Children entering care: what are they like and how do they contribute to foster care relationships?

H Social Sciences (General);HV Social pathology. Social and public welfare

Pritchett, Rachel ; Minnis, Helen

University:University of Glasgow

Department:Institute of Health and Wellbeing

关键词: child, foster care, mental health, development, foster care relationships.;   

Others  :  http://theses.gla.ac.uk/6328/7/2015Pritchettphd.pdf

来源: University of Glasgow

【 摘 要 】

Background:Children who enter foster care are known to show high rates of problems across a number of different areas, including their mental health, relationships and development, with difficulties often continuing into adulthood. There are indications that some of these baseline characteristics have an effect on a child’s outcome from foster care, but this evidence is limited due to an overwhelming reliance on administrative data for the analysis of potential links. In order to explore this more fully, face-to-face assessments with these children need to be conducted. There are known difficulties, including choosing reliable informants for the child, and deciding when is the best time to perform assessments. In this study, the aim was to explore some of the relevant issues while assessing, in the primary research question, how different child characteristics were associated with the quality of the relationship that the child had with their carer.Method:Seventy children aged between 6 and 60 months were examined between one and two months after they entered foster care. They were assessed as regards their mental health, language, cognition and relationships, and the results were compared with normative population data whenever possible (research question 1). The data were also explored to investigate to what extent the children had overlapping problems across the areas studied (research question 2). There is a lack of research on the mental health of very young children in care, and so a control group of 40 children aged 12-24 months were recruited from the general population, against whom they could be compared. This sample was age- and gender-matched with 20 children aged 12-24 months in the foster care sample (research question 3).It was possible to access the birth records of 38 of the sample with a view to assess whether the children had shown signs of being ‘at risk’ at birth (research question 4).The quality of the relationship between the child and their carer was assessed using a structured observation, the Parent-Infant Relationship Global Assessment Scale (PIRGAS). Regression analyses were conducted to analyse how the child characteristics of age,gender, mental wellbeing, cognition and language were associated with PIRGAS score (research question 5). In addition, the carer’s levels of commitment and experience were explored as potential contributors to the quality of this relationship (research question 6). The reliability of foster carers was assessed by investigating whether their level of worry related to the degree of problem that the child had. The child’s level of engagement in the cognitive assessment was measured and compared with the score they attained in the assessment, while the change in scores over time was also calculated (research question 7).Results:Research question 1. The results showed that, in line with previous research in the area, children who enter foster care are likely to be experiencing more problems with mental health, language, cognition and relationships than children in the general population, already at the time of entering care. Research questions 2 and 3. There was some indication that this difference between them and the general population may not be very pronounced in children under the age of 2. Children over the age of 30 months, on the other hand, were likely to have complex and overlapping problems.Research question 4. An examination of routine birth data showed that children who later came into foster care were already different from the general population at birth in having lower mean birth weight and higher likelihood of prenatal exposure to drugs.Research question 5. An examination of the primary research question showed that the child characteristics of age, gender, mental wellbeing, cognition and language together predicted 17% of the variance in the quality of the relationship between the child and their foster carer as measured by the PIRGAS. Some additional analyses revealed that mental wellbeing appeared to be the single most influential of the child characteristics. Research question 6. A complex interplay between the child’s wellbeing, carer commitment and relationship quality was also revealed with associations between all the factors.Research question 7. In some instances, the carers did not appear to be the most reliable informants for children in their care, sometimes reporting a lack of worry even when the child showed concerning symptoms or behaviours, as observed by the research team.There was a strong association between how engaged a child was in the task and how they performed on the task, and this has implications for how meaningful the score is as a predictor of ability.It was also possible to follow up a small number of the sample a year later. It was found that the cognitive percentile scores achieved when a child first entered care were not significantly different to those that they achieved a year later, suggesting that, despite the concerns about the validity of the assessments, these measures can be useful for predicting later performance. A much more mixed picture for language was found, in that scores achieved when a child first entered care showed little relationship to how the child performed a year later.Discussion:Overall, the results lend support to the notion of the importance of early intervention, with children over the age of 2 showing a greater number of problems as well as more complex problems than those under the age of 2. Mental wellbeing in the child, as measured by the presence of positive prosocial behaviours, showed associations with the quality of the relationship with the carer, as well as with the commitment of the carer. Carers did not report being worried about the youngest children who were not displaying these prosocial behaviours; thus it may be that foster carers are underestimating their importance, or are reluctant to report on such behaviours.The observations made over so many assessments and the work carried out to explore potential issues with the assessments guide recommendations for future work in this area. It is clear that there is a need to repeat measures to assess change, and to conduct holistic assessments, so that findings might be clinically interpreted in a meaningful way.Despite difficulties in assessing children who enter foster care, the findings underscore the importance of early assessment. The study findings confirmed that this is a vulnerable group, with very complex needs. Even though all children are likely to be negatively affected by the disruption that is entailed in entering foster care, only a thorough assessment will be able to identify which children also have underlying problems that will require support and intervention in addition to the safe and nurturing foster care that they all require.