Comparing long-term placements for young children in care: The Care Pathways and Outcomes Study – Northern Ireland Book launch 11 September 2013 Council Chambers, QUB

Care Pathways and Outcomes Study Research team: Dominic McSherry, Montserrat Fargas Malet, Kerrylee Weatherall, and Greg Kelly What is it about? Longitudinal study that examines placement patterns for a population of children (n=374) under 5 years old and in care in Northern Ireland on the 31 st March It explores how the children & their parents/carers get on within different types of placement – Key question, does care placement matter? Location: Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University, Belfast Funded by: The HSC Development Division of the Public Health Agency Book publisher: British Association for Adoption and Fostering (BAAF)

History of the Study – Phases 1 & 2 PHASE 1 - Care Pathways and Outcomes: Multiple Placements ( ) -Developed a placement history for the study population to 31 st March 2002, and established baseline characteristics for the study population prior to 31 st March MAIN FINDINGS: Multiple placement not common in Northern Ireland; but unexpectedly high percentage of the study population had been adopted by 2002 (18%) PHASE 2 – Care Pathways and Outcomes: The Carers’ Perspective ( ) -Further developed the placement profile for the study population from 2002 – 2004, and involved interviews with parents/carers in adoption, foster care, and at home -Adopted children were doing marginally better than children in foster care, and both these groups were doing significantly better than those children returned to birth parents, with the high levels of parental stress in the birth parents group being particularly concerning

Phase 3 Care Pathways and Outcomes: The Children’s Perspective ( ) Developed a placement profile for the study population from 2004 to 2007 Interviewed sub-groups of children and their parents/carers Profile of children interviewed: AdoptedFoster CareKinship Care Residence Order Birth Parents Av. age enter placement 1yr 8 mts4 yrs3 yrs 5 mts1 yr 5 mts4 yrs 6 mts Av. time in placement 10yrs 1mt8yrs 5mts8yrs 11 mts10yrs 3 mts8 yrs 3 mts

Quantitative Data - Children Piers-Harris Children’s Self-Concept Scale (Piers & Hertzberg, 2002) -Examined children’s self-concept across 6 dimensions -Applied using post-box activity developed by the research team Inventory of Parent and Peer Attachment - Revised Version (Gullone & Robinson, 2005) -Examined parent and peer attachment across 3 dimensions -Applied using poster activity developed by the research team The British Picture Vocabulary Scale – Second Edition (Dunn et al., 1997) -Examined children’s verbal ability and verbal intelligence -Proxy measure of scholastic aptitude Physical appearance and attributes Intellectual and school status Happiness and satisfaction Freedom from anxiety Behavioural adjustment Popularity Trust Communication Alienation

Quantitative Data – Parents/Carers Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) -Commonly used behavioural screening questionnaire for assessing psychological morbidity in children and adolescents, as perceived by their parents/carers -Comprised of 25 items divided into 5 sub-scales, which in combination provide a ‘Total Difficulties’ score Parenting Stress Index – Short Form (PSI-SF) (Abidin, 1990) -Measures stress in the parent-child relationship -Composed of 36 items divided into 4 sub-scales. A combination of scores across the sub-scales provides a ‘Total Stress’ score Emotional symptoms Conduct problems Hyperactivity / inattention Peer relationship problems Pro-social behaviour Defensive responding Parental distress Parent-Child Dysfunctional interaction Difficult child

Qualitative Data - Children A standard face-to-face interview with a stranger might be uncomfortable for the child. A storybook was developed, the ‘Me-Book’, that acted as a catalyst for the semi- structured interview - Downloadable from: Each page referred to a topic, and involved activities (e.g. writing, drawing, using stickers, circling pictures), covering a range of key issues deemed important for understanding the children’s lives Children who piloted the ‘Me-Book’ described it as providing a ‘protective cover’, where they didn't feel they were being analysed, and could express themselves more freely. Family membership Degree of closeness to family members & friends People important to child’s life Family activities School life Interests / hobbies Health and happiness Feelings about the past / present/ future Future aspirations (employment / accommodation)

Qualitative Data – Parents/Carers Semi-structured interview with parents that covered 12 key areas: How the placement was progressing The child’s attachment to them, and the bonding with child The child’s behaviour Contact with birth family or previous carers Supports Involvement with social services Family activities School and child’s peer relationships The child’s health Communication with the child Feelings and expectations regarding child’s future

Findings Placement profile 2000 – 2007 Care pathway and regional variations Placement stability Attachment Self-esteem and happiness Behaviour Education Parental/carer stress Contact with birth family Social service involvement and social support

Placement Profile

Care Pathway Regional Variations 2007

Placement Stability

Children’s attachments to their parents/carers IPPA-R results

Children’s self-esteem and happiness Piers-Harris self-concept scale

Children’s health and behaviour Who had behavioural difficulties according to SDQ?

Children’s health and behaviour (contd.) Which children had serious health problems according to parents/carers: -1/11 in kinship care (9%) -5/15 in foster care (33%) -6/15 on Residence Order (40%) -5/12 with birth parents (42%) -11/18 Adopted (61%) Children had a range of conditions, BUT these most prevalent in the adoption group, e.g. 8 diagnoses of FAS in total (n=77), with 5 of these in the adopted group. The majority believed that child’s behaviour had stayed the same or improved. Many parents/carers highlighted the strengths of children and positive behaviours.

Children’s education The majority of children had poor scores in the BPVS The majority of children adopted by previous foster carers and nearly half of those in foster care were receiving some additional supports at school. Most children living with birth parents were not receiving supports, despite needing it most. The majority of parents/carers believed children were coping very well/ “alright” at school (considering their limitations), a few identified problems (e.g. bullying and behavioural problems). A few children appeared to do very well at school and had passed the Eleven Plus test – but low expectations from teachers and social services.

Parent/carer stress PSI/SF results

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.

Social Services’ Involvement Birth parents were the most critical of the support provided by social services (feeling marginalised, undermined and distrusted by social services). Some adoptive parents advocated for a continued role of social services; while others in addition to some RO carers felt a sense of ‘abandonment’ by social services post- adoption/post-Residence Order. A few kinship carers experienced a sense of disregard and lack of support, and felt less valued/supported by social services precisely because they were relatives. Some Residence Order carers were happy that social services were no longer there, leading ‘normal’ family lives; others advocated a continued role for social services, in terms of the provision of financial support. Most kinship carers were happy with the support being provided by social services.

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.

Summary Placements characterised by stability, not much evidence of instability, BUT mostly entering teenage years – What happens next is critical All long-term placements have the potential to nurture positive outcomes for children in terms of their attachment to parents/carers and self-concept Highlights the importance of speaking to children -Children perspective, most securely attached and happy -Parental/carer perspective, higher level of problem behaviours and clinical stress for foster carers and birth parents Significant health problems most prevalent in adoption In educational terms, those with greatest need, i.e. children living with birth parents, received least amount of support

Thank you! Book launch 11 September 2013 Council Chambers, QUB