Study Review

Achieving Permanence for Disabled Children

Achieving permanence for disabled children with specific focus on fostering and adoption placements

Outcome Overall
effectiveness

This rating shows how effective the intervention is at achieving the evaluated outcome.

Click here for information about how effectiveness ratings are applied.

Strength of
evidence

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Reunification Overall effectiveness: -1 (maximum 2) Strength of evidence : 0 (maximum 3)
Placement disruption Overall effectiveness: mixed (maximum 2) Strength of evidence : 0 (maximum 3)

Headline points

  • There is a lack of research on disabled children who are looked-after
  • The review does not specify the methods used in each of the included studies. Therefore, conclusions cannot be drawn about the overall quality of the research, and caution should be applied when interpreting the findings
  • This summary of 90 sources included 20 studies from the UK
  • Disabled children are less likely to be reunited home compared to non-disabled children, and they are more likely to remain in out-of-home care placements than others
  • There is mixed evidence around whether disabled children experience more placement disruption than non-disabled children who are looked after
  • Of the very few studies that exist, it is suggested that disabled children are more likely to find their care environment more restrictive than other children
  • Children with mental health needs or behaviour disabilities are less likely to be reunited with their parents and are more likely to experience poorer outcomes in adoptions

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What is this?

The systematic review examined whether placement outcomes are different between disabled and non-disabled children. It also considered the factors that influence placement outcomes for children with disabilities. The factors considered include child characteristics.

Note: The systematic review adopts a social model of disability that included children with physical or sensory impairments, intellectual disabilities, challenging behaviours, mental distress and children on the autistic spectrum.

How is it meant to work?

The review did not report any mechanisms.

What are the evaluated outcomes?

  • Reunification
  • Placement disruption

How effective is it?

Outcome 1: Reunification – Overall the review found that disabled children were less likely to be successfully reunified than non-disabled children. This is based on very low strength evidence, because the review did not include information about the methods or quality of the research involved. Caution should therefore be used when interpreting this finding.

Outcome 2: Placement disruption – Overall, the review found a mixed effect on placement disruption. This means that studies show a mixture of effects and the criteria for negative or tends to positive effect is not met. This is based on very low strength evidence, because the review did not include information about the methods or quality of the research involved. Caution should therefore be used when interpreting this finding.

Strength of evidence:

  • The review does not specify the methods used in each of the included studies. Therefore, conclusions cannot be drawn about the overall quality of the research, and  caution should be applied when interpreting the findings.
  • The evidence is based on international literature published between 1998-2003.

Where has it been studied?

The evidence originates from a total of 90 sources, with 54 from the US, 20 from the UK, 10 from Canada, and with one paper each from both China and the Netherlands.

Who does it work for?

  • It was suggested that compared to girls, boys are more likely to experience longer delays in waiting for adoption, with an average wait for adoption amongst disabled boys of 11.8 years.
  • Looked-after disabled children are more likely to enter care at an older age than non-disabled children.
  • Younger disabled children appeared more likely to be adopted than older disabled children. Moreover, older disabled children appeared more likely to have experienced placement disruption than their younger counterparts.
  • It was suggested that a correlation exists between adoptions at a young age with better outcomes.
  • Black disabled children were more likely to be placed with white adopters than children who were black but not disabled. However, findings suggest that children adjust well to their white families.

When, where and how does it work?

  • Children with behaviour challenges, alongside other impairments, are more likely to experience disruption and/or have more placements.  However, ‘other impairments’ are not clearly specified or defined in the review.
  • Children with behaviour disabilities or mental health needs appeared to be less likely to reunify with their parents, and more likely to experience poorer outcomes in adoptions.
  • Mixed findings emerged in relation to sensory and/or physical impairments. One study concluded that these children were more likely to be adopted, while two studies suggested they were no less likely to be adopted than non-disabled children.
  • In relation to parental substance misuse, children were more likely to be placed in kinship care than foster care.
  • Children on the autism spectrum appeared to experience high levels of placement instability.
  • The review identified that access to, and the provision of specialist services is crucial in ensuring the successful placing of looked after disabled children. However, there is also evidence to suggest that accessing these services can be problematic and does not necessarily meet their needs.
  • Placement success may be associated with access to looked-after disabled children’s background information. Although the review reported that this is a critical factor for adopters, no information is presented on how this directly impacts placement success or failure.

What are the costs and benefits?

No economic analysis is included in the study.

How is it implemented?

For the purpose of this summary, the intervention we are referring to is out of home placement for disabled children.

Little is known about the process of matching disabled children with foster carers or adopters. Findings suggest adopters do adjust their preferences and their notion of a ‘good match’ as the process unfolds. Similarly, some become much more open to considering a disabled child when information or the profile of the child is presented to them.

  • Carers’ own health and wellbeing are often poorly addressed. For example, one study found that the caring responsibilities for disabled children can be demanding and can lead carers to experience fatigue and social isolation.
  • Studies have suggested that adopters experience great satisfaction in adopting disabled children, including developing a positive relationship, and receiving affection from the child, and seeing how the child is able to develop and flourish.
  • Research suggests that carers can experience satisfaction in helping the child return home, or in maintaining connection with the child’s family and community.

Who can deliver it?

  • ‘Specialist’ carers are those who have personal and/or professional experiences of disability and are specially seeking the placement of a disabled child. Generalist carers refers to those who are not necessarily seeking such placements, but may consider one.
  • While having experience of disability may build a carer’s confidence, it is not a necessity in order to adopt or care for disabled children, and both can become successful carers. However, the challenges in the recruitment of ‘specialist’ and ‘generalist’ carers have been well documented. Specialist carers are more likely to be connected to hospitals or special schools, while generalist carers may be harder to reach and more likely to hold stereotypical views of disabled children.
  • One study suggests that ‘unconditional mothers’, who are open to fostering children with various impairments, are more likely to foster disabled children for longer and are more likely to adopt their foster children, when compared with ‘selective mothers’ who feel able to care for children with specific characteristics or circumstances.

What are the training and supervision requirements? 

  • Carers have reported valuing support from their peers, and that caring for a disabled child requires particular skills, including the ability to build networks of support for the disabled child with peers, family and schools and being able to advocate on behalf of the disabled child.
  • Researchers suggest that foster carers require effective coping skills and strategies in order to manage the stress that is associated with caring, arranging support, and managing contact with birth relatives, of the disabled child.
  • Other researchers found that the training that is available to foster carers is not always adequate, and suggest that more intense and tailored training are needed for those caring for disabled children.

What supports good implementation?

  • Research suggests that social worker workload can be a barrier to building relationships with carers, and carers can feel frustrated in trying to be listened to, or seek support from social workers.
  • Where social workers work with a family long-term, the family is more likely to feel listened to.
  • Research also suggests that adopters preferred support from other adopters.

In summary...

  • Disabled children are less likely to be reunited home compared to non-disabled children, and they are more likely to remain in out-of-home care placements than others
  • There is mixed evidence around whether disabled children experience more placement disruption than non-disabled children who are looked after
  • The evidence that exists is limited, and not much is known about disabled children’s personal accounts of their experiences in out-of-home care
  • Of the very few studies that exist, it is suggested that disabled children are more likely to find their care environment more restrictive than other children
  • There appears to be a correlation between adoptions at a young age and better outcomes
  • Children with mental health needs or behaviour disabilities are less likely to be reunited with their parents and are more likely to experience poorer outcomes in adoptions.

Further resources