Children with serious emotional and behavioural problems have been identified as at risk in
the care system (Blower, Addo, Hodgson, Lamington, & Towlson, 2004) especially those
with conduct disorder (Berridge, 1 997). Their behaviours are linked to placement disruption
and breakdown across a range of studies (Barth & Berry, 1 988; C . S . Cooper, Peterson, &
strength established for this relationship (J. G. Barber et aI., 200 1 ) has led some to question whether foster care is a viable option for some older children in this group (J. G. Barber et aI., 200 1 ; Richardson & Joughin, 2000). The behaviours associated with placement
breakdown have been described broadly as including sexualised behaviour, dishonesty, suicidality, fire lighting, encopresis and enuresis, aggression, destructiveness and running away (Barth & Berry, 1 988; Gilbertson & Barber, 2004; Rosenthal & Groze, 1 990).
Caregiver satisfaction has been found to be closely associated with feeling competent to handle behaviours of those children who are placed with them (United States General Accounting Office, 1 989). Triseliotis et a1. ( 1 998) identified that children's behaviours were isolated by carers whose ceased to foster as an important reason for doing this, along with the impact of fostering on caregivers' families and their sense of privacy. When care givers find that the challenging behaviours and the emotional intensity that accompanies mental health problems cannot be managed within their fami ly, placement breakdown is to be expected, although caregivers feel shame and sadness when this happens (Butler & Charles,
1 999a; Richardson & Joughin, 2000).
Recruiting caregivers who are able to withstand these behaviours is crucial to successful care of children with mental health problems. Small-scale, recent research has attempted to describe characteristics of those foster caregivers willing to care permanently for children with high needs (M. E. Cox, Orme, & Rhodes, 2002; Reilly & Platz, 2003) however, the findings are preliminary. In one study willing caregivers were found to be on average in their mid forties with active religious or spiritual beliefs and had fostered their high needs children prior to adopting them (Reilly & Platz, 2003). In another small study (n= 1 42) it was also
established that belonging to a place of worship was associated with a willingness to foster children with bed wetting and troubled behaviour at school (M. E. Cox et aI., 2003). In Wales a study of caregivers looking after children with behavioural problems found them to be predominantly older, describing these caregivers as durable and experienced (Pith ouse, Lowe, & Hill-Tout, 2004).
Behavioural problems and the experience of foster care appear to interact. Two way or interactive effects are noted between child behaviour and placement breakdown for children in care with mental health problems whereby behavioural problems are both a cause and a
consequence of placement breakdown (Ackerman, 2002; Newton, Litrownik, & Landsverk,
2000). While breakdown of foster care is attributed to behavioural problems, these problems
are also exacerbated by the rate of placement change (Fanshel, Finch, & Grundy, 1 989;
Newton et aI., 2000) although the strength of this relationshi p has been questioned in a recent
greater risk of behavioural problems and this trend holds good amongst those who are adopted (Brand & Brinich, 1999).
Cumulative negative experiences are likely to follow placement breakdown. In many cases placement breakdown is accompanied by educational failure (Biehal, Clayden, Stein, &
Wade, 1 994; Causer, 1 996), with school or training positions being hard to maintain for children with behavioural problems (Morton et aI., 1 999). Poor placement history is also linked to discontinuity in mental health treatment and deficiencies in management of
behavioural problems (Mental Health Foundation, 2002a). The longer the initial placement is maintained the more likely a child or young person will receive mental health services (Nugent & Glisson, 1999).
These problems appear to be ongoing. Children and young people with behavioural problems
experience longer periods in care (Landsverk et aI., 1 996; Lawder, Poulin, & Andrews,
1 9 86) and have lower reunification rates after controlling for background characteristics and types of maltreatment (Landsverk et aI., 1 996). There is continuity of troubles whereby reported problem behaviours amongst children in care are predictive of risk behaviours five years later (Taussig, 2002). Re-entry into care has also been linked to the behavioural problems of children (Courtney, 1995) and the inability of parents to manage child problems with insufficient family support (Festinger & Michael, 1 994). The difficulty in diverting
such negative trajectories is explained by the strong influence of background factors, such as
behavioural problems. The best predictor of outcomes for children in care appears at this stage to be their characteristics at the time of placement (Pecora et aI., 2000).
However, within kinship care there is variance in the interaction between disruptive
behaviours and placement breakdown, which as described above is of interest. Landsverk et
al. ( 1 996) found that variance in kinship placement reunification rates was not impacted on by child externalising behavioural problems in the way that foster care rates are. It is suggested that this fmding may be attributed to kin caregivers not accepting children with these problems into their care. Alternatively, McFadden ( 1 998) argues that lower rates of mental health problems amongst children placed with kin caregivers may be because of the pre-existing emotional bonds of caregivers. The recent Swedish study of youth placements concurs, finding that kinship care is protective after controlling for background variables and
arguing for "a more positive attitude to kinship care especially if increased stability in
teenage placement is an important goal" (Sallnas et aI., 2004 p. 1 S0). The relationship between child behaviours, stability and duration of kinship care is insufficiently explored for children with mental health problems to make conclusions possible. It remains a significant care option however, warranting further research.
Looking after children with mental hea lth problems who are in Child, Youth and Fam i ly care
There is very little information available about the mental health problems amongst children in Child, Youth and Family foster care as the research base is small. In Ward's (2000) study while only one third of those in care had an established diagnosis, 9 1% had received mental health services at some point while in care. In over one half of the group, placement
breakdown was attributed to the inability of caregivers to manage behaviour. Yates (200 1 ) also identified serious mental health problems amongst a small group o f young people leaving Child, Youth and Family care.
In Calvert's (2000) review of 3 6 young people with mental health problems in Child, Youth and Family care there appeared to be few non-government organisations able to provide care services for this group. All groups involved commented that meeting child needs was not possible without additional funding. In line with overseas research described above, multiple placements were a key feature of the care histories of this group, with one young person
experiencing 4 1 placements and only two having single placements. Multiple admission to
residential care was attributed to failure to maintain placements which could meet the severity of the behavioural and psychological state of the children and young people. Calvert (2000) comments on the lack of fit between care plans of children and assessments, and the absence of behavioural strategies despite the need for these identified by clinicians (Calvert,
2000).