Families on the edge of care: Enhancing decision-making and care for maltreated children facing an out-of-home placement decision

Child maltreatment is a global phenomenon which brings detrimental consequences for children, parents and society (Gilbert et al., 2009). Child maltreatment is defined by the World Health Organization (WHO, 1999) as ‘‘all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. Maltreated children are at risk of developing numerous negative outcomes including an insecure or disorganized attachment relationship with their parents (Cyr, Euser, Bakermans-Kranenburg & Van IJzendoorn, 2010), internalizing and externalizing behavior problems (Moylan et al., 2010) and mental and physical health problems such as depression and obesity (Anda et al., 2006; Norman, et al., 2012). According to the Dutch National Prevalence Study on Child Maltreatment between 90,000 and 127,000 children were maltreated in 2017 (Alink et al., 2018). When the development of a child is at risk and parents do not accept (parts of) the necessary treatment, a children’s court judge can impose a supervision order regarding the child. Moreover, the children’s court judge can place a child out of home when it is deemed necessary for the development of the child and be placed in foster care or an institution. In 2018, 22,015 children were placed with foster parents in the Netherlands, which figure is proportionately comparable to numbers in the UK and US (Statistics Netherlands, 2019). This number represents an underestimation of the actual number of out-of-home placements since not all children who are placed outside the home are placed with foster parents. Children who are subject to an out of home placement can also be placed in residential or family-home care. In pursuit of the goal of enhancing the decision-making process regarding out-of-home placements, to avoid (unnecessary) out-of-home placements and improve the quality of interventions for maltreated children facing an out-of-home placement decision, we conducted two research projects which are described in this doctoral thesis. First of all, we examined which individual characteristics of (future) professionals play a role in their decisions regarding out-of-home placements and how the quality of these decisions could be improved (Chapter 2 and 3). In other words, do personal factors of professionals such as work experience, professional background, mind-set and their attitude towards out-of-home placement play a role in their out-of-home placement decisions? Furthermore it was investigated whether the decisions of various professionals show a greater degree of concurrence when information about parents’ response to an intervention aimed at increasing parental sensitivity is made available to the decision-makers. In addition to our interest in the decision-making process regarding out-of-home placements, we were also interested in evaluating the effectiveness of a parenting intervention based on enhancing positive parenting and child attachment in maltreating families in the context of an out-of-home placement. Therefore, we investigated in a second research project whether the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD, Juffer, Bakermans-Kranenburg, & Van IJzendoorn, 2008) was effective in enhancing parental sensitivity, child attachment and physiological stress reactivity in maltreated families residing in family psychiatric clinics in the context of an out-of-home placement decision (Chapter 4) and whether this intervention is effective in improving parental sensitive discipline and reducing child externalizing behavior (such as anger and aggression) (Chapter 5). In other words, is the VIPP-SD effective in enhancing parenting of maltreating parents and in improving the parent-child relationship and developmental outcomes for maltreated children? The design and results of both research projects will be discussed in the next part of this summary.