‘She was a foster mother who said she didn’t give cuddles’ : The adverse early foster care experiences of children who later struggle with adoptive family life

Background

In the United Kingdom, a foster care placement provides children with the opportunity to live as part of a family, when living with birth family is not considered safe or possible. It has long been recognised that the family environment provided by way of fostering is preferable to that of residential care for most young children needing to be looked after away from home (Cliffe & Berridge, 1991; Harden, 2002). The importance of the family unit in its many different forms, as the provider of a safe, nurturing environment for children is well established (Livingston-Smith, 2014). Nevertheless, families by their very nature are complicated and families who foster have more complexities than most. Not only do foster carers provide the day-to-day care for a child, but they are also expected to engage with a range of professionals, liaise with birth relatives and for those caring for children with an adoption plan, work together with the prospective adopters to help facilitate the child’s transition to their adoptive home.

The boundaries set within foster families are often complicated by the transient membership of the family. The composition of a foster family can change regularly and swiftly, with the arrival and departure of children. Those caring for children with plans for adoption are often uncertain about precisely how long the process of finding an adoptive family for the child will take or the extent of their involvement with the transition. Nevertheless, foster carers are expected to share their family life and affection with a child, in the knowledge that the child will, most likely, move on.

Family boundary ambiguity is a useful concept in helping to understand the lack of clarity around the composition of foster families and the function of the members within it. It can be defined as ‘a state in which family members are uncertain in their perceptions about who is in and out of the family, and who is performing what roles and tasks within the family system’ (Boss & Greenberg, 1984, p. 536). Attention has been drawn to the experience of such ambiguity within foster families (see, for example, Boss, 2006; Thomson & McArthur, 2009; Twigg & Swan, 2007).

In England, 5,330 children were adopted from care in the year ending 31 March 2015 (Department for Education, 2015), while in Wales, the same was true for 383 children (Welsh Government, 2015). Although nearly all of these children will have lived as part of a foster family on their journey to adoption, little research attention has been afforded specifically to the foster care experiences of this particular group. The emotional impact on children during their transition from foster care to adoption, has been the focus of some recent work (Boswell & Cudmore, 2014), but the foster care experiences of children awaiting adoption has been largely unexplored.

The National Minimum Standards for Fostering Services in England and Wales set out the entitlement of a child in foster care to grow up in a loving environment and to be treated in the same way a good parent would treat their own child (Department for Education, 2011). For optimal development, children need to receive sensitive, responsive care, characterised by warmth, affection and intimacy (World Health Organisation, 2004).

Reporting on their longitudinal study on the strengths and limitations of foster care, Sinclair, Baker, Wilson, and Gibbs (2005) found fewer placement disruptions and small improvements in children’s happiness, behaviour and relationships when fostered by warm, child-orientated carers. However, in their study of young children in foster care, Hardy and colleagues (2013) exposed various deficiencies in meeting children’s needs. They found that while 67% of the children in their sample had mental health concerns, most were not receiving appropriate interventions. The study also highlighted the lack of physical contact between the carers and children and in cases where developmental delay was present, low levels of vocalisation and reciprocity between babies and carers. Carers misinterpreted children’s signals, which were often weak or confused. For example, when children were hurt, tired or distressed, some foster carers believed that the children were not in need of, or did not want their care. Other children in the study would communicate distress or frustration, but then reject the foster carers’ attempts to help or comfort them. Hardy and colleagues (2013) concluded,

Carers tended to feel that they should wait for the child to signal readiness for closer contact, but as avoidant responses were so clearly ingrained in many children, it was observed how a pattern of distant relating between carer and child could become an established norm. (p. 271)

In the United States, Stovall-McClough and Dozier (2004) reported similar phenomena. They observed the differences between those children placed in foster care under 10 months of age, who developed secure attachments and those placed over the age of 10 months, who exhibited insecure behaviours. Importantly, they found that when the older children avoided their foster parents, the foster parents too responded with withdrawal. When the children exhibited resistance by way of difficulty in settling once distressed, foster parents responded with impatience and irritability. Dozier, Bick and Bernard (2011) stressed the importance of identifying such patterns early in placement and ensuring that appropriate interventions are made available.

In this article, we consider the role that poor early foster care experiences had on the risk of a child later experiencing an adoption disruption. The evidence originates from two national adoption studies, focussing on adoptive families who had either experienced an adoption disruption (post order), or who were experiencing great strain and were at risk of disruption. We were interested to find that not only did older age at entry into care, multiple moves in foster care and particularly traumatic early histories afford children elevated risks for adoption disruption, but once in care, many of the children whose adoptions later disrupted were considered by their parents to have had very poor fostering experiences before moving into their adoptive homes.

The research studies

Two national adoption studies were completed: one in England, funded by the Department for Education (Selwyn, Meakings & Wijedasa, 2015) and the other in Wales, funded by the Welsh Government (Selwyn & Meakings, 2015a; Wijedasa & Selwyn, 2014). Both studies used a similar mixed-method approach to calculate the national rate of adoption disruption and to explore the experiences of those who had been involved in, or were at risk of disruption. Detailed methodology has been published and can be found at www.bristol.ac.uk/hadley. The study was approved by the ethics committee at the School for Policy Studies, University of Bristol.

In brief, the study comprised statistical analyses of the national databases of over 40,000 adoptions from care. Abuse and neglect was the main reason for entry into care for three-quarters of all the adopted children. Despite such high incidence of adversity, the rate of post-order adoption disruption was very low: just 3.2% in England over a 12-year period and 2.6% in Wales over an 11-year period.

To understand more about disruption, 13 local authorities in England sent a survey on behalf of the research team to all the families (n = 620) who had adopted a child from their care between 2002 and 2004. A link to the survey was also posted on the Adoption UK (AUK) website for completion by anyone who had adopted a child from care. The survey asked families how the adoption was faring and whether the child still lived at home. A total of 210 families completed the local authority survey (34% response rate), as did 180 AUK members, giving information on 689 adopted children. Even though the response rate was modest, it was no less thn we expected for an approach attempting to trace families whose child had been placed more than 10 years previously. While we can make no claims about the generalisability or representativeness of the sample, it was encouraging to discover that despite the different sampling frames the results of the AUK and Local Authority surveys were remarkably similar. Notably, about a quarter of families whose child still lived at home, reported serious difficulties in parenting their child, the vast majority of whom were teenagers. Challenges reported included children’s violence within the family home (Selwyn & Meakings, 2015b) offending, self-harm, mental illness, and running away.

The third phase of the research comprised in-depth, semi-structured interviews with 90 families: 45 with adoptive parents whose child had left home prematurely (under the age of 18) because of the serious difficulties faced in adoptive family life and 45, whose child still lived at home, but where family life was rated by parents as very difficult and at risk of disruption. The interview sample in England (n = 70) was drawn from those families who had completed the survey and who had given consent to be interviewed, while families in Wales (n = 20) were asked to take part through leads provided by the Local Authorities and snowballing techniques. All but two of the interviews took place in the adopters’ homes. Each interview lasted between 2 and 5 hours. An investigator-based approach to the interviews was used (Brown, 1983; Quinton & Rutter, 1988). This method combines a ‘qualitative’ approach to questioning but allows a ‘quantitative’ treatment of data. It provides systematic and detailed coverage of topics and numerically analysable data while providing extensive case material. The interview schedule followed the adoption journey from the initial adoption application to the present day. This article focuses on just one part of that journey – parents’ accounts of the contact with the child’s foster carers during the introductions to their child and transition to the adoptive home. Eighty-six of the 90 parents spoke about such matters: 4 parents were excluded from the analysis on foster care, as they had been the child’s foster carer before going on to adopt them.

It is important to emphasise that the findings reported here do not represent the views and experiences of the majority (66%) of parents surveyed, who reported no or few difficulties in adoptive family life. The interview work was wholly with those families who had faced an adoption disruption, or those who were in serious difficulty and at risk of disruption. To preserve anonymity, names and identifying details have been changed.

Adoptive parents’ accounts of their child’s experience in foster care

Parents (n = 86) were asked what they knew about their child’s experiences in foster care prior to the adoptive placement. During the introductions to their child, parents had, of course, met the foster carers and had observed the child being cared for in the foster home. Many parents had also spoken at length with the foster carers prior to the child being placed. Just over half of parents (51%) believed that their child had been well cared for while living in their foster family. Occasionally, parents described, what they considered to have been, an exceptionally positive experience. One adoptive mother who had, for many years, remained in touch with her daughter’s foster carer said,

[The foster carers] provided the first experience for my children of genuine care and love, in a way they hadn’t experienced within their birth family. We felt that was really important. We still do think it’s important, and it’s helped our children.

However, nearly as many parents (49%) had serious misgivings about the quality of the care shown to their child while in the pre-adoption foster placement. Notably, the parents in those families who went on to face an adoption disruption, were statistically more likely (χ² = 5.057, df = 1, p < .025) to have harboured concerns about their child’s experiences in foster care, than those whose child still lived at home.

Fourteen per cent of all parents were certain that their child had been abused and/or neglected while in foster care, and a further 13% thought that abuse and or neglect had probably occurred. Whilst physical and sexual abuses were occasionally cited, it was emotional abuse that was most frequently reported. Although the alleged maltreatment occurred while children were in foster care, foster carers were not always the instigators of the abuse. One mother, for example, described how her child had been subjected to continued emotional abuse by birth parents, after the foster carer had befriended the birth family and allowed unauthorised and unsupervised access to the child.

On just a couple of occasions, children had been removed from a foster placement by the local authority because of concerns about their care. There were several other instances of social workers letting the adoptive parents know, often in coded language, that the care shown to children while in their foster care placement had not been satisfactory.

A further 22% of adoptive parents, although unsure whether their child’s foster care experiences qualified as neglectful or abusive, wanted, for the purpose of the study, to register their concerns about the poor-quality care shown to their child. In the main, these concerns centred on the omission by carers in tending to children’s emotional needs.

The lack of warmth shown to the children by foster carers was a recurring theme. Parents described foster carers who had provided adequate physical care, yet who were disengaged emotionally from the child, and who provided very little in the way of nurture. The care shown to children by some foster carers was described by adopters as ‘cold’ ‘clinical’ and ‘professional’. Two parents explained,

[Foster carer] was meticulous actually and met all his physical needs. She said to us, ‘I’m not here to show him affection or love, it’s your job’. So she just did the basics. She said: ‘I’ve had him as a favour to [local authority]. I don’t have babies, but he was a favour’.

There’s this thing about once they’re in foster care they’re okay and I would say although the [foster] family certainly attended to his every physical need, I don’t think his emotional needs were met at all. I think the way he was when we first got him was completely indicative of that. He just had given up showing any emotional response in order to get attention.

There were accounts from parents of very little physical contact between the foster carers and the children. Parents reported instances of infants being prop fed, and of being left to feed unattended at night. According to adoptive parents, several children had not being hugged or cuddled, or even allowed to sit on the laps of foster carers. Two parents, describing this lack of physical contact said,

She was a foster mother who said she didn’t give cuddles because she didn’t want to make the attachment. So she didn’t give cuddles and things like that, and of course Sasha was a four year old who wanted cuddles . . . She was fed and she was clothed, she was well looked after that way, but emotionally, no. She was very emotionally backwards and she still is suffering from that now.

One thing that (foster carer) used to do – and she told us that we could do this with him – is to leave his bottle of milk in his crib at night so he could just grab it and have it in the night. That said something to me, you don’t really do that.

For some parents, the lack of emotional warmth shown to children while in foster care was further evidenced by the way in which the foster carers talked about the child. A few parents described how foster carers had made derogatory or negative remarks about the child during the introductions, for example, harsh comments about the child’s physical appearance or about their lack of potential. One foster carer went as far as to tell the adoptive parents that the child (an infant) was unlovable.

Parents also described children who had been treated less favourably than the foster carers’ own birth children. As one parent explained,

Because they had six children, there were very structured bedtimes . . . our children had to go to bed an hour earlier than their birth children, so [foster carers] had an hour with the birth children on their own. Sophie used to go to bed at 5.30pm. and she was nearly five years old . . . She used to eat her meals in a high chair because there were so many around the table . . . she was left to eat on her own.

One foster carer, who openly acknowledged that she had treated her birth child preferentially, mistakenly thought that by not encouraging attachment behaviours, she was preparing the child well for adoption. The parent explained,

The foster carers were really lovely . . . but I remember them saying to us, ‘We haven’t looked after him like our own children because he’s moving. We wanted to save him for his adoptive family, so we haven’t hugged him, kissed him, or cuddled him and paid him that sort of attention, because we wanted to save all that lovely stuff for you’.

Although concerns relating to the children’s emotional wellbeing dominated the accounts by parents, three other areas of concern were identified. Concerns were as follows: the lack of a family focus within the foster home, the limited stimulation provided to children, and the failure by foster carers to respond adequately to children’s health and/or developmental concerns.

According to some parents, daily life in the foster home had not provided children with experiences from, which they might be helped to learn what family life could offer. One mother, for example, in discussing concerns about her children’s poor integration into the foster family, described the established routine in the foster home:

After school the children stayed in their bedrooms, they had a little television and videos . . . they weren’t allowed in the kitchen. When [foster carer] put food down, they just scrambled on top of the table and ate it with their hands . . . she often ate separately from them.

To illustrate the lack of engagement between the foster carer and child, another mother recalled the remarks made to her:

[During the introductions] we would try and read to him in bed, but the foster carer would say, ‘You don’t want to do that, he’ll want that every night’. We were thinking ‘Yes, absolutely, don’t you want your child to expect a story every night?’

The limited stimulation provided in the foster home worried parents. Foster carers in busy households had sometimes admitted to parents that they had been unable to give the child the amount of attention they needed. One mother recalled,

It was not the right environment for Josie in a sense because [foster carers] just didn’t have the time. They had taken on too much . . . I couldn’t have looked after [foster carer’s] disabled daughter on my own, let alone two other children. She was absolutely amazing . . . But with the best will in the world, the interaction for Josie was mainly coming from her lying next to a severely mentally and physically disabled child. Josie was largely left on the floor all day and then she was sleeping 14 hours. A four or five month old baby, having to be woken up – so she’d obviously just completely shut down.

The failure by foster carers to respond, in a timely manner, to children’s health or developmental difficulties, was also a matter of concern to parents. Social workers and statutory medical officers were thought, by parents, to have been remiss in failing to identify developmental concerns. One mother, for example, described how her daughter’s mobility problems, apparent, but seemingly overlooked while in foster care, were quickly diagnosed once in the adoptive home:

Megan walked in a funny way, it was a very stiff walk. I thought it was just maybe because of the neglect, maybe she just hadn’t learnt to walk properly . . . we were walking in town and she was really struggling. We thought there’s something really not right so we took her to the doctor . . . she has dysplasia, so the joints aren’t joined properly, they’re actually rubbing. She will eventually have to have hip replacements . . . eighteen months she was in care, why didn’t the Looked After Children medical pick this up?’

With just under half of the 86 adoptive parents expressing concerns about the quality of foster care their child had experienced pre-adoption, there was a belief among parents that those experiences had affected relationships within the adoptive family. Parents described children who struggled to accept comfort or intimacy in their adoptive family and who would not allow themselves to be nurtured. For some children, physical contact was difficult. One mother, for instance, said that even now, cuddling her son was like ‘hugging a stone statue’. She blamed this awkwardness on his foster carers, who had always insisted that, as a 5-year old, he greet them with a handshake rather than a cuddle.

Although poor-quality foster care had, in some instances, resulted in social workers speeding up the move to the adoptive home, there was, according to parents, no recognition from professionals that the family and child were likely to need additional supports or interventions. Parents said they were encouraged to believe that with a loving family, the child would recover.

Discussion

For most children in the United Kingdom, who cannot remain living with birth family, foster care provides a positive and safe environment (Sinclair, 2007). It is important to reiterate that this article reports on the findings from a specific group of adoptive families: those who had experienced an adoption disruption and families who were finding parenting very challenging and were at risk of disruption. They were not typical adoptive families.

We know that children whose adoptions later disrupt carry many risks for poor outcomes into their adoptive families. Reviews of the disruption literature (e.g. Coakley & Berrick, 2008) have consistently shown that older age at entry to care and multiple moves while in care are risk factors for disruption. Our statistical analysis of the national data, on over 40,000 adoptions from care, supported these assertions. We found that children who entered care over the age of 4 years had a 13 times greater risk of disruption, while those who had multiple moves in foster care were 5 times more likely to face an adoption disruption. Furthermore, our findings from the two national studies showed that, compared to those who remained living with their adoptive families, children who experienced an adoption disruption were more likely to have been exposed to the most serious extremes of abuse (particularly sexual abuse) and domestic violence in their birth families. The findings presented here suggest that another factor should be considered as one that increases the risk of disruption – namely poor-quality foster care prior to adoption.

The majority of children, even when carrying multiple risks, will not experience an adoption disruption. In fact, despite children’s early adversities, many adoptions are very successful, providing children with opportunity for developmental recovery (Lloyd & Barth, 2011; Van Ijzendoorn & Juffer, 2006). The disruption rate for adopted children, even with known risk factors, is far lower than that for children on other types of permanent legal orders such as Special Guardianship or Residence Orders (Selwyn & Masson, 2014).

In spite of the serious challenges that the foster carers may well have faced in caring for such disadvantaged and vulnerable children, the number of adoptive parents in our studies, who expressed concern about their child’s foster care experience pre-adoption, came as something of a surprise. At the outset of data collection and based on the findings from previous studies, we had anticipated that just a handful of parents might report abusive and/or neglectful foster care experiences. Reporting on a large survey by the National Foster Care Association Biehal and Parry (2010) estimated that confirmed maltreatment occurred in less than 1% of fostering households. Sinclair and colleagues (2005) suggested a slightly higher rate of just under 3%, based on findings from the York Outcomes Study. A more recent study estimated confirmed maltreatment in foster care at about 1% per year, with alleged maltreatment at about 4% (Biehal, Cusworth, Wade & Clarke, 2014).

In our interviews with 86 adoptive families, 14% of parents were certain that their child had been maltreated and a further 13% suspected this might be the case. Emotional abuse was, by far, the most frequently reported form of maltreatment identified by parents in our studies. Of course, the methods used in previous research for estimating maltreatment vary. Our studies used adoptive parents’ reports, and it may be that their threshold for care considered to be abusive or neglectful was lower than that reported by, for example, social workers, especially around the less tangible evidence for emotional abuse. In her review of maltreatment in foster care, Biehal (2014) drew attention to the hesitancy or unwillingness of some professionals to acknowledge emotional abuse in a foster placement. There is also some evidence that social workers accept lower standards of care in foster families than in other family forms (Marshall, Jamieson, & Finlayson, 1999).

Emotional abuse does not usually stem from an incident but is often an omission by parents or carers to respond to a child’s needs or to react in a hostile or dismissive manner, which in turn, makes children feel unloved and unwanted (Howe, 2005; Glaser, Prior & Lynch, 2001). In our studies, it was the accounts by adoptive parents of children not being nurtured or loved as a result of insensitive, dismissive or misguided foster carer’ behaviours that contributed to parents high levels of concern. It should be borne in mind that we were eliciting the views from adoptive parents retrospectively and in the context of families having faced great adversity. It may well be that some parents found it easier to identify external influences, as contributors to the difficulties, than to recognise possible influences from within the family (such as their own parenting behaviours). It should also be noted that we did not speak to the children’s foster carers and they may have had a different view on the care they had provided.

There may be many reasons why foster carers in our studies did not or could not meet the needs of the children in their charge. Several adoptive parents believed that some foster carers were simply looking after too many children, which resulted in chaotic households and missed opportunities to respond adequately to the differing emotional needs of all the children. Perhaps too, as was observed by Hardy et al. (2013) and Stovall-McClough and Dozier (2004), children had struggled to express their distress or needs and therefore did not elicit responsive caregiving. Indeed, parents in our studies did report instances of where they thought children had stopped behaving in ways that should have provoked a nurturing response in their foster home.

It may also be that in some cases, a lack of warmth and affection between foster carers and children existed, simply because they did not ‘click’. Wilson (2006) identifies the importance of the chemistry between children and foster carers, which when absent, leads to pernicious spirals of interaction, where rejection leads to rejection.

It is also possible that the lack of emotional warmth shown towards the children was brought about by compassion fatigue (sometimes referred to as secondary trauma) in the foster carers. In simple terms, compassion fatigue can be understood as the emotional cost of caring for others (Figley, 1995). Compassion fatigue could affect a foster carers’ ability to invest emotionally in the children they look after. In setting out strategies to manage compassion fatigue, Pearlman and Saakvitne (1995) described the importance of achieving an appropriate work–life balance. However, given the very nature of foster care, with work and family life so enmeshed, such advice has little relevance to the foster care context. While a child is in placement, foster carers maintain an all day, every day commitment.

In view of the likely emotional strain in caring for abused and neglected children, foster carers should be not be expected to provide back-to-back placements – to allow for opportunity to reflect, recharge and rejuvenate between caring responsibilities. However, given that the demand for a foster care placement outstrips supply, there remains a constant pressure to fill any ‘empty beds’. In fact, our studies revealed instances of rushed introductions between children and their adoptive parents, in order to accommodate the arrival of the next child lined up for the foster home. There was also a financial incentive for foster carers to avoid breaks between placements, as some received no payments if they were not looking after a child.

The low levels of intimacy and warmth shown by foster carers towards some children may have been influenced by the temporary nature of the placement. Some adoptive parents wondered whether foster carers had never become close to the child in order to protect themselves from distress, as they knew the child was moving on. Other adoptive parents were acutely aware of the foster carers’ anguish in ‘losing’ the child. Attention has been drawn to the grief and loss felt by both foster carers and children when a foster placement ends (see, for example, Browning, 2015; Hebert, Kulkin & McLean, 2013; Lanyado, 2003). It is possible too, that some of the emotional disengagement observed in foster carers by the adoptive parents was heightened because the foster carers, aware that the child’s departure was imminent, had withdrawn from the child, as a way with which to cope with the situation.

As well as a need to better support foster carers emotionally during the challenging task of moving children on for adoption, the findings from our studies raise serious questions about the quality of education and training for foster carers more generally. For example, the misinterpretation of ‘safe caring’ policies, led some foster carers to believe that they must minimise or avoid all physical contact with the child. In addition, a poor understanding of attachment theory resulted in some foster carers purposefully avoiding nurturing children, because of worries that the confusion generated for children might impair their ability to form a secure attachment to their adoptive parents. However, the research evidence is clear that a child with a secure attachment to a primary care giver is more likely to be able to transfer that bond to a subsequent attachment figure, should the need arise. Formal training programmes (e.g. Bick & Dozier, 2013) have been shown to play an important role in helping to promote sensitive caregiving in foster placements.

The interplay of genes, events in the birth family and children’s care experiences are difficult to unpick. Our findings demonstrate that poor-quality foster care pre-adoption is an additional adversity associated with adoption disruption. The children in our study, who were considered by their parents to have been poorly cared for while in their foster placement, were statistically more likely to go on to experience an adoption disruption, than those children whose parents had no such concerns. Social workers therefore need to recognise the risks that children carry after poor foster care experiences and plan additional support. It is likely that interventions aimed at improving parents understanding of the child’s mental state and sensitivity to the child’s signals would be helpful. The research reported here did not set out to investigate specifically how foster care experiences affected children’s development. Specific research on this topic is needed to better understand the impact that good and poor foster care experiences can have on children’s development.