Children referred to foster care, family-style group care, and residential care: (How) do they differ?

Abstract

To date, no evidence-based criteria are available to place children with multiple psychosocial risks and needs in the most appropriate type of (non-secure) out-of-home care. Due to this, other factors than just the clinical needs of the child and its family are in use, which can heighten the risk of both breakdown (i.e. unplanned terminated placement) and/or poor prognostic placement outcomes. To reduce adverse placement outcomes, insight into the risks and needs of the children at the time of referral can be helpful. To this end, this study explores similarities and differences in child, family and care history context of 200 Dutch school-aged children at the time of admission to foster, family-style group, and residential care. A cross-sectional design was used and data were collected through standardized questionnaires that were completed by the caregivers, substitute caregivers, and behavioral scientists. Case file information was also used. The results showed differences between the three subgroups in all three contexts, which suggest several setting-specific guidelines to promote positive outcome. Biological parents of foster children specifically are in need of support for their individual problems. In family-style group care, specifically, help is required for attachment and trauma-related problems. Residentially placed children are in particular need of specialized care for mental illness, behavioral and school/learning problems. Further research is needed to link the outlined specific characteristics at admission to the developmental pathways of out-of-home placed children. Such research may contribute to the development or refinement of a risk-need-responsivity model to support the decision making regarding out-of-home placement of children with serious psychosocial needs.

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Children and Youth Services Review
journal homepage: www.elsevier.com/locate/childyouth
Children referred to foster care, family-style group care, and residential care:
(How) do they differ?
Harmke Leloux-Opmeer
a,⁎
, Chris H.Z. Kuiper
a
, Hanna T. Swaab
b
, Evert M. Scholte
b
a
Horizon Youth Care and Special Education, Mozartlaan 150, 3055 KM Rotterdam, The Netherlands
b
Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
ARTICLE INFO
Keywords:
Characteristics
Foster care
Family-style group care
Residential care
Out-of-home placement
ABSTRACT
To date, no evidence-based criteria are available to place children with multiple psychosocial risks and needs in
the most appropriate type of (non-secure) out-of-home care. Due to this, other factors than just the clinical needs
of the child and its family are in use, which can heighten the risk of both breakdown (i.e. unplanned terminated
placement) and/or poor prognostic placement outcomes. To reduce adverse placement outcomes, insight into
the risks and needs of the children at the time of referral can be helpful. To this end, this study explores
similarities and differences in child, family and care history context of 200 Dutch school-aged children at the
time of admission to foster, family-style group, and residential care. A cross-sectional design was used and data
were collected through standardized questionnaires that were completed by the caregivers, substitute caregivers,
and behavioral scientists. Case file information was also used. The results showed differences between the three
subgroups in all three contexts, which suggest several setting-specific guidelines to promote positive outcome.
Biological parents of foster children specifically are in need of support for their individual problems. In family-
style group care, specifically, help is required for attachment and trauma-related problems. Residentially placed
children are in particular need of specialized care for mental illness, behavioral and school/learning problems.
Further research is needed to link the outlined specific characteristics at admission to the developmental
pathways of out-of-home placed children. Such research may contribute to the development or refinement of a
risk-need-responsivity model to support the decision making regarding out-of-home placement of children with
serious psychosocial needs.
1. Introduction
A child's safety and healthy development may sometimes be
threatened by adverse child or family circumstances (or both). When
in-home (support) services cannot effectively resolve such risky circum-
stances, experts consider placing the child in (24-hour) out-of-home
care a useful alternative strategy (Bhatti-Sinclair & Sutcliffe, 2012;
Pinto & Maia, 2013; Vanschoonlandt, Vanderfaeillie, Van Holen, De
Maeyer, & Robberechts, 2013). This (24-hour) out-of-home care typi-
cally consist of a continuum of intensive and restrictive care services,
which vary from least restrictive types of care (e.g. kinship or non-
kinship foster care) to family-style group care to residential care
(Huefner, James, Ringle, Thompson, & Daly, 2010).
In (family) foster care, a child is considered in need of a (temporary)
out-of-home placement due to concerns for its safety. The child is
preferably placed with relatives (kinship foster care) or non-relatives
familiar with the child; otherwise the child is assigned to a licensed
foster home. There are two main types of foster care in the Netherlands
(i.e. short and long-term foster care). In case of short-term foster care,
the child stays temporarily with a foster family, while the biological
parents are supported to improve their family circumstances in
preparation for reunification (De Baat & Bartelink, 2012; Strijker,
Knorth, & Knot-Dickscheit, 2008). The purpose of long-term foster care
is providing a stable alternate rearing situation in a family setting until
the child reaches the age of 18 years of age (Strijker et al., 2008). In
contrast to the foster care process in the United States, adopting a foster
child (rather than placement in long-term foster care) is very unusual in
the Netherlands and other European countries (Holtan, Handegård,
Thørnblad, & Vis, 2013). Second, a less familiar type of (24-hour) out-
of-home care is family-style group care. Many synonyms are in use for
this type of care (e.g. teaching family homes, family type homes, SOS
children's villages, socio-pedagogical homes) (Farmer, Wagner,
Burns, & Richards, 2003; Frensch & Cameron, 2002; Grietens et al.,
2015; Harder, Zeller, Lopez Lopez, Köngeter, & Knorth, 2013). Family-
http://dx.doi.org/10.1016/j.childyouth.2017.03.018
Received 6 December 2016; Received in revised form 31 March 2017; Accepted 31 March 2017
⁎
Corresponding author.
E-mail addresses: Harmke.leloux@horizon.eu (H. Leloux-Opmeer), Chris.kuiper@horizon.eu (C.H.Z. Kuiper), hswaab@fsw.leidenuniv.nl (H.T. Swaab),
scholte@fsw.leidenuniv.nl (E.M. Scholte).
Children and Youth Services Review 77 (2017) 1–9
Available online 01 April 2017
0190-7409/ © 2017 Published by Elsevier Ltd.
MARK

style group care is defined as follows; children living in home-like
settings with group home parents (often a married couple with socio-
pedagogical experience and training) who live at the setting (Grietens
et al., 2015; Lee & Thompson, 2008). Finally, residential care is an
umbrella term that refers to several types of residential care that vary
from non-secure residential to secure residential to inpatient psychiatric
care (Barth, 2002; Grietens et al., 2015). Residential facilities vary in
their size, target group (e.g. delinquents, disabled children, children
with mental health disorders), and in the therapeutic components
available (Barth, 2002; Cheung, Goodman, Leckie, & Jenkins, 2011;
Chor, McClelland, Weiner, Jordan, & Lyons, 2012; Curtis,
Alexander, & Lunghofer, 2001; Grietens et al., 2015; Hussey & Guo,
2002; James, Zhang, & Landsverk, 2012; Wilson, Sinclair,
Taylor, & Pithouse, 2004). In this study, we focus on non-secure
residential care only, because this specific type of care is closest to
foster and family-style group care across the continuum of out-of-home
care.
In accordance with the United Nations Guidelines for the
Alternative Care of Children (henceforth “UN guidelines”), family-
based settings (i.e. foster and family-style group care) are preferable
when out-of-home placement is deemed necessary (United Nations,
2009, December 18). However, this guideline to date lacks scientific
support (Bartelink, 2013; Grietens, 2012; Hussey & Guo, 2002). Addi-
tionally, there are no clear placement criteria for the various types of
out-of-home care (Chor et al., 2012; Lee, 2010; Strijker,
Zandberg, & Van der Meulen, 2002). Also, or maybe therefore, alloca-
tion is often affected by other than clinical factors such as local referral
policy or placement preferences of the case manager (Barth, 2002;
Bhatti-Sinclair & Sutcliffe, 2012; Curtis et al., 2001; Frensch & Cameron,
2002; Huefner et al., 2010; James, Landsverk, & Slymen, 2004) and
resource availability (Broeders, Van der Helm, & Stams, 2015;
Frensch & Cameron, 2002; Huefner et al., 2010). Finally, placement
instability is a common phenomenon across all three settings. Data on
out-of-home placed children who have experienced an unplanned
terminated placement (also called a “breakdown”) vary roughly from
20% up to even 80%, depending on the types of care included and the
way placement instability was defined (e.g. Barber & Delfabbro, 2002;
Delfabbro, Barber, & Cooper, 2002; Farmer et al., 2003; Jakobsen,
2013; Oosterman, Schuengel, Slot, Bullens, & Doreleijers, 2007;
Scholte, 1997; Van den Bergh & Weterings, 2010; Van Manen, 2011;
Ward, 2009). A breakdown might reflect a mismatch between the risks
(e.g. danger to self, delinquency) and needs (e.g. mental health,
psychosocial, clinical) on one hand and the assigned type of care on
the other. Specifically, literature suggest that an inaccurate matching of
treatment intensity and restrictiveness with the attending level of risks
and needs results in less effective or even adverse treatment outcomes
(e.g. Chor et al., 2012; Grietens et al., 2015; Kamis-Gould & Minsky,
1995; Vanderfaeillie, Damen, Pijnenburg, van den Bergh, & Van Holen,
2016). Therefore, nowadays more and more emphasis is put on the
development of risk-need-responsivity models to support the decision-
making process for children with serious multiple risks and needs and,
in the end, transform and improve the service system (Anderson, Lyons,
Giles, Price, &Estle, 2003; Chor et al., 2012; Fallon et al., 2006; Lyons,
Libman-Mintzer, Kisiel, & Shallcross, 1998). Previous attempts to con-
struct a placement decision support algorithm, are the development of
the Child and Adolescent Severity of Psychiatric Illness (CAPSI) (Lyons
et al., 1998), the Child and Adolescents Needs and Strengths (CANS)
Algorithm (Lyons, 2009), and the Children and Adolescent Service
Intensity Instrument (CASII) (Fallon et al., 2006). For secure residential
care specifically, the risk-need-responsivity model of Andrews, Bonta,
and Wormith (2011) is commonly used for guiding offender assessment
and treatment. Research on decision-making tools showed that im-
portant elements of such a tool are using child-level clinical informa-
tion, emphasizing on the child's level of development in the context of
the family and parents, and involving various types of care which vary
in level of restrictiveness. However, according to Chor et al. (2012)
there is still much to learn about out-of-home placement decision-
making.
Needs assessment is considered to be a first step a more transparent
and informed decision-making strategy (Anderson et al., 2003; Leloux-
Opmeer, Kuiper, Swaab, & Scholte, 2016; Scholte, 1997; Strijker et al.,
2002). More insight into the risks and treatment needs also results in
more knowledge on additional treatment needs along with the place-
ment (Armsden, Pecora, Payne, & Szatkiewicz, 2000). Furthermore,
identified risks and needs at the time of admission can later be linked
to a child's positive or negative developmental outcomes. These
linkages might provide insight into factors that enhance successful
cognitive and social-emotional growth in out-of-home care (Curtis
et al., 2001; Grietens et al., 2015). Besides individual needs assessment
at admission, there is a need for comparative research on the
distinguishing risks and needs of children in different settings of out-
of-home care (Barth et al., 2007; Farmer, Mustillo, Burns, & Holden,
2008). Notwithstanding the fact that such comparative research is
available, it usually concerns a pairwise comparison between two types
of care, mostly foster versus residential care. Examples of such
comparisons are the studies of Allen and Vacca (2011),Barth (2002),
Curtis et al. (2001),De Swart et al. (2012),DeSena (2005),James,
Roesch, en Zhang (2012),Scholte (1997), and Smyke et al. (2012). Next
to this, some studies compare children in family-style group care with
foster or residentially placed children (Berrick, Courtney, & Barth,
1993; Lee & Thompson, 2008). However, little comparative studies
are found concerning a triple comparison of characteristics of children
in the three main types of care (i.e. foster care, family-style group care,
and residential care). Only one scoping review (Leloux-Opmeer et al.,
2016) and one comparative study (Lausten, 2015) were found. There-
fore, the aim of this study is to explore similarities and differences in
risks and needs of Dutch school-aged children at the time of admission
to foster, family-style group, and residential care.
The framework being used is an adaption of the developmental
model of Kerig, Ludlow, and Wenar (2012) and distinguishes five
contexts of development: (a) biological, (b) individual, (c) family, (d)
care history, and (e) social-cultural (Leloux-Opmeer et al., 2016). For
the purpose of conciseness, results on the biological context will be
added to the individual context in this study. The hypotheses consid-
ered in this study are all among the following three contexts: the
(combined) individual, family and care history context. Regarding the
individual context, we hypothesized first that the mean age of admis-
sion is lowest for foster children, on the basis of the current policy to
refer a child to the least restrictive type of care (Chor, McClelland,
Weiner, Jordan, & Lyons, 2013; Grietens et al., 2015; Leloux-Opmeer
et al., 2016). Second, we hypothesized that the level of individual child
issues (i.e. mental health, psychosocial, and school related-problems) is
highest for residentially placed children. Especially the child's level of
externalizing behavior problems seems to be a contraindication for
assigning a family-based setting such as foster care, because of an
elevated risk for a breakdown (Aarons et al., 2010; Barber & Delfabbro,
2002; Barber, Delfabbro, & Cooper, 2001; Minty, 1999; Newton,
Litrownik, & Landsverk, 2000; Strijker et al., 2008; Vanschoonlandt,
Vanderfaeillie, Van Holen, & De Maeyer, 2012; Vanschoonlandt et al.,
2013). The third hypothesis is linked to both the individual and family
context, and specifically relates to family-style group care. In terms of
intensity and restrictiveness, this setting falls between foster and non-
secure residential care across the care continuum. Therefore, we expect
that the level of child and family problems will also be in between those
of foster and residentially placed children. Regarding the family
context, foster care is particularly assigned when the biological parents
(temporarily) cannot offer their child a healthy upbringing, which
require a (least restrictive) alternative family setting. Consequently, the
fourth hypothesis is that the level of family problems and individual
parental problems (i.e. mental health disorders, addiction, material
problems) will be highest for the biological families of foster children
(Leloux-Opmeer et al., 2016; Oswald, 2010). Fifth and finally, concern-
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
2

ing the care history context, we expect the care history to be the longest
and most serious for residentially placed children, because of the
tendency to view residential care as a treatment of “last resort”
(Barth, 2002; Frensch & Cameron, 2002; Grietens et al., 2015;
Huefner et al., 2010; Sunseri, 2005; Van IJzendoorn, 2008).
2. Methods
2.1. Design, study population, and procedures
A cross-sectional study design was used among a population of
Dutch school-aged children at the time of their admission to foster,
family-style group, or non-secure residential care at Horizon. Horizon is
a large organization that offers specialized care and educational
services to young people with complex behavioral or conduct disorders
(as well as to their families), excluding disabled children or those who
need inpatient psychiatric care. The intensity and restrictiveness of
Horizons services is comparable with those in other Dutch child youth
care institutions. Data were collected from October 2012 to March
2014.
As regards to foster care, both types of foster families (kinship and
non-kinship) were included in this study. Evidence regarding superior
performance of either form of foster care is ambiguous or not conclusive
(Holtan et al., 2013; Holtan, Rønning, Handegård, & Sourander, 2005;
Oosterman et al., 2007; Strijker & Zandberg, 2004; Tarren-
Sweeney & Hazell, 2005; Wilson et al., 2004). Additionally, when
controlling for several key variables (e.g. age, gender, level of behavior
problems, and level of family problems) no statistically significant
differences were found between children in kinship and non-kinship
care. Furthermore, this study emphasizes on the needs of the child and
his family of origin, and less on foster placement factors such as type of
foster family. Concerning family-style group care, the study also
included 13 children who were enrolled in this type of care at five
other Dutch youth care institutions to increase the number of partici-
pants in this subpopulation. Additionally, the number of respondents in
family-style group care has been increased by use of 21 retrospective
case file analyses of children who entered this type of care in Horizon in
2011 or the first nine months of 2012.
For the cross-sectional study, the following inclusion criteria for the
children were used: (1) children were of primary school-age
(4–12 years), (2) children were placed from either their birth home or
another setting, and (3) their participation would not harm their
treatment alliance with the childcare workers. The exclusion criteria
were that: (1) a child was adopted or had severe intellectual disabilities,
and (2) the placement was made on a crisis basis or in a secure
residential youth care facility.
Data were collected using different questionnaires for the children's
caregivers, by which we meant their biological parent(s) or, in some
cases, their legal guardians. Additionally, several questionnaires were
used for the children's foster parents, family-style group parents, or
childcare workers (henceforth “substitute caregivers”), as well as for
the behavioral scientist who guides the out-of-home care process. Case
file information was also used. Children were not active participants in
the study.
This study was not subject to the Medical Research Involving
Human Subjects Act (WMO); as such, it did not need to be reviewed
by the Medical Ethics Research Committee (which is charged with
ensuring that protocols are in accordance with Dutch legislation). The
research protocol complied to the Netherlands Code of Conduct for
Academic Practice (2014): (1) written permission was obtained from
the caregivers, (2) all participants had the right to refuse or stop
participation, and (3) to ensure anonymity, distorted case file numbers
were used.
2.2. Participants
In total, nine cases were excluded in advance. Six of them because of
a very premature placement breakdown, two cases due to rejection of
the kinship foster family because of incapacity, and in one case
participation was expected to harm the treatment alliance. Among
the 244 eligible children identified, at least one questionnaire was
completed for 200 of them (which corresponds to 82% of the intended
sample). More specifically, the mean response rate was 40% for
caregivers, 82% for substitute caregivers (inclusive of the 21 retro-
spective case file analyses), and 95% for behavioral scientists. These
response figures are average to high in comparison to the overall
response rate reported in health care research (Baruch & Holtom,
2008). Comparing demographic characteristics (i.e. gender, age), the
participant and non-participant groups within the three main settings of
out-of-home care revealed no differences for family-style group and
residential care. In foster care, participants were more often male (46%)
compared with non-participants (11%).
The total study sample consisted of 72 children in foster care, 38
children in family-style group care, and 90 residentially placed
children. The participants' ages ranged from 4 to 13 years (M= 8.8,
SD = 2.4) and 54% were boys. Significant differences were found in
age, F(2,197) = 8.09, p< 0.001. Foster children (M= 7.9, SD = 2.6)
were younger than children in family-style group (M= 9.2, SD = 2.5)
and residential care (M= 9.3, SD = 2.1). No significant differences
were found in the distribution of gender, χ
2
(2, N= 200) = 4.63,
p= n.s. About half (56%) of all children had a Caucasian ethnic
background; the rest (44%) had at least one parent who was born
abroad (11% in a Western country and 33% in a non-Western country).
No significant differences in ethnic background were found between the
three subgroups, χ
2
(4, N= 151) = 3.85, p=n.s. Regarding foster
children specifically, 39% were in kinship care and 14% were involved
in therapeutic foster care (were therapeutic services are provided such
as individual therapy).
2.3. Measures
A number of different measurement tools were selected to aid in
gathering information for this study. These tools are briefly introduced
below.
2.3.1. Case file characteristics questionnaire (CCQ)
The CCQ is a questionnaire designed by the authors to chart case file
information systematically on demographic characteristics (e.g. age,
gender, ethnicity), clinical characteristics (e.g. social-emotional pro-
blems, school or cognitive problems, child mental illness), family
characteristics (e.g. family composition, clinical family problems),
and care history characteristics (e.g. previous placements, child pro-
tective services) at admission. This 30-item questionnaire was com-
pleted by or under the supervision of a behavioral scientist. Most items
of the CCQ were related to factual information, and all were categor-
ized, and if possible, dichotomized (yes/no). For potentially ambiguous
items which require some interpretation, a scoring protocol was
available. The inter-observer reliability of the questionnaire was used
to measure the intraclass correlation (ICC) of the CCQ (Field, 2009).
Five files were scored with the CCQ by two raters. Based on the
guidelines by Landers (2015), a two-way mixed model was used, with
absolute agreement as a criterion. The mean ICC (95% CI) was 0.66
(0.58, 0.72), which reflects a moderate inter-observer reliability
(Shrout, 1998).
2.3.2. Child behavior checklist (CBCL)/1.5-5 and CBCL/4-18
The Dutch versions of these two checklists were used to identify
psychosocial problems that were observed by caregivers and substitute
caregivers (Achenbach & Rescorla, 2001; Verhulst, Van der
Ende, & Hoolhans, 1996). The CBCL/1.5-5 and CBCL/4-18 ask infor-
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
3

mants to use a three-point scale (where 0 = not true, 1 = sometimes
true, and 2 = very true) to respectively assess 99 and 120 items relating
to behavioral and emotional problems. The summary scale t-scores of
internalizing problems, externalizing problems, and total problems
from both instruments were used in this study. Scores within or above
the 80th percentile reflect performance in the (borderline) clinical
range. Satisfactory psychometric characteristics for these scales have
been reported (Greatest Lower Bound (GLB) > 0.91, test-retest relia-
bility (r) > 0.83) in the literature with regard to the Dutch versions of
the CBCL (Verhulst & Van der Ende, 2013).
2.3.3. Social emotional detachment questionnaire (SEDQ)
The Dutch version of the SEDQ (Scholte & Van der Ploeg, 2007),
which was completed by the substitute caregivers, was used to obtain
signs of social and emotional detachment in children aged 4 to 18. The
questionnaire comprises 16 items that can be scored using a five-point
scale (where 0 = never true, 1 = sometimes true, 2 = regularly true,
3 = often true, and 5 = very often true). This study utilized the total
scale score of this questionnaire. Scores within or above the 95th
percentile reflect evident social and emotional detachment. The SEDQ
meets the psychometric standards required for research purposes
(Scholte & Van der Ploeg, 2007). The internal consistency of the total
scale measured with Cronbach's alpha is 0.92. The test-retest reliability
(r) for this scale is 0.85 (Scholte & Van der Ploeg, 2007).
2.3.4. Student-teacher relationship scale (STRS)
The STRS is based on the presumption that a child's mental
representation of attachment patterns is reflected in his or her relation-
ship with significant adults (Koomen, Verschuren, & Pianta, 2007;
Pianta & Nimetz, 1991). The Dutch version of this questionnaire was
used to assess each substitute caregiver's perception of his or her
parenting relationship with the out-of-home placed child. The STRS,
which is applicable for children aged 3 to 12, consists of 28 items that
are measured on a five-point scale (where 1 = definitely not true,
2 = not really true, 3 = neutral/not sure, 4 = somewhat true, and
5=definitely true). This instrument provides three subscales (namely
proximity, conflict, dependency) and a total scale score that reflects the
general quality of the parenting relationship. Scores at or above the
90th percentile (specifically for the subscales conflict, dependency) and
scores at or below the 10th percentile (specifically for the subscale
proximity and the total scale) all fall within the clinical range. The STRS
meets the psychometric standards required for research purposes
(Koomen et al., 2007). The internal consistency of the total scale
measured with Cronbach's alpha is 0.89, and the test-retest reliability
(r) is 0.70 (Koomen et al., 2007).
2.4. Data analyses
The SPSS (Statistical Package for Social Sciences) 22 software was
used to conduct the statistical analyses. To assess the clinical signifi-
cance of the scores on all of the test instruments equally, raw scores
were converted to T-scores (which are standardized scores with a mean
of 50 and a standard deviation of 10) (Field, 2009). Prior to the
analyses, data were inspected and test assumptions were verified. The
data analyses consisted of two parts. The first component entailed using
analysis of variance (ANOVA) to define similarities and differences
between the three main settings of out-of-home care. A significant F-
statistic indicates that samples have unequal means (Field, 2009). In
these cases, inter-group differences were determined using the Bonfer-
roni's post hoc multiple comparison test. Additionally the effect size
using Cohen's fwas computed. A value of 0.10 is considered to be small,
0.25 as medium and a value equal or above 0.40 as a large effect
(Cohen, 1992).
In the second part of the data analyses, Chi-square tests were used to
compare percentages between groups. Additionally, the effect size was
determined using Cramer's V. A value of 0.10 stood for a small effect,
0.30 for a medium effect and a value of 0.50 for a large effect (Cohen,
1992).
Table 1
Summary table of defining characteristics when placed out-of-home, arranged by context and setting (based on case file information at admission).
FC
%(n)
FCG
%(n)
RC
%(n)
Test Effect size
Individual context
Mean age at admission (yrs.) M=7.9,
SD = 2.6 (72)
a,b
M=9.2,
SD = 2.5 (38)
a
M=9.3,
SD = 2.1 (90)
b
F(2,197) = 8.09
⁎⁎⁎
0.29
Emotional problems 71 (63) 77 (34) 70 (83) χ
2
(2,N= 180) = 0.52
ns
0.05
Behavioral problems 56 (63)
a
59 (34)
b
90 (83)
a,b
χ
2
(2,N=180) = 25.38
+++
0.38
Reactive attachment disorder 15 (55)
a,b
41 (32)
b
35 (83)
a
χ
2
(2,N= 170) = 9.02
+
0.23
Mental illness (child) 27 (55)
a
44 (32)
b
69 (83)
a,b
χ
2
(2,N=170) = 23.42
+++
0.37
School/cognitive problems 52 (52)
a
65 (20) 83 (64)
a
χ
2
(2,N= 135) = 12.79
++
0.29
(Biological) family context
Divorced parents 79 (62) 74 (34) 79 (77) χ
2
(2,N= 173) = 0.23
ns
0.04
Mental illness (parent) 73 (63) 50 (32) 62 (84) χ
2
(2,N= 179) = 5.08 0.17
Material problems/poverty 75 (63)
a,b
50 (32)
b
44 (84)
a
χ
2
(2,N= 179) = 14.18
+++
0.28
Poor parenting skills 89 (63) 69 (32) 88 (84) χ
2
(2,N= 179) = 7.97
+
0.21
Child neglect (physical/emotional) 60 (63)
a
44 (32) 31 (84)
a
χ
2
(2,N= 179) = 21.63
++
0.27
Child abuse (physical/emotional) 25 (63) 31 (32) 18 (84) χ
2
(2,N= 179) = 2.70
ns
0.12
(Suspicions of) child sexual abuse 0 (63)
a
16 (32)
a
5 (84) χ
2
(2,N= 179) = 10.87
++
0.25
Care history context
Admission from birth home 65 (63)
a,b
18 (34)
b,c
43 (83)
a,c
χ
2
(6,N= 180) = 35.91
+++
0.34
Previous placements 53 (62)
a,b
94 (34)
a,c
70 (84)
b,c
χ
2
(2,N= 180) = 17.27
+++
0.31
Mean previous placements M= 0.8,
SD = 1.1 (56)
a,b
M= 2.3,
SD = 1.5 (32)
a
M= 1.6,
SD = 1.8 (83)
b
F(2,168) = 9.98
⁎⁎⁎
0.11
Child protective service custody (%) 78 (63)
a
94 (34)
a,b
70 (84)
b
χ
2
(2,N= 181) = 7.89
+
0.21
FC Foster care, FGC family-style group care, RC residential care.
Means with the same subscript differ significantly.
+
p<0.05.
++
p< 0.01.
+++
p< 0.001 (chi-square test with Cramer's V).
⁎⁎⁎
p< 0.001 (ANOVA with Cohen's f).
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
4

3. Results
Table 1 summarizes the characteristics at admission based on case
file information gathered through the CCQ, arranged by context (of
development) and setting. Table 2 summarizes the results of the test
measures (i.e. the CBCL, the SEDQ, and the STRS), arranged by setting.
The main findings on similarities and differences in characteristics of
children placed in one of the three main settings of out-of-home care are
presented below, arranged by the three contexts of development.
3.1. Results within the individual context
When it comes to age of admission to the current out-of-home
placement, foster children are on average younger than children in
family-style group and residential care (see Table 1). Furthermore in
terms of age, in all three subgroups the first signs of psychosocial
problems were reported on average at 3.8 (SD = 2.9) years of age, and
professional help started on average at 4.5 (SD = 2.9) years of age.
Regarding the level of individual problems of the out-of-home
placed children, first, based on case file information, the percentage
of children with individual problems is highest in residential care
(Table 1). These problems specifically concern behavioral problems, (an
indication of) child mental illness and school related problems. As for
mental illness, the most typical difference between the three subgroups
was the incidence of autism spectrum disorders (ASD). No ASD
diagnosis was found in (the case files of) foster children, while ASD
diagnosis did occur approximately 1 in every 10 children in family-style
group and residential care (χ
2
(2,N=170) = 8.56, p< 0.05). When it
comes to school related problems, residentially placed children speci-
fically show conflicts with both classmates (χ
2
(2,N= 135) = 11.86,
p< 0.01) and teachers (χ
2
(2,N= 135) = 8.98, p< 0.05) twice as
frequently as children in foster or family-style group care. Second,
caregivers equally report the most severe individual problems at
admission for residentially placed children, especially when it comes
to externalizing behavior problems (see Table 2). However, these
results differ from those of the substitute caregivers of residentially
placed children. This leads to the third main finding that, according to
the substitute caregivers, children in family-style group care demon-
strate the most severe behavior problems at admission in comparison
with children in foster or residential care (see Table 2). Additionally,
results of the SEDQ showed that substitute caregivers of children in
family-style group care perceive most signs of social and emotional
detachment at the time of admission, especially in comparison with
residentially placed children. Likewise, the highest percentage of
children with a Diagnostic Statistical Manual of Mental Disorder
(DSM-IV) classification of reactive attachment disorder was found in
family-style group care (see Table 1). Finally, based on case file
information as well as test results, foster children show the least and
least severe individual problems.
3.2. Results within the family context
First of all, in all three subgroups at least three-quarters (78%) of all
biological parents were divorced. Second, with reference to individual
parental problems, in all three settings a more or less similar number of
children (64%) had at least one biological parent with mental illness.
However, it is noteworthy that foster children more commonly had
fathers with mental illness (40%) than children in family-style group
(19%) or residential care (20%), χ
2
(2,N= 179) = 8.23, p< 0.05.
Third, also related to individual parental problems, material problems
such as financial problems, housing problems, and unemployment
occurred most frequently in the biological families of foster children
(see Table 1). Fourth, when it comes to family functioning, poor
parenting skills was the most frequently reported risk factor in the
families of origin, especially for children in foster and residential care
(see Table 1). Fifth, as regards family functioning, the highest percen-
tage of neglected children was found in foster care. However, the
percentage of children experienced physical abuse, emotional abuse, or
both at their birth home is similar in all three types of care (see
Table 1). Notably, no single foster child case file contains a record of
(suspicions of) sexual abuse, in contrast to the files of children in
family-style group (16%) or in residential care (5%). Finally, in contrast
to the aforementioned main findings, the last risk specifically concerns
an aspect within the foster family. Additional analyses of test results on
the subscales of the STRS revealed differences in some dimensions of
the quality of the parenting relationship (STRS) short after admission,
in disadvantage of foster children. The first difference had to do with
the degree of conflict, F(2,145) = 4.30, p< 0.05. Foster parents
perceive their relationship with the child as being more conflictual
(T= 65, SD = 17) than childcare workers in residential care do short
after admission (T=58,SD= 12, p< 0.01). Also differences were
found in the degree of dependency F(2,145) = 7.62, p< 0.001. Foster
parents reported more signs of negative dependency in the out-of-home
placed child (T= 62, SD = 10) than childcare workers in residential
care did (T= 55, SD = 11, p< 0.05).
Table 2
Summary table of T-scores (SD) for at-admission test data, arranged by questionnaire and setting (based on data from caregivers and substitute caregivers).
FC
T (SD)
FCG
T (SD)
RC
T (SD)
ANOVA Effect size (Cohen's f)
ASEBA caregivers n = 31 n = 8 n = 55
Total behavior problems 56 (11)
a
55 (13)
b
68 (9)
a,b
F(2,91) = 14.72
⁎⁎⁎
0.56
Internalizing problems 56 (11) 55 (12) 63 (11) F(2,91) = 3.71
⁎
0.29
Externalizing problems 56 (11)
a
56 (13)
b
68 (9)
a,b
F(2,91) = 16.00
⁎⁎⁎
0.59
ASEBA substitute caregivers n = 48 n = 21 n = 86
Total behavior problems 58 (12)
a
67 (12)
a,b
60 (10)
b
F(2,152) = 6.37
⁎⁎
0.29
Internalizing problems 57 (12) 62 (11) 57 (10) F(2,152) = 1.68
ns
0.14
Externalizing problems 55 (12)
a
66 (13)
a
59 (12) F(2,152) = 6.65
⁎⁎
0.29
SEDQ substitute caregivers n = 45 n = 16 n = 86
Social emotional detachment 65 (17) 72 (16)
a
61 (13)
a
F(2, 139) = 4.38
⁎
0.27
STRS substitute caregivers n = 45 n = 15 n = 88
Total STRS score 64 (15) 64 (15) 58 (12) F(2,145) = 2.96
ns
0.20
FC Foster care, FGC family-style group care, RC residential care.
Means with the same subscript differ significantly.
T-scores from 60 to 64 are in the borderline clinical range. T-scores above 64 are in the clinical range.
⁎
p<0.05.
⁎⁎
p< 0.01.
⁎⁎⁎
p< 0.001.
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
5

3.3. Results within the care history context
To start with, a main finding is the small number of children who
enter family-style group care from birth home. According to case file
information this percentage is more than three times lower than in
foster care and more than two times lower than in residential care (see
Table 1). Differences in prior use of residential care are related to this (F
(2,174) = 19.06, p< 0.001). Children placed in family-style group
care (M= 1.3, SD = 1.1) have previously experienced residential care
more often than foster (M= 0.2, SD = 0.6, p< 0.001) or residentially
placed children (M= 0.8, SD = 0.9, p< 0.01). This suggests that
children in family-style group care relatively more often enter this
setting from residential care. Second, information on former placements
is noteworthy. In general, 69% of the participants have experienced
previous placements. A significant portion (20%) has even been placed
at least three times, with a maximum of nine placements being
reported. The highest percentage of children with a history of previous
placements was found in family-style group care, namely 94%. Like-
wise, children in family-style group care do have the highest average
number of previous placements, particularly in comparison with foster
children (p< 0.001). A third main finding relates to child protective
service custody. Most common form is family supervision (64% of the
entire participant population). The percentage of children in child
protective service custody was highest in family-style group care (see
Table 1).
4. Discussion
To date no evidence-based criteria are available for referral to the
various types of (non-secure) out-of-home care for children (Chor et al.,
2012; Lee, 2010; Strijker et al., 2002). Due to this, policies other than
the clinical needs of the child and the family often determine the 24-h
setting (foster, family-style group, residential care) the child is referred
to for out-of-home care (Barth, 2002; Bhatti-Sinclair & Sutcliffe, 2012;
Broeders et al., 2015; Curtis et al., 2001; Frensch & Cameron, 2002;
Huefner et al., 2010; James et al., 2004). For many years, however,
substantial numbers of breakdowns are observed in all three types of
out-of-home care. These seem mostly related to a mismatch between
the child and family risks and needs on one hand and the referral on the
other. It has been suggested that these mismatches can be prevented by
using an evidence-based risk-need-responsivity model for out-of-home
placement of children (Anderson et al., 2003; Chor et al., 2012; Fallon
et al., 2006; Lyons et al., 1998).
In secure residential care, a risk-need-responsivity model already
exists for guiding offender assessment and treatment (Andrews et al.,
2011). This study aims to contribute to the development of such a
model specifically for school-aged children with serious psychosocial
needs for referral to non-secure out-of-home care. To this end,
similarities and differences in the (child's) individual, family, and care
history context of Dutch school-aged children at admission to foster,
family-style group, and residential care were investigated. Five hypoth-
eses covering this subject were presented in the introduction. Regarding
these the following conclusions can be drawn from our data.
Our first hypothesis states that the age of admission of foster
children is lower than the age of admission of the children in family-
style group and residential care. Our data support this hypothesis.
However, from a developmental perspective the difference in mean age
of admission can be interpreted as small, since all children were at
elementary school-age (first to fourth grade). Nevertheless, since the
age of admission is related to the length of care history, the differences
in mean age found are important from this perspective, as will be
argued beyond.
The second hypothesis is that the severity of the individual
problems of the child at admission is highest for residentially placed
children. This hypothesis was largely confirmed: findings from both
case file information and the caregiver's ASEBA test results stated that
the degree of behavioral problems at admission was highest among
residentially placed children. Furthermore, the percentage of children
disadvantaged by mental illness was the highest in residential care.
Residentially placed children further showed the highest degree of
school/learning problems. Both Courtney (1998) and James (2006)
suggest that this high percentage of children with severe individual
(behavior) problems in residential care would reflect the tendency of
welfare workers to refer these children to more restricted (residential)
care. Conversely, the ASEBA test results of substitute caregivers seem to
argue against this hypothesis, since these results suggest that the
children in family-style group care instead of residentially placed
children have the severest behavioral problems. However, this finding
does not completely refute our second hypothesis. In sum, residentially
placed children appear to be most disadvantaged by multiple individual
problems, as literature demonstrate that both behavioral problems,
mental illness, and school/learning problems negatively affect place-
ment outcomes (Barber & Delfabbro, 2002; Bartelink, 2013; Becker,
Jordan, & Larsen, 2007; Den Dunnen et al., 2012; Jones et al., 2011;
Raviv, Taussig, Culhane, & Garrido, 2010; Taussig, 2002).
The third hypothesis suggests that the level of child and family
problems for children in family-style group care is between those of
foster and residentially placed children. This hypothesis was not
confirmed in this study, since the most severe risk factors were
witnessed in children placed in family-style group care. Specifically
noteworthy is the prevalence of attachment-related problems in these
children, demonstrated through the SEDQ test results of substitute
caregivers and case file information. This is contrary to the suggesting
of Lee (2010) that children with these problems are approximately 75%
less likely to be placed in a family-based setting. Furthermore, findings
from the ASEBA test results of the substitute caregivers showed that the
degree of behavioral problems is highest for children in family-style
group care. This might be related to the reported attachment problems,
as literature show that attachment problems are partially positively
related to behavior problems (Newton et al., 2000; Vanschoonlandt
et al., 2012). Lastly, the case files of children in family-style group care
reported most frequently suspicion of a history of child sexual abuse.
According to Petrenko, Friend, Garrido, Taussig, and Culhane (2012)
such a history also affects the level of externalizing problems (as being a
trauma-related symptom). Altogether the results suggest that the
quality of attachment as well as the prevalence of child sexual abuse
are relevant risk factors in the individual context of children in family-
style group care, since both attachment problems (Oosterman et al.,
2007; Strijker et al., 2008) and a history of sexual abuse (Eggertsen,
2008; Petrenko et al., 2012) are related to negative long-term place-
ment outcomes.
The fourth hypothesis states that the level of family and individual
parental problems will be highest for the biological parents of foster
children. The study results partially confirmed this hypothesis. Many
biological parents of foster children were reported to have mental
problems (especially fathers), which reflects the findings of Minnis,
Minnis, Everett, Pelosi, and Dunn (2006) and Lee and Thompson
(2008). Additionally, the high rate of material problems among these
families of origin was remarkable, but similar to what was found by
James, Roesch, et al. (2012). Furthermore, the percentage of foster
children that experienced physical or emotional neglect, although
corresponding to the literature (Bernedo, Salas, Fuentes, & García-
Martín, 2014; James, Roesch, et al., 2012; Lee & Thompson, 2008;
Strijker & Knorth, 2009; Tarren-Sweeney, 2008; Yampolskaya,
Sharrock, Armstrong, Strozier, & Swanke, 2014), was almost twice the
percentage of children in family-style group or residential care. On the
other hand, some family risk factors were not unique to children in
foster care. Both the number of broken families, the number of children
exposed to poor parenting skills and the prevalence of physical and
emotional child abuse were the same for all three types of care. Further,
it is noteworthy that no foster child's case file contains (signs of a)
history of sexual abuse, which seems unlikely given that literature
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
6

shows that 10% of foster children have on average experienced such
abuse (Bernedo et al., 2014; James, Roesch, et al., 2012; Scholte, 1997;
Strijker et al., 2008; Tarren-Sweeney, 2008). The current study's finding
therefore probably reflects an underreporting. In sum, especially the
number of parents with mental problems, material problems and a
history of child neglect in the family of origin are major risk factors for
foster children, since these may affect placement outcomes adversely
(Amato, 2010; Bartelink, 2013; Boyer, Hallion, Hammell, & Button,
2009; Breivik & Olweus, 2006; Den Dunnen et al., 2012; Garrido,
Culhane, Petrenko, & Taussig, 2011; López, del Valle,
Montserrat, & Bravo, 2013; Marquis, Leschied, Chiodo, & O'Neill,
2008; Raviv et al., 2010; Xue, Hodges, &Wotring, 2004). Also, material
problems as well as parental mental illness specifically enhance the
likelihood of an out-of-home placement in the first place
(Barber & Delfabbro, 2002; Esposito et al., 2013; Perlman & Fantuzzo,
2013).
Ultimately, the study did not confirm the final hypothesis that the
care history would be the longest and most severe for residentially
placed children. Opposite to literature findings (Barth, 2002;
Frensch & Cameron, 2002; Grietens et al., 2015; Huefner et al., 2010;
Sunseri, 2005; Van IJzendoorn, 2008), this was the case for children in
family-style group care. The differences in care history (e.g. in terms of
child protective service custody, history of residential care) cannot
merely be explained by the small differences in age of admission
(1.3 years). Our findings suggest that it is more likely that the majority
of children in family-style group care were firstly placed in residential
care due to the child's level of (externalizing) behavior problems and
treatment needs, after which the child was being placed in family-style
group care to offer a (long-term) professional family setting (corre-
sponding to the UN guidelines). This might indicate (at least in the
Netherlands) that family-style group care instead of residential care is
selected more and more as placement of last resort after a series of
placements. In sum, children in family-style group care are in particular
at a disadvantage by their long and severe care history, since the length
of time in care negatively affects placement outcomes (Bartelink, 2013;
Courtney, 1998; James, 2006; James, Zhang, et al., 2012; Jones et al.,
2011; Oosterman et al., 2007; Strijker et al., 2008).
4.1. Limitations
The strengths of this study were the triple comparison of character-
istics of children in the three main types of care, and the use of multiple
sources and informants. However, some limitations should be consid-
ered in relation to the study's results. The number of children in family-
style group care participating in this study was limited, which may have
affected the power of the analyses. As such, the results should be
interpreted with some caution. However, as the literature provides little
data concerning children in this type of care, the current results still
contribute to filling a knowledge gap. Our study further showed that
specific data concerning relevant aspects of school performance (i.e.
language and math skills) and family functioning (i.e. parental drug
abuse, domestic violence) are not systematically reported in case files.
The comparison between the three subgroups would have been more
complete if full information could have been retrieved. Children with a
history of previous placements were also included in this study. It has
been suggested that this potentially contributes to a higher level of
behavior and attachment problems (Strijker et al., 2008). However,
Barber and Delfabbro (2002) state that this approach best approximates
reality, since most children in care have experienced a previous
placement. Ignoring this reality would therefore make the results less
applicable. Besides, randomly allocating children to the three types of
care would have caused serious ethical problems. As stated by Wilson
et al. (2004), the allocation to different treatments is rarely made ‘blind’
in social work.
4.2. Implications
Notwithstanding its limitations, the triple comparison of the char-
acteristics of school-aged children at admission to one of the three main
types of out-of-home care (foster, family-style group, residential care)
suggests some setting-specific guidelines to increase the effectiveness of
out-of-home care. First, according to our findings, biological parents in
foster care seem most in need of assistance in achieving a healthy
family environment specifically by guidance towards mental health
services and financial services. Additionally, foster parents need sup-
port in establishing a positive parenting relationship with their foster
child during placement. Second, concerning family-style group care, the
level of attachment and trauma-related problems measured, probably
requires extra professional or therapeutic support to both the family-
style group parents as for children placed in this type of care. Third,
concerning residentially placed children, both their behavioral pro-
blems, mental illness, and school/learning problems require an inten-
sive (group and individual) counseling program. If residential care is
enhanced with therapeutic modules, it may lessen its questionable
image and may become a serious option of choice again for youngsters
at risk for complex behavioral, personal and social problems. Finally,
the study demonstrates that the majority of children in family-style
group care were placed in residential care firstly. This might indicate
that family-style group care has switched positions with residential care
on the continuum of care towards the position of placement of last
resort (at least in the Netherlands). It is recommended to discuss this
shift, and to redefine the role and goals of every setting of out-of-home
care more specifically.
4.3. Conclusion
In general, this study showed several differences in the risks and
needs of children and their families at the time of admission to foster,
family-style group, or (non-secure) residential care. The results may
contribute to the development of a risk-need-responsivity model to
support the decision-making process for referral to non-secure out-of-
home care, with the ultimate goal to maximize the chances of long-term
placements in a family-based setting (i.e. foster and family-style group
care) or residential setting, or even at home. In order to develop such a
model (which will increase the likelihood of positive child develop-
ment), the outlined risks and needs at the time of admission should
further be matched with the developmental progress children will make
during their out-of-home placements.
Declaration of conflicting interests
The authors declared no potential conflicts of interests with respect
to the authorship or publication of this article.
Funding
This study was funded by the Reformed Civil Orphanage Rotterdam,
the Netherlands. This foundation is fully independent and will not
receive any benefit from the research results.
References
Aarons, G. A., James, S., Monn, A. R., Raghavan, R., Wells, R. S., & Leslie, L. K. (2010).
Behavior problems and placement change in a National Child Welfare Sample: A
prospective study. Journal of the American Academy of Child and Adolescent Psychiatry,
49(1), 70–80. http://dx.doi.org/10.1016/j.jaac.2009.09.005.
Achenbach, T. M., & Rescorla, L. E. (2001). Manual for the ASEBA school-age
forms & profiles. Burlington, VT: University of Vermont, Research Centre for Children,
Youth and Families.
Allen, B. S., & Vacca, J. S. (2011). Bring back orphanages - An alternative to foster care?
Children and Youth Services Review,33(7), 1067–1071. http://dx.doi.org/10.1016/j.
childyouth.2011.01.013.
Amato, P. R. (2010). Research on divorce: Continuing trends and new developments.
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
7

Journal of Marriage and Family,72(3), 650–666. http://dx.doi.org/10.1111/j.1741-
3737.2010.00723.x.
Anderson, R. L., Lyons, J. S., Giles, D. M., Price, J. A., & Estle, G. (2003). Reliability of the
child and adolescent needs and strengths-mental health (CANS-MH) scale. Journal of
Child and Family Studies,12(3), 279–289. http://dx.doi.org/10.1023/
A:1023935726541.
Andrews, D. A., Bonta, J., & Wormith, J. S. (2011). The risk-need-responsivity (RNR)
model: Does adding the good lives model contribute to effective crime prevention?
Criminal Justice and Behavior,38(7), 735–755. http://dx.doi.org/10.1177/
0093854811406356.
Armsden, G., Pecora, P. J., Payne, V. H., & Szatkiewicz, J. P. (2000). Children placed in
long-term foster care: An intake profile using the child behavior checklist/4-18.
Journal of Emotional and Behavioral Disorders,8(1), 49–64. http://dx.doi.org/10.
1177/106342660000800106.
Association of Universities in the Netherlands (2014). The Netherlands code of conduct
for academic practice: principles of good academic teaching and research. Retrieved
fromhttp://www.vsnu.nl/files/documenten/Domeinen/Onderzoek/The_
Netherlands_Code%20of_Conduct_for_Academic_Practice_2004_(version2014).pdf.
Barber, J. G., & Delfabbro, P. H. (2002). The plight of disruptive children in out-of-home
care. Children's Services: Social Policy, Research, and Practice,5(3), 201–212. http://dx.
doi.org/10.1207/s15326918cs0503_5.
Barber, J. G., Delfabbro, P. H., & Cooper, L. L. (2001). The predictors of unsuccessful
transition to foster care. Journal of Child Psychology and Psychiatry,42(6), 785–790.
Bartelink, C.. Uithuisplaatsing: wat werkt?(2013). [Out-of-home placement: what works?].
Retrieved fromhttp://www.nji.nl/nl/(311053)-nji-dossierDownloads-Watwerkt_
Uithuisplaatsing.pdf (Nederlands Jeugdinstituut).
Barth, R. P. (2002). Institutions vs. foster homes: The empirical base for the second century of
debate. Chapel Hill, NC: Annie E. Casey Foundation, University of North Carolina,
School of Social Work, Jordan Institute for Families.
Barth, R. P., Lloyd, E. C., Green, R. L., James, S., Leslie, L. K., & Landsverk, J. (2007).
Predictors of placement moves among children with and without emotional and
behavioral disorders. Journal of Emotional and Behavioral Disorders,15(1), 46–55.
http://dx.doi.org/10.1177/10634266070150010501.
Baruch, Y., & Holtom, B. C. (2008). Survey response rate levels and trends in
organizational research. Human Relations,61(8), 1139–1160. http://dx.doi.org/10.
1177/0018726708094863.
Becker, M. A., Jordan, N., & Larsen, R. (2007). Predictors of successful permanency
planning and length of stay in foster care: The role of race, diagnosis and place of
residence. Children and Youth Services Review,29(8), 1102–1113. http://dx.doi.org/
10.1016/j.childyouth.2007.04.009.
Bernedo, I. M., Salas, M. D., Fuentes, M. J., & García-Martín, M. A. (2014). Foster
children's behavior problems and impulsivity in the family and school context.
Children and Youth Services Review,42(0), 43–49. http://dx.doi.org/10.1016/j.
childyouth.2014.03.022.
Berrick, J. D., Courtney, M., & Barth, R. P. (1993). Specialized foster care and group home
care: Similarities and differences in the characteristics of children in care. Children
and Youth Services Review,15(6), 453–473. http://dx.doi.org/10.1016/0190-
7409(93)90026-6.
Bhatti-Sinclair, K., & Sutcliffe, C. (2012). What determines the out-of-home placement of
children in the USA? Children and Youth Services Review,34(9), 1749–1755. http://dx.
doi.org/10.1016/j.childyouth.2012.05.004.
Boyer, S. N., Hallion, L. S., Hammell, C. L., & Button, S. (2009). Trauma as a predictive
indicator of clinical outcome in residential treatment. Residential Treatment for
Children & Youth,26(2), 92–104. http://dx.doi.org/10.1080/08865710902872978.
Breivik, K., & Olweus, D. (2006). Children of divorce in a Scandinavian welfare state: Are
they less affected than US children? Scandinavian Journal of Psychology,47(1), 61–74.
http://dx.doi.org/10.1111/j.1467-9450.2006.00493.x.
Broeders, R., Van der Helm, G. H. P., & Stams, G. J. J. M. (2015). Preventie van gesloten
plaatsingen van jongeren met ernstige gedragsproblemen in Friesland: een pleidooi
voor een gerichte aanpak [Prevention of closed residential placement of children with
severe behavior problems in the province of Friesland (the Netherlands): A plea for a
targeted approach]. Orthopedagogiek: Onderzoek & Praktijk,54(8), 318–330.
Cheung, C., Goodman, D., Leckie, G., & Jenkins, J. M. (2011). Understanding contextual
effects on externalizing behaviors in children in out-of-home care: Influence of
workers and foster families. Children and Youth Services Review,33(10), 2050–2060.
http://dx.doi.org/10.1016/j.childyouth.2011.05.036.
Chor, K. H. B., McClelland, G. M., Weiner, D. A., Jordan, N., & Lyons, J. S. (2012).
Predicting outcomes of children in residential treatment: A comparison of a decision
support algorithm and a multidisciplinary team decision model. Children and Youth
Services Review,34(12), 2345–2352. http://dx.doi.org/10.1016/j.childyouth.2012.
08.016.
Chor, K. H. B., McClelland, G. M., Weiner, D. A., Jordan, N., & Lyons, J. S. (2013).
Patterns of out-of-home placement decision-making in child welfare. Child
Abuse & Neglect,37(10), 871–882. http://dx.doi.org/10.1016/j.chiabu.2013.04.016.
Cohen, J. (1992). A power primer. Psychological Bulletin,112(1), 155–159.
Courtney, M. E. (1998). Correlates of social worker decisions to seek treatment-oriented
out-of-home care. Children and Youth Services Review,20(4), 281–304. http://dx.doi.
org/10.1016/s0190-7409(98)00008-5.
Curtis, P. A., Alexander, G., & Lunghofer, L. A. (2001). A literature review comparing the
outcomes of residential group care and therapeutic foster care. Child & Adolescent
Social Work Journal,18(5), 377–392.
De Baat, M., & Bartelink, C.. Wat werkt in de pleegzorg?(2012). [What works in foster
care?]. Retrieved fromhttp://www.nji.nl/nl/Download-NJi/Wat-werkt-publicatie/
(311053)-nji-dossierDownloads-Watwerkt_Pleegzorg.pdf (Nederlands
Jeugdinstituut).
De Swart, J. J. W., Van den Broek, H., Stams, G. J. J. M., Asscher, J. J., Van der Laan, P.
H., Holsbrink-Engels, G. A., & Van der Helm, G. H. P. (2012). The effectiveness of
institutional youth care over the past three decades: A meta-analysis. Children and
Youth Services Review,34(9), 1818–1824.
Delfabbro, P. H., Barber, J. G., & Cooper, L. (2002). Children entering out-of-home care in
South Australia: Baseline analyses for a 3-year longitudinal study. Children and Youth
Services Review,24(12), 917–932. http://dx.doi.org/10.1016/s0190-7409(02)
00252-9.
Den Dunnen, W., St. Pierre, J., Stewart, S., Johnson, A., Cook, S., & Leschied, A. W.
(2012). Predicting residential treatment outcomes for emotionally and behaviorally
disordered youth: The role of pretreatment factors. Residential Treatment for
Children & Youth,29(1), 13–31. http://dx.doi.org/10.1080/0886571x.2012.642268.
DeSena, A. D. (2005). Safe homes: Is it worth the cost? Child Abuse & Neglect,29(6), 627.
Eggertsen, L. (2008). Primary factors related to multiple placements for children in out-
of-home care. Child Welfare,87(6), 71–90.
Esposito, T., Trocmé, N., Chabot, M., Shlonsky, A., Collin-Vézina, D., & Sinha, V. (2013).
Placement of children in out-of-home care in Québec, Canada: When and for whom
initial out-of-home placement is most likely to occur. Children and Youth Services
Review,35(12), 2031–2039. http://dx.doi.org/10.1016/j.childyouth.2013.10.010.
Fallon, T., Pumariega, A., Sowers, W., Klaehn, R., Huffine, C., Vaughan, T., ... Grimes, K.
(2006). A level of care instrument for children's systems of care: Construction,
reliability and validity. Journal of Child and Family Studies,15(2), 140–152. http://dx.
doi.org/10.1007/s10826-005-9012-y.
Farmer, E. M. Z., Mustillo, S., Burns, B. J., & Holden, E. W. (2008). Use and predictors of
out-of-home placements within systems of care. Journal of Emotional and Behavioral
Disorders,16(1), 5–14. http://dx.doi.org/10.1177/1063426607310845.
Farmer, E. M. Z., Wagner, H. R., Burns, B. J., & Richards, J. T. (2003). Treatment foster
care in a system of care: Sequences and correlates of residential placements. Journal
of Child and Family Studies,12(1), 11–25. http://dx.doi.org/10.1023/
A:1021349907744.
Field, A. (2009). Discovering statistics using SPSS. London: Sage.
Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of
residential mental health placements for children and youth. Child & Youth Care
Forum,31(5), 307–339. http://dx.doi.org/10.1023/a:1016826627406.
Garrido, E. F., Culhane, S. E., Petrenko, C. L. M., & Taussig, H. N. (2011). Psychosocial
consequences of caregiver transitions for maltreated youth entering foster care: The
moderating impact of community violence exposure. American Journal of
Orthopsychiatry,81(3), 382–389. http://dx.doi.org/10.1111/j.1939-0025.2011.
01106.x.
Grietens, H. (2012). Aard en omvang van seksueel misbruik in de pleegzorg en de reactie op
signalen (periode 1945–2007)[Nature and extent of sexual abuse in foster care and the
response to signals (period 1945–2007)]. Groningen: Rijksuniversiteit Groningen.
Grietens, H., Knorth, E., Barth, R., Cummings, M., Stein, M., Courtney, M., ... Bravo, A.
(2015). Therapeutic residential care for children and youth: Developing evidence-based
international practice. London: Jessica Kingsley Publishers.
Harder, A., Zeller, M., Lopez Lopez, M., Köngeter, S., & Knorth, E. (2013). Different sizes,
similar challenges: Out-of-home care for youth in Germany and the Netherlands.
Psychosocial Intervention,22(3), 203–213.
Holtan, A., Rønning, J. A., Handegård, B. H., & Sourander, A. (2005). A comparison of
mental health problems in kinship and nonkinship foster care. European Child
Adolescent Psychiatry,14(4), 200–207.
Holtan, A., Handegård, B. H., Thørnblad, R., & Vis, S. A. (2013). Placement disruption in
long-term kinship and nonkinship foster care. Children and Youth Services Review,
35(7), 1087–1094. http://dx.doi.org/10.1016/j.childyouth.2013.04.022.
Huefner, J. C., James, S., Ringle, J., Thompson, R. W., & Daly, D. L. (2010). Patterns of
movement for youth within an integrated continuum of residential services. Children
and Youth Services Review,32(6), 857–864. http://dx.doi.org/10.1016/j.childyouth.
2010.02.005.
Hussey, D. L., & Guo, S. (2002). Profile characteristics and behavioral change trajectories
of young residential children. Journal of Child and Family Studies,11(4), 401–410.
http://dx.doi.org/10.1023/a:1020927223517.
Jakobsen, T. B. (2013). Anti-social youth? Disruptions in care and the role of ‘behavioral
problems’.Children and Youth Services Review,35(9), 1455–1462. http://dx.doi.org/
10.1016/j.childyouth.2013.05.012.
James, S. (2006). Children in out-of-home care: Entry into intensive or restrictive mental
health and residential care placements. Journal of Emotional and Behavioral Disorders,
14(4), 196–208.
James, S., Landsverk, J., & Slymen, D. J. (2004). Placement movement in out-of-home
care: Patterns and predictors. Children and Youth Services Review,26(2), 185–206.
http://dx.doi.org/10.1016/j.childyouth.2004.01.008.
James, S., Roesch, S., & Zhang, J. J. (2012a). Characteristics and behavioral outcomes for
youth in group care and family-based care: A propensity score matching approach
using national data. Journal of Emotional and Behavioral Disorders,20(3), 144–156.
http://dx.doi.org/10.1177/1063426611409041.
James, S., Zhang, J. J., & Landsverk, J. (2012b). Residential care for youth in the child
welfare system: Stop-gap option or not? Residential Treatment for Children & Youth,
29(1), 48–65. http://dx.doi.org/10.1080/0886571x.2012.643678.
Jones, R., Everson-Hock, E. S., Papaioannou, D., Guillaume, L., Goyder, E., Chilcott, J., ...
Swann, C. (2011). Factors associated with outcomes for looked-after children and
young people: A correlates review of the literature. Child: Care, Health and
Development,37(5), 613–622.
Kamis-Gould, E., & Minsky, S. (1995). Needs assessment in mental health service
planning. Administration and Policy in Mental Health,23(1), 43–58. http://dx.doi.org/
10.1007/BF02106861.
Kerig, P. K., Ludlow, A., & Wenar, C. (2012). Developmental psychopathology: From infancy
through adolescence(6th ed.). Maidenhead, United Kingdom: McGraw-Hill Education.
Koomen, H., Verschuren, K., & Pianta, R. (2007). LLRV: Leerling Leerkracht Relatie
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
8

Vragenlijst[STRS: Student teacher relationship questionnaire]. Houten: Bohn Stafleu
van Loghum.
Landers, R. (2015). Computing intraclass correlations (ICC) as estimates of interrater
reliability in SPSS. The Winnowerhttp://dx.doi.org/10.15200/winn.143518.81744.
Lausten, M. (2015). Needs and characteristics of high-resource using children and youth:
Denmark. In J. W. Whittaker, J. F. Del Valle, & L. Holmes (Eds.), Therapeutic
residential care for children and youth: Developing evidence-based international practice.
London: Jessica Kingsley Publishers.
Lee, B. (2010). Transitioning from group care to family care: Child welfare worker
assessments. Children and Youth Services Review,32(12), 1770.
Lee, B. R., & Thompson, R. (2008). Comparing outcomes for youth in treatment foster
care and family-style group care. Children and Youth Services Review,30(7), 746–757.
http://dx.doi.org/10.1016/j.childyouth.2007.12.002.
Leloux-Opmeer, H., Kuiper, C., Swaab, H., & Scholte, E. M. (2016). Characteristics of
children in foster care, family-style group care, and residential care: A scoping
review. Journal of Child and Family Studies,1–15.
López, M., del Valle, J. F., Montserrat, C., & Bravo, A. (2013). Factors associated with
family reunification for children in foster care. Child & Family Social Work,18(2),
226–236.
Lyons, J. S. (2009). Communimetrics: A communication theory of measurement in human
service settings. New York, NY: Springer.
Lyons, J. S., Libman-Mintzer, L. N., Kisiel, C. L., & Shallcross, H. (1998). Understanding
the mental health needs of children and adolescents in residential treatment.
Professional Psychology: Research and Practice,29(6), 582–587. http://dx.doi.org/10.
1037/0735-7028.29.6.582.
Marquis, R. A., Leschied, A. W., Chiodo, D., & O'Neill, A. (2008). The relationship of child
neglect and physical maltreatment to placement outcomes and behavioral adjustment
in children in foster care: A Canadian perspective. Child Welfare,87(5), 5–25.
Minnis, H., Minnis, K., Everett, A., Pelosi, J., & Dunn, M. (2006). Children in foster care:
Mental health, service use and costs. European Child Adolescent Psychiatry,15(2),
63–70.
Minty, B. (1999). Outcomes in long-term foster family care. Journal of Child Psychology
and Psychiatry,40(7), 991–999. http://dx.doi.org/10.1111/1469-7610.00518.
Newton, R. R., Litrownik, A. J., & Landsverk, J. A. (2000). Children and youth in foster
care: Disentangling the relationship between problem behaviors and number of
placements. Child Abuse & Neglect,24(10), 1363–1374. http://dx.doi.org/10.1016/
s0145-2134(00)00189-7.
Oosterman, M., Schuengel, C., Slot, N. W., Bullens, R. A. R., & Doreleijers, T. A. H. (2007).
Disruptions in foster care: A review and meta-analysis. Children and Youth Services
Review,29(1), 53–76. http://dx.doi.org/10.1016/j.childyouth.2006.07.003.
Oswald, S. H. (2010). History of maltreatment and mental health problems in foster
children: A review of the literature. Journal of Pediatric Psychology,35(5), 462.
Perlman, S., & Fantuzzo, J. W. (2013). Predicting risk of placement: A population-based
study of out-of-home placement, child maltreatment, and emergency housing. Journal
of the Society for Social Work and Research,4(2).
Petrenko, C. L. M., Friend, A., Garrido, E. F., Taussig, H. N., & Culhane, S. E. (2012). Does
subtype matter? Assessing the effects of maltreatment on functioning in
preadolescent youth in out-of-home care. Child Abuse & Neglect,36(9), 633–644.
Pianta, R. C., & Nimetz, S. L. (1991). Relationships between children and teachers:
Associations with classroom and home behavior. Journal of Applied Developmental
Psychology,12(3), 379–393. http://dx.doi.org/10.1016/0193-3973(91)90007-Q.
Pinto, R. J., & Maia, Â. C. (2013). Psychopathology, physical complaints and health risk
behaviors among youths who were victims of childhood maltreatment: A comparison
between home and institutional interventions. Children and Youth Services Review,
35(4), 603–610. http://dx.doi.org/10.1016/j.childyouth.2013.01.008.
Raviv, T., Taussig, H. N., Culhane, S. E., & Garrido, E. F. (2010). Cumulative risk exposure
and mental health symptoms among maltreated youth placed in out-of-home care.
Child Abuse & Neglect,34(10), 742–751. http://dx.doi.org/10.1016/j.chiabu.2010.02.
011.
Scholte, E. M. (1997). Exploration of criteria for residential and foster care. Journal of
child psychology and psychiatry and allied disciplines,38(6), 657–666.
Scholte, E. M., & Van der Ploeg, J. D. (2007). The development of a rating scale to screen
social and emotional detachment in children and adolescents. International Journal of
Methods in Psychiatric Research,16(3), 137–149. http://dx.doi.org/10.1002/mpr.222.
Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Statistical
Methods in Medical Research,7(3), 301–317.
Smyke, A. T., Zeanah, C. H., Gleason, M. M., Drury, S. S., Fox, N. A., Nelson, C. A., &
Guthrie, D. (2012). A randomized controlled trial comparing foster care ad
institutional care for children with signs of reactive attachment disorder. The
American Journal of Psychiatry,169(5), 508–514. http://dx.doi.org/10.1176/appi.
ajp.2011.11050748.
Strijker, J., & Zandberg, T. (2004). Over-Leven in de pleegzorg [About live and survive in
foster care]. Pedagogiek,24(3), 230–245.
Strijker, J., & Knorth, E. J. (2009). Factors associated with the adjustment of foster
children in the Netherlands. American Journal of Orthopsychiatry,79(3), 421–429.
http://dx.doi.org/10.1037/a0016598.
Strijker, J., Knorth, E., & Knot-Dickscheit, J. (2008). Placement history of foster children:
A study of placement history and outcomes in long-term family foster care. Child
Welfare,87(5), 107–124.
Strijker, J., Zandberg, T., & Van der Meulen, B. F. (2002). Indicators for placement in
foster care. British Journal of Social Work,32(2), 217–231. http://dx.doi.org/10.
1093/bjsw/32.2.217.
Sunseri, P. A. (2005). Children referred to residential care: Reducing multiple placements,
managing costs and improving treatment outcomes. Residential Treatment for
Children & Youth,22(3), 55–66. http://dx.doi.org/10.1300/J007v22n03_04.
Tarren-Sweeney, M. (2008). Retrospective and concurrent predictors of the mental health
of children in care. Children and Youth Services Review,30(1), 1–25. http://dx.doi.org/
10.1016/j.childyouth.2007.05.014.
Tarren-Sweeney, M., & Hazell, P. (2005). The mental health and socialization of siblings
in care. Children and Youth Services Review,27(7), 821–843. http://dx.doi.org/10.
1016/j.childyouth.2004.12.014.
Taussig, H. N. (2002). Risk behaviors in maltreated youth placed in foster care: A
longitudinal study of protective and vulnerability factors. Child Abuse & Neglect,
26(11), 1179–1199. http://dx.doi.org/10.1016/S0145-2134(02)00391-5.
United Nations (2009, December 18). Guidelines for the Alternative Care of Children
[Resolution General Assembly]. Retrieved fromhttp://www.un.org/en/ga/search/
view_doc.asp?symbol=A/RES/64/142.
Van den Bergh, P. M., & Weterings, A. M. (2010). Pleegzorg in perspectief: Ontwikkelingen in
theorie en praktijk[Foster care in perspective: developments in theory and practice].
Assen, the Netherlands: Koninklijke Van Gorcum BV.
Van IJzendoorn, M. H. (2008). IQ of children growing up in children's homes: A meta-
analysis on IQ delays in orphanages. Merrill - Palmer Quarterly,54(3), 341–366.
Van Manen, O. (2011). Versterking en uitbreiding van pleegzorgplaatsingen voor kinderen die
niet meer thuis kunnen wonen: Opzet voor het pleegzorgprogramma van Stichting
Kinderpostzegels Nederland[Strengthening and expansion for out-of-home placed
children in foster care: Design for the foster care program of Foundation for Children's
Welfare Stamps Netherlands]. Leiden: Stichting Kinderpostzegels Nederland.
Vanderfaeillie, J., Damen, H., Pijnenburg, H., van den Bergh, P., & Van Holen, F. (2016).
Foster care assessment: An exploratory study of the placement assessment process in
Flanders and the Netherlands. Child & Family Social Work,21(3), 358–368. http://dx.
doi.org/10.1111/cfs.12152.
Vanschoonlandt, F., Vanderfaeillie, J., Van Holen, F., & De Maeyer, S. (2012).
Development of an intervention for foster parents of young foster children with
externalizing behavior: Theoretical basis and program description. Clinical Child and
Family Psychology Review,15(4), 330–344. http://dx.doi.org/10.1007/s10567-012-
0123-x.
Vanschoonlandt, F., Vanderfaeillie, J., Van Holen, F., De Maeyer, S., & Robberechts, M.
(2013). Externalizing problems in young foster children: Prevalence rates, predictors
and service use. Children and Youth Services Review,35(4), 716–724. http://dx.doi.
org/10.1016/j.childyouth.2013.01.015.
Verhulst, F., & Van der Ende, J. (2013). Handleiding ASEBA Vragenlijsten voor leeftijden 6
tot en met 18 jaar. Rotterdam: ASEBA Nederland.
Verhulst, C., Van der Ende, J., & Hoolhans, M. (1996). Handleiding voor de CBCL/4-
18[Manual for the CBCL/4-18]. Rotterdam: Sophia Kinderziekenhuis, Erasmus MC.
Ward, H. (2009). Patterns of instability: Moves within the care system, their reasons,
contexts and consequences. Children and Youth Services Review,31(10), 1113.
Wilson, K., Sinclair, I., Taylor, C., & Pithouse, A. (2004). Fostering success: An exploration of
the research literature on foster care. London: Social Care Institute for Excellence.
Xue, Y., Hodges, K., & Wotring, J. (2004). Predictors of outcome for children with
behavior problems served in public mental health. Journal of Clinical Child and
Adolescent Psychology,33(3), 516–523. http://dx.doi.org/10.1207/
s15374424jccp3303_9.
Yampolskaya, S., Sharrock, P., Armstrong, M. I., Strozier, A., & Swanke, J. (2014). Profile
of children placed in out-of-home care: Association with permanency outcomes.
Children and Youth Services Review,36, 195–200. http://dx.doi.org/10.1016/j.
childyouth.2013.11.018.
H. Leloux-Opmeer et al. Children and Youth Services Review 77 (2017) 1–9
9