Short-term Attachment Outcomes of Infants in the Child Welfare System

1 Chapter 1: Introduction and Literature Review. 2 Prenatal Substance Exposure is Prevalent in the United States. 2 Maternal Drug Use Leads to Inconsistent Caregiving. 2 Effects of Secure and Non-Secure Attachment. 3 Child Welfare Services: CAPTA, DCYF, FTDC, and ASFA. 3 Negative Sequelae of Prenatal Substance Exposure. 5 Prenatal drug exposure does not directly impact attachment. 5 Maternal Characteristics. 6 Advent of Kinship Foster Care. 7 Advantages of kinship care. 7 Disadvantages of kinship care. 8 Inequitable access to resources. 8 Attachment comparisons. 9 Ameliorating the Effects of Prenatal Insults with Postnatal Conditions. 9 Effect of Foster Care on Attachment: Research Gaps. 11 Hypotheses and Objectives. 12 Chapter 2: Method. 13 Participant Characteristics. 13 Measures. 14 Infant attachment. 14 Placement frequency. 16 Placement duration. 16 Placement type. 16 Procedures. 16 Semi-Structured Interviews. 17 Chapter 3: Results. 18 Data Cleaning and Preparation. 18 Descriptive Statistics. 18 Statistical Power and Data Analysis. 20 SHORT TERM ATTACHMENT OUTCOMES iv Hypothesis #1: Frequency of foster care placements will be inversely related to attachment security. 21 Hypothesis #2: Kinship based versus non-kin foster care placements will be positively associated with secure attachment. 21 Interviews with Experts in Foster Care. 22 On placement frequency. 22 On the relationship between placement type and attachment. 22 Observed drawbacks of kinship care. 23 Experienced inequity within support services. 23 On what foster care factors support an infant’s healthy development. 23 Flexibility. 24 History. 24 Biological caregiver involvement. 24 Support. 25 Chapter 4: Discussion. 26 Findings. 26 Preliminary interpretation. 26 How Should These Results be Understood? 26 Broad Policy Recommendations. 30 ASFA efficacy. 31 Caveats surrounding confidentiality of infants in foster care . 32 Access to support. 32 Limitations. 34 Data source limitations. 34 Sample specificity. 35 Reductive. 35 Directions for Future Research. 35 References. 37 Appendix A. 44 Appendix B. 45 SHORT TERM ATTACHMENT OUTCOMES v Acknowledgements For the man who hung on by his fingernails and taught me: That there are two ways to react, and to always make the choice to treat people generously To never pay ATM fees, never skip the cheap laugh, and never touch the principal That if you’re going to sing off key, you should at least sing loudly That the activity doesn’t matter, it’s just an excuse to be together That the world is a kind place that accepts me with open arms But also to say ‘screw you’ when the situation warrants That sensitivity is a double-edged sword That there is honor in a hard day’s work That my life is not just my life Thank you for always being in my corner, my cheerleader, my umbrella, my Mickey I love you, Daddy more than life itself, forever and always SHORT TERM ATTACHMENT OUTCOMES 1 Abstract Children with prenatal substance exposure are often born into families of low socio-economic status, low educational level, and with restricted access to health services. Pregnant substance-using mothers tend to reject, neglect, and generally misattune to their infant children. These environmental risk factors increase the likelihood of negative developmental outcomes such as poor academic performance, externalizing behaviors, and an insecure attachment style. In compliance with the Child Abuse Prevention and Treatment Act and the Adoption and Safe Families Act, Child Welfare Services often places at-risk infants into traditional or kinship foster care placements. This study looked at how placement type and frequency of foster care placements affected the development of secure attachment behaviors of 46 prenatally substance-exposed infants as measured by the Attachment Q-Sort (AQS). While findings are statistically nonsignificant, results indicate two interesting patterns: (a) There is a positive association between placement transitions and AQS and (b) Displaced children that were placed into kinship foster care have greater attachment security than their non-placed counterparts. I present these findings to three clinicians who work with children involved in Child Welfare Services. Study results and clinician reactions provide actionable suggestions for shifting childChildren with prenatal substance exposure are often born into families of low socio-economic status, low educational level, and with restricted access to health services. Pregnant substance-using mothers tend to reject, neglect, and generally misattune to their infant children. These environmental risk factors increase the likelihood of negative developmental outcomes such as poor academic performance, externalizing behaviors, and an insecure attachment style. In compliance with the Child Abuse Prevention and Treatment Act and the Adoption and Safe Families Act, Child Welfare Services often places at-risk infants into traditional or kinship foster care placements. This study looked at how placement type and frequency of foster care placements affected the development of secure attachment behaviors of 46 prenatally substance-exposed infants as measured by the Attachment Q-Sort (AQS). While findings are statistically nonsignificant, results indicate two interesting patterns: (a) There is a positive association between placement transitions and AQS and (b) Displaced children that were placed into kinship foster care have greater attachment security than their non-placed counterparts. I present these findings to three clinicians who work with children involved in Child Welfare Services. Study results and clinician reactions provide actionable suggestions for shifting child welfare policy.