Adversity and Adjustment in Children in Institutions, Family Foster Care, and Adoption

Depósito de investigación de la Universidad de Sevilla https://idus.us.es/ This article has been published in a revised form in The Spanish Journal of Psychology, https://doi.org/10.1017/sjp.2015.49 This version is published under a Creative Commons CC BY-NC-ND licence. No commercial re-distribution or re-use allowed. Derivative works cannot be distributed. © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2015 1 <VERSO>J. M. Jiménez Morago et al. <RECTO>Adversity and Adjustment in Children in Protection System <AT>Adversity and Adjustment in Children in Institutions, Family Foster Care, and Adoption <AU>Jesús Miguel Jiménez Morago, Esperanza León Manso, and Maite Román Rodríguez <AFF>Universidad de Sevilla (Spain) <ACK>This study is part of a larger project funded by the Spanish Ministerio de Ciencia e Innovación (SEJ2006–1221 and PSI2010–19287) and the Junta de Andalucía (SI-059/07). It would not have been possible without the collaboration of Jesús Palacios, who directs part of that project. <COR> Correspondence concerning this article should be addressed to Esperanza León Manso. Departamento de Psicología Evolutiva y de la Educación. Facultad de Psicología. Universidad de Sevilla.C/ Camilo José Cela, s/n. Sevilla (Spain).41018. Phone:954–557668. Fax:954–559544. E-mail: ele[email protected] 2 <ABS>Abstract This study’s objective was to identify the adversity profiles of children in different childcare placements, and to analyze their relationship with subsequent psychological adjustment. We studied a group of 230 children 4 to 10 years old indifferent childcare placements(international adoption, institutional care, non-kin foster care, and kinship care), as well as a control group. Information was collected from parent or caregiver interviews and the Strengths and Difficulties Questionnaire (SDQ) . The results showed that children in the child welfare system had experienced significant adversity before their current placement, especially among institutional care cases and international adoptees. Meanwhile, children in kinship care had experienced less adversity (p<.001; size effects from d>.50 to d> .80). After a period of time in their respective placements, children’s psychological adjustment was generally positive, but children living in institutional care exhibited the most problems and difficulties, followed by non-kin foster care cases (p<.001; size effects from d>.50 to d>.80). Finally, we found that children’s early adversity levels (p<.05; r= .16), age of current placement (p<.01; r=.23), and duration of current placement (p< .05: r= –.19) were all tied to current psychological adjustment. <HIS>Received 15 February 2014; Revised 17 September 2014; Accepted 9 October 2014. <KWD>Keywords:adoption;institutional care; foster care; adversity; psychological adjustment 3 In recent decades, the child welfare system in Spain has undergone several wideranging changes affecting its functioning, its agents, and the relative strength of different placement types(Amorós& Palacios, 2004; De Paúl, 2009; León, 2012). Various studies have expanded our knowledge of the different childcare placements, and have drawn comparisons between them (Amorós, Palacios, Fuentes, León,& Mesas, 2003; Del Valle, Bravo,&López, 2009; Del Valle, López, Montserrat,& Bravo, 2008; Jiménez & Palacios, 2008; Palacios, Moreno, &Román, 2013). Still, it remains the case that few studies have compared the results of the three main childcareplacementsin which a boy or girl is separated from his/her family of origin: adoption, kinship care, and residential care. That is true of the Spanish literature (Fernández-Molina, Del Valle, Fuentes, Bernedo,& Bravo, 2011) and that of other countries (Heflinger, Simpkins,& Combs-Orme, 2000). Furthermore, Spain is especially suitable for this kind of research because it has, paradoxically, similarly high rates of international adoption and institutional care placements(Browne, 2005). On the other hand, the overall incidence of family foster care is much lower than that of adoption or institutional care placement (Jiménez & Palacios, 2008; Palacios &Amorós, 2006), whether in non-kin or kin families. Kinship care is the most common family foster care placement in Spain, representing around 80% of reported cases (Del Valle & Bravo, 2003; Del Valle et al., 2008; Jiménez & Palacios, 2008). Many researchers have tried to identify the risk factors characteristic of the population of children who pass through the child welfare system, relating them to past experiences of adversity and the obvious discontinuity – psychological, educational, and social – these boys and girls undergo while transitioning between family situations, or between family and institutional settings (Amorós& Palacios, 2004; Jiménez &Palacios, 2008; Molero, Moral, Albiñana, Sabater,&Sospedra, 2007; Rushton, Mayes, Dance,& Quinton, 2003; Simmel, Brooks, Barth,&Hinshaw, 2001; van der Vegt, van der Ende, Ferdinand, Verhulst,&Tiemeier, 2009). They have identified certain risk factors having to do with adverse circumstances during pregnancy, like prenatal maltreatment, maternal substance abuse, and maternal stress (Crea, Barth, Guo,& Brooks, 2008; Palacios & Jiménez, 2009; Rutter &O’Connor,2004);and during the perinatal period, such as low birth weight, premature birth, and neonatal drug withdrawal (Oliván, 2005; van der Vegt et al., 2009). More often, the literature alludes to postnatal factors prior to foster care or adoption, including childhood maltreatment experiences (Grotevant et al., 4 2006; van der Vegt et al., 2009);developmental delay (Jiménez & Palacios, 2008; Juffer& van IJzendoorn, 2009;Palacios, Sánchez-Sandoval, León, &Román, 2008);stays in institutional care, sometimes longer than desirable or with a very low quality of basic care (Rutter, 1998); number of past foster care placements (Palacios & Jiménez, 2009; Simmel, Barth,& Brooks, 2007); and at what age, sometimes quite late,a childcare placement began (Berástegui, 2005;Jiménez & Palacios, 2008; Simmel, Brooks, Barth,&Hinshaw, 2001). In addition, some studies have reported (Hernández-Muela, Mulas, Téllez de Meneses,&Roselló, 2003; Oliván, 2005) chronic or viral illness among these children, often requiring hospitalization and acute care, and different forms of disability (Fernández-Molina, 2008) that require greater parental dedication and can become a risk factor if parents do not have access to the educational resources and support needed for at least adequate care. In most cases, such studies have identified isolated risk factors that are involved in psychological adjustment during childhood. Nevertheless, in recent years, they have placed greater emphasis on examining the influence of risk factors overall, through cumulative or additive processes. Along those lines, the cumulative model proposes that it is the sum of adverse experiences that determines risk in terms of behavioral and psychological adjustment in children, independently of the factors comprising that accumulated adversity. One of the first authors to propose a cumulative risk model was Rutter (1985), and subsequent research has extensively expanded on and replicated that focus (Atzaba-Poria, Pike,&Deater-Deckard, 2004; Jiménez, Mata, León,& Muñoz, 2013; León, 2011; Sameroff&Fiese, 2000; Sameroff, Gutman,& Peck, 2003; van der Vegt et al., 2009). In addition to the above, children and adolescents in the child welfare system often exhibit behavioral adjustment and psychological problems (Del Valle, López, Monserrat,& Bravo, 2008; Fernández-Molina et al., 2011; Jiménez & Palacios, 2008; Simmel, Brooks, Barth,&Hinshaw, 2001; Sonuga-Barke, Schlotz,&Kreppner, 2010; Vanderfaeillie, van Holen, Trogh,&Andries, 2011). Such issues are apparent even when youths fostered by non-kin are compared to those fostered by kin. While there is not solid consensus among researchers about this, various studies have demonstrated that children in non-kin foster care exhibit fewer behavioral problems (Jiménez & Palacios, 2008; Keller et al., 2001). 5 Several studies have also shown that certain experiences, and children’s early adversity levels, can influence their recovery and subsequent levels of adaptation and psychological adjustment (Palacios & Jiménez, 2009; Rutter, 1998). Nevertheless, despite the great many adverse circumstances and risk factors present in the early histories of boys and girls in the child welfare system, the literature to date indicates that a high percentage of them recover well –physically, socio-emotionally, and in terms of cognitive development – and they usually adjust well to adoption or foster care placement (Jiménez & Palacios, 2008; Juffer&van IJzendoorn, 2009; Palacios, Román,& Camacho, 2011; Rutter & the ERA Study Team, 2010). Furthermore, numerous studies have observed that family foster care and adoption are linked to better adaptation and adjustment in boys and girls than institutional care placement, even when the youths begin with similar adversity levels (Juffer& van IJzendoorn, 2009; Palacios, 2003; Palacios, Moreno,&Román, 2013; Román, 2010; Tizard& Hodges, 1990). With all that in mind, the present study will analyze two important aspects of the trajectory of children who pass through the child welfare system, having received one of three different placements: adoption, kinship care, or institutional care. First, we will analyze the youths’ early histories prior to their current placement, and identify experiences of adversity and clear discontinuity in their lives. Second, we will study their current levels of psychological adjustment and the presence of certain problems. Ergo, this study’s main objective is to identify the adversity profiles of children in different childcare placements and then relate those to current psychological adjustment. <H1>Method <H2>Participants The sample was comprised of 230 boys and girls living in Andalusia, a region in southern Spain. It included groups of children residing in institutional care facilities (n = 50), non-kin foster care (n = 28), kinship care(n = 54), and a final group of international adoptees from Russia (n = 40). The study also included a control group from a normative sample of families with children (n = 58). The children participating were 4 to 10 years old at the time of the study, with an average age of 6.5 years (M = 78 months; SD = 18.103). The gender distribution of the total sample was 43.5% girls (n = 100) and 56.5% boys (n = 130). That gender ratio was highly consistent across groups, except among international adoptees; in that group, boys were overrepresented, which is 6 typically true of international adoptions from the Russian Federation. That being said, differences between groups in gender distribution were not statistically significant. As for level of education, the proportion of families in the control group with higher education was 53.4%, while for the set of international adoptees and children in family foster care (this information was not available for children placed in institutional care), it was 36.9%. The differences were significantly larger when groups of children with different childcare placements were analyzed separately. 82.5% of adoptive families had received higher education, compared to 32.1% of non-kin foster families and 5.6% of kin foster families. That is consistent with the usual characteristics of such families. <H2>Instruments In order to explore – from a cumulative point of view – early adversities in boys and girls in the child welfare system, prior to their current placement, we created an early adversity index comprised of ten variables that reflect the severity of documented situations of suffering these children have experienced. As mentioned above, most research in this population has shown such situations to be both prevalent and related to the child’s difficulty adapting to his/her childcare placement. The index included: childhood maltreatment and having experienced multiple comorbid types of it, chronic and/or viral illness, prenatal drug/alcohol exposure, developmental delay, history of institutional care, disability, and birth problems. Information from the youths’ early histories came from their child welfare system records and from adoptive parent or caregiver interviews. Each variable was scored as either present (1) or absent (0), except that institutional and family foster care history were scored 0 to 2 depending on the number of prior residential or family foster care placements (0 = none; 1 = one foster care placement; 2 = two or more foster care placements). The lowest possible score was 0; the highest was 12. To assess psychological adjustment and the incidence of problems among these children, we utilized the Spanish version of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). It has 25 items, gets administered to parents or guardians, and taps behavioral adjustment in children. It is comprised of five scales with five items each. The questionnaire covers both strengths (Prosocial) and difficulties (Emotional Problems, Conduct Problems, Hyperactivity, and Peer Problems). Here are some sample items:“Often loses temper” (Item 5, Conduct Problems scale); “Helpful if someone is hurt, upset, or feeling ill” (Item 9, Prosocial scale); “Easily distracted, concentration 7 wanders” (Item 15, Hyperactivity scale). Scores on each of the five scales range from 0 to 10. Total difficulties scores are computed by adding all the individual scale scores except Prosocial, so difficulties scores range from 0 to 40 points. Cronbach’s alpha coefficient for total difficulties was .75. The present research employed the official copyrighted version of the SDQ published at the website. <H2>Procedure We applied the inclusion criterion that all boys and girls who participated are between 4 and 10 years of age. Adoptive families were recruited via two Spanish organizations that work with adoptions from Russia. Most of the adoptive and foster families the research team contacted agreed to participate. Only 10 adoptive families and 5 foster families declined to participate, and that was mainly due to difficulty finding an interview time and day that was convenient for the family, or to unforeseen problems (for example, the death of a relative). The regional government of Andalusia granted us permission to identify and contact the foster families and institutional care facility residents who were ultimately included in the sample. To form a control group, we contacted 10 schools from different neighborhoods in Seville, each representing a different socioeconomic status. After seeking families’ collaboration, participants were randomly selected. To participate in the study, boys and girls in the control group could not have had any contact with the child welfare system. Ten percent of families in the control group who received the letter declined to participate in the study. Since the optout rate was so low, we did not specifically study it, so we cannot be sure that those who opted out and those who chose to participate are totally comparable. On a different note, to collect information about each child’s early history and adjustment at home, or to the institution where they resided, his/her primary caregiver was interviewed. In institutional care facilities, personnel identified the caregiver with the closest relationship with the boy or girl, and that person was interviewed. A group of specially trained psychologists were in charge of conducting parent interviews and collecting data. The test of psychological adjustment (SDQ) could not be administered to one disabled youth. Additionally, there were three youths living in institutional care facilities whose caregivers did not complete it. 8 The Research Ethics Committee at the University of Seville approved this research project, in keeping with Spanish and European Union norms governing research in human subjects. Data analysis was conducted in SPSS version 22. <H1>Results As Table 1 illustrates, the average age at which these youths received their current childcare placement was approximately three and a half years old (43.74 months), and was significantly different in each of the groups studied, F(3,171) = 30.179 p< .001. The boys and girls living in institutional care facilities were placed latest (63.73 months), followed by those in non-kin foster care, and by a large margin, adoptees. On the other extreme were children in kinship care, who were placed at barely two years old on average (24.04 months). Also appearing in Table 1, the average duration of current childcare placements was under three years. Nevertheless, that duration, also differed significantly across groups, F(3,171) = 28.670 p < .001. The group of youths in kinship care had been placed for the longest time, over four years on average (49.76 months). They were followed by the adoptees, which had been placed for 10 months less than the kinship care group. They were followed closely by the children in non-kin foster care, who had been placed with their foster families an average of35.57 months. The most recently placed were youths were in institutional care, with an average duration just over one year(13.76 months). Post hoc comparisons (Scheffe’s test) between groups found to be statistically significant appear in Table 1. <Table 1 approximately here> <H2>Boys and Girls’ Early Adversities Predictably, boys and girls in our study had a history of severe difficulties prior to their current childcare placements. As Table 2 points out, the incidence of past institutional care (73.8%) and the incidence of childhood maltreatment (61.0%) were noteworthy. Furthermore, we found that 35.5% of these children had suffered multiple forms ofmaltreatment simultaneously, 32.6% had a chronic illness (for example, respiratory or intestinal disease), and a quarter (26.7%) had prenatal drug/alcohol exposure. Also, 17.5% of these children had previously been placed in kinship care, 15.1% were developmentally delayed, 10.5% had birth problems likelow birth weight or premature birth, and 9.9% had some type of disability. Viral diseases like HIV and 15 the child welfare system should strive to maintain continuity across a child’s placement/s and transition/sto avoid accumulation of changes and childcare placements. 16 <H1>References <REFJ>Amorós, P.,& Palacios, J. (2004). Acogimiento familiar [Familyfostercare]. Madrid, Spain: Alianza Editorial. <REFJ>Amorós, P., Palacios, J., Fuentes, N., León, E.,& Mesas, A. 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(1990). Ex-institutional children: A follow-up study to age 16. Adoption and Fostering, 14(1), 17– 20.http://dx.doi.org/10.1177/030857599001400105 20 <REFJ>van der Vegt, E. J. M., van der Ende, J., Ferdinand, R. F., Verhulst, F. C.,&Tiemeier, H. (2009). Early childhood adversities and trajectories of psychiatric problems in adoptees: Evidence for long lasting effects. Journal of Abnormal Child Psychology, 37, 239–249. http://dx.doi.org/10.1007/s10802- 008-9272-2 <REFJ>Vanderfaeillie, J., van Holen, F., Trogh, L.,&Andries, C. (2011). The impact of foster children’s behavioral problems on Flemish foster mothers’ parentingbehavior. Child & Family Social Work, 17(1), 34– 42.http://dx.doi.org/10.1111/j.1365-2206.2011.00770. 21 Table 1. Children’s Average Age (in Months) When Current Placement Began, and Duration of Placement. Adoptees Non-kin Foster Care Kinship Care Institutional Care Mean (SD) Age of Placement 35.78a 57.43a,c 24.04b,c 63.73a,b 43.74 (28.55) Time Since Placement Began 39.9a 35.57b 49.76b 13.76a,b 34.69 (24.68) Note. Means between groups with the same superscript (a, b, c, d) are significantly different with p ≤ .05. 22 Table 2. Children’s Early Adversity According to Childcare Placement (as a Percentage) Adoptees Non-kin Foster Care Kinship Care Institutional Care Total Sample History of institutional care (0/1/2) 95% 82.1% 29.6% 100% 73.8% Childhood maltreatment 22.5% 57.1% 55.6% 100% 61% Comorbid maltreatment types 10% 42.9% 38.9% 48% 35.5% Chronic illness 75% 17.9% 16.7% 24% 32.6% Prenatal drug/alcohol exposure 30% 17.9% 35.2% 20% 26.7% Prior kinship care placements 12.5% 32.1% 16.7% 14% 17.5% Developmental delays 50% 3.6% 1.9% 8% 15.1% Birth problems (LBW, premat.) 20% 7.1% 11.1% 4% 10.5% Disability 2.5% 17.9% 11.1% 10% 9.9% Viral illness (HIV, hepatitis) 0% 7.1% 5.6% 0% 2.9% 23 Table 3. Children’s Early Adversity Index Scores According to Placement Group. N M SD 1. Adoptees 40 3.7 a 1.36 2. Non-kin foster care 28 3.35 b 1.80 3. Kinship care 54 2.25,a,b,c 1.70 4. Institutionalcare 50 3.64 c 1.22 Total 172 3.17 1.63 Note.Mean between groups with the same superscript (a, b, c, d) aresignificantly different (p ≤ .05). Effect size: 2–3, d >.50; 1–3, 3–4, d >.80. 24 Table 4. Total Difficulties Scores (SDQ) According to Placement Group N M SD 1. Control group 58 11.65a 5.62 2. Adoptees 40 11.15 b 5.32 3. Non-kin foster care 27 15.11 5.53 4. Kinship care 54 13.24 6.69 5. Institutional care 47 15.76 a, b 5.73 Total 226 13.21 6.07 Note.Mean between groups with the same superscript (a, b, c, d) aresignificantly different (p ≤ .05) Effect size: 1–5, d >.50; 2–5, d >.80.