Roughly half a million children are in foster care in the United States, about twice the number of children in care just ten years ago (Administration for Children and Families, 1996; Tatara, 1991). The sharp increase in the number of children in foster care has been largely attributed to the growth in the number of prenatally substance-exposed children entering and staying in the child welfare services system (Feig, 1990). Nearly two-thirds of the children in foster care in 1991, for instance, were considered at risk for serious health problems due to prenatal substance exposure, compared with just over one-fourth of children in care in 1986 (General Accounting Office, 1994). In a recent review, the General Accounting Office (1998) estimates that two-thirds of all children in care had substance abusing mothers, and that 80% of those mothers had been using drugs or alcohol for at least five years, many of them for ten years or more.

Interpreting the sparse research that exists on the developmental outcomes of substance-exposed children is difficult because the prenatal effects of exposure are often clouded by other factors such as poor maternal health, inadequate nutrition, and lack of prenatal care. Similarly, the postnatal effects of exposure are clouded by other factors such as family dysfunction, poverty and environmental deprivation. Despite difficulties interpreting the research, studies show that substance exposure in utero does not inevitably result in poor outcomes for children (Graham et al., 1992; Griffith et al., 1994; Nulman et al., 1994; Rodning, Beckwith & Howard, 1992). The development and well-being of prenatally substance-exposed children appears to be determined, to a large extent, by their caregiving environment.

Kinship Care

More than ever, children are placed into care with extended family members. This type of care is usually called "kinship care" and is the fastest growing out-of-home placement funded by child welfare agencies throughout the United States (Gleeson, 1996). In some areas of the country, approximately half the children in out-of-home placements are in kinship care (Brooks, Webster, Berrick, & Barth, 1998; Dubowitz et al., 1994). The growth in kinship placements can be attributed to several factors including a dwindling pool of traditional foster homes and a growing emphasis among practioners on family continuity.

Kinship care allows children removed from their parents to continue living within the bounds of their extended family. It also may reduce trauma for children who are separated from their parents, reduce stigma they experience from becoming "foster children," and facilitate the transmission of the child's cultural identity. These strengths of kinship care have led to the increased recognition of kin as a valuable child welfare resource. In the past, workers often encouraged voluntary placement of children with kin as an informal and often unregulated means of resolving child protection cases. Over the past decade, though, as the growth in the out-of-home care caseload has outpaced the number of available traditional foster parents, states such as California have moved increasingly toward more formal kinship foster care arrangements. Whereas many view this increase as an encouraging development, it also triggers some complicated issues concerning legal custody arrangements, licensing, and funding. (See Harvey article on p. 3). Further, some states have excluded kinship placements from their formal foster care system, eliminating supports and protections usually required by law.

Characteristics of Kinship Care

Data show that children who are placed with kin have more stable placements than those placed with nonrelatives, and that they are more likely to remain in care for longer periods than children in other placement types. Of children who entered out-of-home care in California, Illinois, Missouri and New York between 1988 and 1994, those placed with relatives remained in care about 30% longer than children in other forms of foster care (Wulczyn, Harden & Goerge, 1997). This may be due to a combination of factors including less intensive contact by child welfare workers with children in kinship care, more complex problems in these families often due to substance abuse, and/or the fact that children in non-relative placements are often reunified too soon. Indeed, this last factor is supported by the finding that children who experience exits from kinship care typically are less likely to reenter foster care than those exiting from nonrelative placements. In California in 1993, the proportion of children who were placed with kin and reentered was 18%, compared with 25% for children placed with nonrelatives (Brooks, et al., 1998).

In general, kinship foster care is used more often as a formal placement option for African American children. In 1996, African American children were the largest group of children in kinship homes in California, for instance, while Caucasian children were the largest group of children in foster homes, foster family agency homes, group homes, and other placements. Like African American children, Latino children were more likely than Caucasian children to be placed in kinship homes. Specifically, half of African American Latino children were placed with kin, compared with 39% of both Caucasian children and children from other racial and ethnic groups (Brooks et al., 1998). The use of kinship homes also appears to vary by the age of the child being placed. Most children in kinship or foster homes in California in 1996, for example, were between 6 and 12 years old. Kinship homes were used less often for infants and teenagers than for children of other ages.

Research on Kinship Care and Substance-Exposed Children

Findings from empirical studies on kinship care are mixed, but generally indicate that foster children benefit from kinship placements. Findings from a study conducted by Fein, Maluccio, Hamilton and Ward (1983) revealed more positive indicators of adjustment for children placed with kin than for those placed with nonrelatives or in residential facilities. The researchers also found less use of educational and health services by kinship providers. More recently, Berrick, Barth and Needell (1994) found that children in both kin and nonrelative placements exhibited a number of health, mental health and behavioral problems. Yet, children between the ages of 4 and 15 who were placed with kin were found to exhibit somewhat fewer problems than children placed with nonrelatives. In contrast, Benedict, Zuravin, and Stallings (1996) found that, although adults who had been placed in foster care with kin had fewer mental health and emotional problems at the time of placement than those placed with non-relatives, both groups were functioning similarly at follow-up in terms of education, employment, physical and mental health, risk-taking behaviors and stresses and supports in their lives.

While these studies provide useful information, they do not consider the interrelated impact of drug exposure and types of caregiving environments on children? outcomes. To compare the characteristics and outcomes of prenatally substance-exposed and non substance-exposed children in kinship and nonrelative foster care, Professor Richard P. Barth and I studied 600 foster caregivers (Brooks & Barth, 1998). The caregivers were taught how to select a child for the study who was older than two years of age and had been in their care at least six weeks. Of the caregivers studied, 258 (44%) were caring for children who were prenatally exposed to substance; the remaining 323 (56%) were caring for children who were not substance-exposed. Caregivers in the study were asked to indicate their relationship to the child who was the subject of the study. Based on their responses, subjects and their caregivers were placed into one of the following groups: (1) non substance-exposed kin (139 families); (2) substance-exposed kin (103 families); (3) non substance-exposed nonrelative (184 families); or (4) substance-exposed nonrelative (155 families).

Findings

Analysis of our data revealed both similarities and differences in foster family and child characteristics. In terms of children's educational performance, no differences were found among groups. Most foster children were doing well in school, making A's and B's (or doing "Very well" or "Well") in their classes, regardless of their substance exposure or kinship status. Children were different, though, in terms of their emotional and behavioral development. Kin caregivers were more optimistic than nonrelative caregivers about the type of adult into which they believed their children would grow. Observed differences in children's emotional development, therefore, seemed to be explained by their kinship status. Differences in problem behavior, on the other hand, appear to be related to children's substance exposure status (substance-exposed children were exhibited more problem behavior than non substance-exposed children). Analysis of the data further revealed that the children least likely to exhibit problem behavior were those who were not prenatally substance-exposed and who were living with kin. These children were one-third as likely as children from either substance-exposed group, and one-half as likely as children from the non substance-exposed, nonrelative group, to exhibit problem behavior. Another analysis showed that children not placed at birth were six times as likely as children placed at birth to exhibit problem behavior, regardless of placement type or drug exposure status.

The above findings suggest that differences in problem behavior between substance-exposed and non substance-exposed children are confounded by children's kinship status and other factors, such age at placement, that are associated with placement type. Stated another way, the differences in problem behavior between the kin and nonrelative groups in our study are confounded by children's drug exposure status. Placement in kinship care seems, then, to pose special challenges for children who were prenatally exposed to substances, but not for non substance-exposed children. The decisions to place substance-exposed children with kin should include special considerations of the family's likely access to, and use of, services to adequately meet potentially complex medical, educational, emotional, and behavioral needs of those children.

Our finding that prenatally substance-exposed children placed with kin exhibited more problem behavior than other children might be related to other family or child characteristics (e.g., confusing and often disruptive relationship with substance abusing birth parents), or to the services and supports they receive. Indeed, findings from a previous analysis of this sample (Berrick et al., 1994) show that kin caregivers in the sample were older, had lower incomes, and received fewer services, compared with nonrelative caregivers. Given these characteristics, older kin caregivers in our study may have found it more difficult to raise young, "high-need," substance-exposed children without proper services and supports. Of all caregivers, kin caregivers of substance-exposed children had the lowest number of contacts with their children's social workers. Similarly, substance-exposed children living with kin were less likely than other children to be seen by their workers. In addition, we found that kin caregivers received an average of $141 less than their nonrelative counterparts and that nonrelative caregivers received approximately $60 more when the children they were caring for were substance-exposed. Kin caregivers received only $10 more when the children in their care were substance-exposed. These findings are consistent with those from other studies (Fein et al., 1983; Walker et al., 1994) which indicate that kin foster families typically receive and/or use fewer services and supports than nonrelative families. This could be related to race/ethnicity, as African American children were significantly overrepresented among the substance-exposed kin group. The disparity in services and supports, therefore, may reflect less help seeking by African Americans caring for substance-exposed kin (Downs, 1986; Fein, Maluccio, Hamilton, & Ward, 1993), or different help-seeking patterns. It may also reflect less effective child welfare responses with African American children and families.

Conclusion

Substance-exposed children may well comprise the majority of children in foster care. Both the number and vulnerability of this population demand more attention by child welfare professionals, policymakers, and researchers. Findings from the study described above show that substance-exposed children can achieve positive educational, emotional, and behavioral outcomes. The findings also suggest that placement in kinship or nonrelative foster care is related to children's outcomes and may even have a causal effect. It appears that kinship placements are particularly effective at fostering the development of non substance-exposed children. Such placements may promote children's development and well-being by providing them with early and stable placements at a very early age.

Notwithstanding, decisions to place substance-exposed children with kin may require the provision of additional and more appropriate services, resources, and supports. Kinship caregivers and their substance-exposed foster children might, for example, benefit from more worker contacts, positive parenting classes, therapeutic child care, respite care, family therapy, support groups, and concrete services such as transportation vouchers or tokens. Without such a commitment, placement with nonrelatives might be more suitable for some substance-exposed children. The practical and ethical issues around determining which children in kinship care are inadequately served and should be moved to other placements with nonrelatives are great and complex. Thus, providing more assistance to kin caregivers of substance-exposed children is probably a more viable alternative than replacing substance-exposed children. Substance exposure, alone, does not appear to decide the fate and well-being of substance-exposed foster children. Perhaps, then, the child welfare services system's greatest contribution to substance-exposed foster children will be sustained efforts toward improving their postnatal, caregiving environments.

This article was adapted and updated from Brooks, D., & Barth, R. P. (1998). Characteristics and outcomes of drug-exposed and non drug-exposed children in kinship and non-relative foster care. Children and Youth Services Review, 20, 475-501.

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