Relational Social Work

Erickson

vol. 1, n. 2, October 2017

(pp. 71-91)

doi: 10.14605/RSW121705

Foster care and residential care: what factors affect the type of placement of children? An Italian study

Francesca Corradini

Catholic University of Milan, Italy

Correspondence to

Francesca Corradini

e-mail: francesca.corradini@unicatt.it

Abstract

When social workers need to place children outside their birth family, the choice between placing them in a foster family or in residential care is crucial. There are many factors that influence the decision for one option over another. This study takes into account figures collected by the Child Protection Services related to 8,438 out-of-home children in a northern Italian region. Four types of placement are taken into account (full-time foster care, part-time foster care, full-time residential services and day care centre). Through bivariate analysis, subsequently verified by means of simple linear regression models, each type of placement has been cross-checked with the variables relating to socio-demographic characteristics of children (gender, age and nationality), prevailing problems of children and prevailing problems of the families, to identify significant correlations. The article reports the results of the analysis and the possible implications of the findings for the professional practice of social workers.

Keywords

Foster care – Residential care – Types of placements – Children prevailing problems – Families prevailing problems.

Introduction: foster care and residential care in Italy

In Italy, out-of-family placements are regulated by Law 184/1983 as amended. There are three main placements for children in need of temporary out-of-home care: children homes (small residential services with professional caregivers, mostly social workers and social pedagogues); non-professional foster families (families or single people who care for a child in their home, without direct payment from the welfare system but with some income support); and professional foster families (families with one or both parents paid as professional caregivers, usually employed by a Voluntary Organization). In all these settings, children can be placed with a full-time, day-time¹ or part-time attendance, depending on their birth families’ problems.

Law 184/1983 as amended provides a kind of order of preference to follow when placing a child. In first place is «a family, preferably with a children»; in second place there is a single person; and lastly, there are children homes. In fact, the placement possibilities are very different; there are also differences between various regions, depending on local regulations.

From a numerical point of view, the latest available national figures indicate an equitable sharing between children placed in non-professional foster care and children homes²: approximately 29,300 children in out-of-home placements at 31.12.2010. Half of them were in foster care and half in residential services (Ministry of Labour and Social Policy, 2014). In Italy, out-of-home placements, either in foster care or in residential services, can be made with the agreement of the parents or disposed by the Juvenile Court, who decides the duration of the placement. In the case of voluntary placement, the family’s agreement is formalized and out-of-home placement is arranged by the local authority, which also has the task of implementing the project. The maximum duration of a voluntary placement is two years, and the intervention may be extended only by the Juvenile Court’s decision. The latest figures of the Ministry tell us that in 2014, 70% of out-of-home placements in Italy were arranged by the Juvenile Court (Ministry of Labour and Social Policy, 2014).

When an out-of-home placement is made, the choice between foster care and residential care is crucial. Studies show that the percentage of children placed in non-professional foster care, children in homes or professional foster care varies considerably depending on the country (Thoburn, 2007). In line with the provisions of the UN Guidelines for the Alternative Care of Children of 2009, in Italy, as already mentioned, the legislation provides that entry in non-professional foster families should be privileged. However, there are no studies that demonstrate greater effectiveness of entries in a family than those in residential services, and the border between the two types of intervention is very labile (Kendric, 2013). It is therefore useful to explore what factors influence the decisions of social workers with respect to the type of placement for a child, as there is high complexity in child protection situations and several factors are crossed at the policy, services and field level.

Foster care and residential care: some reference frameworks

Some studies (Ainsworth & Thoburn, 2014; Thoburn, 2007, 2016; Boddy, 2014; Cameron, 2014) have tried to address the issue of out-of-home placements of children through comparative analysis of the interventions carried out in different countries. The authors note that it is very difficult to make a comparative analysis at the international level, as they use very different operational definitions to indicate interventions (Thoburn, 2007). However, it is evident that the percentage of children placed in residential services and that of children placed in foster care are very different. For example, among looked after children in Japan, the percentage of those placed in residential services is 92% and in Australia it equals 6% (Ainsworth & Thoburn, 2014, p.18). Even the rates of looked after children are very different. Italy is in a relatively low range because of, according to the authors, the «strong family ties and a lower proportion of mothers in the workforce» (Ibid, p. 19).

Analysing the literature, it is clear that the choice between foster care and residential care is linked to factors that are at different levels. The first level is constituted by the political and legislative guidance, which, together with cultural factors, determines the operational choices of professionals (Ainsworth & Thoburn, 2014; Thoburn, 2016; Boddy, 2014). According to the authors, each Child Protection regulatory system refers to a theoretical framework, expressly stated or implied. Most Child Protection systems are figured out by scholars according to two different positions: a Child protection-oriented model approach and a Family service-oriented model approach (Gilbert, 2012; Featherstone et al., 2013; Damman, 2014). The former focuses on the idea that the task of the Child Protection Service is primarily that of the protection of children from their parents’ harmful behaviours. The actions of the social workers, therefore, are primarily aimed at the protection of children, the intervention of out-of-home placement is early and the parental skills recovery is arranged mainly by professionals, with a low level of family involvement. Under the family oriented approach, however, it is believed that the child should be always considered within its network of relationships, which are to be preserved and supported.

The countries that adopt a child protection-oriented approach focus their attention on the protection of the child and see the family in an «adversarial» kind of relationship (Gilbert, 2012, p.532), while countries with a family oriented approach adopt a partnership relationship with the family. In the former case, non-voluntary placements are more common, both in foster care and in residential care. In the latter case, the children are moved away from the family only willingly, except for exceptional cases (Boddy, 2014). Different approaches lead to different visions of the purpose of out-of-home placement, to different conceptualizations of the idea outside family permanence and then, to a different use of the tools that are available (Boddy, 2012). Thoburn (2016) shows that, for example, countries such as the UK, which see placements in residential care as a «last resort», favour placement in foster care and seek to promote the reunification with birth families. On the other hand, countries such as Japan and Eastern European countries, which see residential care as a place of «care and upbringing provision» tend to favour long-term placements in residential care. In countries such as France, Germany and Denmark, insertion in residential services is seen as a therapeutic response to children with complex situations and challenging needs that cannot be addressed by a foster family, as a high level of professional skills is requested (Boddy, 2012).

Cameron’s (2014) analysis is interesting as, in addition to differences related to the child protection approach, the author identifies in the family identity a determining factor in light of the relationship between public and private spheres. According to the author, in some countries, families tend to favour a democratic climate and to enhance the dialogue between generations, while in other countries the relationship is more centred on obedience, respect and discipline. Cameron, in her comparative analysis, also notes that in some countries such as Switzerland, Germany and Austria, the family is socially considered a private domain to be protected from State interference, while in other countries, such as France, the «educational institutions» are an important component in the growth of children. This greatly influences the choice between placement in residential care and foster care when an out-of-home placement is carried out.

Some research also notes that social workers do not have scientific criteria in assessing situations and in choosing the best type of placement for a child (Holland, 2000; Davidson-Arad and Benbenishty, 2016). Choices are often influenced by the availability of local resources (Davidson-Arad et al., 2003; Van Santen, 2010) and personal evaluations about the usefulness of children’s out-of-home placements (Davidson-Arad & Benbenishty, 2016). Maluccio and Ainsworth (2006) showed that it is important for social workers to have in mind what foster care «can and cannot do» with respect to residential care in order to make appropriate choices.

Children and family characteristics

Within a reflection aimed at helping social workers to identify the placement most appropriate for each child, as also indicated by the UN Guidelines for the Alternative Care of Children (Article 5), several studies have focused on the characteristics of children and families as predictive elements with respect to types of placement.

Regarding children, the main feature that seems to guide the choices of social workers between foster and residential care is their age: younger children are welcomed in families, while, as age increases, so does the likelihood of placement in residential services (Courtney & Wong, 1996; Wells and Guo, 1999; Strijker et al., 2002). Most of the studies do not show, however, a correlation with gender (Leloux-Opmeer, 2016). Age is connected, in most studies, to the type of problems presented by children. In one of the first studies on the subject, Farmer (1996) distinguishes protected children, which are small children placed outside of the family due to negligent behaviour on the part of parents and disaffected children, older children manifesting an emotional or behavioural distress who are turned away because parents are unable to cope with their difficulties. Subsequent studies (Delfabbro et al., 2002) have shown that emotional and behavioural problems make placement in foster families less likely, as well as causes frequent placement changes. More generally, some research observes the problems of children in terms of the internalization / outsourcing dichotomy: when the emotional distress of children is addressed towards themselves and manifests itself with depressive tendencies and closing on oneself, a placement in family is more frequent (Bernedo et al., 2014; Vanderfaeillie et al., 2013). When, on the other hand, the aggressiveness is directed outwards and is manifested by hyperactivity, impulsive, provocative, or antisocial behaviour, it is very unlikely that a foster care placement is activated, in which case residential services are favoured (Strijker et al., 2002; Yampolskaia et al., 2014; Vanderfaeillie et al., 2014; Esposito et al., 2013).

In this sense, some studies (Boddy 2012; Leloux-Opmeer et al., 2016) show that an insertion in foster care is more frequent in the presence of parent-specific problems (mental health, substance abuse, criminal problems, but also poverty, neglect and domestic violence), while a placement in residential care is more likely in the presence of children-specific problems (emotional and behavioural difficulties, problematic relationships with peers, learning difficulties).

Vanderfaeillie (2014) identifies some children-specific problems that discourage the inclusion in foster families: abuse of alcohol and hard drugs, insufficient skills in relational issues, presence of delinquent or extremely deviant behaviour, a severe physical disability, mental health problems or psychopathologies. In addition to this, there is also the strong opposition to placement by the birth family. Other research confirms that the presence of serious illnesses in children makes an out-of-home placement more likely, but this happens less frequently in foster care (Knorth et al., 2008; Vanderfaeillie et al., 2013; Yampolskaia et al., 2014; Lopez & Del Valle, 2013).

Some authors highlight that the majority of looked after children present cognitive disorders and poor school performance (Lopez & Del Valle, 2013; Yampolskaia et al., 2014); their presence is very common both among children in foster care (Bernedo, 2014) and among those in residential care, but with different percentages depending on the studies (Leloux-Opmeer et al., 2016).

According to other studies, the choice between foster care and residential care depends not so much on the type of problem presented by the child but on the seriousness of the situation: Strijker et al. (2002) conclude their review of the literature stating that foster care is less likely when the child is older, when the family history reveals problems extended over a long time, or when there are serious emotional and behavioural problems in children.

There are studies that show that, as far as the choice between foster and residential care is concerned, the determining factor is not so much the children’s issues but the household problems (Vanderfaeillie et al., 2013). The presence of maltreating or abusive behaviour is a determining factor in the choice of removing a child from the birth family. Some studies (Leloux-Opmeer et al., 2016) show a lower probability for a child victim of physical abuse to be placed in foster family, while, if the abuse is psychological, the probability is higher (Bernedo, 2014; Strijkier et al., 2002; Yampolskaia et al., 2014). One element that would greatly influence the possibility for a child to be placed outside the family is neglect (Terling, 1999), which affects from a quarter to a third of looked after children (Leloux-Opmeer, 2016); the percentage seems higher among children placed in residential care, but often it depends on the age of the child (Delfabbro et al., 2002). Child victims of sexual abuse are found both in foster and in residential care (Bernedo, 2014; Leloux-Opmeer et al., 2016), regardless of age; a significant factor is the prevalence of the female gender among the abused children placed outside the family (Bernedo, 2014). Also, the presence of domestic violence is a factor that increases the likelihood of out-of-home placement of children (Yampolskaia et al., 2014). A study carried out in Spain (Lopez and Del Valle, 2013) shows that 26% of mothers of children placed in residential services in a Spanish region said they had experienced violence in the family. The presence of mental health problems in parents is an element that favours out-of-home placement (Lopez & Del Valle, 2013; Arad, 2001): an analysis of the literature (Leloux-Opmeer et al., 2016) showed that a third of looked after children has a parent with mental health problems; the percentage, in some studies, reaches 50%, but there were no differences between the placement types. Other elements are very present in the population of looked after children but without a prevalence among one type of placement rather than another, such as substance abuse and the presence of criminal problems (Yampolskaia, 2014; Lopez & Del Valle, 2013; Arad, 2001). Another transversal element is the low socio-economic status of birth families, which seems to characterize all situations of out-of-home children (Esposito et al., 2013; James et al., 2004; Lopez & Del Valle, 2013).

Some studies (Farmer, 2009; Vanschoonlandt et al., 2012) consider the differences between placements in kinship care or foster care: there are no particular differences in children’s characteristics (gender, age and nationality) and parental issues. However, children in kinship care seem to have less difficulties in emotional and behavioural terms, along with fewer disabilities.

Research methods

Aim

This contribution focuses on the elements that affect the possibility for a child to be placed in foster care or in residential care, full time or part time. For this purpose, figures on looked-after children in Emilia-Romagna, a northern Region of Italy, between 2008 and 2012, were examined. Socio-demographic characteristics of the children have been taken into account (age, gender and nationality) along with issues prevalent among children and families. This study is part of a larger work, which aims to describe and evaluate the outcomes and processes of out-of-home placements of children in Emilia-Romagna (Corradini, 2016; 2017).

Source of data

A secondary data analysis has been carried out, with extracted data from the Emilia-Romagna Information System. Emilia-Romagna is a region of the northern part of Italy hosting a population of 4,470,000 dwellers. Since 2000, this region has guaranteed the collection of data on children’s care situations by Social Services through the Sisam Information System. Sisam is a web application that fosters individual data collection on the people followed by Child Protection Services and on delivered services. Data are inserted directly by social workers, and an ID code for each child enables the following of his or her course even if he or she is transferred to another Child Protection Service within the region. The data analysed in this study concerned children who have undergone an out-of-home placement, both in residential care and in foster care and full-time or part-time, during the time span of 2008-2012³ . The total number of children considered is 8,438.

The following data from Sisam Information System were provided within 8 Excel files: taking charge, referral, family members, foster family care and residential care, supervision orders, children victims of violence, interventions. Each file included an ID code for each child, personal data and information about the topic area. There were no aggregate data.

Sample description

Socio-demographic characteristics

Of the sample, 59% were males. The average age at the time of entry in Child Protection System was 9 years, with a high prevalence of children in the 6 to 13 age group. Of the children, 48% had Italian nationality and 52% were foreign nationals (the foreign percentage includes unaccompanied minors). Inclusion in the Sisam Information System of the household composition was optional; thus, the data were available only for 54% of children. Of the children for whom information was available concerning the birth family, 46% lived with both parents at the time they were placed under care, 28% only with the mother, 5% only with the father and 6% only with brothers and sisters.

Prevailing problems in families and children

The Sisam Information System informed about the most frequent problem among children and the family unit as a whole. It was possible to choose a single prevailing issue in a menu, which includes 17 closed-answer items for children and 15 items for the families. To analyse the information, the items related to children were grouped into 8 dichotomous variables and those related to families into 11 dichotomous variables.

In describing the prevailing problems among children and families a few considerations should be made. First, «prevailing problem» means the principal problem of the child or of the family identified by the social worker after the preliminary assessment; therefore, it cannot be automatically identified with the cause of removal. It is also necessary to consider that the sample included children who had benefited from full-time or part-time out-of-home placement. Therefore, the initial conditions of children and families were very different. In addition, if we observe the problems of birth families, we know that these are frequently multi-problem families. Often, practical difficulties related to, for example, housing and economic problems, were intertwined with psychological and relational difficulties.

The prevailing problems among children considered in this analysis are: unaccompanied minors, children with school or relational issues, children victims of violence, children who are disabled or have serious health problems, children with criminal problems, children without specific problems. The problems prevailing in families are: children leaving or absent families (most of them corresponded to the families of the unaccompanied minors or a small percentage of children who might be adopted because the Juvenile Court labelled them as abandoned by their parents), families with economic or housing problems, families with relational or educational problems, families with serious conflicts, families that abuse or maltreat, families with substance misuse, families with mental health problems, families with health problems, families with criminal problems. The variable «other» was introduced to the items with a frequency of less than 2%, both for the problems of children and for those families.

If we look at the children’s prevailing problems, we see that 54% (n = 4,563) of the observed children present no specific problems, but they are looked after because of families difficulties, 19% (n = 1,604) is constituted by unaccompanied minors, 12% (n = 984) are children with school or relational issues, 7% (n = 561) are victims of violence, 5% (n = 444) are disabled children or children with serious health problems, and 1 % (n = 97) have criminal problems. If we look at the prevailing problems among the families, we see that 23% of the families (n = 1,963) have economic or housing problems, 22% (n = 1,914) are families with relational or educational problems, 17% (n = 1,418) are children-leaving families or absent families. Families with heavy conflicts constitute 13% (n = 1,092), families that abuse or maltreat constitute 8% (n = 687), families with substance misuse constitute 5.5% (n = 462), families with health problems constitute 4% (n = 332), and families with mental health problems constitute 2.5% (n = 214).

Placement types

The Information System Sisam offers 8 possible types of placement in foster care and 13 possible types of placement in residential care.

In this analysis, it was decided to group the types of placement according to 4 variables: full-time foster care, part-time foster care, residential service, day-care centre.

Generally, in the observed time span, 11,125 out-of-home placements had been arranged. This number was greater than the number of children under care, as there were children who had benefited from more than one placement, even of a different nature. Most of the interventions provided, corresponding to 41% (n = 3,419), consisted of placements in residential services full time, followed by full-time foster care, which made up 28% (n = 2,339) of the total placements. Part-time foster care constituted 9% (n = 764) of the interventions and the inclusion in day care centre 16% (n = 1,343). There are other interventions (placement in residential homes for mothers and children, placement in boarding schools or hotels), which are not taken into account here.

Data analysis

The data have been processed by the statistical software Stata. Excel files were transposed in Stata and cleaned up from possible errors, double information or misunderstandings. All files were collected in one, which contained all the data. This file was subsequently processed.

Data were initially analysed through the use of double entry tables, in which the placement types in aggregate form (full-time foster care, part-time foster care, residential services, day care centres) have been cross-checked with socio-demographic characteristics of children (gender, age, Italian / foreign nationality) and with the prevailing problems of children and families. With respect to the prevailing problems of children and families, the observations arising from the bivariate analysis were verified through a simple linear regression model. The antecedent variables constituted by the socio-demographic characteristics (gender, age and nationality) and the local Service that takes care of the children, in addition to the concomitant variables, constituted by the other problems of children and families, were introduced into this model.

In this contribution, we have chosen to present the bivariate analysis results and focus on the correlation coefficients, as most of the bivariate observations were confirmed by the analysis carried out with the regression model.

Research findings

Gender, age and nationality

All things considered, in the supplied placements, gender does not seem to be a determining factor with respect to the insertion in foster care: placement in full-time foster care affects 29% both females and males, while there is a slight predominance of females in part-time foster care. In the entries in residential services there are 37% females, 45% males, with a slight predominance of the male gender (Figure 1).

Figure 1 Types of placements by gender - only children affected by an out-of-home placement (Percentages, years 2007-2012) ⁴

The age of the child at the time of out-of-home placement seems to be a very significant factor in relation to the choice for the type of placement. The sample was divided into four age groups: infants (up to one year), from 2 to 5 years (corresponding to preschool), from 6 to 13 years, over 14 years. Considering the types of insertion in full-time foster care and in residential services (Figure 2), we see how infants have the highest odds of being placed in foster care. The percentage (38%) gradually decreases up to 22 % for the 6 to 13 age group. For the 2 to 5 age group, the percentage of foster care placements is still quite high, although down by four percentage points. A severe decline is observed in the age group of 6 to 13, where the percentage of residential placements services exceeds that of full-time foster care placements. On the other hand, the full-time residential services placements have an increasing trend with increasing age and a sudden increase from 14 years on, where the percentage (71%) is almost equal to three times compared to that of infants (27%).

Figure 2 Types of intervention of full-time foster care / full-time residential care by age of the child - only children concerned by a full-time out-of-home placement (Percentages, years 2007-2012)

Focusing on nationality, it should be noted that within the sample, there are children born in 93 different countries; thus, the choice to analyse nationality as Italian or foreigner is undoubtedly reductive. For example, it does not take into account the differences between those who arrived in Italy for family reunification or as unaccompanied minors, and those born in Italy to foreign parents and do not have Italian citizenship, despite having lived in Italy since their birth⁵. Overall, we can see how being foreigner decreases the likelihood of being placed in foster care, both full time and part time: in the interventions of full-time foster care, the percentage of foreigners is 23% and that of the Italians is 34% (Figure 3). The proportions are reversed if we consider residential services, where foreigners are 47% and Italians 35%.

Figure 3. Type of placement according to Italian / foreign nationality of the child - only children affected by an out-of-home placement (Percentages, years 2007-2012) ⁶

Prevailing problems in children

Taking into account our data analysis (Table 1), it seems that there are no specific problems that significantly affect the possibility for a child to be placed in full-time foster care. Some variables, however, show a negative correlation. In particular, the presence of criminal problems reduces by 24% the likelihood to be placed in foster care, and the presence of health problems reduces by 9% the probability of being placed in a full-time foster care placement. To a lesser extent, the presence of relational or school issues (r = -.06) and having been subjected to violence or abuse (r = -.04) have a negative correlation with insertions into full-time foster care.

With respect to residential services placements, some problems are clearly associated. The first is that of unaccompanied minors, which presents the highest correlation (r = .39), the second is that of children with criminal problems (r =.35). Also having been subjected to violence or abuse significantly increases the probability of being inserted in residential services, albeit with a lower percentage. In contrast, disabled children or children with health problems and those with relational or school issues have a lower probability of being inserted in residential services than the others. In other words, in situations where a child has complex problems (victim of violence, criminal problems) he or she is likely to be removed from the family and placed in residential services. This happens even when there is no family, as in the case of unaccompanied minors. If, instead, there is a hardship in school or regarding socialization, it is unlikely for the child to be removed from the birth family. Frequently, he or she is inserted in day care centre (r = .23). This happens even in the presence of health problems that are not associated to a full-time out-of-home placement.

Table 1

Significant Pearson’s correlations between children’s prevailing problems and types of placement (N= 8,230)

	Foster care f. t.		Residential care f. t.		Foster care p. t.		Day care centre
	r	%	r	%	r	%	r	%
relational/ school issues	-.06**	22.66	-.08**	34.04	.00	8.54	.23**	36.59
criminal problems	-.24**	4.12	.35**	76.29	-.07*	2.06	-.00	15.46
disability – health problems	-.09**	19.82	-.12**	29.5	.00	9.46	.05*	21.62
unaccompanied	.04*	31.55	.39**	73	-.10**	0.81	-.18**	1.43
victim of violence	-.04	24.78	.11**	52.41	-.05**	3.92	-.08**	8.56
without specific problems	.03**	30.13	-.23**	31.08	.09**	13.54	.04**	17.93

**p < .001; * p < .01

Prevailing problems in families

An analysis of the prevailing problems of families (Table 2) shows that children living in households where there are problems of substance misuse (r = .25), mental health problems (r = .26) or health problems (r = .16) are more likely to be included in full-time foster care and, in the case of health problems, even in part-time foster care. At the same time, they have a lower probability than other children to be placed in residential care. Children living within families that maltreat or abuse are more likely than others to have a full-time residential services placement (r = .07), as well as children living in absent or children leaving families (r =.36).

It is interesting to note that economic or housing problems are negatively correlated with both the insertion of children in full-time foster care and with the insertion in residential care; instead, economic or housing problems present a positive correlation with the insertion in day care centre. Similarly, when in the family there are issues related to the education of children, insertion in a part-time out-of-home placement is more likely, especially in day care centres, and a full-time placement is less likely.

Table 2

Significant Pearson’s correlations between families’ prevailing problems and types of placement (N= 8,230)

	Foster care f.t.		Residential care f.t.		Foster care p.t.		Day care centre
	r	%	r	%	r	%	r
f. with heavy conflicts	-.06**	22.84	-.03	38.99	.03*	11.56	-.03*
f. that maltreat /abuse	-.00*	28.09	.07**	48.53	-.05**	5.00	-.07**
f. children leaving / absent	.04**	31.98	.36**	72.06	-.10**	1.03	-.17**
f. with substance misuse	.25**	52.51	-.13**	28.76	-.01	8.06	-.09**
f. with criminal problems	.06	34.04	.04	45.39	-.03	6.38	-.03
f. with relational /educational problems	-.00	27.74	-.08**	35.03	.03**	11.54	.11**
f. with mental health problems	.26**	53.55	-.09*	32.70	.03	11.85	-.08*
f. with health problems	.16**	43.67	-.13**	28.92	.10**	18.98	-.06*
f. with economic /housing problems	-.11**	19.95	-.11**	33.16	.05**	12.96	.11**

**p < .001; *p < .01

Discussion

Children characteristics

The first element that appears to influence the likelihood of a child being placed in foster care or in residential care is represented by age. The analysis of the data confirms this fact, as already described in the literature (Wells and Guo, 1999; Shaw, 2006; Akin, 2011); it therefore decreases with increasing age for children who can be accommodated in an environment of family type, and increases the likelihood of a placement in residential services. In Italy this also depends on legislation, which indicates the insertion in foster families as the only possibility for children under six years. The still high percentage of infants and young children who are placed in residential care should be noted, although it should be noted that among residential services considered in Sisam information system, there are also professional foster families. In addition, the average age at the time of removal appears to be rather high and this may affect the prospects of these children. Studies show that in fact, the older the child, the less likely they are to be reunified with their birth families (Farmer and Wijedasa, 2013; Boddy, 2012; Shaw, 2006).

Data confirm the findings from research in the literature relating to foster care placements of adolescents. This path seems difficult to pursue and outcomes are often not positive; there are frequent breakdowns, both because of children giving up and because of unwillingness by families (Farmer et al., 2005; Vanderfaeillie et al., 2014) and this probably tends to discourage social workers to pursue these projects at the very beginning.

It appears that the availability of foster families is devoted primarily to young children and to children of Italian nationality. The arrangement of foreign children is worth noting. Some situations can be very different, but it is evident that there is a higher likelihood for Italian children to be placed in foster families and, overall, a greater chance for foreigners to be inserted in residential services. This seems in line with research that identified an over-representation of ethnic minorities among the looked-after children and, in particular, in residential care (Boddy 2012). The ability to use the foster family placements for unaccompanied minors, a practice that in other European countries seems to be more structured (De Ruijter de Wildt et al., 2015; ALFACA, 2016), seems a long way off.

In line with evidence in the literature (Courtney & Wong, 1996; Leloux-Opmeer, 2016), gender seems to have little influence on the decision to place a child out-of-home. It is also noted that while there is no difference between males and females with respect to the insertion in foster care, males slightly prevail in residential care. This may be due, at least in part, to the large percentage of unaccompanied minors, almost exclusively males placed almost exclusively in residential services.

Prevailing problems

The difficulty of reducing the complexity of situations into a single problem has been discussed above, but the overall impression is that social workers are looking for as much as possible to keep the children within the birth families and that they choose with care whether to place the children in foster care or in residential care. Looking at the prevailing problems of children, we see that inclusion in residential services seems to be implemented mainly when the family is missing (in the case of unaccompanied minors) or when the severity of the issues presented requires a high level of protection for the child (in the case of a victim of violence) or for the community (in the case of criminal problems). In both of these situations, managing the situation by a foster family would be very difficult. We could therefore assume that residential care is seen as a «specialist service» (Boddy, 2013, p.21), where the professionals provide the children not only with care and warmth but also with therapeutic pathways, since there are high levels of need.

In all those situations where problems can be handled with part-time support and home care, the child is usually not separated from the family. It is the case of children with relational or school issues and those with disabilities or with health problems who require specific interventions of an educational nature in the first case, and of socio-rehabilitative value in the second. These data could confirm a framework of the Italian Child protection system that, as highlighted by Ainsworth and Thoburn (2012), bestows great importance to family ties and tries to preserve them as long as possible. One possible consequence of this framework is the choice to use full-time placements as a «last resort» (Thoburn, 2016) to be chosen only after attempting many other strategies to cope with a child’s problems. The consequence is that reunification with birth families becomes unattainable. These data were partially confirmed in the second part of this research (Corradini, 2017), where it was possible to figure out how many looked-after children are in a static situation, where no evolution is seen.

According to Strijker (2002), the tendency to choose the type of placement based on the seriousness of the problems can be observed even if we consider the problems of families. A greater likelihood of residential care placements is, in fact, associated with the problems of families that maltreat or abuse and children leaving / absent families, where parents are not present or have behaved in a harmful way against their children. Residential services placement is chosen, therefore, when it is not possible to retrieve a stable relationship with the parents in a short time and when it is necessary to protect the children, even in emergency situations.

A greater likelihood of being included in full-time foster care is associated with the presence of families with substance abuse, with mental health problems and, to a lesser extent, with health problems. In these situations, parenting skills can be greatly compromised to the point of making it necessary to pursue an out-of-home placement; however, it is possible, through specific therapeutic pathways, to eliminate or control the parent’s prevailing problems. The favoured choice for foster care in these situations is to provide children with a secure and warm growth environment, while at the same time allowing them to maintain flexible family ties. In this way, it is possible to predict both the possibility of reunification and the guarantee of a continuity of care if the parents fail to overcome their problems. Thus, what many authors noted is confirmed (Shaw, 2006; Yampolskaia, 2014; Lopez & Del Valle, 2013): the presence of substance abuse, mental health problems and health problems is associated with a high likelihood for a child to be removed from their birth family.

When the families have relational or educational problems and economic or housing problems, part-time placements (part-time foster care and day care centres) are favoured rather than full-time placements. These issues could be considered less serious from the point of view of social workers: parents mostly need help to strengthen their educational and relational skills, or it is necessary to build projects to get out of poverty, but there is no need for the removal of children, except in the most serious cases. Social worker interventions therefore provide for part-time support from a foster family or place children and young people in an educational day care centre. In the first case, the goal is to increase the social relationships of families and to provide children with an individual space where they find care and positive relationships. In the second case, children are offered an educational and relational path within a peer group, assisted by professionals who act as important role models without substituting the parental relationship.

Research Limitations

One of the limitations of this research is that it has been conducted in a region of Northern Italy, which presents the characteristics of a region with a good socio-economic level⁷ and a high rate of immigration (equal to 12.1% of the resident population, against 8.2% of the national figure) (Emilia-Romagna Region, 2016). In other territories, even Italian ones, there may be a different organization of the welfare state system and lower financial resources may be available, so social workers’ choices about out-of-home placements may be affected by other variables and could be very different.

As noted above, the choice to observe the prevailing problem of children and families is reductive of the complexity of people’s lives, but we believe that the analysis of the data from the problems can be a starting point for further research findings.

The analysis of administrative data provides a large amount of information about a fairly large time period. In the case of the present analysis, the sample is related to over 8,000 children who were in care by the Emilia-Romagna Child Protection Services during the 2008-2012 period. As many authors (Green et al., 2015; Lee et al., 2015; Brownell & Jutte, 2013) noted, there are some issues in the use of administrative data that should be emphasized. The first criticism comes from a fairly obvious consideration, that is, the fact that administrative data are not collected for research purposes but rather, for the purpose of reporting, organizing work or asking for funding (Green et al., 2015). This could result in poor accuracy in data entry or lack of information on some useful search variables. For example, in this research, the information about the removed children’s household composition was only present in half of the cases. Another difficulty for the researcher is the need to understand and interpret the meaning of some labels and, in some cases, variables when aggregating or defining operations. In fact, it is necessary to confront a functional terminology for use by professionals, expressed in a technical language, not always of immediate understanding to those who do not normally deal with this matter. As Farmer states: «case records are, by definition, the social workers “constructions of events”» (Farmer, 2014, p. 352).

Conclusions

Data analysis on out-of-home placements in Emilia-Romagna confirms some evidence found in literature: a decisive factor for choosing between foster and residential care is the age of the child. The difficulty of starting paths of foster care for older children is confirmed. In addition, the presence of issues such as domestic violence, substance abuse and mental health problems of parents have a clear influence on the likelihood of being looked-after full time.

However, looking at the data, it seems that social worker choices regarding out-of-home placements are always based on a degree of graduation in the decision between foster care and residential care. In fact, residential care placements are mainly reserved for situations that are considered more serious, such as when family members are absent, in the presence of problems requiring protection for the child, or when the children are rather old and supposed to undergo a project aimed at gaining independence. On the other hand, full-time foster care pathways are aimed at younger children, in situations where the issues specifically belong to one of their parents (i.e., substance abuse or mental health problems). When the difficulties are milder or are related to factors outside the parents (i.e., economic or housing problems), social workers prefer to provide educational or part-time support from a family.

From the point of view of professional practice, this overall picture points towards the importance of early intervention (Arnkil & Seikkula, 2012). If social workers are able to tackle family difficulties when children are still young and situations are not too serious, starting part-time support or putting children into a foster family is more likely to be performed. Conversely, when children are older and there are serious issues, removal and often a placement in residential services is more likely. An overall view is needed in which, based on the assessment of the characteristics and problems of children and families, adequate and individualized solutions can be identified to guarantee «high quality and stable care; supporting children’s sense of identity and belonging; connecting past, present and future through childhood and transition from care, and on into an adult life» (Boddy, 2013, p. 30).

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