Factors Associated with Kinship Caregivers' Formal Service Use: A Systematic Review

Background and Purpose: Recent changes to U.S. child welfare policies have prioritized placement of foster care children with their relatives.  In consequence,  a growing number of children are placed with kinship caregivers. Because kinship care providers are more likely to be poor and less likely to receive help from child welfare and other human service agencies relative to other caregivers, it is important for human service professionals to provide adequate support to increase kinship care providers’ caregiving capacity. Thus, the purpose of this systematic review was to synthesize research studies examining relative caregivers’ service use in order to summarize key factors that promote and inhibit their service use to inform future policy, practice, and research initiatives with this population.  

Methods: Best practices for the preparation of systematic reviews were followed, as propounded by Littell, Corcoran, and Pillai (2008) and Cooper (2010) and in pertinent (i.e., AMSTAR and PRISMA) guidelines. Six databases (PsychINFO, PubMed, Social Services Abstracts, Family and Society Studies Worldwide, Sociological Abstracts, and Dissertations and Theses:Full Text) were searched with the assistance of a university social science reference librarian, resulting in 337 potentially relevant studies for review. Manual searches of the following three journals were also conducted: Child Abuse & Neglect, Child Maltreatment, Children and Youth Services Review, and the Journal of Family Social Work. Screening and eligibility assessment based on a prioriinclusion criteria led to a final sample of 14 studies, including published studies and those found in the “grey” literature. Pilot-tested coding sheets were used to extract relevant data from all included studies.  

Results: Predictors/correlates associated with kinship caregivers’ service use were grouped into child characteristics and caregiver characteristics. Child factors promoting service use were severity of the child’s emotional/behavioral problems, older age, and gender, with males being more likely to use services. Caregiver factors promoting service use were social support, resources, perceived need, and positive perceptions of the child welfare agency. Caregiver factors inhibiting service use were the lack of adequate resources, poor mental health, lack of perceived need for services, and negative perceptions of the agency. Few of the studies reviewed had strong research designs, comprehensive measures of formal service use, or evaluated service or intervention effectiveness. Also, included studies mostly comprised of African American caregivers and children.

Conclusions and Implications: Findings of this systematic review reveal practice, policy, and research issues related to service provision in child welfare. Findings across studies indicate that children and relative caregivers are in need of services but are not likely to receive them. Social workers, mental health clinicians, and intervention programs should use effective strategies that are age and culturally appropriate for kin and assess their physical and mental health, resources, and perceptions of formal service use when linking them to services. In addition, future policies should incorporate system changes and interagency collaboration between mental health institutions, school systems, and child welfare in order to support a wraparound approach to service delivery for children in kinship care.