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Kinship care for the safety, permanency and well-being of children removed from the home for maltreatment
- Authors: Marc Winokur, Amy Holtan, Keri Batchelder
- Published date: 2014-03-03
- Coordinating group(s): Social Welfare
- Type of document: Title, Protocol, Review, User abstract, Plain language summary, Previous version
- Category Image:
- PLS Title: Health and well-being of children placed in kinship care is better than that of children in foster care
- PLS Logo:
- PLS Description: This Campbell systematic review examines whether kinship care is more effective than foster care in ensuring the safety, permanency and wellbeing of children removed from their home for maltreatment. The review summarizes findings from 102 studies involving 666,615 children. 71 of these studies were included in meta-analyses.
- Title: Kinship care for the safety, permanency and well-being of children removed from the home for maltreatment
- See the full review: https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.2
About this systematic review
This Campbell systematic review examines whether kinship care is more effective than foster care in ensuring the safety, permanency and wellbeing of children removed from their home for maltreatment. The review summarizes findings from 102 studies involving 666,615 children. 71 of these studies were included in meta-analyses.
What are the main results?
Children in kinship care have better behavioural and mental health than children in foster care, i.e. fewer internalising and externalising behaviours, better adaptive behaviours, fewer psychiatric disorders and better emotional health. They also experience greater stability and permanency in their placement and suffer from less institutional abuse than children in foster care. Also, the chance of relatives being awarded guardianship is greater for children in kinship care than for those in foster care.
Children in foster care are more likely to be adopted than children in kinship care, and they utilise mental health services to a greater degree than children in kinship care.
No differences between children in kinship and in foster care are found for the utilisation of other public services than mental health services (i.e. developmental services, or physician services), or for educational attainment, the rate of reunification with birth parents, or for the strength of their relations and attachment to their family.
Some of the findings are context specific, notably the lesser support which may be given to kinship carers compared to foster carers, and whether permanency of the kinship or foster arrangement, adoption or reunification is the preferred end goal.
Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being. However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.
To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.
We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index-Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.
TControlled experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non-kinship foster care for child welfare outcomes in the domains of well-being, permanency, or safety.
Data collection and analysis
Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta-analysis with the results presented in written and graphical forms.
One-hundred-and-two quasi-experimental studies, with 666,615 children are included in this review. The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attrition bias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size -0.33, 95% confidence interval (CI) -0.49 to -0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well-being (OR 0.50, 95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non-kinship foster care. For permanency, there was no difference on reunification rates, although children in non-kinship foster care were more likely to be adopted (OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non-kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).
This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.