Nonrandomized Studies Are Evidence Too: Findings From a Systematic Review of Kinship Care

Description of Problem

Much of the research on kinship care is anecdotal, as ethical standards preclude the random assignment of children to out-of-home placement. Thus, there is a need for systematic reviews that embrace the challenge of synthesizing nonrandomized studies of kinship care. However, there are many unresolved issues including the assessment of methodological quality.

Objectives

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.

Research Questions

Is there a difference between children placed in kinship care and children placed in foster care on safety, permanency, and well-being outcomes?

Methods

Study Design

The systematic review included quasi-experimental studies, in which children placed in kinship care were compared cross-sectionally or longitudinally with children placed in foster care. The types of eligible quasi-experimental designs included studies that employed matching, covariates, or ex post facto comparisons.

Description of Participants

Children and youth under the age of 18 who were removed from the home for maltreatment and subsequently placed in formal kinship care with licensed or unlicensed kin caregivers.

Sampling

A comprehensive electronic search of the kinship care literature base using 15 online databases yielded 4791citations that matched the search terms, 263 references that met the initial criteria, 251 articles/reports that were available for review, 90 studies that were eligible for inclusion, and 62 studies that were ultimately included in the evidence base.

Data Collection

Reviewers independently read the abstracts identified in the search and selected appropriate studies. Reviewers assessed the suitability of studies for the evidence base and evaluated the methodological quality of the included studies. Lastly, outcome data were extracted and entered into a meta-analytical software program.

Measures

Outcome measures included behavioral development, mental health, placement stability, permanency, and service utilization.

Analytical/Statistical Approach

A meta-analytic approach was used to analyze differences between the placement types on outcomes, which generated effect sizes, odds ratios, and heterogeneity statistics.

Results

Summary Children in kinship care experience better outcomes in regard to mental health problems (g = .46), behavior problems (g = .24), adaptive behaviors (g = .45), and placement stability than do children in foster care. Children placed with foster parents are more likely to be adopted and utilize mental health services.

Conclusions and Implications

Main Outcomes

The main outcome is that evidence from nonrandomized studies can inform child welfare practice if rigorously and systematically reviewed. Furthermore, systematic reviews of social work interventions are essential if the appetite for evidence-based practices is to be satisfied.

Implications

Although this review supports the practice of treating kinship care as a viable out-of-home placement option, policies mandating kinship placements may not always be in the best interest of children and families. Professional judgment from child welfare professionals should be used to assess the individual needs of children and the ability of caregivers to meet these needs. It is clear that researchers and practitioners must work together to address the biases that hamper the study of kinship care.