Children cared for by a relative after being removed from the family home because of maltreatment do better on most measures than those placed with strangers in foster care, researchers reported.
But they have a higher risk of pregnancy and a tendency toward greater substance abuse, according to Christina Sakai, MD, and colleagues at the University of Texas Southwestern Medical Center in Dallas.
And so-called kinship caregivers had fewer support services -- including financial support and parent training -- than foster caregivers, Sakai and colleagues reported in the February issue of Archives of Pediatrics & Adolescent Medicine.
The number of children in kinship care is estimated to be 125,000 across the U.S. and the number is growing, Sakai and colleagues noted. However, evidence for improved outcomes as a result of kinship care has been conflicting, they added.
To try to clarify the issue, they turned to the National Survey of Child and Adolescent Well-Being, a nationally representative survey by the Department of Health and Human Services of children in the child welfare system.
For this analysis, they looked at 1,308 children entering out-of-home care following reported maltreatment, including 572 in kinship care and 736 in foster care. They and their caregivers were interviewed when they entered care and again after three years to evaluate the children's behavioral, mental health, and health service use as well as support services for caregivers.
Sakai and colleagues found that kinship caregivers were significantly older and more likely to be single than foster caregivers, at P=0.01 and P=0.008, respectively.
They were also four times more likely to have not finished high school, almost three times more likely to have an annual household income less than $20,000, and more likely to be unemployed -- at P<0.001, P<0.001, and P=0.02, respectively.
Despite their limited resources, they got less support than foster caregivers. They were less likely to get financial support or parent training, have a support group or respite care, or have any part of developing a service plan for the child. (The relative risks were 0.35, 0.23, 0.13. 0.15, and 0.75, respectively, and all were statistically significant.)
The children in kinship care did better on most measures, however:
- 30.2% of children in kinship care had behavioral problems, compared with 53.1% of those in foster care, for a relative risk of 0.59 with a 95% confidence interval from 0.41 to 0.80.
- 23.6% had social skills difficulties versus 40.1%, for a relative risk of 0.61, with a 95% confidence interval from 0.40 to 0.87.
- They were also less likely to use mental health therapy or psychotropic medication. The relative risks were 0.45 and 0.46, respectively, and neither 95% confidence interval crossed unity.
- On the other hand, adolescents had a high risk of pregnancy -- 12.6% versus 1.9%, which yielded a relative risk of 4.78 and a 95% confidence interval 1.07 to 17.11. However, actual numbers were small -- 17 in the kinship group and six in the foster group.
- There was also a tendency toward greater substance abuse, but the relative risk of 1.88 fell short of statistical significance.
The findings suggest that better supervision and monitoring of kinship care giving, combined with more support, is "urgently needed to improve outcomes of children in kinship care," the researchers concluded.
However, they cautioned that the study methods introduce a potential for reporting bias, both at the beginning of care and at the three-year follow-up. Other limitations included the possibility of unmeasured confounders which could affect the result, potential lack of generalizability to informal kinship care since the study only looked at kinship arrangements made through the child welfare system, and inability to assess how long children were in the care arrangement or moved to other care, since only initial placement was considered.
The study had support from the Department of Health and Human Services. The authors did not report any potential conflicts.
- Reviewed by Dori F. Zaleznik, MD Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Archives of Pediatrics & Adolescent MedicineSource Reference: Sakai S, et al "Health outcomes and family services" Arch Pediatr Adolesc Med 2011; 165(2): 159-165.