Care Pathways

and Outcomes

Research Team:

Dominic McSherry, Emma Larkin, Montse

Fargas, Greg Kelly, Clive Robinson, and Kerry-

Lee Weatherall

Institute of Child Care Research,

School of Sociology, Social Policy, and Social Work,

Queen’s University Belfast

Funded by the R&D Office

What is the Study About?

Longitudinal study based at Institute of Child Care Research

(ICCR)(Q.U.B), funded by the R&D Office (now in 7th year).

Aim To examine placement patterns and outcomes for a full

population of children (n=374) who were under five years old and

looked after in Northern Ireland on 31 March 2000 and to explore how

the children appear to be faring within their placements.

Research questions:

1. What are the key placement outcomes for this population?

2. What, if anything, predicts placement outcomes?

3. How are the children (foster, adoptive and birth) getting on in their

placements (child and parent perspectives)?

UNIQUE!- Most research focuses on sub-samples, but Pathways

examines a total population, across a range of care pathways.

How is the study organised?

1. CARE PATHWAYS AND OUTCOMES: MULTIPLE PLACEMENTS

(2000-2003)

• Detailed baseline information on population

- Administrative (SOSCARE) data , NIGALA – adoption data, establish the placement status of the population from point of entry into care to 31st March 2002

- Social work case file data (31 March 2000) child and family background and characteristics

2. CARE PATHWAYS AND OUTCOMES : THE CARERS PERSPECTIVE (2003-2006)

• Semi-structured interviews with: foster parents (of 56 children); adoptive parents (of 51 children); and birth parents (of nine children living with their parents, extremely hard to reach group!) – Also established 2004 profile with Trusts

• Two standardised measures

- Strengths and Difficulties Questionnaire (SDQ)

- Parent Stress Index-Short Form (PSI/SF)

3. CARE PATHWAYS AND OUTCOMES: THE CHILDREN’S PERSPECTIVE(2007-2010)

• Interviews with the children that focus upon their sense of family, identify, and hopes for the future. They will also complete a series of standardised measures which look at their attachments, self concepts, and language development.

Population Characteristics

Male (50%), Female (50%)

Catholic (45%), Protestant denominations (49%)

Family history of alcohol abuse (76%)

............................domestic violence (76%)

............................mental illness (63%)

In care due to neglect (52%)

........................abuse (40%)

Behavioural problems (16%)

Developmental delay (12%)

Reflective of other Northern Irish research (Kelly & McSherry, 2003;

Donaldson, 2004; Devaney, 2007).

Placement patterns 2000-2007 (%)

0

10

20

30

40

50

60

70

2000 2002 2004 2007

Adopted

Birth parents

Non-relative foster care

Relative foster care

Residence Order

Prospective Adoption

2004 care pathway by HSC Board (%)

NorthernSouthern

EasternWestern

Residence Order

Relative foster care

Non-relative foster care

Birth parents

Adopted

Placement Trends

Move towards adoption

Major decline in % children remaining in foster care (71% to 28%)

And a major rise in % children adopted or in pre-adoptive placement

(45% of population)

These figures indicate a significant shift in use of adoption as a long-

term placement option for children in care in Northern Ireland

For example, 5 yrs prior to the beginning of this study Kelly and Coulter

(1995) found very low numbers of children being adopted from care

Regional variation in placement patterns

Northern (59%) and Southern (69%) Boards large % of children adopted

compared to Eastern (33%) and Western (19%)

Southern Board highest % of children who had been adopted and the

lowest % of children in foster care (6%) in 2004

In direct contrast the Western Board has by far the highest % of children

in foster care (60%) and the lowest % of children adopted in 2004

What Predicts Care Pathway?

Used Event-History Analysis to examine the relationship between

background factors and placement type

Factors that increased likelihood of adoption:

Child being less than one year old when first entered care

Child living in the Northern or Southern Board area

Mother living alone

Child not presenting behavioural problems

Factors that increased likelihood of a return to birth parents:

No family history alcohol abuse

Case being open less than a year

Child living in the Eastern Board area

Child being in care on a voluntary basis

Child presenting developmental delay

Implications

Key Question: If the needs of the child are central to deciding on a long-

term placement, how do we explain findings of major variation in

professional decision-making across Northern Ireland?

Does this suggest a ‘postcode lottery’ operating in Northern Ireland

regarding care pathways for younger children in care?

- DoH (1998) highlighted a similar challenge: Balancing the need to

develop local solutions that match situational needs while avoiding the

pitfalls of the post-code lottery, whereby variation can result in less

positive care experiences and opportunities for Looked After children

Our findings show 20% of children under the age of one when they first

entered care still in foster care after seven years, while almost half were

adopted, and 1/5 returned to their birth parents. The KEY question is:

Does this matter? Is there any evidence to suggest that some children’s

care experiences may be more or less positive than others?

How were they getting on?

Semi-structured interviews with: foster parents (of 56 children);

adoptive parents (of 51 children); and birth parents (of nine children

living with their parents)

Purpose:

- to find out how these children appeared to be getting on, & how the

parents were faring with them; and

- to explore parents’ views on issues such as: process involvement;

the child settling into the placement; bonding & attachment; contact;

school & friendships; & support issues.

2 measures

Parent Stress Index – Short form (PSI/SF)

Strengths and Difficulties Questionnaire (SDQ)

Parenting stress

Parent Stress Index-Short Form (PSI/SF) (Abidin, 1995)

measure of stress in the parent-child system

The PSI/SF produces a Total Stress Score from three scales: Parental Distress - distress parent is experiencing in role as a parent

Parent-Child Dysfunctional Interaction - parents perception that child does not meet expectations and that interactions are not rewarding

Difficult Child - parents experience of basic characteristics of the children that make them either difficult or easy to manage.

Defensive Responding - indication of extent to which parents minimise problems

Parenting stress

HOW DO THE GROUPS COMPARE?

Adopted parents experienced the lowest and birth parents experienced the

highest parenting stress scores.

The adopted and foster groups scored within the normal range on Total Stress

and each of the subscales. However, a % of each group experienced

significant problems in relation to parenting stress.

The birth parent group were experiencing difficulties in each of the domains

and clinically significant levels of stress

Abnormally high scores on Parental Distress and Difficult Child (85th

percentile)

Abnormally high scores on Defensive Responding, Parent-child

Dysfunctional Interaction and Total Stress (95th percentile)

The normal range of scores is within 15th to 80th percentiles

These findings highlight that some adoptive and foster parents, and most birth

parents, will require support in relation to these aspects of parenting, as

increased support has been found to reduce parenting stress

Children’s strengths & difficulties

Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) is a brief child behavioural questionnaire

completed by parents

Assesses 5 domains including:

emotional symptoms (complains of headaches, stomach aches, often worried, unhappy, downhearted, nervous/clingy in new situations, many fears/easily scared)

conduct problems (temper tantrums, disobedient, fights with/bullies other children, lies/cheats, steals)

hyperactivity-inattention (restless, overactive, constantly fidgeting/squirming, easily distracted, poor concentration and task completion)

peer relationship problems (solitary, picked on/bullied by other children, gets on better with adults than other children)

pro-social behaviour (considerate, shares readily, helpful, kind)

Total difficulties score

Scores can be classified as normal, borderline or abnormal compared to an age appropriate community sample (typically 10% borderline, 10% abnormal)

Children’s strengths & difficulties

HOW DO THE GROUPS COMPARE?

The adopted group had the lowest and the birth parent group

had the highest total difficulties score.

All of the groups scored highly on the pro-social and the

hyperactivity scales indicating that while the children are

perceived to be functioning well socially they are experiencing

difficulties with concentration and attention span.

Birth parent mean scores were abnormally high on

Conduct problems

Hyperactivity/inattention

Total difficulties

Children’s strengths & difficulties

All groups scored higher than norm on hyperactivity, conduct

problems and total difficulties.

Scored higher than norm (20% of community sample score above norm):

Children returned home had more difficulties, but high percentages within

both the foster and adopted group showing difficulties in relation to behaviour

These difficulties clearly have implications for these children and their parents:

They may impact upon the child’s educational attainment and may also place

strain upon the success of the placement itself.

Hyperactivity/inattention Conduct problems Total difficulties

Adopt 65% 33% 33%

Foster 75% 52% 44%

Birth 9 9 5

PSI and SDQ Trends

Birth parents of children who have been returned home and their children were experiencing considerable difficulties

The Parenting Stress scores of birth parents were abnormally high indicating clinically significant levels of stress

Children returned to birth parents were experiencing considerably higher levels of difficulty than adopted and foster children

Adoptive parents appear to be experiencing less parenting stress and their children appear to be experiencing less overall difficulties than the foster and birth parent groups

While both the adopted and foster groups appear to be falling within norms, a percentage of each of these groups were experiencing significant parental stress and child difficulties, particularly hyperactivity

Parent Perspectives (interviews)

Contact

Support

ContactBENEFITS

Useful source of information on child and his/her background (adoptive)

Facilitate ongoing info exchange (adoptive)

Some adoptive families spoke of the benefit from practical and emotional support

of the child’s birth family ‘To gain a granny’ (adoptive)

Help children make sense of key people (adoptive)

Reduce feelings of abandonment (adoptive)

Child may benefit from witnessing a rapport, sense of unity, agreement and

friendship among key adults (adoptive)

Happy memories with birth parents, invited to celebrate

significant occasions (foster)

Contact

DIFFICULTIES/CHALLENGES

Disruption of children’s routines: sick or aggressive after (foster)

Child too young to make sense of contact (adoptive)

Child upset if parents don’t turn up (adoptive)

Rough play/jealousy with siblings (adoptive)

Visits a burden, disturbed lifestyle & complicated life (foster, adoptive)

Difficult to retain anonymity (adoptive)

Issues of parental role identity (adoptive)

Difficult & stressful, restricted communication (birth)

Important to have a sense of ownership over contact arrangements

(adoptive)

Support

Support from SS was described as insufficient (or non-existent) by birth parents;

initially not needed for adoptive parents; & mostly basic by foster parents

Foster parents

Some didn’t rely on SS support, but reassured support there if needed

Some identified gaps in services

Financial support as little more than adequate and far from generous

Adoptive parents

More intense & frequent at the start, & petered out after

Still available ‘at the end of the phone’

Many not needed, nor wanted support

A few, with more difficult children, were not happy with the level of support

Support

Birth parents

For some, no practical support to prevent children taken into care

and to get them back

After returned home, SS only concerned about checking up on them

Some afraid to ask for support because they were afraid of losing

children again

Many wanted respite care

Most foster and adoptive parents had support of family &

friends, BUT most birth parents did not have this support

Interview Trends

Birth parents – Need for a coherent support structure

for families when children return home from

care, particularly for lone young mothers

Need for targeted long-term foster care, and post-

adoption support services