Appendix 1. Factors related to poor psychosocial outcomes among children and young people looked after away from home

Although it is very difficult to isolate the factors that account for psychological problems among children and young people in out-of-home placements, the characteristics of their biological parents, pre-admission experiences, and changing social environments have all been thought to influence outcomes for them (Simonoff, McGuffin and Gottesman 1994). Genetic studies have shown that the biological parents of children and young people in out-of-home placements have increased rates of mental disorder, criminality, and parental psychopathology (Quinton and Rutter 1988). Other research has identified high levels of parenting problems, cultural deprivations and major deficiencies in basic areas of life such as health, education and housing at the time of placement (McIntyre and Keesler 1986; Maluccio, Kreiger and Pine 1990).

Experiences leading to placement in alternative care have been strongly associated with the emotional and behavioural development of children and young people. Admission into care when precipitated by major family discord or maltreatment has generally been associated with high levels of emotional and behavioural disturbance during placement (Vorria et al. 1998). Moreover, longitudinal studies of children and young people in out-of-home placements have shown that raised levels of disturbance are often evident before admission (St Claire and Osborne 1987).

Although the pre-admission experiences of children and young people's may play a strong role in influencing their psychological outcomes, these effects are likely to be exacerbated when subsequent care experiences are less than optimal. Research studies have shown several factors related to quality of care that may impact on psychological development (Vorria et al. 1998; Maluccio, Kreiger and Pine 1990).

First, the age at which children and young people are placed in alternative care is known to play a strong role in determining whether they are adversely affected by the care experience. As the first three years of life are important to social development (Bowlby 1951), children and young people who spend their early years in inadequate care are likely to have persisting psychological problems. Social inhibition and indiscriminate friendliness in social relationships, for example, are two characteristics found to be associated with institutional rearing in infancy (Chisholm et al.1995; Kaler and Freeman 1994; Tizard and Hodges 1978; Wolkind 1974).

Second, research indicates that children and young people who experience multiple placements during care as a result of planned moves, placement breakdown, misadventure (the death or illness of a carer, for example) or the closure of residential accommodation, are more likely to experience poor psychological outcomes than those who are able to form a warm, intimate and continuous relationship with a mother substitute (Vorria, et al. 1998; Belsky and Cassidy 1994; Rutter 1995). As Cashmore and Paxman note in their study of wards leaving care (1996), 'The degree to which children and young people experience continuity and stability in care is probably the most important factor influencing outcomes in out of home care.'

Third, maintenance of parentÐchild relationships has increasingly been recognised for its influence in placement outcome and the development and wellbeing of children and young people (Aldgate 1980; Fanshell and Shinn 1978; Hess 1987). Most children and young people in substitute care who maintain regular contact with their parents have been found to be more settled in their placements, more able to manage relationships with other adults, and 'more competent socially and educationally' (Berridge and Cleaver 1987; Bullock, Little and Millham 1993).

Fourth, the phenomena of children and young people spending protracted periods of time in care is likely to heighten the deleterious effects of out-of-home care placement already described in this report. As McCotter and Oxnam (1981) have noted, long periods of time spent in care can create a situation worse than the family circumstances that led to placement, preventing links with parents, kin and caretakers being established and jeopardising emotional growth and development.

Fifth, the damaging effects of experiences leading to placement are more likely to be protracted, and the ambiguity of living in the 'limbo' of substitute care (McCotter and Oxnam 1981) more prevalent in certain placement settings than in others. Foster care placements, for example, are more likely to provide a warm, intimate, and continuous relationship with a mother substitute which Bowlby (1951) regarded as a necessary condition for healthy development. In addition, it would be reasonable to expect that normalisation processes would occur, and cognitive improvements would be sustained in placements that maintain the same characteristics as an ordinary family.