Using Quantitative and Qualitative Methods to Explore Barriers to Permanency for Children with SED and Their Parents

Background & purpose: Annually, 700,000 children spend time in foster care; many experience lengthy stays and exit without achieving permanency (DHHS, 2010). Prior research has examined numerous child, family, and case characteristics and their relationship with foster care exit. While many studies found that children's mental health status was significantly related to permanency (e.g., Akin, 2010; Connell et al., 2006; McDonald et al., 2007; Snowden et al., 2008), these studies used varying definitions of mental health and may not generalize across jurisdictions. This study was undertaken to examine the preliminary selection of the target population for a permanency innovations initiative – children with severe emotional disorders (SED). The authors sought to: 1) verify the relevance of children's mental health as a key predictor of long term foster care (LTFC) and reunification and 2) identify critical barriers to permanency encountered by parents of children with SED. Methods: A longitudinal study design was used to observe 7,099 children who entered and stayed in foster care for 30+ days in 2006-2007. This entry cohort was observed prospectively for 3-5 years. Study outcomes were LTFC (yes/no) and time to reunification, which were analyzed with logistic regression and survival analysis. Additionally, case record reviews and caseworker interviews were conducted on 30 randomly selected cases of children with SED who were in care for 3-5 years. These data were coded both to measure the prevalence of characteristics and to identify those characteristics that posed the biggest obstacle to successful reunification or other permanent exit. Results: Findings showed that 14% of children experienced LTFC. The rate was 20% for children with SED and 7% for those without SED. After controlling for all child and case characteristics, SED was the strongest predictor of LTFC. Children with an SED were 3.6 times more likely to experience LTFC. Similar results were found with multivariate survival analyses of reunification: children without SED were nearly twice as likely to reunify, compared to children with SED. Four parent variables were identified by case reviews as both highly prevalent and strongly related to LTFC: 1) poverty issues, 2) parent trauma history and mental health problems, 3) parent substance abuse problems, and 5) parenting competency. Conclusions & Implications: Findings verified that SED was the most robust predictor of LTFC and poor reunification outcomes. Compared to the non-SED population, children with SED experience more placement settings, fewer and slower exits to permanency, and are likelier to remain in foster care for 3+ years. Findings thus confirm that the selected target population is likeliest to benefit from this initiative. Moreover, the study contributed novel information about critical barriers to permanency for parents of children with SED. Our research suggests that to reduce LTFC, interventions targeting children with SED must adequately address parental trauma, mental health and substance abuse problems, need for concrete services, and parenting. The team also concluded that research, policy, and practice were well integrated into these data exploration efforts due to a partnership between a public child welfare agency, private agencies, and a university.