A critical review of research from the USA and the UK.
Famiy reunification offers a potential route to permanency for looked after children – a key issue in contemporary social care.
This report offers policy-makers and practictioners a critical review of the research findings available in the UK and the USA, as well as a guide to the pitfalls in interpreting the research evidence. It assesses:
In recent years there has been a rise in the number of children looked after by local authorities, with consequences both for the children and families themselves and for local authority resources. It is therefore timely to consider the option of reuniting some children with their families. This review of the research in the UK and USA, by Nina Biehal at York University, presents the available research evidence on patterns and outcomes of reunion.
Since the mid-1990s there has been a steady rise in the number of children looked after by local authorities. The trend has been for younger children to enter care and to remain longer due to the seriousness of their difficulties. In the context of this rise in the number of children remaining looked after long-term, the consequent resource pressures on the care system and the drive to increase adoption from care, family reunification is highly topical. However, reunification is not self-evidently a safe policy, since the looked after system is increasingly populated by children who have been abused or neglected. While it may be beneficial for many children to be reunited with their families, it is important to consider carefully which children, in which circumstances, are likely to benefit.
This review offers a critical appraisal of the available research evidence on patterns and outcomes of reunion. Caution is needed in interpreting this evidence since much of it comes from the USA and cannot be directly extrapolated to a UK context.
Research in England and the USA, as well as government statistics, indicate that although many children return home quite quickly after becoming looked after, the likelihood of return declines sharply after around six months in placement. However, evidence from a major study in the USA suggests that this may be true only for children placed for reasons of abuse or neglect and not for those placed as a result of their emotional or behavioural problems or because their parents were unable to care for them.
The fact that many children go home quite rapidly after placement has led to a common misconception that remaining looked after for longer than a few weeks or months may in itself reduce children's chances of being reunited with their families. This view collapses a variety of factors which may contribute to children remaining longer in care into the notion that it is the passage of time which diminishes the likelihood of reunion. The research evidence suggests that a variety of factors are related to the length of time that children remain looked after, including the characteristics and attitudes of parents and children, the reasons for placement and the characteristics of services. Variations in rates of discharge between local authorities may also be related to local thresholds for entry to care
Research in the USA has shown that children in middle childhood (roughly, four- to twelve-year-olds) are more likely to be reunited with their families than infants or adolescents. This may be due to variations in professional perceptions of risk in respect of different age groups, or because different options are available to infants and to adolescents (for example, adoption or independence), or because of differences in the reasons for which children of different ages are placed.
Studies in the USA have concluded that African-American children are reunited with their parents at a slower rate than white children, but the reasons for this are complex. While these findings raise questions that should be explored in the UK, they cannot be directly extrapolated to this country.
There is some evidence from both England and the USA that disabled children tend to remain longer in public care, particularly those with learning difficulties.
American studies have found that a variety of parental problems are associated with a lower probability of reunion, including poverty, parental drug misuse and chronic mental illness. They also indicate that children from lone-parent families are likely to remain longer in public care. English studies have consistently found that the composition of the families of looked after children often changes significantly while they are being looked after. The particular ways in which families have been reconstituted during a child's absence may affect the likelihood of a harmonious return.
Children placed as a result of parental illness are likely to be reunited with their families quite quickly. However, fewer children are placed for this reason today than in the past. Where entry to care is related to their behaviour problems, children are likely to return home more rapidly than those placed due to abuse, neglect or parental problems.
Studies in both the UK and the USA have found that children placed due to physical or sexual abuse are more likely to return to their families than those placed for neglect. One study found that although children placed for neglect tend to remain longer in care, most do eventually return home, whereas a higher proportion of abused children never return home. Children who have been sexually abused are likely to return home soonest, perhaps because the risk to them rapidly diminishes if the perpetrator is removed from the home.
Although many claims have been made as to the importance of continuing family contact in hastening the reunion of children with their families, there is no evidence that it is contact per se that leads to reunification. However, there is some evidence that frequent parental visiting indicates the presence of a number of other factors which may predict reunion, including a positive relationship and strong attachment between parent and child, parental motivation, placement for reasons such as parental ill health or other crises rather than serious and persistent parenting problems, support to parents from social workers and purposeful, planned social work activity. It seems likely from the evidence that it is this cluster of positive factors, including regular parental contact, which are together associated with the reunion of children with their families.
Since the 1970s researchers in the UK have consistently reported that children's return home is often unplanned and that little social work attention is given to reunion. Reunification often occurs as a result of the actions of parents or children or because placements have been disrupted. There may be little clarity about what needs to change in order for children to return home, and decisions about return may occur irrespective of the presence of any changes in the circumstances that led to placement.
Two recent English studies have found that the availability of follow-up support to families once children return home is often patchy, and when it is provided it is usually available only for a short period.
Most American studies have found that children placed in kinship care tend to be reunited with their families at a slower rate. There is some evidence that children placed with relatives may have entered care for different reasons or may be more likely to come from lone-parent families and experience poverty.
Only a small number of studies in the UK have followed up children reunited with their families. Most of these have found that between one-third and just over half of reunited children subsequently return to care or accommodation. There is wide variation in the rates of re-entry identified, due to the small sample sizes of these studies and differences in the samples of children and the follow-up periods used. Some children were found to have returned home and then re-entered care at least twice within a two-year period. Evidence from American studies which tracked large samples of children indicates that 19-24 per cent of children in the USA return to care within two to three years of discharge.
Some American studies have suggested that children in middle childhood are most at risk of re-entry to care, while some English studies have identified the phenomenon of adolescents who 'oscillate' in and out of the care system. Several studies have indicated that family poverty, parental drug abuse, the severity of parental problems and poor parenting skills may be associated with a higher risk of re-entry. A few other studies have cited parental mental health problems, social isolation and a lack of social support as factors associated with re-entry to care.
An in-depth study in the USA suggested that re-entry was often related to a shortage of social workers and a consequent failure to allocate cases, poor assessment and the poor implementation of case plans, as well as decisions to return children home in the absence of any change in parental problems or parenting skills.
There has been very little research on the outcomes of reunion, but the small number of UK studies which have considered this issue have indicated that some children who return home may be at considerable risk of re-abuse or neglect. Studies in the USA have raised similar concerns and have also found that children were more likely to re-enter care as a result of further neglect than due to re-abuse.
A comprehensive American study of re-entry to care due to re-abuse found that children who had been in care for three or more years and those returned to caregivers who suffered from mental illness were more likely to suffer re-abuse. Children who had experienced a high degree of placement instability, who were likely to be those with the most severe emotional and behavioural problems, were also at higher risk of further maltreatment.
Evidence from the few studies which have addressed the issue of psychosocial outcomes suggests that children reunited with their families are likely to have more serious emotional and behavioural problems, poorer social functioning, educational participation and adjustment and higher rates of re-offending than those who continue to be looked after.
In the UK, there has been relatively little policy attention to the issue of reuniting looked after children with their families, in comparison with the attention given to the question of placement. A sharper focus on this issue would be timely, given the trend in recent years for children to remain longer in care and the fact that adoption is likely to be a route to permanence for only a minority of looked after children. However, care is needed to ensure that the focus is on achieving positive outcomes for individual children, measured in terms of child well-being, and not solely on service outcomes, measured in terms of rates of discharge. Equally, reunion needs to be considered as part of a continuum of services for children and efforts to achieve it, where appropriate, should be properly resourced.
Much of the research evidence comes from the USA and it is unclear how far this is directly transferable to a UK context. Further research is needed in the UK, particularly in relation to the outcomes of reunion. Although few studies have examined outcomes for children reunited with their families, the findings of those that have done so raise questions about the quality of social work assessment, decision-making and follow-up in respect of children who return home.
This literature review was guided by the principles of systematic review. The researcher critically appraised study design and analysis according to a set of explicit criteria and only those considered of sufficient quality were included. Searches were carried out to identify:
Studies were included only if they reported on patterns or outcomes of reunion for looked after children.