Children who encounter the looked after system are likely to have already experienced very high levels of disruption and instability in their lives, and the impact of this history will be exacerbated by further instability (Boddy 2013 p.22).

Working to build stability and better understand factors leading to instability are high priorities for children’s services agencies and foster care providers. In March 2014 there were nearly 69,000 looked after children (LAC) in England with 73% of these in foster care. The statistics for all LAC show that 67% had one placement during the year; 22% had two placements and 11% had three or more placements (DfE 2014 p.8). The figure for three or more placements has improved since 2000 when it stood at 18% but has remained static at 11% since 2010.

As with any national data these statistics tell a high level story. Some placement moves may be positive decisions informed by a child or young person’s wishes and supported by a good analysis of issues and proposed solutions. Research certainly provides examples of children’s unhappy experience of long term placements and feeling that no one listened to them (Sinclair et al 2007, cited in Boddy 2013 p.22).

Nevertheless, repeated moves are associated with a range of negative outcomes and we know enough about the importance of building secure relationships in care to know that a good deal more may be done to support stability.

High quality research informs understanding of placement stability and the authors highlight Ian Sinclair’s significant contribution (2005a; 2005b; 2007). The Centre for Research on Children and Families at East Anglia; the Centre for Child and Family Research at Loughborough the Rees Centre at Oxford; the Hadley Centre at Bristol and the Social Policy Research Unit at York all engage in research, review and synthesis on key aspects of foster care.

This systematic review and narrative synthesis was the first phase of a project intended to bring together evidence on placement instability and to use this to ‘derive key practice outputs’. The methods outlined and the framework for synthesis are markedly oriented towards practice development and deliver a study designed to be utilised by professionals in the field.

Method

The review was carried out in line with procedures recommended by the NHS Centre for Reviews and Dissemination (2008). The search strategy; study selection; quality assessment; data synthesis and analysis are all clearly laid out in the paper.

A large number of health and social care electronic databases (including PsycINFO, Medline, Embase, OVID Social policy and practice, Scopus, Web of Knowledge and Applied Social Sciences Index and Abstracts) were searched using appropriate criteria.

Quantitative  studies were selected for inclusion using a number of criteria such as study population being a majority of children in foster-care and if it used certain robust ways to measure placement instability. Qualitative studies were included if they were explict about their methodology and looked at the views and experiences of LAC. The researchers did not include intervention studies that looked at outcomes. Study quality was assessed using standard checklists.

Findings

Of 301 studies considered, a total of 58 were included in the review – 40 quantitative and 18 qualitative studies. Most were carried out in the UK (22) or USA (21) seven were from Canada and the remainder from Australia, Holland and Sweden.

The authors identified five thematic categories for analysis:

• child
• birth parent
• carer
• relationship and
• placement factors.

These themes were broken down into 69 factor subcategories. The framework was used to organise the findings before integrating them into an overall conceptual framework.

Findings are reported against the thematic categories. Some sub factors were explored in many of the 58 studies (e.g. child’s age was an extensively investigated demographic factor) while others were examined in only one or two studies.

Child factors

• Older age was consistently linked to increased placement instability.
• A history of unstable placements was associated with future instability; qualitative studies highlighted children ‘giving up’, ‘disconnecting’, or ‘withdrawing’ from people.
• There was strong evidence for an association between child mental health problems and placement instability, most consistently evident in relation to externalising problems.

Birth parent factors

While no single factor stood out here, parental substance misuse, poverty, criminal activity and the death of a birth mother were all significant correlates of instability in the small number of studies that investigated these sub factors.

Child-birth parent contact

Different studies reported frequency of contact as associated with increased stability, more instability or found no association at all.

Quality of contact is a harder factor to research than frequency but is likely to provide more useful data for understanding the role of contact in the lives of children in care.

Carer factors

Protective factors in carers’ approaches included:

• effective boundary setting
• discipline and routine tolerance
• flexibility
• emotional involvement
• child centeredness
• kindness and affection.

Support and encouragement for academic achievement appears to be a feature of more stable placements. Children spoke of the stability and confidence they derived from achieving at school and how this was facilitated by high expectations from carers and social workers.

Placement factors

Kinship foster placements come through strongly in this review as more stable than non-relative foster care. The qualitative data indicated that

kinship carers tend to offer care unconditionally and feel a sense of binding duty to the relative in their care.

Separation from siblings was associated with instability in a majority of studies, though conflict between siblings in a foster placement may also contribute to placement breakdown.

Relationship factors

Commitment, good communication and attachment were all factors supporting stability. These were facilitated by carers being informed and prepared on a child’s difficulties and what to expect in terms of behaviour. A feeling of being accepted into a family unconditionally was identified by children as key to building relationships.

Repeated changes of social worker were associated with instability while a consistent relationship supported stability. Involving children in decision making has been shown to predict fewer moves.

Conclusion

The authors sum up that strongest evidence pointed to the following factors:

• older age
• externalising behaviour
• longer total time in care
• residential care as first placement setting
• separation from siblings
• foster-care (versus kinship care)
• experience of multiple social workers
• being placed out of area of origin and
• poor integration into a foster family.

Protective factors identified included the skills and personal characteristics of carers and placement with siblings.

Strengths and limitations

The study is a methodologically sound and practice-oriented and adds to the literature by including international qualitative and quantitative evidence.

The parameters of the review preclude analysis of factors which appear to underpin the wide variation in stability data across local authorities and point to the significance of organisational culture in supporting or undermining placement stability.

It is worth grounding any analysis of placement instability in the conceptual framework of permanence set out by the Care Inquiry (2013): ‘security, stability, love and a strong sense of identity and belonging’.

Link

Rock, S., Michelson, D., Thomson, S. and Day, C. (2015) Understanding foster placement instability for looked after children: a systematic review and narrative synthesis of the evidence, British Journal of Social Work, 45 (1) pp.177-203 [Abstract]

References

Boddy J (2013). Understanding Permanence for Looked After Children a review of research for the Care Inquiry. London: The Care Inquiry. [Full Text]

Care Inquiry (2013). Making not breaking. Building relationships for our most vulnerable children. London: Care Inquiry. [Full Text]

Department for Education (2013). Data pack: improving permanence for looked after children. London: DfE [Full text]

Department for Education (2014). Statistical First Release: Children looked after in England (including adoption and care leavers) year ending 31 March 2014. London: DfE [Full text]

Sinclair, I. (2005a) Fostering Now: Messages from Research. London: Jessica Kingsley Publishers.

Sinclair, I., Baker, C., Wilson, K., & Gibbs, I. (2005b). Foster children: Where they go and how they do. London: Jessica Kingsley Publishers.

Sinclair I., Baker C., Lee J. and Gibbs I. (2007) The pursuit of permanence: a study of the English child care system. London: Jessica Kingsley Publishers.