Kinship Care and Foster Care: A Comparison of Out-of-Home Placement from the Perspective of Child Abuse Experts in North Carolina

Background: Guided by federal and state regulations, children in North Carolina (NC) removed from their homes because of allegations of maltreatment are preferentially placed in kinship care. Kinship care’s definition is variable, with NC moving towards using the term to exclusively refer to a care arrangement in which the Department of Social Services (DSS) has taken custody of a child and placed them with a family member or friend, as opposed to foster care, in which a child in DSS custody is placed with a licensed foster parent previously unknown to that child. Although national research is inconsistent as to which form of placement leads to better outcomes for children, it appears that children in kinship care receive less formal support. Objectives: To investigate from the perspective of child abuse medical experts practicing in NC: 1) their understanding of the state’s kinship care system; 2) the health needs of children in kinship care vs. foster care; and, 3) how multidisciplinary stakeholders can better work together to serve children in kinship care. Methods: A mixed method design was used to conduct semi-structured interviews with child abuse medical providers. Data were coded with a team generated codebook and qualitative data were analyzed in ATLAS.ti 7.5.10. Conclusions: Major themes included: 1) providers have a foundational understanding of the NC kinship care system, but pockets of uncertainty mark this knowledge; 2) children in kinship care and foster care have equivalent, elevated health needs, but children in kinship care may not receive the same level of care, particularly in terms of their mental health; 3) social workers and medical professionals can make individual and structural changes to improve the ability of the multidisciplinary team to facilitate the health of children in kinship care compared to foster care.Master of Public Healt