the role of decision-making in influencing outcomes in long-term care findings from the care...
TRANSCRIPT
The role of decision-making in influencing outcomes
in long-term care
Findings from the Care Pathways and Outcomes Study
What will be presented?
• Introduction to the CPO study
• Summary of the findings
• Implications for decision-making and practice
o Children’s placement profile o Education
o Regional variations o Parent/carer stress
o Placement stability o Contact with birth family
o Attachment o Family communication
o Self-esteem and happiness o Social services involvement
o Behaviour o Social support
The Care Pathways and Outcomes Study
• Research team: Dominic McSherry, Montserrat Fargas Malet, Kerrylee
Weatherall and Greg Kelly
• Longitudinal study following a population of children (n=374) under 5
and in care in NI on 31/03/2000.
• 3 completed phases. All children’s placements profiled in 2000, 2002,
2004 and 2007.
• Phase 3: The Children’s Perspective (interviews with subgroups of 9-
14 year old children and their parents/carers – quantitative &
qualitative data)
Placement profile 2000-2007
2000 2002 2004 20070
10
20
30
40
50
60
70
Adopted
Birth parents
Foster care
Kinship care
Residence Order
Prospective Adop-tion
Regional variations
NorthernSouthern
South EasternWestern
BelfastTotal Population
63
69
39
25
32
45
18
15
36
14
23
209
6
15
43
23
207
2 5
14
11
9
38
54
10
6
Adoption
Birth Parent
Foster care
Kinship care
Residence Order
Placement stability
Adoption Foster care Kinship care Residence order
Birth parents
99
87
96 95 95
Placement stability achieved by 2007
Children’s attachment to their parents/carers
Adoption Foster care Kinship care Residence order
Birth parents
High
Medium
Low
Children’s behaviour
Adoption
Foster care
Kinship care
Residence Order
Birth parents
Gen. Pop.
28
44
25
14
50
10
% clinically high difficulties
Children’s health and behaviour
• Which children had serious health problems according to
parents/carers:
• A range of conditions
• Child’s behaviour stayed the same or improved
• Highlighted the strengths of children and positive behaviours
o 1/11 in kinship care (9%) o 5/12 with birth parents (42%)
o 5/15 in foster care (33%) o 11/18 adopted (61%)
o 6/15 on residence order (40%)
Children’s education
• Poor scores in the BPVS
• Receiving additional supports at school: majority of children adopted
by carers; nearly half of those in foster care; BUT only a few with birth
parents.
• Children coping very well/ “alright” at school (considering
limitations); a few - with problems (e.g. bullying and behavioural
problems).
• A few doing very well at school and passed the Eleven Plus test – BUT
low expectations from teachers and social services.
Adoption Foster care
Kinship care
Residence order
Birth parents
Gen. Pop.
3950 50
36
78
25
% low scores
Parent / carer stress
Adoption (n=18)
Foster care (n=16)
Kinship care
(n=12)
Residence order
(n=14)
Birth parents (n=12)
Gen. Pop.
22
44
33
21
50
15
% clinically high stress
Contact with birth families
• Majority had some sort of contact
• Regular face-to-face contact with parents/siblings common for foster,
kinship and RO children but adopted children – post-box contact.
• Contact arrangements changed over time, reducing or stopping altogether
• Many children, especially in foster or kinship care, used to have negative
reactions to contact in the past, but for the majority, the situation had
improved.
• Some children were happy with the level of contact, others longed for more
contact with birth family or even wished to live with them.
• The majority of parents/carers whose children had face-to-face contact had
no issues, but where tensions existed - in kinship care.
Family communication
• sharing info about birth family/past in care: (1) sharing all the
info; (2) concealing certain facts deemed potentially distressful
(adoptive); & (3) simplified or romanticised version of the
past/birth family (adoptive & kinship).
• (1) some children were asking questions / talking about birth
family though not often; (2) some were not doing that now but did
in the past; and (3) some never did, because already knew
everything, had forgotten, or were not interested.
• A few children were curious about their birth family but their
parents/carers appeared unaware of this.
Social services’ involvement
• Birth parents most critical of support provided by social services
(marginalised, undermined and distrusted).
• Some adoptive parents advocated for a continued role of social services;
others and some RO carers felt a sense of ‘abandonment’ by ss post-
adoption/post-residence order.
• A few kinship carers experienced a sense of disregard and lack of
support, and felt less valued/supported by ss precisely because they
were relatives.
• Some RO carers happy that ss were no longer there, leading ‘normal’
family lives; others advocated a continued role for ss, in terms of the
provision of financial support.
Social support
• The most important source of support provided for the parents
and carers was their family.
• Birth parents had the least extensive network of support, in
relation to both family and friends.
• Foster carers and residence order carers had access to the most
extensive family support networks. Their extended family were
closely involved in the lives of their children.
• Support from extended family also provided on an extensive basis
for the majority of adoptive parents who also fostered the child.
Implications for decision-making
• Imp of finding stable placements – early decision-making
• Post-code lottery
• Need to acknowledge high level of health needs for
children in adoption, living with birth parents & in foster
care + high level of parent/carer stress – Post-adoption
support plans; support packages for birth families??
• Informing residence order carers
• Getting the child’s perspective
Thank You
Montserrat Fargas Malet
For more info: McSherry, D., Fargas Malet, M., Weatherall, K. (2013). Comparing long-term placements for young children in care. The Care Pathways and Outcomes Study – Northern Ireland. London: BAAF
I had to fight with social services to get him to do the Eleven Plus… They
weren’t going to let him do it… and I felt he should do it … The
Education Board wasn’t going to let him do it. … At the end, they allowed him to do it but he had to sit in a room on his own… in case he would disrupt the class… he got a B1. I
was all delighted.
(Martin’s foster mum)
But things seem to be going well this last year or so,
better than it had been, so I mean the kids come back and
I don’t have any problems now. Whereas at the
beginning there were lots of problems with behaviour and different things, but that has
all settled down now and things have been going well this past year because they
have been doing more family orientated things. Whereas before they were in a Family Centre and the kids would be
bored …
(Pol’s foster mum)
[In the future] I might go and live
with my birth parents …
Because I’ve never seen them
before and I don’t know anything
about them.
(Bridget – adopted by carers)
Just she didn’t grow up in mummy’s
tummy, she grew in somebody else’s
tummy and then we picked her specially.
So that is really as far as she understands.
So far. You say that to her and she will repeat it, you know, that is it.
(Ciara’s adoptive mother)
We would have done (talk about birth family) right up until after the court there last year, whenever his mother took us back to court over access… Now we wouldn’t really talk
about her because he just doesn’t want to…
he just doesn’t want to know anything about
her.
(Ryan’s residence order carer)
I don’t know what to say there [at the LAC
reviews]… I think they’re a bit sore on
me at times… They put it down as neglect… Does she look like somebody who’s
neglected? I’m sitting crying usually.
(Alexandra’s birth mum)
We sort of felt that once we took over the role
nobody else wanted to know … It just seemed to me you could bluff your way through the whole
thing … There have been no checks whatsoever
since, a small concern of mine.
(Ciara’s adoptive mother)
No other option. The children were dumped on us… and the social worker says you have to take them, didn’t
ask will you take them… just take them.
(Nathan’s grandmother – kinship carer)
As for my brothers and
sisters, as I said, I never see them so they weren’t
suportive at all… so we were doing it by ourselves…
(Bronagh’s birth parents)
Especially my son and daughter-in-law are very, very
supportive … would babysit at
the drop of a hat… and even my older
daughter… it’s very good
(Ryan’s residence order carer)