Medium level of evidence

In a study of 290 reported incidents of abuse and neglect in Colorado family foster homes, group homes, and residential treatment centers, male children were the predominant victims of both physical abuse and neglect. Female children were the predominant sexual abuse victims.

In the same study, researchers suggested that the need to place children in the least restrictive setting leads to children with serious emotional problems being placed in settings in which carers have inadequate training, resources, and support. The stress of fostering SED children contributes to maltreatment in care.

Data Analysis. Ensure accurate reporting of abuse and neglect in care. Analyze data from out-of-home placement maltreatment reports to determine if similar patterns exist in your agency. Look at type of abuse, age, gender, type of placement, and perpetrator.

Training/Education. Ensure that everyone involved in a case is getting adequate training around issues of maltreatment in care:

• Train foster parents about sexual, physical, and emotional abuse and its symptoms in children.
• Help foster parents deal with abuse reactive behaviors in the home, especially sexual acting out or provocative behaviors from sexually and physically abused kids.
• Train foster parents to recognize the signs of sibling abuse in foster care-particularly sexual abuse from siblings.
• Educate the kids themselves about overcoming the clinical and day-to-day effects of abuse or neglect-and how to report ongoing abuse.
• Train CPS workers to respect and respond quickly to the reports of kids in care-even when workers suspect the report is an effort on the child's part to regain some control of his or her life or to act out.

Support/Monitoring of Out-of-Home Placements. Foster parents (and other out-of-home carers) need ongoing support and supervision to ensure that they provide the safest placements possible.

Consider creating a foster care liaison program with a trained foster care liaison in each county. Some states have found this approach to improve satisfaction and retention among foster parents.

Encourage foster parents to join the local or regional branch of the National Foster Parent Association. For more information, go to:
http://www.nfpainc.org/

To ensure safety in care, monitoring of visitation is also crucial. For resources on supporting foster parents around visitation, go to:
http://sswnt7.sowo.unc.edu/fcrp/Cspn/vol5_no4/ways_support_foster_parents.htm

High level of evidence

In a study of the type and frequency of maltreatment in family foster care in Baltimore between 1984-88, researchers found that foster families were three times more likely than non-foster families (families in the community) to receive a report of maltreatment.

In this same study, report frequency for foster families was highest for physical abuse, with 60% of reports alleging physical abuse. Report frequency was lowest for sexual abuse, which comprised 10.5% of reports.

In this same study, foster parents were the designated perpetrators in over 80% of physical abuse and neglect allegations, but only 40% of sexual abuse allegations. Other children in care and "others" were more frequently the alleged perpetrators of sexual abuse.

Also in the Baltimore study, despite more reports, physical abuse by foster parents had the lowest rate of substantiation, with only 9% of reports substantiated, compared with 55% of substantiated sexual abuse reports.

In a 1993 Baltimore study, regular foster homes were 2.4 times more likely to have confirmed maltreatment reports than kinship or specialized foster homes.

In a study of 290 incidents of abuse and neglect in Colorado:
Foster carers were identified in 45 cases of physical abuse, 34 cases of neglect, and 20 cases of sexual abuse.
Foster siblings (other children in the home) were identified in 7 cases of physical abuse, 9 cases of neglect, and 15 of sexual abuse.

Data Analysis. The authors of the Baltimore study attribute the higher rates of reports among foster families to a number of things you may want to investigate in your agency.

To target program improvement efforts, perform systematic reviews of maltreatment reports to determine if your rates of maltreatment in care are affected by:

• Increased scrutiny of foster families as compared to non-foster families
• Larger foster family size & thus increased risk of a report being filed due to more kids
• Foster children or their relatives reporting abuse in an attempt to get the child moved
• Child's previous history of abuse; abuse-reactive behavior
• The overloading of otherwise competent foster parents due to placement shortages

Careful Assessments of Foster Family Households.

Foster Siblings (other children in the home). Since several studies have demonstrated the prevalence of abuse, particularly sexual abuse, by foster siblings, it is important to include other children in the home in the screening and preparation process. The age and gender of other children in the home should be considered (if possible) before placement is made. In some cases, foster children will initiate inappropriate sexual behavior with older children in the home, but more often, they are victims of older or same-age children in the home.

"Other Relatives". Statistics indicate that "other relatives" are sometimes the perpetrators of abuse of foster children, particularly sexual abuse. States record "others" differently in their data systems, but for example, foster fathers, siblings (as mentioned above), baby-sitters, and the paramours of foster mothers can be recorded as "other" perpetrators of neglect or physical or sexual abuse. All members of potential foster families should be carefully screened before placement is made.

In a study of 292 maltreatment cases in Illinois, sexual abuse was the most prevalent form of maltreatment reported for all types of placements: Sexual abuse comprised 74% of reports in family foster care; 76% of relative foster care cases; 62% of specialized foster care cases; and 89% of institutional cases.

In this same study, birth parents were the most frequent perpetrators of sexual abuse (45% of cases) followed by unrelated parent substitutes (20%).

In a study of 290 incidents of abuse and neglect in Colorado family foster homes, group homes, residential treatment centers, and other institutions, 29% of confirmed incidents took place in family foster homes.

Medium level of evidence

In a study of children in foster care in Illinois, lack of supervision and sexual abuse were the most frequent types of abuse and neglect in family foster care (20% of cases).

In the same study, sexual abuse rates were higher in family foster care cases (36.9% of cases) and specialized foster care (45.2%) than other types of care. Neglect accounted for less than 10% of cases in both family and specialized foster care.

In the Illinois study, the perpetrator of abuse was most likely to be the foster parent. Birth parents, however, were perpetrators in 26.5% of relative care placements, 26.4% of family foster homes, and 19.8% of specialized foster care placements.

Data Analysis. To the extent possible, find out when reported abuse in care happened. Because children often report abuse in care retrospectively, an accurate count of current maltreatment may be hard to get. This knowledge will help you to estimate, on average, the percentage of maltreatment reports that are likely to have occurred in the past. For example, in Illinois, the percentage of retrospective reports ranged from 32-34%. Differentiating past maltreatment in care from current maltreatment in care will allow you to better target interventions and better track incidence of maltreatment in care.

Monitor Visitation. In cases in which ongoing abuse is reported or suspected, monitor child-birth parent visitation closely. This is especially important in relative care placements, as relatives may experience a loyalty conflict and allow birth parents more contact with children than is warranted.

Institutional Abuse. In institutional settings (residential treatment centers, temporary shelters, group homes, inpatient treatment centers) in which abuse is repeatedly experienced by children, alert state officials to patterns of abuse so an agency audit may take place.

Internal Audit. Ensure that in internal audit or quality control system is in place in your agency so that repeat offenders of abuse or neglect in care may be quickly identified and removed from the provider pool. This includes family foster care, kinship care, group home, RTC, and other institutions.

Training/Education. Ensure that everyone involved in a case is getting adequate training around issues of maltreatment in care:

• Help foster parents deal with abuse-reactive behaviors in the home, especially sexual acting out or provocative behaviors from sexually and physically abused kids.
• Train foster parents to recognize the signs of sibling abuse in foster care-particularly sexual abuse from siblings.
• Educate the kids themselves about overcoming the clinical and day-to-day effects of abuse or neglect-and how to report ongoing abuse.

In a study of factors that contribute to maltreatment in care, researchers suggested that a shortage of qualified foster homes (due in part to low pay to both relative and non-relative foster parents) creates agency pressure to license marginal foster placements.

Examine Foster Care Recruitment Strategies. Identify recruitment needs and obstacles to recruitment. How does recruitment currently take place in your agency? Are there full-time positions devoted to foster care campaigns? Can there be? Are workers following through on recruitment strategies already in place? Does your agency need to work with community groups (such as in the One Church, One Child program, now in 20 states)? Could you partner with community groups to start a new program for hard-to-place children? For more ideas: http://naic.acf.hhs.gov/faqs/five.cfm

Examine Incentives. Are kinship placements subsidized? Are foster parents paid enough to support all the kids in care? Given other budget constraints, provide adequate subsidies to foster parents to support foster children.

Placement Training. Ensure that caseworkers have adequate training (on developmental, learning, physical and behavioral disabilities) to accurately assess a child's functioning and needs, to match a child with the best out-of-home placement, and to connect foster parents or other carers with appropriate resources to manage problem behaviors, etc.

Cultural Competence. Assess your agency's level of cultural competence, since this may affect your agency's ability to attract foster parents from different cultures. Click here to go to a website that has a form for a staff assessment of agency cultural competence.

Click here for a Self-Assessment Checklist on Promoting Cultural Diversity and Cultural Competency for Personnel Providing Services and Supports to Children and Youth with Special Health Needs and their Families.

Language Barriers. How many children/families served by your agency speak Spanish or another language as their first language? Where there are large numbers of non-English clients, take measures to insure that your agency has enough workers who speak this language. Language competence will assist with recruitment as well as both inracial and transracial out-of-home placements.

In one study, heavy caseloads were identified as a contributor to abuse in care, since overloaded caseworkers spend less time supporting foster parents, responding to crises, and monitoring placements and visitation.

Caseload Standards. To meet the federal outcomes, your state will have to change long-standing problems with adequate funding of positions. Lobby to ensure that caseload standards are followed. Read this publication for more information on state efforts to reduce caseloads:
http://www.afscme.org/publications/child/cww00101.htm

Medium level of evidence

In a study of factors that contribute to maltreatment in care, researchers suggested that a shortage of qualified foster homes (due in part to low pay to both relative and non-relative foster parents) creates agency pressure to license marginal foster placements.

Targeted Recruitment. According to several studies, targeted recruitment for children with special needs is effective. Public and private agencies may have been hesitant to create or use specialized minority recruitment programs, but there is evidence that specialized programs are more likely to make successful foster and adoptive placements. For more resources on targeted recruitment:

• http://216.239.39.104/search?q=cache:iOZGnJ13T5gJ:www.nacac.org/pdfs/recruitment_ strategy.pdf+targeted+recruitment+foster+care&hl=en&ie=UTF-8
• http://naic.acf.hhs.gov/faqs/five.cfm

Media, Websites, Videos, Adoption Fairs. Use these recruitment techniques to present specific children who are awaiting foster placement.

To read an ACF publication on effective components of foster care and adoption recruitment, go to:

• http://www.acf.dhhs.gov/programs/cb/laws/pi/pi9523a4.htm

To read exemplary Title IV-B Recruitment strategies, go to:

• http://www.acf.dhhs.gov/programs/CB/laws/pi/pi9523a3.htm

To read about a foster care recruitment video being used in New Jersey, go to:

• http://www.state.nj.us/humanservices/Press-2002/VIDEOrelease1.htm