PROTOCOL: Kinship care for the safety,permanency,and well-being of children removed from the home for maltreatment

Kinship Care

Kinship care is broadly defined as, “the full-time nurturing and protection of children who must be separated from their parents, by relatives, members of their tribes or clans, godparents, stepparents, or other adults who have a kinship bond with a child” (CWLA 1994, p. 2). Kinship care is known by many other names around the world, including family and friends care in the United Kingdom and kith and kin care in Australia. There are several variations of kinship care including formal, informal, and private placements. Formal kinship care is a legal arrangement in which a child welfare agency has custody of a child (Ayala-Quillen 1998). Informal kinship care is when a child welfare agency assists in the placement of a child but does not seek custody (Geen 2000). Private kinship care is a voluntary arrangement between the birth parents and family members without the involvement of a child welfare agency (Dubowitz 1994).

The most commonly perceived benefits are that kinship care “enables children to live with persons whom they know and trust, reduces the trauma children may experience when they are placed with persons who are initially unknown to them, and reinforces children's sense of identity and self esteem which flows from their family history and culture” (Wilson 1996, p. 387). The primary aims of kinship placements are family preservation, in which the permanency goal is reunification with birth parents, and substitute care, in which kinship care is considered to be a long-term arrangement when restoration is not possible or the permanency goal is adoption or guardianship by kin caregivers (Scannapieco 1999). Kinship care also is considered to be the least restrictive (Scannapieco 1999) and safest setting (Gleeson 1999) on the continuum of out-of-home placements.

Intervention Context

Although an ancient practice in many cultures, formal kinship care is a newer placement paradigm in countries like the United States and Australia due to its recent adoption by the child welfare field as the placement of choice, when appropriate, in the continuum of out-of-home care services for children (Ainsworth 1998; Geen 2000; Scannapieco 1999). For example, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 explicitly required American states to give preference to family members when placing a child outside of the home (Leos-Urbel 2002). The most recent United States legislation, the Adoption and Safe Families Act of 1997, continues this federal commitment towards promoting and supporting kinship care (Ayala-Quillen 1998). In some European countries, there also has been a shift in policy regarding kinship placements. Specifically, the Children Act 1989 (United Kingdom), the Children Act 1995 (Scotland), and the Children Order 1995 (Northern Ireland) are generally supportive of kinship care (Broad 2005a).

During the past 15 years there has been a rapid increase in the number of children removed from home and placed with relatives (Cuddeback 2004). The main reasons for the growth of this placement option include an influx of abused and neglected children into out-of-home care (Berrick 1998), concern about poor outcomes for children leaving care (Broad 2005b), a persistent shortage in foster care homes (Berrick 1998), and a shift in policy toward treating kin as appropriate caregivers with all of the legal rights and responsibilities of foster parents (Leos-Urbel 2002).

In a comprehensive review of the literature, Cuddeback 2004 confirmed much of the conventional wisdom about kinship care while identifying many of the weaknesses of quantitative research on the topic. Cuddeback found that kinship caregivers are more likely to be older, single, less educated, unemployed, and poor than are foster parents and non-custodial grandparents. Furthermore, Cuddeback reported that kin caregivers report less daily physical activity, more health problems, higher levels of depression, and less marital satisfaction. Cuddeback also concluded that kinship care families receive less training, services, and financial support than do foster care families. In addition, Cuddeback reported that birth parents rarely receive family preservation services, which means that children in kinship care are less likely than children in foster care to be reunified. Lastly, Cuddeback found inconclusive evidence that children in kinship care have greater problems related to overall functioning than do children in foster care.

Rationale for this Review

Geen 2004 argues that, “despite the centrality of kinship foster care in child welfare, our understanding of how best to utilize and support kin caregivers, and the impact of kinship foster care on child development, is limited” (p. 144). Specifically, social work researchers have not kept up with the exponential growth of kinship care as a placement option (Berrick 1994; Dubowitz 1994). Furthermore, much of the research supporting kinship care is anecdotal and conjectural, which does not allow child welfare professionals to make evidence-based decisions from comparisons of children in out-of-home care (Goerge 1994). For example, there is great interest in the safety and well-being of children placed in kinship care, but very little experimental research on these outcomes (Gibbs 2000). However, ethical standards preclude the random assignment of children to kinship or foster care, as these placements typically are based on the appropriateness and availability of kinship caregivers or foster parents.

We will address these methodological challenges by identifying and synthesizing the most strongly designed and executed studies on kinship care. Thus, this review will have important policy and practice implications for maltreated children, kin caregivers, birth parents, and child welfare systems.

Types of studies

Randomized experimental and quasi-experimental studies, in which children placed in kinship care are compared cross-sectionally or longitudinally with children placed in foster care. Studies that compare kinship care to more restrictive out-of-home settings (e.g., residential treatment centers) will not be considered for this review. Relative to children who are placed in kinship or foster care, children placed in more restrictive settings tend to differ in important ways. These differences complicate inferences about the effects of placement and as such, the review will focus on kinship and foster care placements only.

Types of participants

Children and youth under the age of 18 who were removed from the home for abuse, neglect, or other maltreatment and subsequently placed in kinship care.

Types of interventions

Formal kinship care placements, irrespective of whether the kin caregivers were licensed (paid) or unlicensed (unpaid). Thus, studies that exclusively examine informal or private kinship care arrangements will not be considered. Studies will be considered if participants experienced other placement types in conjunction with the kinship care intervention. For example, the treatment group may include children for whom kinship care was their first, last, or only placement in out-of-home care. However, these children must have spent the majority (i.e., more than 50%) of their total time in out-of-home care in kinship care.

Types of outcome measures

Eligible studies must analyze child welfare outcomes in the well-being, permanency, or safety domains. Although caregiver and birth parent outcomes are very relevant, they will not be considered in this review because child outcomes are what drive the policy and practice of kinship care. However, these outcomes may mediate or moderate the effect of kinship care on child welfare outcomes and should be explored in future research on the topic.

Primary outcomes for the review are behavioral development, mental health, placement stability, and permanency. Secondary outcomes include educational attainment, family relations, service utilization, and re-abuse. The following list of outcome domains is meant to be exhaustive, although the examples in each domain are illustrative of the outcomes to be considered in this review.

Search strategy for identification of studies

To identify relevant studies, the following online databases will be searched: Cochrane Library (CENTRAL), MEDLINE, Campbell Collaboration's Social, Psychological, Educational, and Criminological Trials Register (C2-SPECTR), Sociological Abstracts, Social Work Abstracts, Social Sciences Citation Index, Family and Society Studies Worldwide, Child Abuse and Neglect (CANDIS), Education Resources Information Center (ERIC), PsycINFO, ISI Web of Knowledge, ISI Proceedings, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA), System for Information on Grey Literature in Europe (SIGLE), and UMI Dissertation Abstracts International (DAI).

The following search strategy will be used to search CENTRAL: ((relative* near foster*) or (relative near substitute) or (family near foster) or (families near foster) or (family near substitute) or (families near substitute) or (kin near care*) or (kinship near care*) or (kin near caring) or (kinship near caring)) AND ((child* or girl* or boy* or adolescent* or teen* or baby or babies or infant* or preschool* or pre school* or (young person*) or (young people)). This strategy will be modified, where necessary, to search the other databases listed above. Both published or unpublished studies will be sought, and there will be no language, date, or geographic limitations.

The following also will be searched: the websites of international child welfare organizations, University libraries, and State departments to identify governmental and non-governmental reports and texts. The most recent volumes of peer-reviewed social work journals also will be manually searched. In addition, authors of studies included in this review will be contacted for knowledge of other studies not yet identified. Lastly, the reference lists of published literature reviews will be screened for relevant studies.

Methods of the review