Winokur, M., Holtan, A., & Valentine, D. (2009). Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. Campbell Collaboration Systematic Reviews, DOI: 10.4073/csr.2009.1, retrieved online at: www.campbellcollaboration.org/library.php.
Kinship care has been an increasingly prevalent foster care placement for children removed from their homes due to maltreatment. However, we do not know in general whether children in kin placements fare better than children placed in traditional foster care (i.e., placed with someone without a prior relationship to the child). Some have argued that we should be cautious about placing children with family members of parents who have maltreated their children. Others advocate for the use of kinship care in almost all circumstances. This Campbell Collaboration systematic review included 62 randomized and quasi-experimental studies extending over 15 years to compare outcomes such as safety, permanency, and well-being between kinship care and traditional foster care.
Results of this systematic review indicate that children in kinship care have a variety of outcomes superior to children placed in traditional foster care. Children placed in non-kin foster care had almost three times the odds of having a placement change than children in kin care (OR = 2.78)1. Children in kin placements had slightly better behavioural development (g = -.24)2 and had approximately twice the odds of having improved mental health functioning (OR = 2.17) than children in non-kin placements. In addition, children in traditional foster care were somewhat more likely to have used mental health services than children in kinship care (OR = 1.69). With respect to long-term placement, children in traditional foster care were much more likely to be adopted (OR = 2.50) while children in kinship care had almost four times the odds of residing with their guardians (OR = 3.85). While the debate as to the safety, permanence, and well-being of children in kinship care will surely continue, this review indicates that, when kinship placements of adequate quality are used, outcomes for children appear to be at least as good as they are for children placed in non-related foster care across a range of indicators.
1 An Odds Ratio (OR) is a way of expressing the relative strength of a finding for one group with respect to another group. OR’s greater than 1 reflect that one group has a higher probability of an outcome than its comparison group while scores of less than 1 reflect a lower probability.
2 Hedge’s G is an effect size, indicating the standardized difference, or effect, between one group and another. According to Cohen’s (1977) rubric, .24 would be a small effect size.
This Campbell/Cochrane Systematic Review followed a prescribed and transparent method of retrieving, appraising and synthesizing empirical studies relevant to the research question. This study was vetted by both experts in the field of practice and by experts specializing in data synthesis methodologies. Systematic reviews of existing literature are increasingly being used to harness existing research evidence while addressing many of the biases inherent in narrative reviews. Systematic reviews differ from narrative reviews because they are more rigorous in information retrieval strategies; they follow an explicit and transparent criteria for appraising the quality of existing research evidence, they attempt to identify and control for different types of bias in existing studies; and they have explicit ways of establishing the comparability (or incomparability) of different studies. These steps increase the scientific merit of combining studies to establish a cumulative effect of what the existing evidence is telling us about the research question. In reviewing systematic reviews, it is important to consider both the overall effects and the effects based on sub-analyses, as systematic reviews can provide rich details about the complexity of trying to apply this new knowledge to a practice and/or policy context. Campbell Collaboration and Cochrane Collaboration reviews are generally considered to be of the very highest quality systematic reviews and they receive extensive peer review from methods and content experts in the field. Due to the nature of this particular intervention (kinship care), this review included non-randomized studies that used a parallel cohort design (i.e., studies where a control condition was followed at the same time as the intervention condition, but the control condition did not receive the intervention). The use of such studies, while necessary and informative in this case, means that there is less certainty with respect to causality. That is, there is less certainty that kinship care results in better or worse outcomes for children than there would be if children were randomly assigned to receive either kinship care or foster care (an obvious ethical impossibility). Nonetheless, this systematic review appears to offer a best guess as to the effectiveness of kinship care as an intervention.