dissertation on kinship care

Examining the kinship care experience: the impact of social support and family resources on caregiver health, family involvement with the child welfare system, and permanence for children

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• March 21, 2019
• Affiliation: School of Social Work
• This study had two purposes: (1) to describe the quality of the kinship caregiving experience for kinship caregivers and (2) to assess whether social support and family resource needs impact the health of kinship caregivers, family involvement in the child welfare system, and permanence for children living in kinship care. In the first part, semi structured interviews were used to examine the caregiving experiences of fifteen grandmothers raising grandchildren in Pinellas County, Florida. Overall, the qualitative results shed some light on what it is like to be a relative caregiver. Most caregiving took place out of obligation, not by choice or by an explicit decision. In light of all the stressors in their lives, the caregivers in the study found much solace in their involvement with a community program. Three case studies were used to provide examples of different experiences with caregiving. The second part of the study used a correlational one-group posttest only design. All caregivers (N=175) enrolled in programs offered by a consortium of non-profit community organizations completed the Family Support Scale (FSS), Family Resource Scale (FRS), and General Health Questionnaire (GHQ-SF12). Hierarchical linear regression was used to estimate the relation of social support and family resources to the health of the caregiver, child welfare involvement, and permanence of child placement. Family resource needs predicted physical health, mental health and permanency. Social support predicted physical, but not mental health. None of the study variables predicted the family's involvement with the child welfare system. A further exploration into the permanency variable revealed that African American caregivers cared for children for longer periods than other ethnic groups, on average about 15 months more. Additionally, caregivers who had basic resource unmet needs took care of children for 19 months longer than those whose needs were better met. These data suggest that physical and psychological wellbeing of informal caregivers is at risk due to the needs and demands associated with caregiving and that better outcomes for children may result from more intense efforts to identify and address the resource needs of grandparents and other relatives raising children.
• https://doi.org/10.17615/5rrb-1v03
• Dissertation
• In Copyright
• Barbarin, Oscar A.
• Open access
• October 19, 2010

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CHAPTER 5 Formal Kinship Care Practice Models

• Published: May 1999
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This chapter presents the current kinship care service delivery models used by public child welfare institutions. It discusses the current state of practice for children who live with relatives and are involved in the child welfare system. The use of family decision-making meetings, caregiver support groups, and the need for differential assessment are highlighted.

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Kinship care for the safety, permanency, and well‐being of children removed from the home for maltreatment

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out‐of‐home settings that will facilitate their safety, permanency, and well‐being. However, children in out‐of‐home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well‐being of children removed from the home for maltreatment.

Search methods

We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index‐Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.

Selection criteria

Controlled experimental and quasi‐experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non‐kinship foster care for child welfare outcomes in the domains of well‐being, permanency, or safety.

Data collection and analysis

Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies. Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan ) for meta‐analysis with the results presented in written and graphical forms.

Main results

One‐hundred‐and‐two quasi‐experimental studies, with 666,615 children are included in this review. The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attrition bias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size ‐0.33, 95% confidence interval (CI) ‐0.49 to ‐0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well‐being (OR 0.50, 95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non‐kinship foster care. For permanency, there was no difference on reunification rates, although children in non‐kinship foster care were more likely to be adopted (OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non‐kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).

Authors' conclusions

This review supports the practice of treating kinship care as a viable out‐of‐home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Plain language summary

Kinship care for the safety, permanency, and well‐being of maltreated children

Child abuse and neglect are common problems across the world that result in negative consequences for children, families, and communities. Children who have been abused or neglected are often removed from the home and placed in residential care or with other families, including foster families. Foster care was traditionally provided by people that social workers recruited from the community specifically to provide care for children whose parents could not look after them. Typically they were not related to the children placed with them, and did not know them before the placement was arranged. In recent years many societies have introduced policies that favour placing children who cannot live at home with other members of their family or with friends of the family. This is known as 'kinship care' or 'families and friends care'.  We do not know what type of out‐of‐home care (placement) is best for children. 

This review was designed to help find out if research studies could tell us which kind of placement is best. We found 102 studies with 666,615 children that met the methodological standards we considered acceptable. Wherever possible we combined the data from studies looking at the same outcome for children, in order to be more confident about what the research was telling us. Current best evidence suggests that children in kinship foster care may do better than children in traditional foster care in terms of their behavioural development, mental health functioning, and placement stability. Children in traditional foster care placements may do better with regard to achieving adoption and accessing services they may need. There were no negative effects experienced by children who were placed in kinship care. The major limitation of this systematic review is that the quality of research on kinship care is weakened by the poor methods of the included studies. Implications for practice and future research are discussed.

Description of the condition

Every year a large number of children around the world are removed from their homes because they are abused, neglected, or otherwise maltreated. For example, there were 408,425 children in foster care in the United States as of September 2010 ( USDHHS 2011a ), 64,400 looked‐after children in England as of March 2010 ( DFE 2010 ), 35,895 children in out‐of‐home care in Australia as of 2010 ( AIHW 2012 ), 15,892 looked‐after children in Scotland as of July 2010 ( Scottish Government 2011 ), 8408 children in out‐of‐home therapeutic placement in Israel as of 2010 ( CBS 2011 ), 5419 looked‐after children in Wales as of March 2011 ( NAW 2011 ), and 7270 looked‐after children in state custody in Norway as of 2011 ( Statistics Norway 2011 ). Except for the United States which has experienced a 20% decrease in the number of children in foster care from 2005, the other countries all experienced an increase in the number of children placed in foster care. Specifically, England had a 5% increase from 2005, Israel had an 8% increase, Wales had a 16% increase, Norway had a 21% increase, Scotland had a 23% increase, and Australia had a 50% increase from 2005.

The main reasons for the removal of children in the United States are neglect, physical abuse, sexual abuse, psychological maltreatment, abandonment, threats of harm, and drug addiction ( USDHHS 2011b ). Abuse and neglect are the most prevalent causes of children being removed from the home in other countries as well (e.g., Wales) ( NAW 2011 ).

Internationally, child welfare systems are accountable for the safety, permanency, and well‐being of children in their care. For children removed from the home, child welfare professionals are responsible for placing them in out‐of‐home settings that will facilitate these outcomes. Specifically, the primary placement options are traditional foster care, kinship care, institutional care, and group homes ( AIHW 2012 ; USDHHS 2011a ). Children in out‐of‐home placements typically display more educational, behavioural, physical, and psychological problems than do their peers ( Gleeson 1999 ), although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system. In addition to experiencing poor adult outcomes, these children are at risk for drifting in out‐of‐home care until, in some cases, they 'graduate' from the system because of age ( Zuravin 1999 ).

Description of the intervention

Kinship care.

Kinship care is broadly defined as, "the full‐time nurturing and protection of children who must be separated from their parents, by relatives, members of their tribes or clans, godparents, stepparents, or other adults who have a kinship bond with a child" ( CWLA 1994 , p. 2). This is contrasted with traditional foster care or non‐kinship foster care, which is the placement of children removed from the home with unrelated foster parents. Kinship care is known by many other names around the world, including family and friends care in the United Kingdom, kith and kin care in Australia, and kinship foster care in the United States. For this review, kinship care will refer to kinship foster care placements, while foster care will refer to non‐kinship foster care placements.

There are several variations of kinship care, including formal, informal, and private placements. Formal kinship care is a legal arrangement in which a child welfare agency has custody of a child ( Ayala‐Quillen 1998 ). Informal kinship care is when a child welfare agency assists in the placement of a child but does not seek custody ( Geen 2000 ). Private kinship care is a voluntary arrangement between the birth parents and family members without the involvement of a child welfare agency ( Dubowitz 1994a ).

The most commonly perceived benefits are that kinship care "enables children to live with persons whom they know and trust, reduces the trauma children may experience when they are placed with persons who are initially unknown to them, and reinforces children's sense of identity and self esteem which flows from their family history and culture" ( Wilson 1996 , p. 387). The primary aims of kinship placements are family preservation, in which the permanency goal is reunification with birth parents, and substitute care, in which kinship care is considered to be a long‐term arrangement when restoration is not possible or the permanency goal is adoption or guardianship by kin caregivers ( Scannapieco 1999 ). Kinship care is also considered to be the least restrictive ( Scannapieco 1999 ) and safest setting ( Gleeson 1999 ) on the continuum of out‐of‐home placements.

Intervention context

Although an ancient practice in many cultures, formal kinship care is a newer placement paradigm in countries like the United States and Australia, due to its recent adoption by the child welfare field as the placement of choice, when appropriate, in the continuum of out‐of‐home care services for children ( Ainsworth 1998 ; Geen 2000 ; Scannapieco 1999 ). For example, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 explicitly required U.S. states to give preference to family members when placing a child outside of the home ( Leos‐Urbel 2002 ). The Adoption and Safe Families Act of 1997 continued this federal commitment towards promoting and supporting kinship care ( Ayala‐Quillen 1998 ). In Australia, the Aboriginal Child Placement Principle has resulted in the increased use of kinship placements, although this differs by state or territory ( Paxman 2006 ). In addition, the New South Wales Children and Young Persons (Care and Protection) Act 1998 encourages the 'least intrusive' principle, which is interpreted by caseworkers as placements with kin ( Spence 2004 ). In some European countries, there has also been a shift in policy regarding kinship placements. Specifically, the Children Act 1989 (United Kingdom), the Children Act 1995 (Scotland), and the Children Order 1995 (Northern Ireland) are generally supportive of kinship care ( Broad 2005a ), as are regulations from 2003 in Norway ( MCESI 2003 ). However, there is no legislation in Israel concerning kinship care, and a lack of consensus about how to define and serve the population of children at risk for maltreatment ( Schmid 2007 ).

For the countries included in this review (i.e., Australia, Ireland, Israel, Netherlands, Norway, Spain, Sweden, United Kingdom, and U.S.), there are essential differences in child welfare policy and practice for placing children in out‐of‐home care. Outside of the U.S., long‐term foster or kinship care is the preferred placement, which implies that parents have right of access to their child provided it is not considered damaging, and also a right to express their opinion on important issues like education and religion. In Australia, Israel, Netherlands, Norway, and Sweden, foster care placement is not time‐limited and can be extended until the child emancipates from care (e.g., Strijker 2003 ). As the preferred option is long‐term stable placements, there are foster children in Norway and Sweden who remain in foster homes throughout their entire childhood (e.g., Sallnas 2004 ). The concept of breakdown (premature termination of placement), therefore, is a more relevant measure in the evaluation of foster care than is reunification or adoption ( Sallnas 2004 ).

During the past 25 years in many countries, there has been a rapid increase in the number of children removed from home and placed with relatives ( Cuddeback 2004 ). The main reasons for the growth of this placement option include an influx of abused and neglected children into out‐of‐home care ( Berrick 1998 ), concern about poor outcomes for children leaving care ( Broad 2005b ), a persistent shortage in foster care homes ( Berrick 1998 ), and a shift in policy toward treating kin as appropriate caregivers with all of the legal rights and responsibilities of foster parents ( Leos‐Urbel 2002 ). In New South Wales, Australia, the most important factor accounting for historically high numbers of children in foster care is the low use of residential care ( Tarren‐Sweeney 2006a ). This trend toward lower use of residential care also exists in the United Kingdom ( Berridge 1998 ). Although the use of residential care has increased for older children in Israel and Sweden ( Mosek 2001 ; Sallnas 2004 ), this practice runs counter to official childcare policies in Sweden ( Sallnas 2000 ).

Similar to other child welfare interventions, kinship care is faced with its fair share of controversial issues. The major controversy centres on the unequal financial support ( Brooks 2002 ) and service provision received by kinship caregivers compared with traditional foster parents ( Dubowitz 1994a ). The licensing and certification of kinship caregivers is also a source of much disagreement and dissatisfaction ( Gibbs 2000 ). Relatedly, the appropriate level of oversight of kinship caregivers by child welfare agencies is another area of discord ( Cohen 1999 ). One of the key debates is over the appropriate level of involvement for biological parents prior to and after the removal of their children ( Ayala‐Quillen 1998 ).

In a comprehensive review of the American literature, Cuddeback 2004 confirmed much of the conventional wisdom about kinship care while identifying many of the weaknesses of quantitative research on the topic. Cuddeback found that kinship caregivers are more likely to be older, single, less educated, unemployed, and poor than are foster parents and non‐custodial grandparents. Furthermore, Cuddeback reported that kin caregivers report less daily physical activity, more health problems, higher levels of depression, and less marital satisfaction. Cuddeback also concluded that kinship care families receive less training, services, and financial support than do foster care families. In addition, Cuddeback reported that birth parents rarely receive family preservation services, which means that children in kinship care are less likely than children in foster care to be reunified. Lastly, Cuddeback found inconclusive evidence that children in kinship care have greater problems related to overall functioning than do children in foster care.

Why it is important to do this review

In 2004, Geen argued that, "despite the centrality of kinship foster care in child welfare, our understanding of how best to utilize and support kin caregivers, and the impact of kinship foster care on child development, is limited" (Geen 2004 p. 144). Furthermore, it is difficult for social work researchers to keep up with the exponential growth of kinship care as a placement option (Berrick 1994a; Dubowitz 1994a).  

Ethical standards preclude the random assignment of children to kinship or foster care, as these placements typically are based on the appropriateness and availability of kinship caregivers or foster parents (Barth 2008a). However, recent studies have used propensity score matching as a means of statistically simulating random assignment to placement conditions ( Barth 2008b ).

Even the better‐designed studies need to be brought together and appropriately synthesised to provide child welfare professionals with an accessible summary of research on which to make evidence‐based decisions (Goerge 1994). 

In 2005, we identified a need to undertake a systematic review of the available evidence from those quasi‐experimental study designs best able to provide ‘good enough’ evidence of the effectiveness of kinship care. That review was published in January 2009. Unfortunately, the best available evidence on kinship care was seriously lacking in many ways, especially in regard to controlling for baseline differences in non‐randomised studies. In keeping with Cochrane Collaboration Policy we have updated this review, which now includes studies published between March 2007 and March 2011.

Criteria for considering studies for this review

Types of studies.

Controlled experimental and quasi‐experimental studies, in which children placed in kinship care are compared cross‐sectionally or longitudinally with children placed in foster care. The types of eligible quasi‐experimental designs include studies that employ matching, covariates, or ex post facto comparisons of children in kinship care and foster care. Studies that compare kinship care to more restrictive out‐of‐home settings (e.g., residential treatment centres) were not considered for this review. Relative to children who are placed in kinship or foster care, children placed in more restrictive settings tend to differ in important ways. These differences complicate inferences about the effects of placement and as such, the review focuses on kinship and foster care placements only.

Types of participants

Children and youth under the age of 18 who were removed from the home for abuse, neglect, or other maltreatment, and subsequently placed in kinship care.

Types of interventions

Formal kinship care placements, irrespective of whether the kin caregivers were licensed (paid) or unlicensed (unpaid). Thus, studies that exclusively examine informal or private kinship care arrangements were not considered. Studies were considered if participants experienced other placement types in conjunction with the kinship care intervention. For example, the treatment group may include children for whom kinship care was their first, last, or only placement in out‐of‐home care. However, these children must have spent the majority (i.e., more than 50%) of their total time in out‐of‐home care in kinship care.

Types of outcome measures

Eligible studies must analyse child welfare outcomes in the well‐being, permanency, or safety domains. Although caregiver and birth parent outcomes are very relevant, they were not considered in this review because child outcomes are what drive the policy and practice of kinship care. However, these outcomes may mediate or moderate the effect of kinship care on child welfare outcomes and should be explored in future research on the topic.

Primary outcomes for the review are behavioural development, mental health, placement stability, and permanency. Secondary outcomes include educational attainment, family relations, service utilisation, and re‐abuse. The following list of outcome domains is meant to be exhaustive, although the examples in each domain are illustrative of the outcomes to be considered in this review.

Behavioural development

Behaviour problems, adaptive behaviours, delinquency. Measured by case records, caregiver reports, teacher reports, self reports, and standardised instruments.

Mental health

Psychiatric illnesses, psychopathological conditions, well‐being. Measured by case records, caregiver reports, self reports, and standardised instruments.

Placement stability

Number of placements, re‐entry, length of stay. Measured by child welfare administrative databases.

Reunification, adoption, guardianship. Measured by child welfare administrative databases.

Educational attainment

Graduation, grades, test scores, attendance, academic success. Measured by school and case records, caregiver reports, self reports, and standardised instruments.

Family relations

Problem‐solving, tolerance, commitment, conflicts, emotional availability, home environment. Measured by caregiver reports, self reports, and standardised instruments.

Service utilisation

Mental health services, foster support groups, family therapy, developmental services, physician services. Measured by medical records, caregiver reports, self reports, and child welfare administrative databases.

Re‐abuse

Recurrence of abuse, institutional abuse. Measured by child welfare administrative databases.

Search methods for identification of studies

Preliminary searches indicated that a narrowing of the search strategy using a methodological filter resulted in the exclusion of potentially relevant studies so we ran the searches without a study methods filter. The original search strategies ( Appendix 1 ) were revised for this update by adding appropriate controlled vocabulary terms for foster care, where they were available. We also included additional free text phrases (for example 'custodial grandparent') to increase the sensitivity of the updated search strategies ( Appendix 2 ). We ran the updated searches from the inception of each database and imported the records into Procite. We compared these with records from the previous searches and discarded any duplicates. New records identified by the updated searches were imported records into Reference Manager 11/12 for screening. Searches were not limited by language, date, or geographic area.

Electronic searches

We ran updated searches of the following databases in March 2011:

Cochrane Central Register of Controlled Trials (CENTRAL), 2011 Issue 1, part of The Cochrane Library ; Ovid MEDLINE,1948 to March Week 1 2011; PsycINFO, 1887 to 14 March 2011; CINAHL, 1937 to current; Sociological Abstracts, 1952 to current; Social Sciences Citation Index (SSCI), 1970 to 12 March 2011; Conference Proceedings Citation Index ‐Social Science and Humanities (CPCI‐SSH), 1990 to 12 March 2011; ERIC, 1966 to current; Applied Social Sciences Index and Abstracts (ASSIA), 1987 to current; Dissertation Abstracts (via Dissertation Express), last searched 14 March 2011.

We could not update the searches of the following three databases because they have either ceased to function or are no longer available to us:

Campbell Collaboration's Social, Psychological, Educational, and Criminological Trials Register (C2‐SPECTR), last searched 9 March 2007; Social Work Abstracts, last searched February 2007; Family and Society Studies Worldwide, last searched February 2007.

Searching other resources

For the original review, we handsearched volumes of Child Abuse & Neglect, Children and Youth Services Review, Child Welfare, Research on Social Work Practice, and Families in Society from 2006 and 2007. We contacted several authors of studies included in this review for knowledge of other studies not yet identified. Lastly, we screened the reference lists of published literature reviews for relevant studies.

The procedures for collecting and analysing the data for this review are detailed below.

Selection of studies

Two review authors independently read the titles and abstracts of identified articles and reports to select those that described an empirical study of kinship care. A study was obtained if either review author believed it was appropriate. Once the studies were retrieved, two review authors used a 'keywording' rubric to categorise each study by the type of design, participants, intervention, and outcome measure(s). Two review authors then determined if each study was eligible for selection based on the aforementioned criteria for considering studies for this review. When we could not reach a consensus regarding selection decisions, we resolved it through discussion with a third review author.

Data extraction and management

We entered citations for all selected studies into Reference Manager 11/12, which is an interactive literature management software package. We then uploaded the citations for included studies into The Cochrane Collaboration's Review Manager 5 software (RevMan). We extracted outcome data from studies and entered them into RevMan, where they were meta‐analysed for this review. We present the statistical results in both narrative form, and in figures and tables. Specifically, RevMan‐generated forest plots are used to display effect size estimates and confidence intervals from the meta‐analyses. We use funnel plots generated from RevMan to examine the presence of publication bias in the evidence base. In addition, we present data from the quality assessment process in a table created in RevMan.

Assessment of risk of bias in included studies

Existing scales for measuring the quality of controlled trials have not been properly developed, are not well‐validated, and are known to give differing (even opposing) ratings of trial quality in systematic reviews ( Moher 1999 ). At present, evidence indicates that "scales should generally not be used to identify trials of apparent low quality or high quality in a given systematic review. Rather, the relevant methodological aspects should be identified a priori and assessed individually" ( Juni 2001 , p. 45). Thus, studies were assessed in regard to the following research quality dimensions: selection bias, performance bias, detection bias, reporting bias, and attrition bias ( Higgins 2011 ).

Two review authors independently extracted data from each study before coming to consensus on the assessment of risk of bias for each of the following domains for each study. The methodological criteria were operationalised as follows:

• The studies rated at high risk did not attempt to equate the kinship care and foster care groups through matching or controlling for covariates AND did not provide evidence on the comparability of the groups on setting (e.g., urbanicity), placement characteristics (e.g., age at placement, removal reason), or child demographics (e.g., gender, ethnicity). The studies rated at unclear risk either attempted to equate the groups OR provided evidence on the comparability of the groups. The studies rated at low risk attempted to equate the groups AND provided evidence on the comparability of the groups. For example, these studies provided evidence that the groups were comparable at baseline in regard to placement history, visits to biological parents, and caregiver characteristics (e.g., family composition, age, education).
• In the studies that were rated at high risk, the kinship care and foster care groups experienced different exposure to the intervention (e.g., length of stay) AND received different services during placement (e.g., caseworker contact). In the studies that were rated at unclear risk, the groups either experienced different exposure OR received different services. In the studies that were rated at low risk, the groups did not experience different exposure AND did not receive different services.
• In the studies rated at high risk, the kinship care and foster care groups were not defined in the same way (e.g., caregiver licensure, caregiver characteristics) AND there was evidence of biased assessment resulting from the type of placement (e.g., caregiver reports only). In the studies rated at unclear risk, the groups were not defined in the same way OR there was evidence of biased assessment. In the studies rated at low risk, the groups were defined in the same way AND there was no evidence of biased assessment.
• In the studies rated at high risk, the instrumentation used to measure the outcomes was not specified completely (e.g., data collection procedures) AND reliability with or without validity information was not reported for the instrumentation. In the studies rated at unclear risk, the instrumentation used to measure the outcomes was specified completely OR reliability with or without validity information was reported for the instrumentation. In the studies rated at low risk, the instrumentation was completely specified AND reliability with or without validity information was reported.
• In the studies rated at high risk, not all participants were accounted for in the reporting of results (e.g., low response rate, missing outcome data) AND attrition could have influenced the results (e.g., significant difference between participants and non‐participants). In the studies rated at unclear risk, not all participants were accounted for OR attrition could have influenced the results. In the studies rated at low risk, all participants were accounted for AND attrition could not have influenced the results.

Measures of treatment effect

Continuous data.

We computed a standardised mean difference (SMD) effect size for the continuous outcome variables. For this review, we created a corrected Hedges' g by dividing the difference between group means by the pooled and weighted standard deviation of the groups. Specifically, Hedges' g corrects for a bias (overestimation) that occurs when the uncorrected standardised mean difference effect size is used on small samples. The combined effect size for each outcome was computed as a weighted mean of the effect size for each study, with the weight being the inverse of the square of the standard error. Thus, a study was given greater weight for a larger sample size and more precise measurement, both of which reduce standard error. We computed a 95% confidence interval for each combined effect size to test for statistical significance; if the confidence interval did not include zero, we rejected the null hypothesis that there is no difference between the group means.

Dichotomous data

We computed Mantel‐Haenszel odds ratios (ORs) for the dichotomous outcome variables. Based on the assumption of proportional odds, ORs can be compared between variables with different distributions, including very rare and more frequent occurrences. Specifically, the odds of an event (e.g., reunification) were calculated for each group by dividing the number of events (i.e., re‐entry, reunification) by the number of non‐events (i.e., re‐entry, no reunification). We then calculated an OR by dividing the odds of the kinship care group by the odds of the foster care group. In addition, we calculated and reported 95% confidence intervals for the dichotomous effect size estimates.

Unit of analysis issues

The unit of analysis for this review was children. There were no unit of analysis issues identified for the included studies.

Dealing with missing data

Although studies with incomplete outcome data (e.g., missing means, standard deviations, sample sizes) were included in the review, they were excluded from the meta‐analyses unless the review authors could calculate an effect size from the available information. When outcome data were missing from an article or report, we made reasonable attempts to retrieve these data from the original researchers. Attrition overall and by group were accounted for in the quality assessment and sensitivity analyses.

Assessment of heterogeneity

We assessed the consistency of results using the I² statistic ( Higgins 2002 ; Higgins 2003 ). If there was evidence of heterogeneity (P value from test of heterogeneity < 0.1 coupled with an I² value of 25% or greater), we also considered sources of methodological and practice diversity according to prespecified subgroup and sensitivity analyses (see below). The values of the Q heterogeneity statistic and the between‐studies variance component Tau² were also reported.

Assessment of reporting biases

With the additional studies identified in the updated review, we assessed publication bias through the use of funnel plots. This method of assessing reporting bias was only used for outcomes that included meta‐analytic findings from at least 10 studies ( Higgins 2011 ).

Data synthesis

As heterogeneity is to be expected with similar interventions provided under different circumstances and by different providers, we used a random‐effects model for data synthesis. If a study reported multiple effect sizes (e.g., grades, behaviour problems), the results were included in the meta‐analysis for each outcome. If a study reported effect sizes for multiple samples (e.g., male, female), we aggregated the results for the main effects meta‐analyses before splitting them for the subgroup meta‐analyses. We conducted data synthesis for outcomes in which at least three studies contributed effect sizes to the meta‐analysis.

Subgroup analysis and investigation of heterogeneity

We considered subgroup analyses to explore different effects of the intervention (if any) by gender, ethnicity, and age at placement.

Sensitivity analysis

We planned sensitivity analyses to explore the impact of the risk of bias dimensions on the specific outcomes of the review. Specifically, we considered the following planned comparisons:

• Studies that used matching or covariates versus studies that did not control for confounders;
• Studies with outcomes measured by caregiver or teacher reports versus studies with outcomes measured by self reports;
• Studies at low risk of attrition bias versus studies at high risk of attrition bias;
• Studies at low risk of selection bias versus studies at high risk of selection bias.

We conducted the sensitivity analyses using simple unweighted ANOVA models.

Description of studies

The included studies are described in terms of the location, participants, interventions, and outcome measures.

Results of the search

As displayed in the study flow diagram ( Figure 1 ), a comprehensive electronic search of the kinship care literature base up until March 2011 yielded 9643 records with eight additional records identified through other sources. After 72 duplicates were removed, there were 9579 records with 4797 records from the search during the original review and 4782 records from the search during the updated review (of which 2728 were records found using the modified search strategy for the period covered by the original review).

Study flow diagram (complete review)

Included studies

9174 studies, which were not empirical studies of kinship care, were eliminated by screening titles and abstracts . We made every effort to retrieve the full text of the remaining 405 records (271 records from the original search and 134 records from the updated search). Of these 405 records, 16 were intractably unavailable as full‐text articles and were transferred to the excluded studies. We assessed the remaining 389 full‐text articles for eligibility and identified studies which had multiple reports: 102 studies (comprised of 105 papers) met the inclusion criteria and 280 studies (comprised of 284 papers) were excluded. Thus, a total of 102 studies were identified and included in the qualitative synthesis (62 from the original review and 40 from the updated review, of which six were published pre‐2007), while 71 studies were included in the meta‐analysis (46 from the original review and 25 from the updated review, of which none was published pre‐2007).

Location of Studies

All but 13 of the 102 studies were conducted in the U.S. The 13 international studies were Del Valle 2009 and Palacios 2009 conducted in Spain, Holtan 2005 conducted in Norway, Lernihan 2006 conducted in Ireland, Lutman 2009 conducted in the United Kingdom, Mosek 2001 conducted in Israel, Sallnas 2004 conducted in Sweden, Strijker 2003 and Strijker 2008 conducted in the Netherlands, and Tarren‐Sweeney 2006a , Tarren‐Sweeney 2006b , Tarren‐Sweeney 2008a , and Tarren‐Sweeney 2008b conducted in Australia.

Participants

As displayed in the Participant Baseline Characteristics Table ( Table 1 ), 87 of the 102 studies reported data for at least one of the following participant characteristics: age at placement, gender, ethnicity, removal reason, or urbanicity.

For age at entry into the specific placement, there was an overall unweighted mean age at placement of 7 years 10 months, based on 14 studies. Eleven studies reported a mean age at placement by placement type. For the kinship care group, the unweighted mean age at placement was 4 years 10 months. For the foster care group, the unweighted mean age at placement was also 4 years 10 months.

For gender, there were overall unweighted frequencies of 52% female and 48% male children, based on 57 studies. Furthermore, 33 studies reported gender frequencies by placement type. For the kinship care group, the unweighted frequencies were 50% female and 50% male. For the foster care group, the unweighted frequencies were 52% female and 48% male.

For ethnicity, there was an overall unweighted frequency of 45% African‐American children, based on 53 studies. There was an overall unweighted frequency of 22% Hispanic children based on 45 studies. Furthermore, 25 studies reported the frequency of African‐American children by placement type. For the kinship care group, the unweighted frequency was 51% African‐American. For the foster care group, the unweighted frequency was 44% African‐American. In addition, 20 studies reported the frequency of Hispanic children by placement type. For the kinship care group, the unweighted frequency was 24% Hispanic. For the foster care group, the unweighted frequency was 26% Hispanic.

For removal reason, there was an overall unweighted frequency of 60% of children removed for neglect, based on 31 studies. Furthermore, 15 studies reported the frequency of children removed for neglect by placement type. For the kinship care group, the unweighted frequency was 67% of children removed for neglect. For the foster care group, the unweighted frequency was 63% of children removed for neglect.

For urbanicity, there was an overall unweighted frequency of 80% of children from urban settings, based on 17 studies. In addition, there was an overall unweighted frequency of 13% of children from rural settings based on four studies. However, no studies reported the urbanicity of children by placement type.

Interventions

As displayed in Table 2 , all 102 studies reported data for at least one of the following intervention characteristics: caregiver licensure, timing of placement, length of stay, or timing of data collection.

OOH: out‐of‐home

For caregiver licensure, nine studies reported information on whether kinship caregivers were licensed or unlicensed. Specifically, six studies included licensed kinship placements, two studies included unlicensed kinship placements, and one study included both licensed and unlicensed kinship placements.

For the timing of placement, 40 studies reported information on whether children were in their first, last, or only kinship or foster placement. Specifically, the kinship or foster placement was the first in 29 of the studies, the last in eight of the studies, the only placement in one study, and either the first or last placement depending on the outcome being measured in two studies.

For length of stay, there was an unweighted mean length of placement of 36.0 months for the kinship care group and 34.2 months for the foster care group, based on 16 studies. In addition, there was an unweighted mean length of stay in out‐of‐home care of 48.7 months for the kinship care group and 45.5 months for the foster care group based on 14 studies.

For the timing of data collection, 62 studies used a cross‐sectional data collection approach while 40 studies used a longitudinal data collection approach with a follow‐up ranging from one year to 10 years.

Outcome measures

There were eight outcome categories and 29 specific outcomes considered in this review (including the same outcome measured both dichotomously and continuously). The following narrative contains the definitions and instrumentation used to measure the outcome variables in which bivariate data were extracted for the meta‐analyses. The Outcomes Measures Table ( Table 3 ) displays the outcomes and measures for all 102 studies in the review.

AFCARS: Adoption and Foster Care Analysis and Reporting System GPA: Grade point average OOH: out‐of‐home PTSD: Post‐traumatic Stress Disorder

The two behavioural development outcomes were behaviour problems and adaptive behaviours. Behaviour problems were defined dichotomously as the presence or absence of internalising (e.g., withdrawn, passive) and externalising (e.g., aggressive, delinquent) problem behaviours and continuously as the level of these behaviours. The continuous outcome was measured by the total problems scale of the Child Behavior Checklist (CBCL) in 12 studies ( Davis 2005 ; Ford 2007 ; Holtan 2005 ; Jones‐Karena 1998 ; Lawler 2008 ; Linares 2010 ; Orgel 2007 ; Rudenberg 1991 ; Strijker 2003 ; Tarren‐Sweeney 2006a ; Timmer 2004 ; Villagrana 2008 ), the Behaviour Problems Index ( Brooks 1998 ), and caregiver reports in two studies ( Metzger 1997 ; Surbeck 2000 ). The dichotomous outcome was measured by the CBCL in two studies ( Ringeisen 2009 ; Sakai 2011 ), the Behavioural Assessment Scoring System for Children ( McCarthy 2007 ), an administrative database ( Ryan 2010a ), and case records in two studies ( Iglehart 1994 ; Landsverk 1996 ). Adaptive behaviours were defined continuously as the level of competence or positive behaviours and were measured by the total competence scale of the CBCL in three studies ( Holtan 2005 ; Tarren‐Sweeney 2006a ; Villagrana 2008 ), the adaptive composite score on the Vineland Adaptive Behavior Scales (VABS) in three studies ( Belanger 2002 ; Jones‐Karena 1998 ; Villagrana 2008 ), and caregiver reports ( Surbeck 2000 ).

The two mental health outcomes were psychiatric disorders and well‐being. Psychiatric disorders were defined dichotomously by the presence or absence of mental illness and continuously by scores on a measure of psychopathology. The dichotomous outcome was measured by the Composite International Diagnostic Interview ( Keller 2010 ), the Child Depression Inventory and Trauma Symptoms Checklist for children ( Sakai 2011 ), paid claims data ( Bilaver 1999 ), the DSM‐IV ( McMillen 2005 ), and case records in two studies ( Harris 2003 ; Iglehart 1994 ). The continuous outcome was measured by the Devereaux Scales of Mental Disorders ( Belanger 2002 ) and the Columbia Impairment Scale and the Self‐Perception Profile of Adolescents ( Mennen 2010 ). Well‐being was defined dichotomously by the presence or absence of positive emotional health and continuously by the level of well‐being or self worth. The dichotomous outcome was measured by the Foster Care Questionnaire ( Dunn 2010 ), child self reports ( Wilson 1999 ), the R.C. Monitoring Protocol ( Harris 2003 ), and caseworker reports ( Tompkins 2003 ). The continuous outcome was measured by the Personal Attribute Inventory for Children ( Metzger 1997 ) and a measure from the National Longitudinal Study of Adolescent Health ( Farruggia 2009 ).

Placement s tability

The four placement stability outcomes were number of placements, length of stay, placement disruption, and re‐entry as measured by secondary data from administrative databases for all studies except for case records in two studies ( Strijker 2008 ; Valicenti‐McDermott 2008 ), and caseworker reports in two studies ( Del Valle 2009 ; Sakai 2011 ). Number of placements was measured both continuously by the number of out‐of‐home placements and dichotomously by experiencing either two or fewer or three or more placement settings. The dichotomous outcome was used in six studies ( Courtney 1997b ; Harris 2003 ; Metzger 1997 ; Pabustan‐Claar 2007a ; Ryan 2010a ; Zimmerman 1998 ). The continuous outcome was used in six studies ( Belanger 2002 ; Davis 2005 ; Ryan 2010a ; Sakai 2011 ; Strijker 2008 ; Winokur 2008 ). Length of stay in placement was measured continuously in six studies ( Berrick 1994 ; Brooks 1998 ; Cole 2006 ; Davis 2005 ; Surbeck 2000 ; Valicenti‐McDermott 2008 ). Length of stay in out‐of‐home care was measured continuously in nine studies ( Belanger 2002 ; Clyman 1998 ; Jenkins 2002 ; Ryan 2010a ; Sivright 2004 ; Strijker 2008 ; Tompkins 2003 ; Valicenti‐McDermott 2008 ; Winokur 2008 ). It should be noted that longer lengths of stay in placement or in out‐of‐home care are considered negative outcomes in the U.S., as reunification within 12 months is the primary permanency goal for children placed in short‐term kinship or foster care. Placement disruption was measured dichotomously by whether the kin or foster placement ended without permanency in five studies ( Del Valle 2009 ; Koh 2008b ; Rubin 2008 ; Sallnas 2004 ; Testa 2001 ). Re‐entry was measured dichotomously by whether there was a re‐entry to out‐of‐home care after achieving permanency in two studies ( Frame 2000 ; Winokur 2008 ).

The four permanency outcomes were reunification, adoption, guardianship, and still in placement. All four outcomes were measured dichotomously by secondary data from administrative databases in 15 studies ( Akin 2011 ; Barth 1994 ; Berrick 1999 ; Johnson 2005 ; Koh 2008b ; McIntosh 2002 ; Pabustan‐Claar 2007a ; Sivright 2004 ; Smith 2002 ; Smith 2003 ; Testa 1999 ; Testa 2001 ; Wells 1999 ; Winokur 2008 ; Zimmerman 1998 ) and case records or caseworker reports in four studies ( Del Valle 2009 ; Lutman 2009 ; Sakai 2011 ; Valicenti‐McDermott 2008 ). Reunification was defined as a return home to biological or birth parents after placement in out‐of‐home care. Adoption was defined as a termination of parental rights with legal custody transferred to adoptive parents (in most cases non‐relatives). Guardianship was defined as an allocation of parents' rights with legal custody to relative caregivers (in most cases relatives). 'Still in placement' was defined as remaining in either kinship or foster care at the time data were collected for the study.

Educational a ttainment

The three educational attainment outcomes were repeating a grade, graduation, and grade level, and all were measured dichotomously. It should be noted that these outcomes are all U.S. measures of educational attainment. Repeating a grade was defined by whether a child had been retained in one or more grades as measured by caregiver or self reports in five studies ( Berrick 1994 ; Brooks 1998 ; Ford 2007 ; Metzger 1997 ; Sripathy 2004 ) and case records ( Valicenti‐McDermott 2008 ). Graduation was defined by whether a child completed high school and was measured by case records ( Christopher 1998 ). Grade level was defined by whether a child's academic performance was below their actual grade level and was measured by child self reports ( Iglehart 1995 ) and case records ( Iglehart 1994 ).

The three family relations outcomes were attachment, conflict, and home environment. Attachment was defined as perceived level of relatedness or attachment between child and caregiver and was measured continuously by child self reports ( Chapman 2004 ), the Attachment Q‐Sort Version 3 Assessment ( Chew 1998 ), caregiver reports ( Strijker 2003 ), the Assessment of Interpersonal Relations ( Davis 2005 ), and the Child Well‐Being Scales ( Surbeck 2000 ). Attachment was measured dichotomously by the Ainsworth Strange Situation Procedure ( Cole 2006 ), case records ( Jenkins 2002 ), the Offer Self‐Image Questionnaire ( Mosek 2001 ), and the Relationship Story Completion Test ( Orgel 2007 ). Conflict was defined continuously as the level of family functioning as measured by the Index of Family Relations ( Berrick 1997 ). Home environment was defined as the milieu within the foster and kinship care households (e.g., emotional climate, paternal involvement, and family participation) and was measured by the Elementary HOME Inventory ( Ford 2007 ).

The three service utilisation outcomes were mental health services, physician services, and developmental services defined dichotomously as whether a child actually received services (not just referral). Mental health service utilisation was measured by paid claims data ( Bilaver 1999 ), caseworker reports in two studies ( Metzger 1997 ; Tompkins 2003 ), case records in three studies ( Jenkins 2002 ; Scannapieco 1997 ; Sivright 2004 ), caregiver reports in three studies ( Berrick 1994 ; Sakai 2011 ; Sripathy 2004 ), The Young Kids Early Services Assessment (TYKES) ( Clyman 1998 ), and the Child and Adolescent Services Assessment in three studies ( Farmer 2010 ; Ringeisen 2009 ; Villagrana 2008 ). Physician service utilisation was measured by paid claims data ( Bilaver 1999 ), caseworker reports ( Tompkins 2003 ), case records in two studies ( Scannapieco 1997 ; Valicenti‐McDermott 2008 ), caregiver reports in two studies ( Sakai 2011 ; Schneiderman 2010 ), and the TYKES ( Clyman 1998 ). Developmental services were measured by paid claims data ( Bilaver 1999 ), the TYKES ( Clyman 1998 ), and the Child and Adolescent Services Assessment ( Ringeisen 2009 ).

The two re‐abuse outcomes were recurrence of abuse and institutional abuse, as measured dichotomously by secondary data from administrative databases. Recurrence of abuse was defined as whether a new substantiated incident of intrafamilial abuse or neglect (by birth or biological parent(s) not kin caregiver(s) or foster parent(s)) occurred after a previous substantiated incident and was reported in one study ( Fuller 2005 ). Institutional abuse was defined as whether a substantiated incident of abuse or neglect occurred in an out‐of‐home placement setting (by kin caregiver(s) or foster parent(s) not birth or biological parent(s)) and was reported in three studies ( Benedict 1996a ; Winokur 2008 ; Zuravin 1993 ).

Excluded studies

As displayed in the Characteristics of excluded studies table, 296 studies (comprised of 300 reports) were excluded from the review for the following reasons: 102 were excluded because there was no formal kinship care group or the kinship care group was not disaggregated from the foster care group; 40 studies were excluded because there was no foster care comparison group or the foster care group was not disaggregated from other out‐of‐home placement types; 38 studies were excluded because they reported on an intervention other than out‐of‐home placement; 37 studies were excluded because they were non‐empirical (e.g. literature reviews); 29 studies were excluded because they were survey, descriptive, or qualitative research designs; 23 studies were excluded because child welfare outcomes were not reported; 16 studies were excluded because they were intractably unavailable; 11 studies were excluded because they were based on an adult sample.

Risk of bias in included studies

The included studies were assessed for risk of selection bias, performance bias, detection bias, reporting bias, and attrition bias. Specifically, each study was rated either at low risk, unclear risk, or high risk based on two sub‐questions for each of these areas. The 'Risk of bias' tables included with the Characteristics of included studies display the ratings for each type of bias and the support for these judgements. Specifically, selection bias is reported in 'allocation concealment', performance bias is reported in 'blinding of participants and personnel', detection bias is reported in 'blinding of outcome assessment', reporting bias is reported in 'selective reporting', and attrition bias is reported in 'incomplete outcome data'. There is nothing reported for 'random sequence generation', 'blinding', and 'other bias' because of the different dimensions of risk of bias assessed for the quasi‐experimental studies that comprise this evidence base. As displayed in the 'Risk of bias' Summary Figure ( Figure 2 ), the risk of bias analysis indicates that the evidence base contains studies with unclear risk in all five categories, with the highest risk associated with selection bias and the lowest risk associated with reporting bias. It should be noted that there were some changes in the risk of reporting bias ratings for studies included in the original review. Specifically, studies from the original review that utilised administrative databases for outcome measurement were categorised as being at low risk of reporting bias rather than at unclear risk of reporting bias, to align them with the judgements made on the studies added for the updated review.

Risk of bias summary: Review authors' judgements about each risk of bias item for each included study.

For selection bias, 21 studies ( Belanger 2002 ; Berger 2009 ; Clyman 1998 ; De Robertis 2004 ; Ford 2007 ; Holtan 2005 ; Koh 2008a ; Koh 2008b ; Koh 2009 ; Lawler 2008 ; Linares 2010 ; Metzger 1997 ; Rudenberg 1991 ; Ryan 2010a ; Sakai 2011 ; Schneiderman 2010 ; Tarren‐Sweeney 2008a ; Tarren‐Sweeney 2008b ; Winokur 2008 ; Testa 2001 ; Zinn 2009 ) were rated at low risk, 55 studies were rated at unclear risk, and 26 studies were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for selection bias were the lack of equating procedures and uncertainty or non‐reporting for placement and demographic data.

For performance bias, four studies ( Berrick 1997 ; Holtan 2005 ; Metzger 1997 ; Sivright 2004 ) were rated at low risk, 92 were rated at unclear risk, and six were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for performance bias were uncertainty regarding both the length of stay and receipt of services during placement.

For detection bias, six studies ( Benedict 1996a ; Cole 2006 ; Jenkins 2002 ; Leslie 2000a ; Scannapieco 1997 ; Zuravin 1993 ) were rated at low risk, 90 were rated at unclear risk, and six were rated at high risk. The primary reasons that studies were assessed to have unclear or high risk for detection bias were uncertainty in how the groups were defined and the use of only caregiver or self reports to measure the outcome. Although biased assessment is not necessarily due to the type of placement, it may differentially impact the detection of a placement's effect on child welfare outcomes.

Incomplete outcome data

For attrition bias, 44 studies were rated at low risk, 54 studies were rated at unclear risk, and four studies were rated at high risk. The primary reason that studies were assessed to have unclear or high risk for attrition bias was the loss of participants due to missing outcome data.

Selective reporting

For reporting bias, 71 studies were rated at low risk, 28 studies were rated at unclear risk, and three studies were rated at high risk. The primary reason that studies were assessed to have unclear or high risk for report bias was the lack of reliability and/or validity information.

Other potential sources of bias

There were no other potential sources of bias assessed.

Effects of interventions

Meta‐analyses.

There were sufficient data for meta‐analysis for 21 of the 29 outcomes in the review. As a result, we generated at least one meta‐analysis for each outcome category. We report the results for these 21 outcomes as the statistical significance of the effect, the direction and magnitude of the effect size, the 95% confidence interval around the effect size estimate, and the evidence of heterogeneity for the individual effect sizes. The effect sizes were drawn exclusively from the studies reporting bivariate data, and thus do not reflect adjustment by covariates (although bivariate data from studies that used matching designs were included in the effect size analyses). It should be noted that all standardised mean difference (SMD) effect sizes that are negative indicate better outcomes for the kinship care group, while all odds ratio (OR) effect sizes that are less than 1.0 also indicate better outcomes for the kinship care group.

Behavioural Development

There was a statistically significant overall effect size for the 15 studies ( Brooks 1998 ; Davis 2005 ; Ford 2007 ; Holtan 2005 ; Jones‐Karena 1998 ; Lawler 2008 ; Linares 2010 ; Metzger 1997 ; Orgel 2007 ; Rudenberg 1991 ; Strijker 2003 ; Surbeck 2000 ; Tarren‐Sweeney 2006a ; Timmer 2004 ; Villagrana 2008 ) that reported sufficient bivariate continuous data to generate effect size estimates for behaviour problems. Specifically, the overall effect size estimate was g = ‐0.33, 95% confidence interval (CI) ‐0.49 to ‐0.17 (see Analysis 1.1 ). Thus, children in kinship care ( N = 1158) had lower reported levels of internalising and externalising behaviour problems than did children in foster care ( N = 1657). The test of heterogeneity was significant for this outcome (P < .00001; I² = 73%; Tau² = 0.07; Chi² = 51.23).

Comparison 1 Behavioural Development, Outcome 1 Behaviour problems continuous.

There was a statistically significant overall effect size for the six studies ( Iglehart 1994 ; Landsverk 1996 ; McCarthy 2007 ; Ringeisen 2009 ; Ryan 2010a ; Sakai 2011 ) that reported sufficient bivariate dichotomous data to generate effect size estimates for behaviour problems. Specifically, the overall effect size estimate was reported OR 0.62, 95% CI 0.41 to 0.93 (see Analysis 1.2 ). Thus, children in foster care ( N = 8407) had 1.6 times the odds of reporting internalising and externalising behaviour problems than did children in kinship care ( N = 8042). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 92%; Tau² = 0.21; Chi² = 59.90).

Comparison 1 Behavioural Development, Outcome 2 Behavioural problems dichotomous.

There was a statistically significant overall effect size for the six studies ( Belanger 2002 ; Holtan 2005 ; Jones‐Karena 1998 ; Surbeck 2000 ; Tarren‐Sweeney 2006a ; Villagrana 2008 ) that reported sufficient bivariate data to generate effect size estimates for adaptive behaviours. Specifically, the overall effect size estimate was g = ‐0.42, 95% CI ‐0.61 to ‐0.22 (see Analysis 1.3 ). Thus, children in kinship care ( N = 491) had higher reported levels of competence than did children in foster care ( N = 796). The test of heterogeneity was significant for this outcome (P = 0.03; I² = 61%; Tau² = 0.03; Chi² = 12.69).

Comparison 1 Behavioural Development, Outcome 3 Adaptive behaviours.

There was a statistically significant overall effect size for the six studies ( Bilaver 1999 ; Harris 2003 ; Iglehart 1994 ; Keller 2010 ; McMillen 2005 ; Sakai 2011 ) that reported sufficient bivariate dichotomous data to generate effect size estimates for psychiatric disorders. Specifically, the overall effect size estimate was OR 0.51, 95% CI 0.42 to 0.62 (see Analysis 2.1 ). Thus, children in foster care ( N = 35448) had 2.0 times the odds of experiencing mental illness as did children in kinship care ( N = 15303). The test of heterogeneity was not significant for this outcome (P = 0.26; I² = 23%; Tau² = 0.01; Chi² = 6.51).

Comparison 2 Mental Health, Outcome 1 Psychiatric disorders dichotomous.

There was a statistically significant overall effect size for the four studies ( Dunn 2010 ; Harris 2003 ; Tompkins 2003 ; Wilson 1999 ) that reported sufficient bivariate dichotomous data to generate effect size estimates for well‐being. Specifically, the overall effect size estimate was reported OR 0.50, 95% CI 0.38 to 0.64 (see Analysis 2.2 ). Thus, children in kinship care ( N = 126054) had 2.0 times the odds of reporting positive emotional health as did children in foster care ( N = 191955). The test of heterogeneity was not significant for this outcome (P = 0.33; I² = 12%; Tau² = 0.02; Chi² = 3.41).

Comparison 2 Mental Health, Outcome 2 Well‐being dichotomous.

There was a statistically significant overall effect size for the six studies ( Courtney 1997b ; Harris 2003 ; Metzger 1997 ; Pabustan‐Claar 2007a ; Ryan 2010a ; Zimmerman 1998 ) that reported sufficient bivariate dichotomous data to generate effect size estimates for placement settings. Specifically, the overall effect size estimate was OR 0.39, 95% CI 0.33 to 0.45 (see Analysis 3.1 ). Thus, children in foster care ( N = 15729) had 2.6 times the odds of experiencing three or more placement settings as did children in kinship care ( N = 10763). The test of heterogeneity was significant for this outcome (P = 0.05; I² = 55%;Tau² = 0.01; Chi² = 11.14).

Comparison 3 Placement Stability, Outcome 1 Number of placements dichotomous.

There was a statistically significant overall effect size for the six studies ( Belanger 2002 ; Davis 2005 ; Ryan 2010a ; Sakai 2011 ; Strijker 2008 ; Winokur 2008 ) that reported sufficient bivariate continuous data to generate effect size estimates for number of placements. Specifically, the overall effect size estimate was g = ‐0.38, 95% CI ‐0.58 to ‐0.17 (see Analysis 3.2 ). Thus, children in kinship care ( N = 7749) had fewer mean number of placements as did children in foster care ( N = 7928). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 90%; Tau² = 0.05; Chi² = 51.14).

Comparison 3 Placement Stability, Outcome 2 Number of placements continuous.

There were six studies ( Berrick 1994 ; Brooks 1998 ; Cole 2006 ; Davis 2005 ; Surbeck 2000 ; Valicenti‐McDermott 2008 ), with a total sample size of N = 634 for the kinship care group and N = 883 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for length of placement. The overall effect size estimate was g = 0.90, 95% CI ‐0.66 to 2.46 (see Analysis 3.3 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 99%; Tau² = 3.73; Chi² = 631.50).

Comparison 3 Placement Stability, Outcome 3 Length of stay in placement.

There were nine studies ( Belanger 2002 ; Clyman 1998 ; Jenkins 2002 ; Ryan 2010a ; Sivright 2004 ; Strijker 2008 ; Tompkins 2003 ; Valicenti‐McDermott 2008 ; Winokur 2008 ), with a total sample size of N = 129503 for the kinship care group and N = 201218 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for length of stay in out‐of‐home care. The overall effect size estimate was g = 0.02 with a confidence interval of ‐0.04 to 0.09 (see Analysis 3.4 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 75%; Tau² = 0.00; Chi² = 32.46).

Comparison 3 Placement Stability, Outcome 4 Length of stay in out‐of‐home care.

There was a statistically significant overall effect size for the five studies ( Del Valle 2009 ; Koh 2008b ; Rubin 2008 ; Sallnas 2004 ; Testa 2001 ) that reported sufficient bivariate data to generate effect size estimates for placement disruption. Specifically, the overall effect size estimate was OR 0.52, 95% CI 0.40 to 0.69 (see Analysis 3.5 ). Thus, children in foster care ( N = 3541) had 1.9 times the odds of experiencing a placement disruption as did children in kinship care ( N = 3340). The test of heterogeneity was significant for this outcome (P = 0.00003; I² = 81%; Tau² = 0.07; Chi² = 21.12).

Comparison 3 Placement Stability, Outcome 5 Placement disruption.

There were 13 studies ( Akin 2011 ; Berrick 1999 ; Del Valle 2009 ; Koh 2008b ; McIntosh 2002 ; Pabustan‐Claar 2007a ; Smith 2002 ; Testa 1999 ; Testa 2001 ; Valicenti‐McDermott 2008 ; Wells 1999 ; Winokur 2008 ; Zimmerman 1998 ), with a total sample size of N = 22907 for the kinship care group and N = 44496 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for reunification. The overall effect size estimate was OR 1.09, 95% CI 0.85 to 1.40 (see Analysis 4.1 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 93%; Tau² = 0.15; Chi² = 173.03).

Comparison 4 Permanency, Outcome 1 Reunification.

There was a statistically significant overall effect size for the 12 studies ( Akin 2011 ; Barth 1994 ; Berrick 1999 ; Del Valle 2009 ; Koh 2008b ; Pabustan‐Claar 2007a ; Smith 2002 ; Testa 1999 ; Testa 2001 ; Valicenti‐McDermott 2008 ; Winokur 2008 ; Zimmerman 1998 ) that reported sufficient bivariate data to generate effect size estimates for adoption. Specifically, the overall effect size estimate was OR 2.52, 95% CI 1.42 to 4.49 (see Analysis 4.2 ). Thus, children in foster care ( N = 44600) had 2.5 times the odds of being adopted as did children in kinship care ( N = 22217). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 98%; Tau² = 0.86; Chi² = 533.68).

Comparison 4 Permanency, Outcome 2 Adoption.

There was a statistically significant overall effect size for the eight studies ( Akin 2011 ; Berrick 1999 ; Koh 2008b ; Pabustan‐Claar 2007a ; Testa 1999 ; Testa 2001 ; Winokur 2008 ; Zimmerman 1998 ) that reported sufficient bivariate data to generate effect size estimates for guardianship. Specifically, the overall effect size estimate was OR 0.26, 95% CI 0.17 to 0.40 (see Analysis 4.3 ). Thus, children in kinship care ( N = 21590) had 3.8 times the odds of having relatives assume legal custody as did children in foster care ( N = 43143). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 91%; Tau² = 0.29; Chi² = 82.29).

Comparison 4 Permanency, Outcome 3 Guardianship.

There was a statistically significant overall effect size for the 11 studies ( Barth 1994 ; Berrick 1999 ; Johnson 2005 ; Lutman 2009 ; Sakai 2011 ; Sivright 2004 ; Smith 2002 ; Smith 2003 ; Testa 2001 ; Winokur 2008 ; Zimmerman 1998 ) that reported sufficient bivariate data to generate effect size estimates for the still‐in‐placement outcome. Specifically, the overall effect size estimate was OR 1.18, 95% CI 0.77 to 1.80 (see Analysis 4.4 ). Thus, children in kinship care ( N = 19416) had 1.2 times the odds of still being in care as did children in foster care ( N = 37830). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 96%; Tau² = 0.42; Chi² = 237.39).

Comparison 4 Permanency, Outcome 4 Still in placement.

There were six studies ( Berrick 1994 ; Brooks 1998 ; Ford 2007 ; Metzger 1997 ; Sripathy 2004 ; Valicenti‐McDermott 2008 ), with a total sample size of N = 546 for the kinship care group and N = 673 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for the 'repeated a grade' outcome. The overall effect size estimate was OR 0.73, 95% CI 0.50 to 1.07 (see Analysis 5.1 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was not significant for this outcome (P = 0.16; I² = 37%; Tau² = 0.08; Chi² = 7.94).

Comparison 5 Educational Attainment, Outcome 1 Repeated a grade.

There were five studies ( Chapman 2004 ; Chew 1998 ; Davis 2005 ; Strijker 2003 ; Surbeck 2000 ), with a total sample size of N = 217 for the kinship care group and N = 282 for the foster care group, that reported sufficient bivariate continuous data to generate effect size estimates for the attachment outcome. The overall effect size estimate was g = ‐0.01, 95% CI ‐0.30 to 0.28 (see Analysis 6.1 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P = 0.09; I² = 50%; Tau² = 0.05; Chi² = 8.04).

Comparison 6 Family Relations, Outcome 1 Attachment continuous.

There were four studies ( Cole 2006 ; Jenkins 2002 ; Mosek 2001 ; Orgel 2007 ), with a total sample size of N = 163 for the kinship care group and N = 212 for the foster care group, that reported sufficient bivariate dichotomous data to generate effect size estimates for the attachment outcome. The overall effect size estimate was OR 1.21, 95% CI 0.56 to 2.59 (see Analysis 6.2 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was not significant for this outcome (P = 0.08; I² = 56%; Tau² = 0.33; Chi² = 6.80).

Comparison 6 Family Relations, Outcome 2 Attachment dichotomous.

There was a statistically significant overall effect size for the 13 studies ( Berrick 1994 ; Bilaver 1999 ; Clyman 1998 ; Farmer 2010 ; Jenkins 2002 ; Metzger 1997 ; Ringeisen 2009 ; Sakai 2011 ; Scannapieco 1997 ; Sivright 2004 ; Sripathy 2004 ; Tompkins 2003 ; Villagrana 2008 ) that reported sufficient bivariate data to generate effect size estimates for mental health service utilisation. Specifically, the overall effect size estimate was OR 1.79, 95% CI 1.35 to 2.37 (see Analysis 7.1 ). Thus, children in foster care ( N = 107705) had 2.4 times the odds of receiving mental health services as did children in kinship care ( N = 44921). The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 96%; Tau² = 0.17; Chi² = 289.17).

Comparison 7 Service Utilisation, Outcome 1 Mental health services.

There were three studies ( Bilaver 1999 ; Clyman 1998 ; Ringeisen 2009 ), with a total sample size of N = 14314 for the kinship care group and N = 33744 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for developmental service utilisation. The overall effect size estimate was OR 0.94, 95% CI 0.38 to 2.32 (see Analysis 7.2 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < .03; I² = 72%; Tau² = 0.44; Chi² = 7.02).

Comparison 7 Service Utilisation, Outcome 2 Developmental services.

There were seven studies ( Bilaver 1999 ; Clyman 1998 ; Sakai 2011 ; Scannapieco 1997 ; Schneiderman 2010 ; Tompkins 2003 ; Valicenti‐McDermott 2008 ), with a total sample size of N = 74354 for the kinship care group and N = 139651 for the foster care group, that reported sufficient bivariate data to generate effect size estimates for physician service utilisation. The overall effect size estimate was OR 1.37, 95% CI 0.48 to 3.93 (see Analysis 7.3 ). However, the analysis could not rule out zero as a likely population value. The test of heterogeneity was significant for this outcome (P < 0.00001; I² = 99%; Tau² = 1.84; Chi² = 454.25).

Comparison 7 Service Utilisation, Outcome 3 Physician services.

There was a statistically significant overall effect size for the three studies ( Benedict 1996a ; Winokur 2008 ; Zuravin 1993 ) that reported sufficient bivariate data to generate effect size estimates for institutional abuse. Specifically, the overall effect size estimate was OR 0.27, 95% CI 0.10 to 0.71 (see Analysis 8.1 ). Thus, children in foster care ( N = 659) had 3.7 times the odds of experiencing institutional abuse as did children in kinship care ( N = 543). The test of heterogeneity was significant for this outcome (P = 0.003; I² = 83%; Tau² = 0.62; Chi² = 11.62).

Comparison 8 Re‐abuse, Outcome 1 Institutional abuse.

Multivariate analyses

As studies that reported multivariate data controlled for covariates, such as age at placement, gender, ethnicity, socioeconomic status, geographic region, behaviour and health problems, placement reason and history, and caregiver variables, they potentially provide a stronger level of evidence regarding the effect of kinship care on child welfare outcomes. Thus, results from the weaker quasi‐experimental designs comprising the meta‐analytical data could also be considered stronger evidence if corroborated by the multivariate results which are summarised in the Outcomes for Studies with Multivariate Analysis Table ( Table 4 ). It should be noted that some studies reported both bivariate and multivariate data, and were included in both analyses. Overall, the multivariate results generally support the results generated from the meta‐analyses.

AFDC: Aid to Families with Dependent Children BIA: Behavioural Influences Analysis CBCL: Child Behaviour Checklist DSMD: Devereux Scales of Mental Disorder OOH: Out‐of‐home VABS: Vineland Adaptive Behaviour Scales

For behavioural development, Bennett 2000 , Holtan 2005 , Rubin 2008 , and Sakai 2011 found that children in kinship care had significantly lower likelihood of behaviour problems than did children in foster care. Furthermore, three studies reporting multivariate adaptive behaviours data ( Belanger 2002 ; Bennett 2000 ; Brooks 1998 ) found that children in kinship care had significantly greater adaptive behaviours than did children in foster care. However, De Robertis 2004 , Linares 2010 , Mennen 2010 , Surbeck 2000 , Tarren‐Sweeney 2008b , and Zima 2000 did not find a significant difference between the groups on behaviour problems, while Berger 2009 found that time spent in foster care homes was associated with decreased externalising behaviour problems. Again, Zima 2000 did not find a significant difference between the groups on adaptive behaviours.

For mental health, Belanger 2002 and Metzger 1997 found that children in kinship care had significantly better reported well‐being and fewer psychiatric disorders than did children in foster care. However, Ford 2007 , Mennen 2010 , and Tarren‐Sweeney 2008a found that type of placement was not a significant predictor of well‐being, while McMillen 2005 and Tarren‐Sweeney 2006a found no significant difference between the groups on psychiatric disorders. Sakai 2011 found that children in kinship care had a lower risk of depression but a higher risk of post‐traumatic stress disorder (PTSD).

For service utilisation, Clyman 1998 , Farmer 2010 , Leslie 2000a , McMillen 2004 , and Sakai 2011 found that children in foster care were significantly more likely to utilise mental health services than were children in kinship care. As for physician service utilisation, Clyman 1998 found no significant difference between the groups, while Schneiderman 2010 found that children in kinship care had a greater likelihood of utilising physician service than did children in foster care.

The greatest amount of multivariate data was reported for the permanency outcomes. Similar to the nonsignificant meta‐analysis results for reunification, the findings from the 12 studies reporting multivariate data were also inconclusive. Specifically, four studies ( Akin 2011 , Berrick 1999 ; Courtney 1996a ; Grogan‐Kaylor 2000 ) found that children in kinship care were more likely to reunify, while two studies ( Connell 2006a ; Courtney 1996b ) found that children in foster care were more likely to reunify. Furthermore, Courtney 1997a , Frame 2002 , Wells 1999 , and Zimmerman 1998 found no significant difference between the groups on reunification, while Koh 2008a reported mixed findings on reunification depending on the state being analysed. As for adoption, Akin 2011 , Barth 1994 , and Courtney 1996b found that children in foster care were significantly more likely to be adopted than were children in kinship care. However, Courtney 1996a found that children in kinship care were more likely to be adopted, while Connell 2006a found no significant difference between the groups, and Koh 2008a reported mixed findings on adoption depending on the state being analysed. Berrick 1999 and Smith 2003 found that children in foster care were significantly less likely to still be in placement than were children in kinship care, while Frame 2002 and Johnson 2005 found no significant difference between the groups, and Koh 2008a reported mixed findings on this permanency outcome depending on the state being analysed.

For placement stability, Chamberlain 2006 , Connell 2006b , Helton 2010 , Hurlburt 2010 , Koh 2008a , Koh 2009 , and Testa 2001 found that children in kinship care were less likely to disrupt from placement than were children in foster care. Perhaps the most compelling evidence from the multivariate analyses was for re‐entry, in that seven studies ( Berrick 1999 ; Courtney 1995 ; Courtney 1997a ; Frame 2000 ; Frame 2002 ; Jonson‐Reid 2003 ; Wells 1999 ) reported that children in kinship care were significantly less likely to re‐enter care than were children placed in foster care, while only one study ( Koh 2008a ) reported mixed findings on re‐entry depending on the state being analysed. Vogel 1999 found that children in kinship care had significantly longer lengths of stay than did children in foster care, while Koh 2008a reported that children in kinship care were less likely to experience three or more placements within a year.

For the safety outcomes, Benedict 1996a and Zuravin 1993 found that children in kinship care were less likely to experience institutional abuse than were children in foster care. However, the multivariate results were inconclusive for recurrence of abuse, as Jonson‐Reid 2003 found that children in kinship care were less likely to experience recurrence of abuse, while Fuller 2005 found that children in kinship care were more likely to experience recurrence of abuse.

For family relations, the USDHHS 2005 study reported that children in kinship care had higher levels of attachment, while Davis 2005 and Lawler 2008 found that type of placement was not a significant predictor of relatedness or emotional availability, respectively. Finally, for educational attainment, Shin 2003 found that children in kinship care had significantly higher reading scores than did children in foster care, while Zinn 2009 found no difference between the groups on educational attainment.

Bivariate analyses

As summarised in the Outcomes for Studies with Bivariate Analysis Table ( Table 5 ), there were several studies that reported findings from bivariate analyses but did not report sufficient information for effect size calculation. Typically, these studies reported nonsignificant findings in the narrative but did not include the relevant data in a table. For example, five studies ( De Robertis 2004 ; Landsverk 1996 ; Sripathy 2004 ; Tarren‐Sweeney 2008b ; Valicenti‐McDermott 2008 ) found no difference between children in kinship care and foster care on the level of behaviour problems as measured by the Child Behavior Checklist (CBCL). However, Berrick 1994 , Metzger 2008 , Palacios 2009 , and Tarren‐Sweeney 2008b confirmed the results from the meta‐analysis, in that children in kinship care had significantly fewer reported behavioural problems than did children in foster care. As for adaptive behaviours, Sripathy 2004 found no difference between children in kinship care and foster care on the level of adaptive behaviours as measured by the CBCL.

CBCL: Child Behaviour Checklist GPA: Grade point average HR: hazard ratio OOH: Out‐of‐home M: mean

For mental health, Mosek 2001 and Tarren‐Sweeney 2008a found that children in kinship care had significantly higher well‐being than did children in foster care, while Palacios 2009 found that foster parents reported greater well‐being in regard to basic needs and educational supervision, and Valicenti‐McDermott 2008 found no difference in well‐being or psychiatric disorders between the groups. For family relations, Metzger 2008 and USDHHS 2005 found higher levels of attachment for children in kinship care than for children in foster care. For educational attainment, Geenen 2006 found that children in foster care had significantly higher grade point averages and earned credits than did children in kinship care, although there were no differences for attendance, number of grades retained, and test scores.

For placement stability, two studies, Scannapieco 1997 and Zimmerman 1998 , found that children in foster care had significantly shorter placement lengths than did children in kinship care, while Metzger 1997 found that children in kinship care had significantly shorter lengths of placement, and Lernihan 2006 found no differences between the groups on length of placement. The bivariate results were similar for length of stay in out‐of‐home care, as Zimmerman 1998 found that children in foster care had significantly shorter lengths of stay than did children in kinship care, while Sakai 2011 found no difference between the groups on length of stay in out‐of‐home care. Helton 2010 found that children in kinship care had significantly lower rates of placement disruption, while Strijker 2008 and Tarren‐Sweeney 2008a found no difference between the groups on placement disruption. Zimmerman 1998 found no difference between the groups on re‐entry rates. Lastly, Zinn 2009 found no differences between the groups on the permanency outcomes of reunification and adoption.

Sensitivity analyses

Sensitivity analyses comparing studies with high risk of attrition bias and low risk of attrition bias were planned but were not conducted because only four studies were rated at high risk. Furthermore, attrition rates could not be accurately determined for the quasi‐experimental studies included in the review. Specifically, all of these studies were post‐test only, so there were often incomplete data on how many children were originally placed in kinship or foster care and no pre‐measures to indicate how many children 'dropped out' of the study by the time of the post‐measures data collection. There were missing data in some of the studies, in that multiple measures had different sample sizes, presumably because data were either not available from case files or not collected. However, the missing data are presumed to be missing at random, so no sensitivity analysis is warranted.

Sensitivity analyses comparing studies with child self reports and parent/teacher/caregiver reports were planned for the review, but were not conducted because of the lack of such comparisons for the included outcomes. For example, there were no studies that measured behavioural development by child self report and only one study each that measured service utilisation and educational attainment by child self report. Furthermore, there were only two studies that measured mental health by child self report. Lastly, three studies used child self reports for family relations, but there were no studies that measured family relations by caregiver reports.

Sensitivity analyses comparing studies that controlled for confounders with those that did not were not possible using statistical techniques because of differences in the type of data reported. Specifically, the studies that controlled for confounders used multivariate analyses rather than matching (except for Koh 2008a ; Rudenberg 1991 ; Testa 2001 ; Winokur 2008 ). As such, many of the multivariate data were reported as correlation and beta coefficients or odds and risk ratios. These data could not be used in the meta‐analyses to generate multivariate effect sizes to compare with the bivariate data effect sizes. However, we employed vote counting for the multivariate studies to provide some comparison with the results from the bivariate studies.

We conducted sensitivity analyses comparing studies at low, unclear, and high risk for selection bias, as there were 21 studies rated at low risk, 55 studies rated at moderate risk, and 26 studies rated at high risk. Specifically, we conducted sensitivity analyses for selection bias on behaviour problems and mental health service utilisation because these two outcomes had at least three studies in each of the risk groups. For the continuous behaviour problems outcome, we used a simple unweighted ANOVA model with the risk groups as the independent variable and the standard mean difference from each study as the dependent variable. The following are the mean effect sizes and 95% confidence intervals for the low risk group: ‐0.65 (95% CI ‐1.56 to 0.24), the unclear risk group: ‐0.23 (95% CI ‐0.36 to ‐0.10); and the high risk group: ‐0.17 (95% CI ‐0.66 to 0.33). The result was nonsignificant (F = 1.53, P = 0.257), which indicates that the effect sizes for behaviour problems are similar between the low risk ( Ford 2007 ; Holtan 2005 ; Lawler 2008 ; Linares 2010 ; Metzger 1997 ; Rudenberg 1991 ), the unclear risk ( Brooks 1998 ; Davis 2005 ; Orgel 2007 ; Surbeck 2000 ; Timmer 2004 ), and the high risk ( Jones‐Karena 1998 ; Strijker 2003 ; Tarren‐Sweeney 2006a ; Villagrana 2008 ) for selection bias groups.

For the mental health service utilisation outcome, we used a simple unweighted ANOVA model with the risk groups as the independent variable and the odds ratios as the dependent variable. Before conducting the ANOVA, the odds ratios were transformed into standard mean differences using a method from Chinn 2000 , in which the log transformation of each odds ratio is divided by 1.81. The following are the mean effect sizes and 95% confidence intervals for the low risk group: 0.39 (95% CI ‐0.84 to 1.62), the unclear risk group: 0.19 (95% CI ‐0.13 to 0.51); and the high risk group: 0.39 (95% CI 0.19 to 0.60). The result was nonsignificant (F = 0.75, P = 0.496), which indicates that the effect sizes for mental health service utilisation are similar between the low risk ( Clyman 1998 ; Metzger 1997 ; Sakai 2011 ), unclear risk ( Berrick 1994 ; Farmer 2010 ; Sivright 2004 ; Sripathy 2004 ; Tompkins 2003 ), and high risk groups ( Bilaver 1999 ; Jenkins 2002 ; Ringeisen 2009 ; Scannapieco 1997 ; Villagrana 2008 ) for selection bias.

Subgroup analyses

There were insufficient data to examine different effects of the intervention by gender, ethnicity, and age at placement. Specifically, only three studies ( Farruggia 2009 ; Holtan 2005 ; Ryan 2010a ) reported outcome data by gender for each placement type, only Farruggia 2009 and Smith 2002 reported outcome data by ethnicity for each placement type, and no studies reported outcome data by age at placement for each placement type.

Summary of main results

Based on the preponderance of the available evidence, it appears that children in kinship care experience better outcomes in regard to behaviour problems, adaptive behaviours, psychiatric disorders, well‐being, placement stability (placement settings, number of placements, and placement disruption), guardianship, and institutional abuse than do children in foster care. There were no detectable differences between the groups on reunification, length of stay (in placement or out‐of‐home care), educational attainment, family relations, developmental service utilisation, and physician service utilisation. However, children placed with kin are less likely to achieve adoption and to utilise mental health services, while being more likely to still be in placement than are children in foster care. Although there were some findings of no difference between the groups for certain outcomes, the multivariate results generally support the findings from the meta‐analyses while indicating that children in kinship care are less likely to re‐enter out‐of‐home care than are children in foster care. However, these conclusions are tempered by the pronounced methodological and design weaknesses of the included studies and particularly the absence of conclusive evidence on the comparability of groups. It is clear that researchers and practitioners must do better to mitigate the biases that cloud the study of kinship care.

Although this review supports the practice of treating kinship care as a viable out‐of‐home placement option for children removed from the home for maltreatment, policies mandating kinship placements may not always be in the best interest of children and families. Professional judgement from child welfare practitioners must also be used to assess the individual needs of children and the ability of kin caregivers to attend to these needs.

Overall completeness and applicability of evidence

With the inclusion of 40 new studies and an overall evidence base of 102 studies, this systematic review represents the most complete synthesis of kinship care research to date. The findings presented here are robust, in that the addition of the 40 studies did not change any of the previous results and in fact consolidated many of them. Although two years have passed since the updated search date of March 2011, it would take an additional 40 studies with dramatically different results to have any impact on the findings. Furthermore, the context in which kinship care is practised (at least in the U.S.) has not changed in the past two years, as kinship care is still the preferred out‐of‐home placement option. Thus, the decision was made to proceed with the publication of the updated systematic review to maximise the applicability of the evidence for child welfare practitioners and policymakers. All studies produced after March 2011 will be considered for the next update of this systematic review.

Overall, a very secure picture of the outcomes for kinship care has emerged. However, the applicability of the evidence is still worth considering, especially for the key outcomes. For example, the lack of a baseline measurement of initial behavioural functioning makes ambiguous the conclusion that children in foster care have lower levels of current behavioural functioning. Furthermore, caregiver reports may be biased because foster parents have more incentive to report behavioural and mental health issues, whereas relatives are more apt to view the behaviour as acceptable and thus less likely to report it as problematic.

The mixed findings for the permanency outcomes could be interpreted in the context that long‐term kinship care arrangements satisfy the definition of permanency in many countries, as kinship caregivers are allocated the parental rights for a child. Thus, an undesirable outcome (e.g., remaining in care) might actually be desirable if the kinship care placement is considered to be safe and stable. Adoption and guardianship are secondary permanency goals, which are considered only after reunification has been ruled out. Furthermore, these permanency outcomes are fundamentally dependent on the public and legal policy of individual countries. For example, adoption is not a viable permanency option in many countries outside of the U.S., including Australia, Israel, Netherlands, and the Nordic nations.

The commonly‐held idea that foster parents are more 'system involved' may explain the greater propensity for children in foster care to receive mental health services. Furthermore, the training and supervision of foster parents may contribute to the higher identification of mental health problems, and as such contribute to higher levels of service utilisation. The lower licensure rate for kin caregivers may be another factor in the unequal receipt of services for children in kinship care. However, the greater likelihood for children in foster care to utilise mental health services may have less to do with the type of placement and more to do with these children having a greater need for services.

Quality of the evidence

The major limitation encountered in this systematic review is the weak standing of quantitative research on kinship care ( Cuddeback 2004 ). Specifically, the "differences between the children who enter kinship care and those who enter nonkinship care" lead to a lack of confidence regarding the comparability of groups and the subsequent lack of control over contaminating events such as family preservation services ( Barth 2008b , p. 218). In general, the included studies also have unclear to high risks of performance, detection, reporting, and attrition bias, which compromise the tenability of the findings from the systematic review. However, the sensitivity analyses indicate that the results for behavioural development and mental health service utilisation are more robust, in that the effect sizes for studies with low, unclear, and high risk of selection bias were comparable.

Another concern regarding the quality of evidence is the potential misalignment between the intervention and child welfare outcomes, in that the fullest representation of the effects of kinship care has yet to be truly measured ( Cuddeback 2004 ). When compared to traditional foster care, in which the relationship between foster parents and the 'system' is more standardised, the effect of kinship care may be more difficult to detect. For example, there is seemingly a lack of implementation fidelity within and across countries in regard to kinship care. Furthermore, kinship placements, especially with unlicensed caregivers, are often more private and out of the control of child welfare agencies than are foster placements. The concepts, terminology, and outcomes typically ascribed to out‐of‐home care may not always be appropriate for kinship placements. As a result of these limitations, it is more appropriate to research kinship care after it has been fully and consistently integrated into the fabric of child welfare policy and practice.

Potential biases in the review process

One potential bias in the review process is that the robustness of the meta‐analysis results is weakened by challenges confronted during the effect size calculations. Specifically, the heterogeneity statistic was significant for 17 of the 21 outcomes, which indicates that the effect sizes were not always consistent within the same outcome. In addition, bivariate data were not reported in every study, which restricted the meta‐analysis of some outcomes to the bare minimum of three studies and eliminated other outcomes from consideration. Another potential bias is that many studies analysed a small sample of children, while others utilised a much larger dataset. However, this was somewhat mitigated by the use of random‐effects weighting, which gave more weight to the studies with smaller sample sizes and less weight to the studies with larger sample sizes, than would a fixed‐effect analysis.

The presence of publication bias in this review was examined for behavioural problems (continuous), reunification, adoption, still in placement, and mental health service utilisation, as these outcomes had at least 10 studies included in the respective meta‐analyses. Overall, a visual inspection of the funnel plots suggests that publication bias is likely not present for these outcomes. Specifically, the funnel plots for behavioural problems, mental health service utilisation, reunification, and still in placement appear symmetrical. The funnel plot for adoption ( Figure 3 ) appears asymmetrical with a gap in the bottom left corner of the graph. However, the three studies represented in the bottom right corner have the smallest sample sizes, the largest effect sizes, and the largest standard errors, which may indicate poor methodological quality rather than publication bias. Furthermore, these three studies are in favour of the control condition, so it does not appear that any studies that may be 'missing' are missing because of negative findings.

Funnel plot of comparison: 4.2 Adoption.

Agreements and disagreements with other studies or reviews

The results of this review are in strong agreement with the only previous narrative review of kinship care, conducted by Cuddeback 2004 .

Implications for practice

Several implications for social work professionals and policymakers emerged from this review, although they are dependent on how individual countries interpret the results. If the goal of kinship care is to enhance the behavioural development, mental health functioning, well‐being, and placement stability of children, then the evidence base is supportive. However, the findings from the review do not support implementing kinship care solely to increase the permanency rates and service utilisation of children in out‐of‐home care.

The primary implication for practitioners to consider is whether kinship placements would be even more effective with increased levels of caseworker involvement and service delivery ( Geen 2000 ). However, the potential benefits of greater financial and therapeutic support must be weighed against the independence that some kin caregivers demand. Relatedly, the main implications for policymakers is whether licensing standards should be required for kin caregivers ( Geen 2000 ), and whether additional financial resources should be made available to these providers ( Hornby 1996 ).

On the other hand, there may be a cost‐effectiveness component to placing children with relatives in light of the comparable permanency outcomes, and lower payments and fewer services offered to kin caregivers. As such, this could play an important role in how child welfare agencies view their current approach to kinship care. That being said, foster care should continue to be an essential out‐of‐home care option, as children in these placements also experience positive outcomes and appropriate kinship placements are not always available.

Implications for research

To address the major limitations of research on kinship care, there is a demand for studies that employ generalisable samples, equivalent groups, and repeated measurements ( Berrick 1994a ). Cuddeback 2004 advocates longitudinal designs to investigate the outcomes of children over time, the development of psychometrically sound instruments of family and child functioning that allow for more reliable comparisons across groups and studies, and greater emphasis on controlling and understanding selection bias through the use of emerging statistical models (e.g., meta‐regression analysis). Furthermore, the duration effect or the relationship between length of stay and child welfare outcomes should be explored in greater depth. For example, survival analysis could be used to investigate the timeliness of achieving reunification and other permanency outcomes for children in out‐of‐home care. There is also a need to disaggregate the effects of kinship care across important subgroups of target participants, settings, and intervention variations. For example, there are few studies that reliably measure the effect of kinship care on caregiver outcomes ( Gibbs 2000 ). As for other topics, Testa 1992 calls for research on the financial implications of kin caregivers becoming licensed, while Cuddeback 2004 recommends studies that examine the relationship between certification and the provision of services to kin caregivers. Studies that focus on the educational outcomes of children in kinship care are certainly warranted, as education is essential to effective integration into adult life. In addition, research on informal and voluntary kinship care arrangements should be a top priority for child welfare researchers.

Qualitative research that explores the underlying dynamics of kinship care along with the factors associated with positive outcomes is a natural outgrowth of this systematic review. Specifically, investigating the lived experiences of different types of kin caregivers (e.g., grandparents, other relatives, family friends) would greatly enhance our understanding of this placement option.

As research on this topic is predominantly U.S.‐based, studies from other countries are sorely needed, especially as kinship care is increasing in popularity elsewhere in the western world. For example, the different permanency goals should be examined in greater depth to determine which outcome offers greater practical permanency to children removed from the home.

For kinship care to remain a viable option in the social work repertoire, researchers must work more closely with practitioners to design, implement, and disseminate innovative studies of the intervention. For example, new predictor variables and outcome measures should be included in data collection instruments to facilitate richer analyses of the effect of kinship care.

Lastly, the Methods for Future Updates Table ( Table 6 ) displays methods such as sensitivity and subgroup analyses that were not conducted in this review but should be included in future updates.

Protocol first published: Issue 2, 2007 Review first published: Issue 1, 2009

This review is co‐registered within the Campbell Collaboration.

Acknowledgements

Thank you to SFI Campbell (previously the Nordic Campbell Center), Danish National Institute of Social Research and the Applied Research in Child Welfare (ARCH) Project (USA) for funding this review. Thank you to Laura MacDonald, Trine Bak Nyby, Krystyna Kowalski, Jane Dennis, Geraldine Macdonald, and Julia Littell for their timely feedback and generous support during the writing of the protocol, original review, and updated review. Thank you to Margaret Anderson and Jo Abbott, Trial Search Co‐ordinators for the Cochrane Developmental, Psychosocial and Learning Problems Group (DPLPG), and Merinda McLure, Applied Human Sciences Librarian at Colorado State University (CSU), for assistance in developing and executing the search strategy for the review. Thank you to Toby Lasserson (Cochrane Airways Group, London, UK), Celia Almeida (Cochrane DPLPG, Bristol, UK), Soyna Curtis, and Professor Jelena Marinkovic and Dr. Jelena Marinkovic both from University of Belgrade, Serbia for translating the foreign language articles for the review. Thank you to Jeff Valentine and the content reviewers along with Brian Cobb and Jeffrey Gliner of CSU for their helpful suggestions. Special thanks to Stephanie Mace of CSU for her assistance in acquiring the studies, extracting data, and conducting quality assessments for the updated review. Thank you to Frank Ainsworth, Marianne Berry, Morten Blekesaune, and Amy Holtan, as this protocol incorporates elements of their jointly registered Cochrane and Campbell Collaboration protocol prepared in 2004 on the same topic.

Appendix 1. Search strategies for updated review (2011)

Cochrane Central Register of Controlled Trials (CENTRAL) , 2011 (1), part of the Cochrane Library, last searched 14 March 2011 #1MeSH descriptor Foster Home Care, this term only #2((kin or kinship) NEAR/3 (care* or caring)) #3((kin or kinship) NEAR/3 foster*) #4((kin or kinship) NEAR/3 placement*) #5((family or families) NEAR/3 foster*) #6((family or families) NEAR/3 placement*) #7((family or families) NEAR/3 substitute*) #8(relative* NEAR/3 substitute*) #9(relative* NEAR/3 foster*) #10 (custodial NEXT grandparent*) #11(#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10) #12MeSH descriptor Adolescent explode all trees #13MeSH descriptor Infant explode all trees #14child near "MESH check words" #15(child* or girl* or boy* or adolescen* or teen* or baby or babies or infant* or preschool* or pre NEXT school* or preteen* OR pre NEXT teen* OR young NEXT person* or young NEXT people) #16(#12 OR #13 OR #14 OR #15) #17(#11 AND #16) Ovid MEDLINE(R), 1948 to March Week 1 2011, last searched 14 March 2011 1 foster home care/ 2 ((kin or kinship) adj3 (care$ or caring)).tw. 3 ((kin or kinship) adj3 foster$).tw. 4 ((kin or kinship) adj3 placement$).tw. 5 ((family or families) adj3 foster$).tw. 6 ((family or families) adj3 placement$).tw. 7 ((family or families) adj3 substitute$).tw. 8 (relative$ adj3 substitute$).tw. 9 (relative$ adj3 foster$).tw. 10 custodial grandparent$.tw. 11 Infant/ 12 exp Child/ 13 adolescent/ 14 (baby or babies or infant$ or toddler$ or PRESCHOOL$ or PRE‐SCHOOL$ or CHILD$ or BOY$ or GIRL$ or preteen or teen$ or adolescen$ or youth$ or young person$ or young people).tw. 15 or/11‐14 16 or/1‐10 17 15 and 16 CINAHLPlus (EBSCOhost), 1937 to current, last searched 14 March 2011 S18 S12 and S17 S17 S13 or S14 or S15 or S16 S16 AG ADOLESCENT S15 AG CHILD S14 AG INFANT S13 (baby or babies or infant* or toddler* or PRESCHOOL* or PRE‐SCHOOL* or CHILD* or BOY* or GIRL* or preteen* or teen* or adolescen* or youth* or young person* or young people) S12 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 S11 custodial grandparent* S10 (relative* N3 foster*) or (relative* N3 substitute*) S9 (family N3 substitute*) or (families N3 substitute*) S8 (family N3 placement*) or (families N3 placement*) S7 (family N3 substitute*) or (families N3 substitute*) S6 (family N3 foster*) or (families N3 foster*) S5 (kin N3 placement*) or (kinship N3 placement*) S4 (kin N3 foster*) or (kinship N3 foster*) S3 (KINSHIP N3 CARE*) OR (KINSHIP N3 CARING) S2 (kin N3 care*) or (kin N3 caring) . S1 ((MH "Foster Home Care") OR (MH "Foster Parents") OR (MH "Child, Foster") OR (MH "Foster Home Care") ) AND ((MH "Family Relations") OR (MH "Extended Family") ) PsycINFO (EBSCOhost), 1887 to current, last searched 14 March 2011 S18 S13 and S17 S17 S14 or S15 or S16 S16 AG Adolescence S15 AG childhood S14 (baby or babies or infant* or toddler* or PRESCHOOL* or PRE‐SCHOOL* or CHILD* or BOY* or GIRL* or preteen* or teen* or adolescen* or youth* or young person* or young people) S13 S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 S12 custodial grandparent* S11 (relative* N3 foster*) or (relative* N3 substitute*) S10 (family N3 placement*) or (families N3 placement*) S9 (family N3 substitute*) or (families N3 substitute*) S8 (family N3 foster*) or (families N3 foster*) S7 (kin N3 placement*) or (kinship N3 placement*) S6 (kin N3 foster*) or (kinship N3 foster*) S5 (KINSHIP N3 CARE*) OR (KINSHIP N3 CARING) S4 (kin N3 care*) or (kin N3 caring) S3 S1 and S2 S2 (DE "Kinship") OR (DE "Family Members") S1 DE "Foster Care" OR DE "Foster Children" OR DE "Foster Parents" ERIC (Cambridge Scientific Abstracts ‐ CSA), 1966 to current , last searched 14 March 2011 (((DE=("grandparents raising grandchildren")) or(DE=("family sociological unit" or "family relationship"))) and(DE=("foster care"))) or((((relative* within 3 foster*) or (relative* within 3 substitute) or (family within 3 foster*)) or ((families within 3 foster*) or (family within 3 substitute) or (families within 3 substitute)) or ((kin within 3 care*) or (kinship within 3 care*) or (kin within 3 caring)) or (kinship within 3 caring)) or((kin within 3 placement*)or (kinship within 3 placement*)or (family within 3 placement*)or (families within 3 placement*)or (custodial grandparent*))) and((DE=("children" or "infants" or "adolescents")) or (child* or girl* or boy* or adolescen* or preteen* or teen* or baby or babies or infant* or preschool* or pre school* or (young person*) or (young people) or youth*)) Sociological Abstracts (Cambridge Scientific Abstracts ‐ CSA), 1952 to current, last searched 14 March 2011 ((DE=("foster care" and "kinship")) or(((relative* within 3 foster*) or (relative* within 3 substitute) or (family within 3 foster*)) or ((families within 3 foster*) or (family within 3 substitute) or (families within 3 substitute)) or ((kin within 3 care*) or (kinship within 3 care*) or (kin within 3 caring)) or (kinship within 3 caring)) or((kin within 3 placement*)or (kinship within 3 placement*)or (family within 3 placement*)or (families within 3 placement*)or (custodial grandparent*))) and((DE=("children" or "infants" or "adolescents")) or (child* or girl* or boy* or adolescen* or preteen* or teen* or baby or babies or infant* or preschool* or pre school* or (young person*) or (young people) or youth*)) ASSIA (Cambridge Scientific Abstracts ‐ CSA), 1987 to current, last searched 14 March 2011 (((DE=("children" or "adolescents" or "babies")) or (child* or girl* or boy* or adolescen* or teen* or baby or babies or infant* or preschool* or pre school* or (young person*) or (young people))) and ((((relative* within 3 foster*) or (relative* within 3 substitute) or (family within 3 foster*)) or ((families within 3 foster*) or (family within 3 substitute) or (families within 3 substitute)) or ((kin within 3 care*) or (kinship within 3 care*) or (kin within 3 caring)) or (kinship near caring)) or (DE="kinship foster care"))) or((KIN WITHIN 3 PLACEMENT*) OR (KINSHIP WITHIN 3 PLACEMENT*) OR (FAMILY WITHIN 3 PLACEMENT*) OR (FAMILIES WITHIN 3 PLACEMENT*) OR (CUSTODIAL GRANDPARENTS*)) Social Science Citation Index, 1970 to 12 March 2011, last searched 14 March 2011 #21 #20 AND #16 #20 #19 OR #18 OR #17 #19 TS=(young person* or young people or youth*) #18 TS=(baby or babies or infant* or preschool* or pre school*) #17 TS=(child* or girl* or boy* or teen*) #16 #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 #15 TS=(custodial grandparent*) #14 TS=(relative* SAME foster*) #13 TS=(relative* SAME substitute) #12 TS=(family same foster*) #11 TS=(families same foster*) #10 TS=(family SAME placement*) #9 TS=(family SAME substitute) #8 TS=(families SAME placement*) #7 TS=(families SAME substitute) #6 TS=(kin SAME placement*) #5 TS=(kinship SAME placement*) #4 TS=(kin SAME care*) #3 TS=(kinship SAME care*) #2 TS=(kin SAME caring) #1 TS=(kinship SAME caring) Conference Proceedings Citation Index ‐ Social Sciences and Humanities (CPCI‐SSH), 1990 to 12 March 2011, last searched 14 March 2011 #21 #20 AND #16 #20 #19 OR #18 OR #17 #19 TS=(young person* or young people or youth*) #18 TS=(baby or babies or infant* or preschool* or pre school*) #17 TS=(child* or girl* or boy* or teen*) #16 #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 #15 TS=(custodial grandparent*) #14 TS=(relative* SAME foster*) #13 TS=(relative* SAME substitute) #12 TS=(family same foster*) #11 TS=(families same foster*) #10 TS=(family SAME placement*) #9 TS=(family SAME substitute) #8 TS=(families SAME placement*) #7 TS=(families SAME substitute) #6 TS=(kin SAME placement*) #5 TS=(kinship SAME placement*) #4 TS=(kin SAME care*) #3 TS=(kinship SAME care*) #2 TS=(kin SAME caring) #1 TS=(kinship SAME caring) Dissertation Express , last searched 14 March 2011 Search terms: Kinship , kin (limited by publication year 2007 or later)

Appendix 2. Search strategies for original review (2007)

CENTRAL ( searched via the Cochrane Library, 2007, Issue 1) #1 (relative near foster*)

#2 (relative* near substitute)

#3 (family near foster*)

#4 (families near foster*)

#5 (family near substitute)

#6 (families near substitute)

#7 (kin near care*)

#8 (kinship near care*)

#9(kinship near caring)

#10 (#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9)

#11 MeSH descriptor Adolescent explode all trees

#12 MeSH descriptor Infant explode all trees

#13 child near "MESH check words"

#14 (child* or girl* or boy* or adolescen* or teen* or baby or babies or infant* orpreschool* or pre school* or (young person*) or (young people))

#15 (#11 OR #12 OR #13 OR #14)

#16 (#10 AND #15) OVID MEDLINE, 1966 to February 2007 1 Child/

3 Adolescent/

4 (child$ or girl$ or boy$ or adolescent$ or teen$ or baby or babies or infant$ or preschool$ or pre school$ or young person$ or young people).tw.

5 or/1‐4

6 (relative$ adj3 foster$).tw.

7 (relative$ adj3 substitute).tw.

8 (family adj3 foster$).tw.

9 (families adj3 foster$).tw.

10 (family adj3 substitute).tw.

11 (families adj3 substitute).tw.

12 (kin adj3 care$).tw.

13 (kinship adj3 care$).tw.

14 (kin adj3 caring).tw.

15 (kinship adj3 caring).tw.

16 or/6‐15

17 5 and 16

Campbell Collaboration's Social, Psychological, Educational, and Criminological Trials Register (C2‐SPECTR) ( searched March 9th 2007) {Kin}or {kinship} or {family} or {families} or {relative} AND {Foster} or {substitute} or {care} or {caring} AND {Child} or {girl} or {boy} or {adolescent} or {teen} or {baby} or {babies or {infant} or {preschool} or {pre school} or {young person}or {young people} Sociological Abstracts ( searched via CSA, 1962 to February 2007) Query: (((relative* within 3 foster*) or (relative* within 3 substitute)or (family within 3 foster*)) or ((families within 3 foster*) or (familywithin 3 substitute) or (families within 3 substitute)) or ((kin within 3 care*) or (kinship within 3 care*) or (kin within 3 caring)) or (kinship near caring)) and ((DE=("children" or "infants" or "adolescents")) or(child* or girl* or boy* or adolescen* or teen* or baby or babies or infant* or preschool* or pre school* or (young person*) or (youngpeople))) Social Work Abstracts (searched 1977 to February 2007) 1  (child* or girl* or boy* or adolescent* or teen* or baby or babies or infant* or preschool* or pre school* or young person* or young people) [Terms anywhere] 2           (relative* near3 foster*) [Terms anywhere] 3           (relative* near3 substitute) [Terms anywhere] 4           (family near3 foster*) [Terms anywhere] 5           (families near3 foster*) [Terms anywhere] 6           (family near3 substitute) [Terms anywhere] 7           (families near3 substitute) [Terms anywhere] 8           (kin near3 care*) [Terms anywhere] 9           (kinship near3 care*) [Terms anywhere] 10         (kin near3 caring) [Terms anywhere] 11         (kinship near3 caring) [Terms anywhere] 12         or/2‐11 13         1 and 12 SSCI ( searched 1970 to February 17th 2007); ISI Proceedings ( searched 1990 to February 16th 2007), both accessed via ISI Web of Knowledge

#17 #16 AND #11DocType=All document types; Language=All languages; #16 #15 OR #14 OR #13 OR #12DocType=All document types; Language=All languages; #15 TS=(young people)DocType=All document types; Language=All languages; #14 TS=(young person*)DocType=All document types; Language=All languages; #13 TS=(baby or babies or infant* or preschool* or pre school*)DocType=All document types; Language=All languages; #12 TS=(child* or girl* or boy* or teen*)DocType=All document types; Language=All languages; #11 #10 OR #9 OR #8 OR #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1DocType=All document types; Language=All languages; #10 TS=(kinship SAME caring)DocType=All document types; Language=All languages; #9 TS=(kin SAME caring)DocType=All document types; Language=All languages; #8 TS=(kinship SAME care*)DocType=All document types; Language=All languages; #7 TS=(kin SAME care*)DocType=All document types; Language=All languages; #6 TS=(families SAME substitute)DocType=All document types; Language=All languages; #5 TS=(family SAME substitute)DocType=All document types; Language=All languages; #4 TS=(families near foster)DocType=All document types; Language=All languages; #3 TS=(family SAME foster*)DocType=All document types; Language=All languages; #2 TS=(relative* SAME substitute)DocType=All document types; Language=All languages; #1 TS=(relative* SAME foster*)DocType=All document types; Language=All languages; Family and Society Studies Worldwide (Searched 1970 to February 2007) 1   (child* or girl* or boy* or adolescent* or teen* or baby or babies or infant* or preschool* or pre school* or young person* or young people) [Key words/phrases] 2    (relative* near3 foster*) [Key words/phrases] 3    (relative* near3 substitute) [Key words/phrases] 4    (family near3 foster*) [Key words/phrases] 5    (families near3 foster*) [Key words/phrases] 6  (family near3 substitute) [Key words/phrases] 7  (families near3 substitute) [Key words/phrases] 8  (kin near3 care*) [Key words/phrases] 9  (kinship near3 care*) [Key words/phrases] 10 (kin near3 caring) [Key words/phrases] 11 (kinship near3 caring) [Key words/phrases] 12 or/2‐11 13 1 and 12 ERIC (searched via Dialog DataStar, 1966 to February 2007) 1 RELATIVE$ NEAR FOSTER$ 2 ERIC ‐ 1966 to date RELATIVE$ NEAR SUBSTITUTE 3 ERIC ‐ 1966 to date FAMILY NEAR FOSTER$ 4 ERIC ‐ 1966 to date FAMILIES NEAR FOSTER$ 5 ERIC ‐ 1966 to date FAMILY NEAR SUBSTITUTE 6 ERIC ‐ 1966 to date FAMILIES NEAR SUBSTITUTE 7 ERIC ‐ 1966 to date KIN NEAR CARE$ 8 ERIC ‐ 1966 to date KIN NEAR CARING 9 ERIC ‐ 1966 to date KINSHIP NEAR CARE$ 10 ERIC ‐ 1966 to date KINSHIP NEAR CARING 11 ERIC ‐ 1966 to date 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR 9 OR 10 12 ERIC ‐ 1966 to date CHILD$ OR GIRL$ OR BOY$ OR ADOLESCEN$ OR TEEN$ OR BABY OR BABIES OR INFANT$ OR PRESCHOOL$OR PRE ADJ SCHOOL 13 ERIC ‐ 1966 to date YOUNG ADJ PERSON$ OR YOUNG ADJ PEOPLE 14 ERIC ‐ 1966 to date 12 OR 13 15 ERIC ‐ 1966 to date 11 AND 14 PsycINFO ( searched via SilverPlatter, 1872 to January week 5 2007)

#12 ((( (young person*) )or( (young people) )) or (child* or boy* or girl* or adolescen* or teen* or baby or babies or infant* or preschool* or pre school*)) and ((family near3 substitute) or (families near3 foster*) or (family near3 foster*) or (relative* near3 substitute) or (relative* near3 foster*) or (( kin near3 care* )or( kinship near3 care* )or( (kin near3 caring) or (kinship near3 caring) )) or (families near3 substitute)) #11 (( (young person*) )or( (young people) )) or (child* or boy* or girl* or adolescen* or teen* or baby or babies or infant* or preschool* or pre school*) #10 ( (young person*) )or( (young people) ) #9 child* or boy* or girl* or adolescen* or teen* or baby or babies or infant* or preschool* or pre school* #8 (family near3 substitute) or (families near3 foster*) or (family near3 foster*) or (relative* near3 substitute) or (relative* near3 foster*) or (( kin near3 care* )or( kinship near3 care* )or( (kin near3 caring) or (kinship near3 caring) )) or (families near3 substitute) #7( kin near3 care* )or( kinship near3 care* )or( (kin near3 caring) or (kinship near3 caring) ) #6 families near3 substitute #5 family near3 substitute #4 families near3 foster* #3 family near3 foster* #2 relative* near3 substitute #1 relative* near3 foster* CINAHL (searched via OVID, 1982 to February week 3 2007)

1 Child/ 2 Infant/ 3 Adolescent/ 4 (child$ or girl$ or boy$ or adolescent$ or teen$ or baby or babies or infant$ or preschool$ or pre school$ or young person$ or young people).tw. 5 or/1‐4 6 (relative$ adj3 foster$).tw. 7 (relative$ adj3 substitute).tw. 8 (family adj3 foster$).tw. 9 (families adj3 foster$).tw. 10 (family adj3 substitute).tw. 11 (families adj3 substitute).tw. 12 (kin adj3 care$).tw. 13 (kinship adj3 care$).tw. 14 (kin adj3 caring).tw. 15 (kinship adj3 caring).tw. 16 or/6‐15 17 5 and 16 ASSIA (searched via CSA, 1987 to February 2007) Query: ((DE=("children" or "adolescents" or "babies")) or (child* or girl*or boy* or adolescen* or teen* or baby or babies or infant* or preschool*or pre school* or (young person*) or (young people)))

and ((((relative*within 3 foster*) or (relative* within 3 substitute) or (family within 3foster*)) or ((families within 3 foster*) or (family within 3 substitute)or (families within 3 substitute)) or ((kin within 3

care*) or (kinshipwithin 3 care*) or (kin within 3 caring)) or (kinship near caring)) or(DE="kinship foster care"))

Dissertation Abstracts International , (accessed via Dissertation Express, searched late 1960s to February 2007) Search terms used: kinship care, kin care, family foster care

New search for studies and content updated (no change to conclusions)

Data and analyses

Comparison 1, comparison 2, comparison 3, comparison 4, comparison 5, comparison 6, comparison 7, comparison 8, characteristics of studies, characteristics of included studies [ordered by study id].

AFCARS: Adoption and Foster Care Analysis and Reporting System AFDC: Aid to Families with Dependent Children CPS: Child Protection Services DCFS: Department of Children and Family Services DHHS: Department of Health and Human Services DOCS: Department of Community Serives DSS: Department of Social Services GPA: Grade Point Average IDCFS: Illinois Department of Children and Family Services LONGSCAN: Longitudinal Studies of Child Abuse and Neglect NSCAW: National Survey of Child and Adolescent Well‐being OOH: out‐of‐home RCSA: Relative Caregiver Social Assessment

Characteristics of excluded studies [ordered by study ID]

Differences between protocol and review.

There were no substantive differences between the protocol and review. There were some differences between the review and the update. Specifically, sensitivity analyses and reporting bias analyses were conducted with the addition of the 40 new included studies. The methods section was enhanced with additional information on the assessment of risk of bias and the assessment of heterogeneity. The results section was enhanced with additional information on the effects of the interventions, the interpretations of the meta‐analytic and odds ratios results, and the sensitivity analyses. The discussion section was enhanced with additional information on the overall completeness and applicability of the evidence and potential biases in the review process. The plain language summary was enhanced with additional information on adverse effects and limitations. Meta‐analyses with less than three studies were removed from the review. The risk of bias table was changed to a risk of bias figure. Lastly, studies awaiting classification were moved to excluded studies as being intractably unavailable.

Contributions of authors

Marc Winokur, Amy Holtan, and Deborah Valentine contributed to the writing and revising of the original review. Marc Winokur, Amy Holtan, and Keri Batchelder contributed to the writing and revising of the updated review. The original search strategy was developed with Jo Abbott, Trial Search Co‐ordinator for the Cochrane DPLPG. The updated search strategy was developed with Margaret Anderson, Trial Search Co‐ordinator for the Cochrane DPLPG. Marc Winokur will be responsible for updating this review as additional evidence accumulates and as funding becomes available.

Sources of support

Internal sources.

• SFI Campbell, Denmark.

External sources

• Applied Research in Child Welfare Project, USA.
• University of Tromsø, Norway.

Declarations of interest

Marc Winokur, Amy Holton and Keri Batchelder ‐ the original review was funded by the Applied Research in Child Welfare Project (USA), SFI Campbell (Denmark), and the University of Tromsø, Center for Child and Adolescent Mental Health (Norway), and the updated review was funded by the Applied Research in Child Welfare Project (USA) and UiT The Arctic University of Norway, Regional Centre for Child and Youth Mental Health and Child Welfare (Norway). There are no competing interests that influenced, or may give the appearance of potentially influencing, what we wrote in the submitted work.

References to studies included in this review

Akin 2011 {published data only}.

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Smith 2003 {published data only}

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Tarren‐Sweeney 2006a {published data only}

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What is kinship care? Why is it favoured for Aboriginal children over foster care?

Research Associate in Justice Health and Social Issues, Curtin University

Associate professor, Curtin University

Research Officer, Curtin University

Disclosure statement

Jocelyn Jones receives funding from the National Health and Medical Research Council

Hannah McGlade is a member of the Noongar Family Safety and Wellbeing Council (NFSWC), a peak body in WA for Noongar children and families.

Sasha Moodie is affiliated with the Australian Red Cross (volunteer), National Drug Research Institute (employment) and Melbourne School of Population and Global Health (employment).

Curtin University provides funding as a member of The Conversation AU.

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The 1997 Bringing Them Home report into the removal of Aboriginal children from their families was a turning point in Australia’s history. The inquiry rejected past government policies of assimilation and endorsed the importance of keeping Aboriginal and Torres Strait Islander children with their families.

Reducing the over-representation of Aboriginal children in out-of-home care is now a target of the federal government’s Closing the Gap policy.

Yet the rate of Aboriginal and Torres Strait Islander children in out-of-home care is increasing. Between 2021–2022 around 4,100 Indigenous children were placed in out-of-home care nationally. The highest rates were among children under one year old.

Across all age groups, Indigenous children are placed in out-of-home care at almost 12 times the rate of non-Indigenous children. In Western Australia, Indigenous children are placed in out-of-home care at 20 times the rate of non-Indigenous children.

Alongside the Closing the Gap target, the Aboriginal and Torres Strait Islander Child Placement Principle recognises the rights of Indigenous children in maintaining connections with their culture, family and community.

Yet until recently, fewer than half of Indigenous children removed from their families were placed with kin or in their community. National efforts to better meet best-practice standards has led to a small increase in Indigenous children placed in kinship arrangements from 50% in 2017 to 54% in 2022 . Clearly this situation must improve.

Read more: We checked the records of 6,000 kids entering care. Only a fraction received recommended health checks

What is kinship care?

Studies show institutional racism, trauma, violence, homelessness, socioeconomic disadvantage and poverty present significant challenges for Aboriginal and Torres Strait Islander children and families.

Out-of-home care means overnight care of a temporary or permanent nature for children under 18 who aren’t able to live with their family for risk-related issues determined by the state. Common types of out-of-home care include foster care, residential care and kinship care.

A kinship carer is an Indigenous person who is a member of the child’s community, a compatible community, or from the same language group. Kinship care aims to maintain a child’s social and cultural connections .

Compared to foster care, children in kinship care tend to have more contact with their parents, family and community. Children may visit their country, learn their languages and learn about their cultural and family background.

A kinship carer involved in the Indigenous Child Removals Western Australia (I-CaRe) study spoke about how he connects the children in his care with their culture. The grandfather, aged 60, from Perth, Boorloo, said:

Yeah, I’ll take them to sites and explain to them what the site is all about. We will go up to Yagan memorial site there. We’ll go to the statue. We’ll talk about the river and the Derbarl Yerrigan, and I’ll tell them why that name is there. I take them downtown to [Tuyim] Park, for example, and say, this is where all the Noongars used to hang around here. Look, see here?

Research shows Indigenous children with strong cultural identity and knowledge are less likely to experience emotional and social problems. So, the risks of placing Aboriginal and Torres Strait Islander children in non-kinship care arrangements are serious.

Indigenous children aren’t always placed with kin. Why?

The Aboriginal and Torres Strait Islander Child Placement Principle recognises kinship care as the preferred placement and is included in child protection laws. Child protection practices, research and policies are increasingly promoting contact with parents and family members, where possible.

All jurisdictions have committed to the principle, however, non-Indigenous departmental staff and judicial officers can readily make contrary decisions and place children in non-Indigenous care. While child protection workers across the nation must develop “cultural support plans” for Aboriginal children in out-of-home care, such plans often lack content and can be tokenistic. They are no replacement for kinship care.

Aboriginal researchers have highlighted that while connection to culture is critical to Aboriginal children’s health and wellbeing, it is poorly understood by departmental staff.

Also, child protection’s reliance on western psychological theory (“attachment theory”) is being used to displace kinship care . Aboriginal children’s placements with non-Aboriginal carers is given priority over the Aboriginal and Torres Strait Islander Child Placement Principle and reunification with their Aboriginal family and kin. This is identified as systemic racism on the part of child protection systems.

The Indigenous Child Removals WA research found further significant barriers facing Indigenous kinship carers. This included complex and demanding interactions with government departments, lack of support, health risks, and difficulty meeting the needs of children impacted by trauma. Kinship carers may receive a subsidy payment, but this depends on the nature of the care arrangement and whether it’s formalised through a court order.

Read more: 'We had to Google a lot': what foster and kinship carers looking after babies told us about the lack of support

There are considerable screening requirements including working with children clearances, health checks and criminal checks, household inspections, and screening of all family members living in the household.

Some kinship carers described their experiences as very hard and even traumatic. As one Aboriginal kinship carer, a 51-year-old grandmother from Geraldton, explained:

Apparently, I wasn’t fit enough for my grandchildren, so I had to go through the court cases and everything to prove that we were fit enough […] I just went downhill and yeah, we just kept fighting and then it got to that stage where we’re getting interrogated and I’ve had enough, because it went over a period of six months.

The high rate of Indigenous children in non-kinship arrangements has concerned Aboriginal and Torres Strait Islander people over many years. South Australia’s Commissioner for Aboriginal Children and Young People, April Lawrie, recently said unless changes are made, Aboriginal children will enter care at rates similar to those of the Stolen Generations.

And SNAICC, the National Voice for our Children, has warned that when the Bringing Them Home report was issued more than 25 years ago, one in every five Aboriginal children were in out of home care. Today, one in every three Aboriginal children is in care.

Australia cannot continue to harm First Nations children in this way, and kinship care must be improved urgently if we are to address this dire situation.

Read more: 'Life changing' – what 50 years of community-controlled housing at Yumba-Meta tells us about home and health

• Child development
• Indigenous health
• Child health
• Foster care
• kinship care
• Indigenous foster care
• First Nations children
• disadvantage and institutions series
• Social determinants of Indigenous health

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Dissertations / Theses on the topic 'Kinship'

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Leake, Lauren. "Forced Kinship." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/3226.

Nakagawa, Yuri. "Kinship written, kinship practised : a study of kinship and the writing of genealogies in contemporary Korea." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244177.

Varto, Emily. "Early Greek kinship." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/17421.

Sooter, Jan E. "Kinship: A Pastoral Approach." Digital Commons at Loyola Marymount University and Loyola Law School, 2013. https://digitalcommons.lmu.edu/etd/38.

Carroll, Jordan S. "Utopia, Kinship, and Desire." Miami University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=miami1213363990.

Calleja, Carlo. "Kinship as a Political Act: Responding to Political Exclusion through Communities of Solidaristic Kinship." Thesis, Boston College, 2020. http://hdl.handle.net/2345/bc-ir:108721.

Ince, Lynda C. "Kinship Care : an Afrocentric perspective." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/492/.

Appleby, Nellie Helen Frances. "Toward a New Kinship Constellation." VCU Scholars Compass, 2007. http://scholarscompass.vcu.edu/etd/1085.

Clark, Nancy Elizabeth. "Perceptions of satisfaction in the delivery of services to kinship and non-kinship care providers." CSUSB ScholarWorks, 2004. https://scholarworks.lib.csusb.edu/etd-project/2463.

Liow, Joseph Chinyong. "The kinship factor in international relations : kinship, identity construction, and nation formation in Indonesia-Malaysia relations." Thesis, London School of Economics and Political Science (University of London), 2003. http://etheses.lse.ac.uk/1716/.

Yonas, Eva. "Calder and Mondrian an unlikely kinship /." Connect to resource, 2006. http://hdl.handle.net/1811/24056.

Caldwell, David E. "Production grammars for romance kinship terminology." Thesis, McGill University, 1986. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=66069.

Wood, Victoria Jane. "Subordinate kinship : families living with incarceration." Thesis, Durham University, 2008. http://etheses.dur.ac.uk/1929/.

Okruhlicová, Naďa. "Simply Wood : The Kinship of Care." Thesis, Linnéuniversitetet, Institutionen för design (DE), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-95488.

Leo, de Belmont Laura Ana. "Seminole kinship system and clan interaction." Mendoza, República Argentina : Facultad de Filosofía y Letras, Universidad Nacional de Cuyo, 1985. http://catalog.hathitrust.org/api/volumes/oclc/16078022.html.

VIEIRA, Tiago Figueiredo. "Identifying Kinship Cues from Facial Images." Universidade Federal de Pernambuco, 2013. https://repositorio.ufpe.br/handle/123456789/13315.

Saunders, Janine Michelle. "Exposure to chronic community violence : formal kinship, informal kinship, and spirituality as stress moderators for African American children /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.

Johnson, Lizabeth J. "Kinship and violence in Wales, 800-1415 /." Thesis, Connect to this title online; UW restricted, 2008. http://hdl.handle.net/1773/10409.

Sakya, Anil M. "Newar marriage and kinship in Kathmandu, Nepal." Thesis, Brunel University, 2000. http://bura.brunel.ac.uk/handle/2438/5413.

Coster, William. "Kinship and community in Yorkshire, 1500-1700." Thesis, University of York, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316165.

Fortunato, L. "The evolution of kinship and marriage systems." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/18995/.

Breeze, Justin. "Beyond the kinship of pessimism : Beckett's Schopenhauer." Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/49703/.

Ogawa, Jane. "Kinship terminology in the greater Hindu Kush." Thesis, Stockholms universitet, Institutionen för lingvistik, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-157463.

Tjon, Sie Fat Franklin Edmund. "Representing kinship : simple models of elementary structures /." Leiden : Leiden University, 1990. http://catalogue.bnf.fr/ark:/12148/cb37483458t.

Chabot, Hendrik Theodorus Rössler Martin Röttger-Rössler Birgitt. "Kinship, status and gender in South Celebes /." Leiden : KITLV press, 1996. http://catalogue.bnf.fr/ark:/12148/cb37507090p.

Cathcart, Alison. "Kinship and clientage : Highland clanship 1451-1609 /." Leiden : Brill, 2006. http://catalogue.bnf.fr/ark:/12148/cb40163033k.

Immel, Nancy. "Family Naming Practices and Intergenerational Kinship Affiliations." DigitalCommons@USU, 1991. https://digitalcommons.usu.edu/etd/2413.

Cervantes, Danya Brenda. "Kinship Support Group: Addressing Grandparent Caregiver Challenges." CSUSB ScholarWorks, 2016. https://scholarworks.lib.csusb.edu/etd/332.

Griesser, Michael. "The Nepotistic Parent; Predator Protection, Kinship and Philopatry." Doctoral thesis, Uppsala : Universitetsbiblioteket : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3384.

Carriere-Laboucane, Jeannine. ""Kinship care: A community alternative to foster care"." School of Native Human Services, 1997. http://142.51.24.159/dspace/handle/10219/470.

Cowley, Lorraine Liddell. "Genetics and kinship : finding morality at their intersection." Thesis, University of Newcastle Upon Tyne, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.577489.

Benedek, Marton. "Conditionality and Kinship : Hungarian Neighbourhood Policy, 1990-2004." Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517684.

Spiro, Alison Mary. "Moral continuity : Gujarati kinship, women, children and rituals." Thesis, Brunel University, 2003. http://bura.brunel.ac.uk/handle/2438/5521.

Economou, Leonidas. "Kinship and politics in a Midwestern University city." Thesis, London School of Economics and Political Science (University of London), 1994. http://etheses.lse.ac.uk/1285/.

Deevey, Sharon. "Bereavement experiences in lesbian kinship networks in Ohio /." The Ohio State University, 1997. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487942739807836.

Burkhart, Brian Yazzie. "Respect for kinship toward an Indigenous environmental ethics /." [Bloomington, Ind.] : Indiana University, 2009. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3354896.

Moua, Teng. "The Hmong culture kinship, marriage & family systems /." Online version, 2003. http://www.uwstout.edu/lib/thesis/2003/2003mouat.pdf.

Squires, Munir. "Kinship taxation as a constraint on microenterprise growth." Thesis, London School of Economics and Political Science (University of London), 2016. http://etheses.lse.ac.uk/3523/.

Trionfera, Cristiana <1992&gt. "the morphosyntax of kinship terms in Italian dialects." Master's Degree Thesis, Università Ca' Foscari Venezia, 2018. http://hdl.handle.net/10579/12765.

Newson, Lesley. "Kin, culture and reproductive decisions." Thesis, University of Exeter, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.273006.

Widdig, Anja. "Paternal kinship among adult female rhesus macaques (Macaca mulatta)." [S.l. : s.n.], 2002. http://deposit.ddb.de/cgi-bin/dokserv?idn=966456939.

Park, Hwan-Young. "Kinship in post-socialist Mongolia : its revival and reinvention." Thesis, University of Cambridge, 1998. https://www.repository.cam.ac.uk/handle/1810/265421.

Gutierrez, Nadia M. "Preparing kinship foster youth for success| A grant proposal." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1522576.

The purpose of this project was to write a grant proposal to fund a program which would concentrate on teaching and equipping emancipating foster youth with basic life skills in order for them to successfully transition to young adulthood. The target population for this program are dependent youth of the County of Los Angeles, Department of Children and Family Services (DCFS). While there are currently existing program models which promote independent living skills, there are restrictions on the eligibility requirements. This grant writer identified the Stuart Foundation as an appropriate funding source for the proposed program due to the foundation's commitment to education and improving the child welfare system. The grant was written to provide the vulnerable population of emancipating foster youth with knowledge and access to community resources in hopes they will become successful, law abiding and contributing members of society. In addition, the proposed program will provide transitioning foster youth with support and reinforce their self-confidence to reduce and/or counteract effects of childhood abuse and neglect. Securing the funding was not a thesis requirement.

Hindson, James. "Family, household, kinship and inheritance in Shrewsbury, 1650-1750." Thesis, Aberystwyth University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.482035.

Stivens, Maila Katrin Vanessa. "Women, kinship and economy in Rembau, Negeri Sembilan, Malaysia." Thesis, London School of Economics and Political Science (University of London), 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362320.

Torrance, David Alan. "Christian kinship : relatedness in Christian practice and moral thought." Thesis, University of Cambridge, 2017. https://www.repository.cam.ac.uk/handle/1810/269744.

Pérez, Erika. "Family, Spiritual Kinship, and Social Hierarchy in Early California." UNIV PENNSYLVANIA PRESS, 2016. http://hdl.handle.net/10150/622741.

Napier, William John. "Kinship and politics in the art of plaster decoration." Thesis, University of Dundee, 2012. https://discovery.dundee.ac.uk/en/studentTheses/5898b964-6fcf-40b5-9bba-b059ffa7178a.

Martínez, Rodríguez Elena Cristina. "Corpus of the Lycian and Hieroglyphic Luwian Kinship Terms." Doctoral thesis, Universitat de Barcelona, 2020. http://hdl.handle.net/10803/673408.

Reece, Koreen May. "An ordinary crisis? : kinship in Botswana's time of AIDS." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/21083.

Michigan to become first in U.S. to implement kinship care rule for relatives taking in loved ones

Michigan will become the first state in the country to acknowledge kinship caregivers with the same level of financial assistance and licensing requirements as other foster care providers.

Michigan follows the Salt River Pima Tribe in Arizona and will be the first state to implement separate licensing standards for kin caregivers to make the process simpler and allow them to get aid, Secretary of Health and Human Services Xavier Becerra announced late last week.

Kinship caregivers are extended family members such as grandparents, friends of family, and multiple generations of people taking care of loved ones they did not birth.

Becerra said the change allows families to stay together and increases equity in the child welfare system. Kinship care also allows children to remain tied to their cultural heritage, family and community.

“It is often grandparents who step up to care for a grandchild when that child’s parent can’t. We must be partners with those grandparents and support their commitment to care for the child while a parent gets back on their feet, so more children don’t end up in foster care,” Becerra stated in a press release. “Michigan’s robust support for kin caregivers has made it a national leader. The approval of Michigan’s plan means more kin caregivers will receive the financial support they deserve when caring for family members.”

Michigan was selected first because it submitted a plan to the U.S. Department of Health and Human Services to allocate funding and create licensing requirements for kin caregivers. Michigan's plan was approved first because the state already had a robust approval process for relatives, said Lynn Sutfin, spokeswoman for the state's department of health and human services. Michigan was previously providing relatives the same level of support as licensed families, using state and county funding.

As of May, the state health department said 7,268 foster families were serving children and youth in Michigan and 42% were kin families. The new standards for kinship approval will also increase access to subsidized guardianship, the state health department said. This will allow Michigan to officially approve these kinship families, ultimately improving permanency outcomes through an increase in subsidized guardianship placements.

The decision to simplify the licensing process for kinship caregivers in the state comes after a Detroit News project in 2022, supported by the New York & Michigan Solutions Journalism Collaborative, found these caregivers are often overlooked and undercounted in Michigan, especially as they are rarely defined or recognized in most state laws. The most recent data available indicated there are about 54,000 Michigan children in kinship caregiving situations, both formally and informally, but that figure is likely the low end.

Kinship caregivers describe limited support when taking in loved ones, with no guidance or resources about how to transition into an unforeseen circumstances.

In September, the U.S. Health and Human Services Department finalized a new regulation that allows a state's child welfare agency to adopt simpler licensing or approval standards for all kin foster family homes. It also requires that states provide kin caregivers with the same level of financial assistance that any other foster care provider receives.

In many instances, grandparents are caring for grandchildren and suffering in applying for assistance as they are not their court-appointed guardians. Area Agencies on Aging note the most common reasons for kinship caregiving follow parental incarceration or substance abuse.

Elizabeth Hertel, director of the Michigan Department of Health and Human Services, said the state is excited to be the first in the country to have an approved licensing standard for kin, saying Michigan has "long recognized" the value of these caregivers.

“It is often grandparents and other family members who step in to provide a loving home when parents are unable to do so and they must be supported," said Hertel.

It's unclear how much funding Michigan will receive or allocate from its existing budget to accommodate kinship care.

The Detroit News looked into the growing shortage of traditional caregivers for its " Care in Crisis " series in 2022. A survey the newsroom commissioned showed that for caregivers in Metro Detroit, those who have the least to give find themselves giving the most.

The second part of the series noted that kinship caregiving is rarely surveyed, meaning equivalent data for people caring for those younger than 18 doesn't exist. As a result, the number of kinship caregivers is likely undercounted.

Previously, federal regulations made it harder for family members such as grandparents, aunts, and uncles to become caregivers when a child in their family entered foster care as courts did not recognize the term kinship. Without obtaining legal guardianship over a person, families can’t seek financial assistance through the state. Many don’t realize their informal living situation is disqualifying them from receiving available financial assistance. Some are too disconnected or have never heard the term "kinship caregiver."

The new rule ensures that during times of family crisis, kin can more readily become licensed or approved, according to the department.

“When times are tough, many of us turn to family for help,” stated Jeff Hild, deputy assistant secretary for the Administration for Children and Families. “ACF understands grandparents and other kin who are raising children in safe, loving homes deserve support and we applaud Michigan for developing licensing standards that reflect the unique needs and strengths of kin caregivers.”

Those providing resources and working on how this will be implemented include Area Agencies on Aging, Grandparents Raising Grandchildren , and Michigan State University, which has a resource center for kinship caregivers.

MDHHS encourages caregivers to call the Kinship Support Program to connect with a kinship navigator to learn about the resources available in their community. They also can reach the Kinship Support Program by calling (800) 535-1218 or visiting  www.kinship.msu.edu .

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HHS Secretary Becerra Announces Michigan as First State to Implement Kinship Care Rule

Leads the way in transforming kinship care practices for underserved communities

Today, Secretary of Health and Human Services Xavier Becerra announces approval for Michigan to become the first state to implement separate licensing standards for kin caregivers. Michigan is the first state approved following the Salt River Pima Tribe in Arizona. Last September, HHS finalized a new regulation that allows a child welfare agency to adopt simpler licensing or approval standards for all kin foster family homes as well as requiring that states provide kin caregivers with the same level of financial assistance that any other foster care provider receives. This rule and approval of state’s and jurisdiction’s plans, fulfill executive orders by President Biden and align with the administration’s priorities to keep families together and increase equity in the child welfare system.

“It is often grandparents who step up to care for a grandchild when that child’s parent can’t. We must be partners with those grandparents and support their commitment to care for the child while a parent gets back on their feet, so more children don’t end up in foster care,” said HHS Secretary Xavier Becerra. “Michigan’s robust support for kin caregivers has made it a national leader. The approval of Michigan’s plan means more kin caregivers will receive the financial support they deserve when caring for family members.”

Encouraging and helping kin caregivers become licensed or approved foster caregivers is beneficial to both the child and the kin providing foster care. Previously, federal regulations made it harder for family members like grandparents, aunts, and uncles to become caregivers when a child in their family entered foster care as all foster family homes were required to meet the same licensing standards, regardless of whether the foster family home was a kin or non-kin placement. The new rule makes it possible for kin to more readily become licensed or approved, and more quickly receive services and funding for children in kinship foster care, ensuring that during times of family crisis children and caregivers receive assistance sooner.

“When times are tough, many of us turn to family for help,” said Principal Deputy Assistant Secretary for ACF, performing the delegable duties of the Assistant Secretary for Children and Families, Jeff Hild. “ACF understands grandparents and other kin who are raising children in safe, loving homes deserve support and we applaud Michigan for developing licensing standards that reflect the unique needs and strengths of kin caregivers.”

“Supporting kin caregivers is critical to whole family well-being and we are excited to support Michigan as the first state to implement the rule,” said Commissioner of the Administration on Children, Youth and Families, Rebecca Jones Gaston. “This is a profound acknowledgement of the critical role family connections play in ensuring a child’s safety, stability and emotional growth.”

“Michigan has long recognized the value of kin caregivers and we are excited to be the first state in the country to have an approved licensing standard for kin,” said Elizabeth Hertel, Director, Michigan Department of Health and Human Services. “It is often grandparents and other family members who step in to provide a loving home when parents are unable to do so and they must be supported.”

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MSU Extension Parenting Education Classes

Online kinship caregiver building strong adolescents webinar series 2024.

May 31, 2024 - June 28, 2024 11:00am-1:00pm ET

Dates: Fridays, May 31, June 7, 14, 21, 28 2024

Time: 11:00am - 1:00 pm et, location: the link for this webinar will be sent out after registration is complete. , this event is offered at no cost. .

Class Information:

Offered in partnership with the MSU Kinship Care Resource Center, Building Strong Adolescents is a MSU Extension authored program for parents and guardians of adolescents ages nine to 17. The program focuses on the external and internal assets teens need to succeed.

Topics include:

• The need for teens to develop internal and external assets and strategies to promote growth
• Setting limits
• Applying consequences
• Fostering independence
• Promoting self-esteem and school success
• Encouraging positive friendships (including dating)
• Discussing substance abuse and sex with your teen
• Helping your teen prepare for the future.

By the end of the program parents and guardians will be educated on methods to surround teens with positive relationships and opportunities that are important for a successful future.

Participation Information:

This is a series class and participants must plan on attending all five weeks.  Certificates for participation are provided upon completion of the series. In order to receive a certificate, participants must actively participate in the webinar throughout all five sessions.  Participants have the option to attend and actively participate via computer, or an app on a tablet or smartphone. Attendees can also listen to the presentation via phone (by calling in), but active participation is difficult over the phone due to the webinar format. Those who choose to call in must contact the instructor for instructions on how to be eligible for a certificate. If multiple people in the same location want to participate in the webinar and need certificates, they have to join the webinar separately or contact the instructor for special instructions to each receive a certificate.

Tags: building early emotional skills , building strong adolescents , child , children , discipline , discipline and children , early childhood development , family , guiding principles , guiding principles for highly successful parenting , michigan state university extension , michigan state university extension parenting , msu extension , parenting , parenting class , parenting class online , parenting education classes , parenting teens , parenting the preschooler , teen , teenager , virtual

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Watch CBS News

Michigan kinship care rule will "make a huge difference," advocates say

By Elle Meyers

April 2, 2024 / 5:55 PM EDT / CBS Detroit

(CBS DETROIT) -  A rule change will create licensing standards for kin caregivers in Michigan, benefiting family members, like grandparents, who step in to help raise loved ones. 

The change, which is a first for any state, would give these families the same level of assistance as foster care providers.

"We are raising my 10-year-old grandson, and that is due to parental rights were terminated," said Debra Palumbo. "We were put in that position where if we don't want to adopt him, he would be put into an adoption for anyone. Of course, any person would want their family with them."

Palumbo and her significant other, Richard Liscomb, say they took in Anthony and wouldn't have it any other way, but they are doing so on a fixed income and at an advanced age. 

"It's very overwhelming to have to raise a child again when you thought, 'Oh, retirement. I'm going on vacation," Palumbo said. "No, those plans are put on the back burner now."

Palumbo and Liscomb are just two of the thousands of relative providers caring for more than 4,000 children in our state. 

"It's so important that when children do have to be removed from their parents, that they are able to go somewhere that is familiar to them," said Elizabeth Hertel, the director of the Michigan Department of Health and Human Services. "The experience can be incredibly traumatic."

This rule change allows for simpler licensing and approval standards for kin foster family homes, according to the federal Department of Health and Human Services, and additional financial assistance than before. 

"Access to the supportive relative assistance benefits that are very crucial often because their placements come to them with much less notice and preparation than foster families," said Beth Lindley, who serves as the director of the Kinship Care Resource Center at Michigan State University. "Being able to facilitate a more streamlined process for them to be approved and vetted so that they can receive the financial support that they're eligible for is going to be it's going to make a huge difference."

Elle Meyers joined the CBS News Detroit team in April of 2023 after spending two years covering Michigan's capitol. Elle is an Oregon native and a graduate of the University of Oregon (go Ducks!), where she double majored in journalism and political science, both of which have served her well in her journey to Detroit.

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CBS Detroit

Michigan kinship care rule will "make a huge difference"

Posted: April 2, 2024 | Last updated: April 2, 2024

A rule change will create licensing standards for kin caregivers in Michigan, benefiting family members, like grandparents, who step in to help raise loved ones.

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