Listen to thisThis article analyses out of home care (foster care) programs within a framework of human development and resiliency studies. Despite concerns about the importance of contextual relevance in assessing program development and outcomes, the author argues that a development framework allows for the identification of common processes for reducing risk across diverse situations including within both minority world and majority world conditions
Introduction
In this overview, the author describes common processes that define out of home (foster) care programs globally and offers principles for program delivery and assessment that appear to have transcontextual validity.
The term foster care is used to refer to care for children who are without access to familial support. Although out of home care is gaining popularity as a less emotive and more descriptive term, foster care is still used in most majority nations. Foster children include orphans, unaccompanied children (whose parents are inaccessible or their whereabouts unknown), wards of the state (whose parents or guardians are unable to care for the child because of external events or personal circumstances), and children/families who are in need of temporary respite.
Human development needs: Research that
informs care systems for children
It is safe to assume that every child who comes into the foster care
system has experienced disruption and trauma. In studies of World War II
orphans, Bowlby (1965) and others identified long-term deleterious
effects on children who had not been able to form bonds or attachment
with their mother. Since those early studies, we have refined our
understanding of the foundations of positive human development and the
bases for health and well-being. We know now that to meet potential in
terms of biological, psychological, and emotional health, a child needs
stable and consistent relationships with loving adults in a nurturing,
protective, and safe environment. Bonding and attachment, the
development of security and trust through consistent care-taking,
freedom to interact with surroundings, predictability, success
experiences, responsiveness, exposure to opportunities for cognitive and
emotional development, and other nurturing interactions form the
foundation for positive developmental outcomes and healthy lives. We
know, too, that some children are highly resilient and that they can and
do overcome disruptive and traumatic circumstances to become thriving,
healthy adults (Clark and Campbell, 1989; Manisses Communication Group,
2001).
Current research into human development and resilience suggests the following outcomes for children who have suffered disruption and/or trauma.
Youngest children are more likely to have long-term effects from disruption and trauma but also most likely to recover when reparative attention is swift.
Children who have suffered significant emotional stress, such as the death of a parent, require reparative attention even when the child appears to be coping.
Children are more likely to present long-term behavioural effects and cognitive impairment when post-trauma events are disjointed.
A return to normalcy and experiences that replicate normal family life are most likely to heal traumatized and troubled lives (all children are more likely to thrive when they are cared for in small groups with consistent and loving care givers).
(Sims, Dubowitz and Szilagyi, 2000; McCain and Mustard, 1999; Gammage, 2000; Ferguson, Horwood and Lynskey, 1994; Bilavar, Keinberger, Koepke and Goerge, 1999; Mannisses, 2000).
Importance of early years
Children who experience trauma in the early years are more
likely to present long-term physical, psychological, and behavioural
disorders together with biological and cognitive impairment
(Ferguson, Horwood and Lynskey, 1994; Cadiz, 1994; Mannisses, 2000;
Carnegie Corporation, 2000; Clarke and Campbell, 1989; Zigler and
Gilman, 1998; Zeanah, Larrieu, Scott Heller and Valliere, 2001). On the
other hand, a child is most likely to recover from physical deprivations
and emotional trauma in early life when interventions occur swiftly and
healthy environments are sustained (Schweinhart and Weikart, 1993;
Barry, 1996; Carnegie Corporation, 2000; UNICEF, 1994; McCain and
Mustard, 1999; Gammage, 2000).
In the case of residence in an orphanage or severe disruption of lifestyle, it has been shown that children who have had nurturing care in early life can develop into healthy adults despite traumatic separations and death. Separation during the first year of life, especially during the first six months, may not have a deleterious effect on social or emotional functioning if the subsequent care is individualized and nurturing (Simms, et al., 2000). Separations occurring between six months and about three years of age are most likely to result in subsequent emotional disturbances (Zeanah, et al., 2001). However, long-term risks are reduced when lifestyle conditions following the trauma are not radically changed from those prior to the separation. Adult-to-child bonding and intense attention to the child's needs can overcome long-term effects of separation trauma during the critical early years (Ball and Pence, 1999; Barry, 1996; Carnegie Corporation, 2000; UNICEF, 1994).
Children of any age who are parentless are much more likely to have psychosocial problems, to be physically ill, and to not attend school than are children living with families (Bauman and Krause-Eheart, 2000). Children who feel let down and uncared for by society can become angry and hostile. Feelings of worthlessness and alienation can result in alienation, crime, and other anti-social, violent behaviours (Fortune, 2000; Wadsworth, 1999; Talbot, 1998; Yashikawa, 1995; Coleman, 1988; Jfe, 1998; Stansfield, 1999; Gammage, 2000; Shonkoff and Phillips, 2000).
Components of foster care programs
The list of program components below represent those traditionally
associated with the delivery of foster care programs. In theory, foster
care programs include support programs to prevent family
breakdown. Prevention of family breakdown involves macro- and
inter-sectoral programs which include socio-cultural, economic, and
political forces as well as environmental conditions, including poverty
reduction and health-promoting programs. Indeed, almost any community
support program is a preventative foster care program. However, the
connection between preventative foster care and prenatal support, mother
and child support, health services, early childhood education, poverty
reduction, income generation, housing and water improvement, drug and
alcohol rehabilitation, prison reform, and all other aspects of
community development care is seldom recognized (see Melamid, 2002:
131).
Instead, most formalized systems of foster care restrict their focus to the care of children after family breakdown. Most formalised programs include the components listed below. However, lack of resource commitment, lack of trained personnel, and fragmented infrastructure are common obstacles for successful program outcomes.
Foster care needs assessment
Research is needed to prioritize and plan foster needs. Specific
information on the cohort of children in need (age, gender, presenting
problem, geographical location, and other variables) and forecasts on
future needs will be used to inform legislation, training, and other
components of the program. Qualitative research such as case studies of
children in care will illustrate current capacities and where gaps in
services exist. Qualitative research is also needed to analyze issues
related to foster families. Surveys and interviews with foster families
will identify motivators and other matters that can be incorporated into
recruitment drives. This research will inform program development
including the identification of specific support and training needs for
potential foster families.
Legal and structural infrastructure
A government or other sanctioned structure needs to be in place whereby
guardianship responsibilities are designated. Community standards of
care for children need to be articulated and legislated. Legislation
will also address standards of care and responsibilities for monitoring
compliance with standards. Entrance and exit policies that are equitable
and transparent need to be in place and grounded in legislation. The
rights of birth families need to be addressed in legislation as well. A
system of appeal needs to be established.
Public awareness campaign
Campaigns of community awareness to promote acceptance of the foster
care system will support recruitment drives and avoid the stigmatisation
of children and of birth and fostering families.
Recruitment and training of foster care workers
Training in foster care is now recognized as a specialized area.
Training can be available through schools of social work or in-service
professional development programs.
Recruitment and training of foster families
A foster care system involves the identification, training, and ongoing
support to families in the community who are willing and able to take
one or several children into their homes. A home assessment needs to be
done to ensure that children will be safe and nurtured in the foster
setting. All members of the fostering family should be involved in this
assessment.
Matching of children to foster situation
Children need to be matched to most suitable arrangements and linked to
a range of community resources. Fostering arrangements aim at least
disruption. This could include older children remaining in their family
home with supports provided. Precedence should be given to community
placements and kinship programs (whereby blood relatives give support to
care for fostered and/or orphaned children).
Ongoing support to foster families
Foster homes need to be monitored on an ongoing basis. The purpose is
not only to ensure that the child is thriving but also to identify needs
and provide ongoing support, training, health services, relief services,
and emergency assistance including financial assistance. A sympathetic
and trained professional should be assigned to each home on a long-term
basis. Security support needs to be available as well.
Support to the child
A foster child should be assigned a permanent advocate who ensures that
the child's interests are met and who can intervene quickly in times of
breakdown or need for change in care arrangements.
Programs towards reunification, where possible
This involves a focus on the reunification of the child and the birth
family. Family counselling, rehabilitation, and other programs targeting
the birth family as well as the foster child are considered to be an
integral part of the system.
After-care
Children who have reached the age of majority and/or are exiting the
system to rejoin family members need ongoing after-care. Financial
assistance, employment counseling, and other supports need to be
available long term for the fostered child.
Issues regarding foster care
The issues listed below are those most commonly debated in the
development, implementation, and assessment of foster care programs.
Consideration of these issues can assist with the adaptation of generic
programs to meet regional and contextual needs. Some discussion of these
issues is offered in terms of current research findings, practice, and
hindsight.
Community homes versus identifiable institutions
and residences
In nations where programs for orphans and foster children have existed
for some time, the use of institutional care is rare. The consistent
care by one or two significant adults, which is vital to healthy
psychosocial development, is difficult to deliver in institutionalized
settings (Fortune, 2000). Even where staff has the highest
qualifications, ratios and conditions do not support the one-on-one
bonding associated with the development of attachment and feelings of
worthiness in children. Children who grow up separated from mainstream
society and/or under the auspices of charitable organizations tend to
develop low self-concepts and to have problems integrating into society
as adults (Scahill and Froese-Fretz, 2000). This is exacerbated in those
cultures where the ancestral home is critical to self-identity
(Mupedziswa and Kanyowa, 1997).
Some forms of residential care reflect the most recent research on children's needs and the highest standards of care. In many nations, agencies have developed what are called Children's Villages. These represent attempts to create a community lifestyle for large numbers of orphans. Villages generally incorporate many residential “homes” along with sites for social and recreational activities. Villages are often characterized by programs which keep siblings together, have consistent adult caretakers, replicate family groupings, attempt to have children integrate into the community by attending community schools, and feature many other aspects of best practice. While villages can be secure, predictable, and joyful places for children, there is a concern that the high-level lifestyle makes it difficult for “villagers” to re-integrate into normal community life. The difficulty is exacerbated because village children often lose ties with their ancestral locations and/or heritage.
Informal care systems versus formalized care
systems
In recent times, kinship care has been formalized. Relatives of children
in need can apply for state support to take in these children. In many
nations, and in earlier eras, kinship care just happened, but this is
becoming less realistic in terms of global social trends. Ironically,
the formalizing of programs sometimes increases the risk for abuse “perhaps because rewards associated with formal structures can over-ride
humanitarian motives. Informal arrangements whereby community norms are
monitored could decrease disruption and the trauma associated with
drifting (whereby the child ends up drifting in and out of
birth-family care). Drifting has such negative outcomes that sometimes
children are left in high-risk situations simply to avoid yet another
change in their lives (Clare, 2002).
Normalization is also most likely to occur in informal arrangements. Most researchers argue for a multi-level system that incorporates a continuum of programs ranging from informal supports through to partnership arrangements, and finally to formalized structures with rigorous accountability. The diversity of this approach allows for individualized needs and can incorporate the implications of changes in child and/or family circumstances (Colton and Williams, 1997).
Contacts with family or chance to re-bond with
new family
The balance between the rights of the birth family and the rights of the
foster family is a source of much contention. Theoretically, children
are believed to develop a self-concept and a sense of belonging when
they maintain contact and bonds with their birth relatives. In practice,
the issues that forced child removal in the first place often remain as
barriers to reunification. Poverty and substance abuse, poor or
neglectful parenting skills, and/or economic and social conditions which
make parenting extremely difficult do not change quickly – and even when
they are ameliorated, need constant monitoring and support to sustain
the standard of care. Drifting in and out of family situations is highly
detrimental for children. Some foster parents have reported abusive and
violent behaviour from birth families toward themselves and their
non-fostered children. Others report regression and trauma after foster
children have visited birth parents. Some fostering parents have refused
to accept foster children if there is an insistence of birth-family
involvement.
Keeping siblings together versus finding viable
placements
Most researchers argue for keeping siblings together wherever possible.
In areas where families are large, this can reduce the likelihood of
fostering within a family home. Few families are set up for, or willing
to take on, more than two or three children at one time. Large families
may be able to remain in a house with older siblings taking
responsibility for the younger ones. This arrangement, however, could
disadvantage the older children whose schooling and lives are disrupted
to care for the young ones.
Payment for fostering families versus minimal
supports
In some nations, allowances are given and supplemented based on factors
such as age, special needs, etc. Families can cover expenses and make
some financial gains. In some nations, payment or support is minimal and
fostering costs the foster family in real terms.
Some analysts believe that payment detracts from the spirit of fostering. The care and time needed to foster cannot be measured in wages, and generous allotments can result in suspicious motives. Foster parents may neglect or mistreat foster children while they keep the funds for themselves or their own children.
Alternatively, many researchers insist that remuneration is valid and equitable. Children benefit when foster parents are financially rewarded because this increases the pool of foster families. Appropriate matching can then take place, which decreases the risk of placement breakdown. The care and time needed to foster cannot be measured in wages, nor will wages be enough to sustain the commitment needed to get through the tough times of child fostering. Drop out rates tend to be higher amongst foster families that receive low remuneration (Pangan, 1999).
Most analysts agree that fostering is most likely to be successful when it is done in the spirit of a sense of shared responsibility for children in the community, with supports being distributed on an as-needed basis. Public recognition and visible benefits for the whole fostering family and the whole community are motivating factors for foster parents.
Cultural consistency
Many arguments are advanced about the benefits of ensuring that children
are cared for and nurtured in the culture and belief systems of their
birth families. Feelings of belonging, which are crucial to healthy
emotional development, are more difficult to achieve when children live
in families or communities that do not reflect their birth heritage. The
Aboriginal Stolen Children of Australia speak of this sense of “not belonging” as the most traumatic area of their lives.
Cross-cultural, cross-religious, and cross-racial fostering is frowned
upon in many areas. On the other hand, there have been successful
fosterings and adoptions that have crossed all these barriers. The issue
seems to be respect the championing of the child's background and
allowing the child to follow whatever her/his conscience dictates.
Post-care programs
How children exit the fostering system and when and what supports are
given to them have implications for long-term health and well-being.
Some programs have halfway houses whereby young people are left in
semi-independent states before going off on their own. These are often
operated by organizations that have run villages or foster care
programs. Some of the concerns are similar to those regarding the
villages themselves: children may become depressed and dysfunctional
when they find that they are unable to maintain their past standard of
life when left to their own devices. Research on post-foster care
outcomes and on the factors most likely to contribute to the successful
integration of foster children is lacking.
Conclusion
The best way to provide an effective foster care situation is to recognize that every child is part of a system that incorporates the mother-child dyad, the family, kinship ties, and the community – and to target support to every level of this “system”.
While stand-alone programs of foster care are difficult to measure in terms of sustainable outcomes, research and experience have contributed to our understanding of the components and the issues that need to be considered for developing and implementing foster care programs in any context. The basic axioms for the development and delivery of any social program also remain true for foster care. These axioms include the following.
Interventions need to be focused upon the early years of life (including supports for mothers in the prenatal and perinatal periods).
Children need to have a voice in decisions affecting their lives.
Children should be kept in family-like environments, close to their birth community.
All stakeholders involved in social service interventions need training and support.
Children need to be viewed as a whole – their health, educational outcomes, and well-being cannot be separated from emotional stability and/or feelings of belonging. The availability of care, nurturance, health services and education for all children should be consistent and seamless from birth to adulthood.
Foster care needs to be viewed as part of the
continuum of healthy communities – not a crisis intervention program
that identifies the disrupted child as the problem to be solved
(Hayden, 2002).
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This feature: Hayden, J. (2004). Out of home programs: A global overview. Journal of Child and Youth Care Work, 19. pp. 52-61.
