Maltreatment can impact the earliest stages of development during which time patterns of emotion regulation and attachment begin to be established (Carlson, Cicchetti, Barnett, & Braunwald, 1989b; Cicchetti, Ganiban, & Barnett, 1991). These disruptive patterns are problematic for early moral development and are likely to play a role in the development of conduct disorders (Aber & Cicchetti, 1984). Thus, maltreated children are clearly in a high-risk situation. To examine emotion regulation, internal representations of relationships, and early moral development, the use of a play narrative story stem technique (Bretherton, Ridgeway, & Cassidy, 1990; Buchsbaum & Emde, 1990) with maltreated children and a nonmaltreated disadvantaged comparison group of children is described. Representative case examples from each group are used to illustrate the effectiveness of this technique for eliciting themes about family relationships, conflicts, and their resolution or lack thereof as well as defenses and coping styles. The potential usefulness of this paradigm for clinical assessment and intervention are discussed.

ABSTRACT. Objective. Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify.Design. Prospective cohort. Setting. Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months.Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later).Outcome Measures. 1) Risk behaviors: delinquent, sexual, self-destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence.Results. Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs ؊0.11), substance use (0.16 vs ؊0.11), and total risk behavior problem standardized scores (0.12 vs ؊0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender.Conclusions. These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed. Pediatrics 2001;108(1). URL: http://www.pediatrics.org/cgi/content/full/108/1/ e10; foster care, risk behaviors, child abuse, adolescence.ABBREVIATIONS. SD, standard deviation; CBCL, Child Behavior Checklist.C hildren entering foster care have high rates of emotional, behavioral, developmental, and physical health problems and are in need of many specialized services. [1][2][3][4][5][6] In one California study, children in foster care comprised Ͻ4% of Medi-Cal-eligible children, but accounted for 41% of all children who used Medi-Cal mental health services. 7 The limited long-term research on children in foster care suggests that they are at risk for continued difficulties, including not finishing high school, incarceration, and chronic problems with employment and housing....

ABSTRACT.Objective. Each year more than 500 000 children enter out-of-home placement. Few outcome studies of these children specifically address high-risk sexual behavior and adolescent pregnancy. Our study investigated the relationship between living in kinship or foster care and high-risk reproductive behaviors in a nationally representative sample of women.Methods. Data from 9620 women ages 15 to 44 years in the 1995 National Survey of Family Growth were analyzed in a cross-sectional study. Three groups-foster (n ‫؍‬ 89), kinship (n ‫؍‬ 513), and comparison (n ‫؍‬ 9018)-were identified on the basis of self-reported childhood living situations. Bivariate and multiple linear regression analyses were performed. The outcome variables were age at first sexual intercourse and at first conception and the number of sexual partners.Results. After adjustment for multiple predictor variables, foster care was associated with younger age at first conception (difference: 11.3 months) and having greater than the median number of sexual partners (odds ratio: 1.7, 1.0 -2.8). Kinship care was associated with younger age both at first intercourse (difference ‫؍‬ 6 months) and at first conception (difference: 8.6 months) and having greater than the median number of sexual partners (odds ratio: 1.4, 1.1-1.8). There were no differences between the kinship and foster groups.Conclusions. A history of living in either foster or kinship care is a marker for high-risk sexual behaviors, and the risk is comparable in both out-of-home living arrangements. Recognition of these risks may enable health care providers to intervene with high-risk youth to prevent early initiation of sexual intercourse and early pregnancy. Pediatrics 2001;108(3). URL: http://www. pediatrics.org/cgi/content/full/108/3/e46; foster care, kinship care, adolescent pregnancy.ABBREVIATIONS. NSFG, National Survey of Family Growth; OR, odds ratio. I n 1999 in the United States, approximately 547 000 children were in formal out-of-home placement on any given day. 1 Many more have spent some portion of their lives in foster care. The majority of these children are removed from the care of their biological parents because they have been physically abused (12%-25%), neglected (50%-75%), sexually abused (2.7%-9%), or abandoned (9%-23%) or have a parent who is incarcerated or otherwise unable to care for them (15%-30%). [2][3][4][5][6] Approximately 25% of foster children will live in 3 or more foster homes. 7 During the past decade, the most common type of placement for these children shifted. Formal kinship care, defined as placement by a child welfare agency with relatives, is now the fastest-growing type of out-of-home placement. 8 Nationally, the percentage of children who are in out-of-home placement and were in formal kinship care increased from 18% in 1986 to 31% in 1990. 9 In some states, it is as high at 50%. 10 Increased use of kinship care has resulted from an increase in the number of children who need placement and a decreased availability of nonrelative foster ...

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This study assessed relations among number of out-of-home placement changes, time in caregivers’ care, caregiver type (i.e., foster parent, adoptive parent, kinship relation, and biological parent), child gender, and caregiver-child Emotional Availability (EA) as predictive of child attachment security when children were 3 years old in a sample of 104 caregivers and children. Children entered court-ordered care by six months of age. On average, children at the age of three spent 30 months with their caregivers, and nearly half of them were adopted by that time. Child attachment was assessed using the Attachment Q-set (Waters & Deane, 1985), and caregiver-child EA was assessed using the EA Scales, 4th edition (Biringen, 2008). Sixty-six percent of children at age 3 showed secure attachments with caregivers, and EA subscale scores were also relatively high on average. The study predictor variables of EA Caregiver Sensitivity, Child Responsiveness, and Child Involvement predicted attachment security, with girls more likely to be securely attached to their substitute caregivers at age three than boys. Study limitations and directions for future research are discussed.

Objective-Many children in the US who are court-ordered to live in out-of-home care are placed with kinship caregivers. Few studies have examined the impact of living with kin on child well-being. This study examined the relationship between length of time living with kin and indices of adolescent well-being in a cohort of children who were initially court-ordered into outof-home care.Methods-Prospective cohort design with 148 youth, ages 7-12, who entered out-of-home care between May, 1990, and October, 1991. Seventy-five percent of those interviewed at T1 (6 months following placement) were interviewed at T2 (5 years later).Results-Bivariate analyses did not demonstrate significant relationships between length of time living with kin and the outcome variables. In multivariate analyses, longer length of time living with kin was related to: 1) Greater involvement in risk behaviors including: delinquency (β = .22, p < .05), sexual risk behaviors (β = .31, p < .05), substance use (β = .26, p < .05), and total risk behaviors (β = .27, p < .05), and 2) Poorer life-course outcomes including: tickets/arrests (OR=1.4, p<.05) and lower grades (β = −.24, p < .05). Time living with kin was not related to total competence, or self-destructive, internalizing, externalizing, or total behavior problems. There were trends (p <.10) for time living with kin to predict greater trauma symptomatology (β = .17) and suspensions (OR=1.1).Conclusions-There were no significant bivariate findings. The multivariate findings suggested a pattern of poorer functioning for youth who spent more time living with kin. No differences were found in current symptomatology.Practice implications-Although findings from a single study should not dictate changes in practice or policy, the current study's findings do suggest that the field needs to conduct more methodologically-sophisticated research on the impact of kinship care.

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