhealthy behaviors when faced with challenges

Increased movements while in care or multiple returns to foster care from the biological home post-reunification

Comparison of Practice Results

Best Practice ResultsStandard Practice Results

Can assist in the establishment of a healthy attachment pattern, decreasing the probability of negative mental and emotional effects including psychiatric disorders

Are linked to better transitions out of foster care into mainstream adult society, including lowered rates of adult homelessness and incarceration

Often result in increased presence of psychiatric disorders such as ADHD, Bipolar Disorder, RAD, and ODD due to the disrupted attachment cycle.

Are tied to post-care mainstream lifestyles involving risky behaviors including drug and alcohol abuse, prostitution, homelessness and criminal activity.

Comparison of Practice Results (cont)

Conclusion

Using the best practices in foster care can help prevent unnecessary trauma related to attachment to the child in care by encouraging the development of secure attachments in substitute care.

Secure attachment is the foundation for healthy development and an indicator of low risk for future concerning behaviors such as drug or alcohol usage, cutting, promiscuity, unprotected sexual activity, and so forth.

Secure attachment is linked to positive accomplishments in school, low placement movement rate, and overall life success