Richard Barth and Laura Chintapalli (chapter 5 in this volume) provide a rich review of recent research documenting the challenges of achieving permanence for adolescents in the child welfare system. They describe evidence that adolescents in foster care are likely to experience “a heightened state of impermanence” as a result of placement instability, failed reunification and reentry, lengthy stays in group care, and termination of parental rights (TPR) without subsequent adoption. Poor outcomes among youth who age out of foster care are viewed as a direct result of the failure to achieve permanence for youth in care. Both interventions and policy changes that could be implemented to enhance permanence for youth are presented.
Barth and Chintapalli provide a definition of permanence that highlights the importance of the emotional quality of the relationship between caregivers and youth. They state, “permanency is a state of security and attachment that involves a parenting relationship that is mutually understood to be a lasting relationship.” This child-focused definition spotlights optimal conditions for child development and helps distinguish the greater potential for family connection and nurturing parental relationships present in family-based care but typically absent in institutional placements.
Often, the discourse concerning research, interventions, and policy centers on the more common focus and more conveniently measured outcome of legal permanence. In most research and legislation, achieving “permanence” refers to successful reunification, adoption, or guardianship. This focus obscures the importance of nurturing parental connections that are critically important for youth development, irrespective of whether the relationships are formally recognized with legal sanction. Seminal research in attachment theory has established that children need the opportunity to form personal relationships with select caregivers who provide responsive, sensitive, and continuous parenting over time (Bowlby, 1988; Rutter and O'Connor, 1999). Research further shows that relationships with caring adults and significant others offset the risk of parental impairment and maltreatment (Werner and Johnson, 2004; Werner and Smith, 1982; Feldman et al., 2004).
As researchers and advocates focus on permanency for youth in child welfare, it is essential that the developmental and relational qualities of permanence that underlie legal status and placement characteristics be considered. The qualities of youth's relationships with caregivers and significant others are distinct aspects of permanency that are too often overlooked when agencies focus exclusively on increasing the numbers of youth who achieve legal permanence. Prospects for relationships that provide emotional security and a sense of belonging need to be explored as agencies make efforts to enhance permanence and improve outcomes for youth in foster care. Maintaining a comprehensive notion of permanence opens additional avenues for understanding and improving the experience of foster care for youth who are not legally connected to families and for youth who return home or legally join new families.
Permanency advocates have proposed a conceptualization of permanence that encompasses multiple dimensions and that explicitly acknowledges the importance of the emotional and relational aspects of permanency and connections to culture, family, and tradition in addition to physical stability and legal status. According to Lauren Frey et al. (2005:5), in achieving any of the permanency outcomes, the objective is the optimal balance of physical, emotional and relational, legal, and cultural dimensions of permanency within every child's and youth's array of relationships.
• Physical permanency relates to a safe and stable living environment.
• Emotional and relational permanency relates to the primary attachments, family, and other significant relationships that offer trust and reciprocity.
• Legal permanency relates to the rights and benefits of a secure legal and social family status.
• Cultural permanency relates to a continuous connection to family, tradition, race, ethnicity, culture, language, and religion (Frey et al. 2005:5).
When youth cannot return home to their birth families, it is essential that they be given opportunities to develop relationships with caregivers that are continuous over time and that provide responsive and sensitive care. Recognition of the importance of these relationships is not new in the field of child welfare. Early research in attachment demonstrated the deleterious effects on children when they were maintained in environments that did not allow for the formation of selective and continuous attachment relationships (Bowlby, 1951). This research provided an impetus for communities to discontinue the widespread use of orphanages or group care settings as a first choice for youth who could not live with their birth parents and to rely instead on family foster care (Cliffe and Berridge, 1991). Further research in attachment theory demonstrated that the need for selective attachments is rooted in the biological nature of children and serves the specific purpose of providing emotional security during times of stress (Bowlby, 1982 [1969], 1988; Ainsworth et al., 1978). In addition, the quality of early care that a child receives has an important influence on adjustment and social relatedness (Rutter and O'Connor, 1999). According to attachment theory, early experiences with caregivers are internalized in “working models” of the self in relation to others (Bowlby, 1988). Children who experience sensitive, responsive caregiving are more likely to develop secure attachment relationships with caregivers that increase the likelihood of positive adjustment over time (Simpson et al., 2007; Sroufe et al., 1990; Urban et al., 1991).
Family foster care was intended to provide a better alternative to group care settings for children who could not return home to live with their birth parents. Foster care provides children with the opportunity to receive parenting from only one or two individuals and thus form selective attachments to these specific caregivers within a family setting. It was expected that relationships formed within these family settings would provide a greater continuity of care than group settings (Rutter and O'Connor, 1999). Foster care youth who cannot be reunited with their birth parents have typically experienced early maltreatment, as well as the separation and loss of birth parents as primary caregivers (whether or not parents rights are terminated), and, as a result, they often face challenges in forming secure relationships. By forming attachments to new caregivers, youth can meet their developmental need for an attachment that provides emotional security. They also have an opportunity to internalize new expectations of themselves and others that challenge early expectations learned in the context of relationships characterized by abuse and neglect.
Youth enter foster care with different relational needs depending, in part, on the age at which they enter care. Infants who enter foster care before having developed significant attachment relationships need a sensitive and responsive caregiver who will provide continuity of care over time. This type of care allows children to develop the attachments they need to establish a sense of emotional security and internalize positive expectations of themselves and others. Older youth who enter foster care after having established significant attachments with caregivers and significant others need to maintain these connections whenever feasible. They also need to be afforded opportunities and assistance in forming and maintaining continuous relationships with caregivers that can become significant attachments.
Barth and Chintapalli's review includes several domains of inquiry that suggest the important role of significant attachments, emotional security, and a sense of belonging in the lives of adolescents in the child welfare system. They cite evidence that placement instability is not only the result of emotional and behavioral problems among youth and systemic issues but also can result from uncertainty or hopelessness about reunification and separation from siblings (Barth et al., 2007). Recent evidence from qualitative analyses of youth who run away from foster care (Courtney et al., 2005b) highlights the relational motivations behind this pathway to “impermanence.” Youth who enter care between seven and twelve years of age are most likely to exit by running away. In interviews, youth described running away as an attempt to “make connections with family, friends and a community where they sensed (or hoped) they belonged, were cared about and were wanted” (45). Youth most often reported running toward something, to find the family connections, and the significant relationships from which they had been separated (Courtney et al., 2005b). Additional relational precursors to running away included high levels of family conflict and low levels of family involvement in current placements; reduced running away was associated with placement environments considered warm and caring and placement with a relative. Interestingly, some youth described how they created a sense of family through their relationships with caseworkers, caregivers, and other adults when they did not have a connection to their birth family.
These findings highlight the motivational effect on youth of the need to feel a sense of emotional security and belonging. Older children and adolescents come into foster care with a legacy of attachments. When they are not with people to whom they have formed significant attachments, youth are more likely to disrupt their placements by running from otherwise safe environments so that they can be with important people in their lives. This motivation to connect is likely due, in part, to the role that significant attachments play in reducing stress. It highlights the need for youth to remain connected to their significant relationships while in care whenever possible and their needs for opportunities to form new attachments with caregivers who can serve in this role.
For child welfare professionals, practical implications of this work are evident. It seems likely that many episodes of running away can be prevented by providing youth with ongoing safe contact with the important people in their lives. Of particular importance are interventions that proactively support the development of relationships with caregivers and inclusive teaming approaches that reach out to significant others. Through these interventions, it is possible to foster a sense of emotional security and belonging that may help reduce youth's need to run to be with people whom he or she cares about. Teams can implement plans to ensure youth have access to their significant others. In addition, these interventions can transform the diverse perspectives and too often conflicting agendas of the important people in youth's lives into a group effort to facilitate emotional and relational permanence in conjunction with legal, cultural, and physical permanence.
For youth who cannot return home to live with their birth parents, there is much to be learned regarding how various dimensions of permanence can assist these youth in overcoming multiple risks of early maltreatment and loss so that they can reach adulthood having achieved a sense of well-being and competence. Poor outcomes among youth who “age out” of foster care are often attributed to a failure to achieve legal permanency. Comparisons of outcomes between youth who achieve legal permanence through adoption and those who age out of foster care have been hampered by methodological challenges, yet the limited existing evidence generally indicates that youth who are adopted fare better than those who age out of foster care, particularly with regard to emotional security and a sense of belonging (Triselotis, 2002). There is little research, however, that examines the processes underlying these differences in outcomes.
An understanding of the processes that lead to better outcomes for youth is critical in identifying areas where interventions will be most effective. For example, several differences between youth who are adopted and those who are not may account for the differences in outcomes observed. Youth who are adopted from foster care tend to be younger and have lower levels of emotional and behavioral problems than those who remain in foster care (Connell et al., 2006; Schmidt-Tieszen and McDonald, 1998). Early positive adjustment may result in better outcomes during adolescence and adulthood due to continuity over time, highlighting the need to intervene early to offset the likelihood that problems will develop later. In addition, youth who are adopted are less likely to experience the level of placement instability that is typical among foster youth (Triseliotis, 2002). Given the importance of placement stability in facilitating the continuity of care that is essential for security of attachment to develop, the differences between adopted and foster youth are likely due, in part, to foster youth's lack of opportunity to develop secure attachments with caregivers. Adopted youth also may be more likely to benefit from greater financial support and other resources provided by adoptive families who are particularly invested in their well-being.
Not all youth who age out of foster care without legal permanence fare worse than youth who are adopted. As shown in Figure 6.1, Kerman et al. (2002) examined the outcomes for three groups of alumni from Casey Family Services: youth who had been adopted, youth who remained in foster care for a lengthy period of time (through age nineteen), and youth who had experienced shorter stays (that is, exited before age nineteen). Youth who were adopted and those who stayed for a lengthy period of time had similar outcomes in a variety of domains involving personal well-being and self-sufficiency, including educational attainment, employment, legal involvement, substance abuse, and mental health symptoms. Youth in extended foster care and youth who were adopted fared better than those who experienced shorter stays in foster care.
These findings draw attention to the need to understand the processes involved in achieving positive outcomes for young adults with histories of foster care rather than assuming that permanence defined as a legal status (such as adoption) is the most important element. It is often assumed that foster care is less adequate than adoption in providing placement stability, continuity of relationships, and emotional security, but this assumption may not always be accurate. In some cases, the differences between adoption and long-term foster care may be little more than name and legal status. It is also important to bear in mind that not all adoptions result in stability or emotional security. In the Casey Family Services’ alumni study, youth in long-term foster care had a high level of stability of both family placement and social worker and received services from a well-resourced private foster care agency. Each of these factors is a potentially important aspect of promoting positive adjustment among youth.
Figure 6.1 A general model of placement instability and placement type
Youth who do not achieve legal permanence while in foster care often are described as lacking significant relationships with adults, yet there is evidence that some youth form significant attachments to their caregivers or others and create their own families with individuals with whom they do not have biological or legal relationships. As part of an ongoing longitudinal study of foster youth transitioning to early adulthood at Casey Family Services, we asked foster youth if they had someone in their lives who was not their birth parent that they consider a “parent,” someone whom they could count on when they needed someone, and someone whom they expected would be there for them in the years to come. Interim results indicate that more than 80 percent report they had someone in their lives who fit the description of “parent,” most often a current or former foster parent. These results were obtained for a group of foster youth in a well-resourced private foster care agency, which may account, in part, for these findings. Further research is needed to learn the extent to which youth who are aging out of foster care nationwide may or may not have connections to significant adults and, importantly, what relationship qualities (i.e., emotional security, instrumental support, and financial assistance) may be most beneficial in improving outcomes for youth as they transition to adulthood.
Recent evidence suggests that the quality of youth's relationships with former foster parents has an important effect on their adjustment after leaving care. In an investigation of foster youth five years after leaving care (Cashmore and Paxman, 2006), researchers found that felt security while in foster care, continuity of relationships, and social support were the most robust predictors of positive outcomes. Stability while in care was found to be the means to achieve the more meaningful goals of a sense of security, belonging, and the development of trusting relationships (Cashmore and Paxman, 2006). Similarly, qualitative findings among adults who grew up in foster care highlight the central role that foster families often play in meeting youth's emotional needs for security and belonging (Schofield, 2002).
A large body of research has documented that youth and families involved with the child welfare system need a range of services and supports, whether youth and families are in need of assistance to maintain and sustain the family unit or are working toward permanency, or whether youth are aging out of foster care. Perceptions that supports and services will not be available for families after adoption pose considerable obstacles to promoting legal permanency (Greenblatt et al., 2003; Kirton et al., 2006), and the frequency of service needs following adoption finalization makes this concern a wise one (Festinger, 2006). A lack of services and supports also has been often cited as a barrier to achieving permanency through guardianship and reunification. As in adoption, the anticipated lack of financial and service supports for guardian families often deters youth's kin and others from moving to a legally permanent guardianship situation (Allen et al., 2003). The supports available to families after reunification are badly needed to increase the number of youth who can be successfully reunified.
A number of practice tools and models supporting preparation for permanency are emerging. Casey Family Services, for example, has developed the Belonging and Emotional Security Tool (BEST: Frey et al., 2008) to assist social workers in conversations with youth and foster parents about youth's sense of emotional security with their foster parents and the extent to which each foster parent has a sense that the youth belongs in the family. Foster parents and youth are asked to respond to thought-provoking sentences about their relationship such as, “I would not kick this youth out of the family, no matter what” (foster parent version) or “My foster parent(s) would not kick me out of the family, no matter what I do” (youth version). Administration of the tool serves to introduce the topic of permanence in a comfortable way. Through processing responses to the items, social workers are able to assess the relationship and facilitate discussions with youth and foster parents that often can lead to a stronger commitment and discussion of legal permanence.
Practice models also have been developed to help prepare youth for permanency. The 3-5-7 model (Henry, 2005), for example, assists children and youth in grieving past losses of their birth families, neighborhoods, schools, and other important aspects of their lives; formulating self-identity; establishing relationships with adults that are characterized by trust and security through attachments; and developing a willingness to permanently join families. This model provides guidelines to assist social workers in working with youth to complete tasks, answer specific questions about their past experiences and future expectations, and use specific skills in the process. Practice frameworks and tools such as the 3-5-7 model and BEST can provide valuable assistance in concretizing potentially ambiguous assessment and intervention work.
Several studies have reported poor outcomes such as high rates of unemployment, homelessness, and mental health problems as foster youth reach young adulthood (e.g., Courtney et al., 2005a; Pecora et al., 2005). Referring back to Figure 6.1, the results of Casey Family Services alumni indicate that youth who spent less time in foster care (exited before age nineteen), compared with youth who spent more time in foster care (exited after age nineteen), did not fare as well (Kerman et al., 2002). Similar results were reported in a recent multistate project (Courtney et al., 2005a). These findings suggest that services and supports provided to adolescents as they transition to young adulthood may confer an advantage.
The implementation of these services, however, often has proved challenging. Benjamin Kerman et al. (2004), for example, reported that when Casey Family Services offered an array of transitional services to youth, only 41 percent accepted the services and received them. This finding is of particular concern given the high level of needs documented among these youth. In efforts to attract more youth to these services, leveraging the motivational impact of significant relationships may be helpful.
With regard to behavioral interventions, a number of evidence-based approaches have proven to be particularly successful with adolescents in recent years. These approaches are family therapies that include, as examples, multisystemic family therapy and functional family therapy (Alexander et al., 2002; Carr, 2000; Thompson et al., 2005). These approaches are based in part on a recognition that adolescents are likely to be more motivated to engage in services when their family members are involved. Family members can help motivate and support youth on an ongoing basis to facilitate their engagement with services and the achievement of positive outcomes. As noted earlier, youth who age out of foster care without a permanent legal family do not necessarily lack significant relationships. These significant relationships can be drawn on when planning for and providing services, providing youth with opportunities to receive the additional support and motivation they need to engage with and follow through on services. Services that respect and involve caregivers who are not legally connected to youth may also serve to assist youth and caregivers in solidifying their bonds and moving toward making a legal commitment.
Barth and Chintapalli call for policy changes to better address youth's experiences with impermanence while in foster care. Their recommendations include a national accounting of youth impermanence that extends beyond reentries to foster care and placement moves while in foster care (which are currently monitored by Child and Family Service Reviews) and includes replacements to other relatives outside of the formal foster care program, re-abuse reports for youth who have returned home, and the proportion of children who emancipate from foster care whose parents’ rights have been terminated. They also advocate for the separate reporting of Child and Family Service Review data (and with separate indicators) for those who enter foster care as youth, as distinguished from those who enter foster care as children.
In addition to monitoring youth impermanence as measured by placements and the number of youth who age out of foster care, as Barth and Chintapalli recommend, efforts to measure and account for the quality of youth's relationships are needed. Youth who age out of foster care with or without a legal tie to family need relationships with stable adults on whom they can rely. An accounting is needed of the extent to which these relationships are being developed. Many youth may have important relationships with foster parents or relative caregivers who can and should be included in services to assist youth in making a successful transition to adulthood.
The broadening of any research agenda places a premium on clarified definitions, refined measures, and heuristic frameworks that organize observations and root new work to prior theory and evidence. In order to assess and implement an accounting of permanency as a “state of security and attachment,” emotional security, belonging, or other aspects of relationships between youth and caregivers, psychometrically sound measures for these constructs must be developed. This work requires careful attention to existing measures of closely aligned constructs (such as attachment, warmth, and bonding) and empirical assessment of the relationships among the constructs. Challenges in using psychometri-cally sound measures in applied settings—where they may be viewed as too cumbersome, given the many pressing demands of casework—must be met. Potential solutions may lie in the further engagement of practice leaders in the development and refinement of sound measures that facilitate practice.
Conceptual frameworks, along the line suggested by Barth and Chin-tapelli, represent another important step in helping to tie child welfare research into allied fields’ more extensive basic and applied empirical literature and to catalyze hypothesis testing. Further conceptual work in defining the nonlegal dimensions of permanency and outlining how these dimensions relate to developmental outcomes is needed to facilitate this process. Better definitions and more crystallized hypotheses together will lay the foundation for the development of reliable measures, predictive model testing, and, ultimately, more successful research contributions to practice and policy.
Further research is needed to clarify the processes that lead to better outcomes among youth in the child welfare system, whether they are reunified or adopted, achieve legal guardianships, or age out of foster care as young adults. We need to know more about their relationships with significant adults and how the characteristics of these relationships (such as emotional security, instrumental support, and legal status) contribute to positive adjustment and well-being.
Beginning in early childhood and continuing throughout the lifespan, individuals need to form attachments to selective others to develop a sense of emotional security and protect against stress. The quality of the caregiving environment in early childhood and adolescence affects the likelihood of youth achieving positive adjustment and social relatedness. As researchers and advocates focus on permanence, it is critical that permanence be conceptualized in a way that includes the quality of relationships that can provide emotional security for youth across the lifespan and includes connections that are legally sanctioned and those that are not. There is much to be learned about how these relationships may assist youth in achieving positive outcomes in spite of histories of maltreatment and the loss of birth-parents as their primary caregivers.
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