research paper topics about foster care

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111 Exceptional Foster Care Research Paper Topics

Foster care is not a common topic of discussion in academic papers. Those who handle it may not have enough data or have missing links due to the topic’s limited attention on the internet. Nonetheless, you are here because you have an assignment in this field, and you need impressive foster care topics for your research paper.

This article contains all the best writing ideas for foster care that will make you the top of your class. It is not your ordinary blog article on the internet looking for clicks! On the contrary, it is the product of professionally researched content that will enrich your academic prowess. Watch this space!

How To Write Foster Care Research Paper Topics

Writing foster care research topics is primarily tricky for college and university students who are starting. However, those who have been writing such papers can easily sail through and achieve high grades in the end. Making your professor smile while reading your article starts with eye-catching research. That is why our experts give their all into collating top-notch foster care paper topics.

Do you want fast and professional research topics for your paper? Well, follow the steps below:

Understand the scope of the question Find out your professor’s objective Identify what you know about the question Move on to look at what others say Collate a list of similar work done on the same question Develop an award-winning topic!

The means to success is doing what others are not doing. By following the tips above, you can be sure that you will end up with a great foster care topic that will envy many.

Look at the sample foster care research questions below for your motivation:

Foster Care Research Questions

What is the importance of foster care on a child?
What factors are considered for a child to be a candidate for foster care?
How long does it take for one to register and to be able to foster a child?
Is there any support given to foster parents?
What is required for one to be a foster child?
What measures are put in place to ensure a child’s wellbeing in the foster care system?
How long can foster the same child?
What disqualifies a person from fostering?
In what state should a foster home be in before a minor comes in to live there?
What are the measures taken in cases of child abuse in foster homes?
Does one make money from fostering?
What are the risks of becoming a foster parent?
How should one respond to the problematic stories surrounding struggling foster families?
What is the goal of a foster care system?
How are kids impacted by the trauma they experienced?
At what age is a child involved in foster care?
Can children with special needs be involved in foster care?
What are the rules and regulations for foster care parents?
How does foster care affect the child’s life stability?
In what way does the system affect foster children?
What are the effects of foster children interacting with biological parents?
How much support should foster parents have?
How fast is the foster care adoption process?
What measures should be in place for drug addicts?

Top Foster Care Issues

Challenges that children in extended foster care experience?
How the system is dealing with the rising number of children in foster care
Problems faced in recruiting, training and retaining foster families
How the foster care agencies get the resources needed to sustain them
How does the foster care agency handle the sibling issue during adoption
How orphan children end up in foster care
How is the safety of a child ensured in the foster homes
How do foster care agencies deal with child abuse and its effect on the child
The disruption of child’s schooling due to foster parenting

Top Developmental Issues For Young Children In Foster Care In 2023

Poor communication between social workers, foster parents and health care providers concerning services
Public funded programs available for children in foster care
How long-term foster care has affected children
What strategies are in force to guarantee a child’s schooling goes on smoothly?
How maltreatment of children in foster care has increased health care concerns
Health risks on adolescents in the foster care
The discrepancy in the number of children resulting with developmental and mental health care needs
Foster parents training to be therapeutic agents
Frequent changes experienced by children resulting in the incomplete transfer of information
Effects of early intervention services on children in foster care
The development of an orderly growth of the foster care system
Management of foster care resources and equal distribution

Foster Care Problems

Challenges faced by students that grew in foster care
The increase of child abuse in foster care
Children feeling guilty about separation from birth parents
On waiting for adoption for a long time, children think unwanted
Children questioning positive feelings towards foster parents
The difficulty foster parents experience in letting the child return to birth parents
Foster parents dealing with the needs of children in their care
The feel helplessness on a child who has been to several foster homes
The difficulty of the foster parent to answer medical questions
Reasons why foster children should have maximum attention
The parent has a lot of work ensuring they bond with all the children given to her
Why foster parents do not provide enough support to the foster children
Mixed emotions affecting foster parents
Challenges foster parents experiencing when dealing with sponsoring social agencies.
Dealing with a child’s emotions and behaviour
Foster parents understanding mixed toward child’s birth parents
How extensive is the licensing process to foster parents
The uncertainty about a child’s living situation
The cost of foster care to the foster parents

Top-Grade Foster Care Essay Topics

The importance of foster care agencies to the society
Benefits of the foster care system on the child
Development and orderly growth of foster care
How to decrease homelessness of children after foster care
Problems faced in the social services and their solutions
Ways of funding foster care organizations
Positive and negative aspects of foster care
The role of foster parents to the children
Effects of long term care with foster parents
Limitations of foster parents in the child’s everyday life
How a child in foster care becomes available for adoption

Informative Speech Topics On Foster Care

The increase of child abuse prevention efforts
Sensitization of domestic abuse in the society
Ways to improve foster care around the world
Problems faced in the foster care system
Ways to make adoption more accessible and better in the society
How to make foster care more accessible in the world
The impact of foster parents on a child’s life
How better adoption is beneficial to both the foster parent and the child
Foster care effects on the health of the child
Why should one go to a foster care
Ways in which foster care can change for the better
Conditions that lead one to a foster care
What next after children in foster homes get to 18 years of age
The desired outcome of a foster care child
Advantages and disadvantages of a foster care system

Foster Care Problems And Issues In The US

How children adopt to foster parents in teenage versus adolescent stage
The impact of legal regulations on foster care in the United States
Why foster parents need to exhibit good parenting skills being getting children
The effect of social perceptions towards foster care
How social media and other interactive technologies are influencing foster care
Explain why society should not look down upon foster parents
Discuss the role of the media in highlighting the plight of foster parents
Evaluate the distribution of foster care homes in the United States
Why it is necessary to create awareness on foster care
The impact of coronavirus on adapting children for foster care
Why should children homes investigate foster parents
Are there complications that may arise as a result of foster care
Why it is necessary to ask the child is taking them to foster care
Malpractices in the nursing industry towards foster care
How to encourage children to interact with their peers
Challenges in finding the right foster parents
Discuss the impact of stigmatization on foster children
Discuss the likeliness of foster children ending up as single parents
Discuss the place of clinical therapy in foster care
Are there enough legal measures about foster care
What should the government do to crook foster parents?

We hope you enjoyed our professionally researched topics on foster care. Our proficient ENL US writers are ready to offset your paper any moment from now. Try our cheap research paper writing services for professional results!

83 Foster Care Essay Topic Ideas & Examples

🏆 best foster care topic ideas & essay examples, 🎓 good research topics about foster care, ⭐ simple & easy foster care essay titles, ❓ research questions about the foster care system.

Children in Foster Care In instances where any or all of the factors are noted in a parental case, it is likely that reunification, despite the protests of a parent, will not be possible given that the government has […]
Youths Transitioning Foster Care System These problems have led to the necessity of occupational therapy in the foster care systems where they enable the young people aging out of foster care to deal with these issues. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
Non-Relative Care Placements for Children in Foster Care Here, the main issues to be addressed are the problems of children who are placed in foster care, the social impact of foster care centers, whether these centers are run as they are supposed, the […]
New York’s Homeless Children and Foster Care System Foster homes have to also face the challenge of developing the mentalities of the children are their clients, and care should be provided on that basis.
Foster Care Crisis in Georgia: Children in Substitute Families It decides whether a child is to be placed in foster care or to remain in the home of their caregiver.
Foster Care System in the “Antwone Fisher” Film What could be done to improve the foster care system today? The foster system failed Antwone because they shifted him from a foster home he had innocently believed and enjoyed to be his birth family […]
Foster Care of Children With a Different Background The ethical dilemma here was detected later when the social worker was able to contact the child’s mother, who insisted that such behavior was not a sign of anxiety but rather of respect and proper […]
Healthcare, Human Services and Foster Care in the US Particularly, it is essential to enhance the importance of the caretakers’ role in both the provision of the necessary healthcare assistance to their foster children after the people in question become legal guardians of the […]
Foster-Care Centers and Public Health Over the past ten years, California spent over $200 million on psychotropic drugs, which is about 70 percent of total foster care drug spending in the US.
Group Home and Foster Care Forensic Settings The residents of the group home often access treatment through the treatment centers located within the homes. The foster cares are located in areas accessible to the amenities and other resources.
Attachment Disorder Among Young Children in Foster Care Attachment refers to a deep connection between a child and a primary caregiver that plays an important role in the optimal growth and development of the child with regard to expression of emotions and creation […]
Foster Care and Adoption Service The role of the human services professional is to understand the behavior and the expectations of each party in the adoption agreement and offer appropriate information to avoid misunderstanding in the future.
Foster Care in the Criminal Justice System Throughout the history of the United States, the children welfare system has evolved according to shifting values and attitudes about what responsibilities governmental agencies should take in the defence and care of abandoned and abused […]
African American Extended Families and Kinship Care: How Relevant Is the Foster Care Model for Kinship Care
Childhood: Foster Care and Young Mothers
Adoption Subsidies and Placement Outcomes for Children in Foster Care
Leaving Foster Care: The Influence of Child and Case Characteristics on Foster Care Exit Rates
Health Outcomes for Adults in Family Foster Care as Children: An Analysis by Ethnicity
Adopting Children Through the Foster Care System
Child Protection and Adult Crime: Using Investigator Assignment to Estimate Causal Effects of Foster Care
Need for Change: The Harmful Effects of the Foster Care System
Natural Mentoring and Psychosocial Outcomes Among Older Youth Transitioning From Foster Care
Mental and Emotional Health of Children When Leaving Foster Care
Cognitive, Educational, and Self-Support Outcomes of Long-Term Foster Care Versus Adoption
Educational and Employment Outcomes of Adults Formerly Placed in Foster Care
Trauma Treatments for Among Culturally Diverse Foster Care Youth: Treatment Retention and Outcomes
Minority Children and Adolescents in Transracial Foster Care
Balancing Permanency and Stability for Youth in Foster Care
Risk and Protective Factors for Residential Foster Care Adolescents
Attachment Theory and Change Processes in Foster Care
Economics Incentives and Foster Care Placement
Improved Intelligence, Literacy and Mathematic Skills Following School-Based Intervention for Children in Foster Care
Foster Care: Protecting Bodies but Killing Minds
Outcomes for Young Adults Who Experienced Foster Care
Stability for the Children Leaving the Foster Care System
Kinship Foster Care: Placement, Service, and Outcome Issues
Adoption and Family Safety and Foster Care Plan
New Policy for Getting Therapeutic Foster Care For Children With Mental Illnesses
Evaluating Housing Programs for Youth Who Age Out of Foster Care
Adolescent Resilience, Gender, and Foster Care
Competencies and Problem Behaviors of Children in Family Foster Care: Variations by Kinship Placement Status and Race
After Parental Rights Are Terminated: Factors Associated With Exiting Foster Care
Increasing College Access for Youth Aging Out of Foster Care
Career Readiness Programming for Youth in Foster Care
Kinship Family Foster Care: A Methodological and Substantive Synthesis of Research
Child Abuse Prevention and Foster Care
Foster Care and Adoption as a Tool of Superior Care
Granting Gay Couples to Adopt Children From Foster Care
Factors Associated With Reunification: A Longitudinal Analysis of Long-Term Foster Care
Behavioral Health Needs and Service Use Among Those Who’ve Aged Out of Foster Care
Differences Between Foster Care and Adoption
Context Matters: Experimental Evaluation of Home-Based Tutoring for Youth in Foster Care
Natural Mentoring Among Older Youth in and Aging Out of Foster Care
What Factors Are Considered for a Child to Be a Candidate for Foster Care?
Should the Foster Care System Be Reformed?
What Measures Are Put in Place to Ensure a Child’s Wellbeing in the Foster Care System?
How Does Foster Care Affect Children?
Should Race and Culture Matter for Children in Foster Care Place With Adoptive Families?
What Factors Impact the Educational Outcomes of Children in Foster Care?
Why Do Children Run Away From Foster Care?
What Is the Importance of Foster Care on a Child?
How Long Does It Take for One to Register and to Be Able to Foster a Child?
Is There Any Support Given to Foster Parents?
What Is Required for One to Be a Foster Child?
How Long Can Foster the Same Child?
What Disqualifies a Person From Fostering?
In What State Should a Foster Home Be In Before a Minor Comes in to Live There?
How Is the Safety of a Child Ensured in the Foster Homes?
What Are the Measures Taken in Cases of Child Abuse in Foster Homes?
Does One Make Money From Fostering?
What Are the Risks of Becoming a Foster Parent?
How Should One Respond to the Problematic Stories Surrounding Struggling Foster Families?
What Is the Goal of a Foster Care System?
How Are Kids Impacted by the Trauma They Experienced?
At What Age Is a Child Involved in Foster Care?
Can Children With Special Needs Be Involved in Foster Care?
What Are the Rules and Regulations for Foster Care Parents?
How Does Foster Care Affect the Child’s Life Stability?
In What Way Does the System Affect Foster Children?
What Are the Effects of Foster Children Interacting With Biological Parents?
How Much Support Should Foster Parents Have?
What Measures Should Be in Place for Drug Addicts?
How Fast Is the Foster Care Adoption Process?
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Childcare Research Topics

Qualitative studies of the lived experiences of being in foster care: A scoping review protocol

Affiliations.

1 Nursing, Monash University, Clayton, Victoria, Australia [email protected].
2 Psychology, Victoria University, Melbourne, Victoria, Australia.
3 Lighthouse Foundation, Melbourne, Victoria, Austalia.
4 Psychology, The University of Adelaide, Adelaide, South Australia, Australia.
5 Nursing, Monash University, Clayton, Victoria, Australia.
6 Department of Regional Health, University of Southern Denmark, Odense, Denmark.
PMID: 36854595
PMCID: PMC9980361
DOI: 10.1136/bmjopen-2022-069623

The aim of this scoping review is to provide an overview of the existing qualitative research concerning the lived experiences of children and young people currently in foster care.

Introduction: Lived experience of foster care is an area of limited research. Studies tend to focus on foster caregiver retention rates, education performance outcomes, evaluations and policy development. Although these studies are important, they provide little insight into the everyday lives of those currently in foster care, which is likely to influence these previous areas of research.

Methods and analysis: The scoping review will be guided by Arksey and O'Malley's approach to scoping studies. A systematic database search of PubMed, CINAHL and PsycINFO will be conducted followed by a systematic chain search of referenced and referencing literature. English-language peer-reviewed qualitative studies of children and young people currently in foster care will be included. We will exclude studies linked to transitioning out of foster care and studies with samples mixed with other types of out-of-home care. Mixed-methods studies will be excluded in addition to programme, treatment or policy evaluations. Following removal of duplicates, titles and abstracts will be screened, followed by a full-text review. Two researchers will independently screen references against inclusion and exclusion criteria using Covidence software. The quality of the included studies will be assessed by two independent reviewers using the appropriate Critical Appraisal Skills Programme checklist.

Ethics and dissemination: Information gathered in this research will be published in peer-reviewed journals and presented at national and international conferences relevant to foster care services and quality improvement. Reports will be disseminated to relevant foster care agencies, where relevant. Ethical approval and informed consent are not required as this protocol is a review of existing literature. Findings from the included studies will be charted and summarised thematically in a separate manuscript.

Keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH; SOCIAL MEDICINE.

Publication types

Research Support, Non-U.S. Gov't
Databases, Factual
Educational Status
Home Care Services*
Qualitative Research
Review Literature as Topic

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142 Foster Care Research Paper Topics: Top Ideas

Choosing a great topic is essential for any research project. But a lot of students struggle to come up with ideas and as a result are unable to impress their professor with their assignments. This can be even tougher for ENL students that can have trouble developing original ideas in any discipline. We understand the challenges of this situation and provide some of the best ideas at no cost to help students get a great start toward putting together a top-notch research paper. In this article, our US writers list 142 foster care research paper topics for free. You can modify them to fit any kind of assignment and can share them with other students.

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Students and young professionals interested in going into a career related to foster care should know that it is a structure in which a minor has been planted into a ward, society home, or private home of a state-certified caregiver.

There are many developmental issues for young children in foster care that have given rise to a lot of government-sponsored and independent research. This gives people in this field a lot of opportunities to explore foster care issues and make valuable contributions to improve the system.

You must make sure you do several things to craft a great research paper about foster care. Follow the tips listed below to ensure you receive high marks on your project and effectively present your ideas clearly and concisely:

Research Your Topic Carefully Using Reputable Sources Start with background research by searching the web for anything related to your topic. Write down source leads and search for in-depth facts and figures from trustworthy sources like government, academic, and certified foster care programs.
Organize Your Notes, Develop a Thesis, and Create an Outline After your research, you need to gather all the notes you took and ensure that citation information is accurate. Organize the notes into related arguments and select the best ones to support your draft thesis. Finally, create an outline to guide your writing.
Write the First Draft in One Sitting as Fast as Possible The best way to get started on any assignment is to get the first draft written as fast as possible. This doesn’t mean you can’t take any breaks, but you are encouraged to tackle each section in one sitting and get the first draft written in a few hours.
Set Your Research Paper Draft Aside for a Few Days After completing your first draft you want to get away from reviewing and rewriting for a few days. Assuming you have adequately planned to complete your project by starting as early as possible, you can take a break from it all together so that you can return feeling refreshed.
Revise Your Argument and Write a Second Draft The process of revision is to re-imagine your work through a critical lens which must identify areas that need to be strengthened by rearranging, adding, or deleting content. Revise your first draft to make sure you structure and format your work to better present your arguments.
Set Your Second Draft Aside Before You Edit and Proofread You will likely want to wrap up your assignment soon after you complete your second draft. But you will have more success editing and proofreading if you set your work aside for at least another day. This ensures you will submit the best research paper possible.

You can also use an opportunity to custom college papers and feel free to enjoy more pleasant activities.

An informative speech intends to educate an audience about a particular subject. It should bring up valuable points so that an audience can better understand and remember what they learned later. The following are great foster care essay topics you might want to consider for this kind of assignment:

Impact on children put in long-term foster care.
A study of adults that grew in the foster care system.
The foster care system and its advantages.
Characteristics of a trustworthy foster care family.
The rise of adoption rates in the United States.
Adoption rules for children in foster care.
Understanding the foster care system pros and cons.
Race and ethnic prejudice in foster care placement.
Examining the mission of the foster care system.
Evaluating the methods used to determine if a child is at risk.
The impact international adoption has had on the foster care system.
Examining the ethics of the foster care system.
The role of foster care agencies in urban areas.
Understanding the current state of the foster care system.
Explaining the foster care system to parents wanting to adopt.
Improvements to the foster care system over the years.
Foster care for non-English speaking children.
Examining the current state of the foster care system in the U.S.
Evaluating the educational system for children in foster care.
Characteristics of healthy foster care homes.
Evaluating the safety of foster care homes.
Principles of the Foster Care Independence Act.
Requirements to become a parent of a foster child.
The benefits of the foster care program.
Mental health concerns for children in foster care.
The importance of foster care agencies in rural areas.
Examination of child welfare policies in the U.S.
Analyze the impact foster care has on marginalized groups.
The impact federal foster programs have had on low-income communities.

Earlier we discussed how there are numerous foster care problems and issues that students and professionals alike can explore. These occur even among the more reputable foster care organizations. Here are some great ideas you can consider for a research assignment of about 5 – 10 pages long:

The risks and dangers of a growing foster care system.
Challenges of getting adequate foster care financial support.
Analyzing the factors that must be considered for a child to be in foster care.
Adequate training for foster care parents.
Length of time it takes for someone to qualify for adoption.
Financial support for parents of foster children.
Length of time required to be available to adopt a child.
The problem with the disparity in the foster care system.
Determining the need for foster care need for children.
The problem with homelessness of children after foster care.
Instances of child abuse for children in foster care.
Educational problems for children in foster care.
Issues with separating siblings in foster care.
Characteristics of the current foster care system.
Federal support of the national foster care system.
LGTBQ youth and the risk of homelessness in foster care.
Inadequate funding for foster care organizations.
The rights of children in foster care homes.
Evaluating qualified parents in the foster care system.
Adoption process for children that come from abusive homes.
Interstate laws prevent adequate foster care programs.
Financial disparity among foster care programs.
The harsh reality of foster care for many children.
Abusive foster parents and the impact on children.
Systematic problems in foster care social programs.
Problems with separating foster care children through adoption.
Examining the importance of foster care to a child.
Evaluating the support foster parents receive financially.

These research paper topics about foster care focus specifically on evaluating the system in various settings and situations. Regional or financial challenges often make it difficult to efficiently run a program and these topics cover some of the major issues:

Foster care effectiveness across the 50 states.
The problem with older children in foster care.
The likelihood of success for children in foster care.
Debate over gay foster care and adoption.
Separating siblings through the adoption process.
The effect of social perceptions toward foster care.
Methods to encourage children to interact with their peers.
Misconceptions about the behaviors of children in foster care.
The relationship between foster care and single parents.
Examination of parenting skills required to foster children.
Encouraging children in foster care to socialize.
How to use social media to encourage home placements.
The stigmatizing of foster parents.
How teenagers adopt to foster parents in the first three months.
The impact of legal regulations on the foster care system.
How children adopt to foster parents in the first three months.
The importance of mental health for children in foster care.
Criminal proceedings for abusive foster parents.
Media and the portrayal of foster parents.
Analyzing legal measure regarding foster care.
The importance of clinical therapy in foster care.
Interactive technologies and their influence on foster care.
Trust issues in children from foster care homes.
Challenges in finding the right foster parents.
The stigmatization of adults coming from foster care.
Foster parents that abuse the system for financial support.
The impact social media has on the foster care system.
Encouraging children to interact with foster care parents.
Effective placement of children in foster care.
The role of the social worker in the foster care system.

These are controversial foster care problems that have been in discussion for several years. There are varying viewpoints you can take for each one and you can develop an assignment that will generate a lot of interest and debate:

Creating effective awareness of the foster care system.
Problems faced in the foster care system.
The negative impact Covid-19 has had on foster care.
Public education and children of foster care.
Highlighting the plight of foster parents in the U.S.
Foster care and the relationship with academic success.
Ways to improve foster care around the world.
Frequency of foster home visitation and evaluation.
The need for more qualified parents to foster children.
The impact of foster parents on a foster child’s life.
Medical and health negligence for children in foster care.
Challenges of providing adequate social services to foster children.
Examining why foster care children are more likely to fail.
The investigation process for potential foster parents.
Complications that arise because of foster care.
Foster care systems in the United Kingdom.
Analyze the distribution of foster homes in the U.S.
The positive and negative effects on mental health.
The challenges of getting more people to adopt.
Interviewing children in foster care homes.
Nursing malpractice for children in foster care.
Advantages and disadvantages of the foster care system.
The health effects of children coming from foster care.
Compare and contrast foster care in the U.S. and U.K.
Analyzing desired outcomes for children in foster care.
How to make adoption more accessible.
Examining proposals to improve the effectiveness of foster care.
Providing social services to foster care children turning 18.
Increasing efforts to prevent child abuse.

This set of research paper ideas can be modified to fit any kind of assignment of any length. Most cover current issues that are so new that you may have some trouble finding a lot of information. So, you can take the opportunity to be among the first ones to do work in these areas:

Sensitization of foster care abuse in society.
The effects of long-term care with foster parents.
Responding to child abuse and neglect in foster homes.
Development and orderly growth of foster care.
Stress issues in parents that foster children.
The problems in social services for foster care children.
Foster care system and special needs children.
Child abuse & neglect among low-income households.
The financial burden for parents that foster children.
Children from foster care and the connection with crime.
Health risks on adolescents in the foster care system.
Mandatory reporting of child abuse and neglect.
Feelings of helplessness among children in foster care.
Mental health in foster care parents.
Encouraging increased adoption of older children.
Achieving and maintaining permanency.
The challenges of providing adequate medical care to children.
Improving the foster parent licensing process.
Mental issues related to the adoption of children.
Providing parent education to strengthen families.
Examining the signs and symptoms of child neglect.
Supporting and preserving families.
Providing out-of-home care for children in the foster care system.
Providing more attention to children in foster care.
Partnering with families to improve child welfare outcomes.
How to improve a child’s chances for adoption.

Foster Care Research Paper Assistance

If you are a college or university student requiring foster care research questions or assistance editing or writing an assignment, our college paper writing service provides custom solutions that will earn you high grades. Our online services will deliver high-quality products fast and we have cheap packages that can fit any student’s budget. Learn more about our services by chat, email, or phone. Our friendly and knowledgeable customer support staff is ready to help.

189 Social Media Research Paper Topics To Top Your Paper

Social media has been around since the late 1990s and refers to the means of interaction and communication between groups of people from all over the world. It allows them to create, share, and exchange information, ideas, and conversations in virtual communities over the internet. Society embraced social media and it was made popular by individuals that wanted to connect with others but quickly became a tool used by businesses and organizations to promote products and services and is now a vital component in building relationships, broadcasting, and marketing at small- and large-scale levels.

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A national campaign to improve foster care

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Ron haskins ron haskins senior fellow emeritus - economic studies.

June 22, 2017

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In the U.S., it remains an unfortunate reality that many children—including those born to low-income parents whose families live in poor neighborhoods with low-quality schools or who are members of minority groups—are statistically disadvantaged from the moment of birth or even earlier. Though some are able to break out and achieve educational and economic success, the odds are stacked against these children—now more than ever.

Among this already disadvantaged group of children, one subgroup stands out for the accumulation of factors that work against them enjoying a happy and normal childhood or beating the odds to achieve a fulfilling life as an adult characterized by a stable family, a good job, and financial independence. These most unfortunate and at-risk children are those removed from their homes by local officials and placed in the nation’s foster care system. These are the most disadvantaged children in the nation, and therefore have the greatest claim to public support.

The magnitude of the problem is shown by a recent survey that found that nearly 40 percent of the nation’s children experienced a child protective services investigation by age 18. 1 In 2014 alone, reports to public authorities documented child abuse or neglect allegations affecting 3.2 million children. 2 Not all children who are victims of abuse or neglect are identified when the maltreatment occurs—and even fewer receive services—but every state has a public entity, often called the Department of Social Services (DSS), that investigates these reports of abuse or neglect and, in the cases that the local DSS finds to be most serious, formulates and executes a plan for helping the parents and the child improve their relationship and reduce the problems that led to the maltreatment.

In the most serious cases of abuse or neglect, DSS may remove children from their parents and place them in a setting outside their family household, sometimes in a group or institutional care setting, sometimes with a relative, and sometimes with another family that has been determined to meet at least minimum standards of being able to provide an adequate environment for raising the child. About 260,000 children enter foster care each year; at any given moment, a total of around 400,000 of the nation’s children are in foster care. 3

The needs of children in foster care

Imagine the emotional condition of children who enter foster care. Before entering care, nearly all of them experience trauma that can have serious and sometimes lasting impacts on their development and personality. Once placed in foster care, their contact with their own parents is greatly reduced, at least temporarily. Although child welfare agencies are supposed to keep children in their home communities and in their own schools if possible, achieving these two placement goals is often difficult, in which case children may be placed in a new neighborhood where they must go to a new school and make new friends. Thus, children who already face many disadvantages can lose major parts of their familiar environment while facing what must seem to them an uncertain and deeply confusing future.

It is little wonder that these children, when studied over many years, have outcomes in education, delinquency, mental health, employment, and many other areas that are far below average. One of the best studies of the long-term impacts of foster care and the conditions that cause children to enter foster care followed about 730 adolescents who were in foster care at age 17 in Iowa, Wisconsin, and Illinois. They were followed until they reached age 26. The authors’ conclusion provides a clear picture of the fate of many of these young people who experienced years in foster care:

The picture that emerges . . . is disquieting, particularly if we measure the success of the young people . . . in terms of self-sufficiency during early adulthood. Across a wide range of outcome measures, including postsecondary educational attainment, employment, housing stability, public assistance receipt, and criminal justice system involvement, these former foster youth are faring poorly as a group. . . . Our findings raise questions about the adequacy of current efforts to help young people make a successful transition out of foster care. 4

Research in recent decades has established that for most children, their parents are the most important influence on their development. 5 Parents establish and maintain most parts of the preschool child’s rearing environment and have more interactions with the child than any other person. Parents establish the child’s daily routines, listen to and talk to the child more than anyone else, and are the child’s original source of information and values. But just as children who enter foster care come from neighborhood and school environments that are less than ideal, their home environments—including their parents—are also unlikely to have supported normal child development. Most enter foster care already carrying emotional—and often physical—scars.

How foster care placement works

Precisely because parents are so important to children’s development and well-being, when children are removed from their parents by public officials, the public assumes responsibility for their development and well-being. For the approximately 260,000 children placed in foster care each year, the choice of foster care setting is central to the child’s future.

There is now almost universal agreement that group or institutional care should be considered an option of last resort. 6 In 2014, a group of ten leading child welfare researchers with extensive careers of research on children felt so strongly about this issue that they issued a “consensus statement” on group care. Their conclusion, stated with admirable conciseness, is that children should be placed in group care only “when necessary therapeutic mental health services cannot be delivered in a less restrictive setting.” 7 Nonetheless, according to a report from the U.S. Department of Health and Human Services, nearly 15 percent of children are placed in group homes or institutional care. 8

Far preferable to group care is placement with a qualified, loving family. Two types of placements with families are used by child welfare offices across the nation. In one type, children are placed with family members, often grandparents. This mode of placement has been used for centuries and is today a form of foster care endorsed by child welfare agencies, government agencies responsible for administering child welfare programs, and child welfare professional organizations. 9 There are two major factors that make kinship placements so desirable: First, children are usually familiar with the adults with whom they will be living. Second, both the parents and the child experience less trauma if the child is placed with someone known to and trusted by the parents and the child. About 30 percent of children in foster care are in kinship care.

Many families whose children enter foster care do not have relatives available or able to provide reliable and loving care to the child. Thus, DSS agencies find families—usually unknown to the child and the child’s family—that are willing to devote themselves to the care and nurturing of the child. Children placed with foster families are often traumatized, especially if they have been living in difficult circumstances with their biological family for many years. Thus, the children often act out and are resistant to adult supervision. As every parent knows, raising children is always challenging. But raising a foster child can be especially challenging due to the unique needs of foster children and tensions with parents who have lost temporary custody of their children. Both conditions weigh heavily on foster parents.

Given these challenges, DSS agencies have a demanding task in selecting, training, and certifying foster parents who can stand up to these various pressures—and all so they can serve a child and family they don’t know. Despite these barriers, however, placement with non-relative families is the most common placement type: 45 percent of foster children live with non-relative foster families.

A national campaign to catalyze foster care reform

Given the stakes, and our nation’s public responsibility for providing the best possible care for these abused and neglected children, a group of child welfare advocates, researchers, community activists, and foundation officials have initiated a national campaign called CHAMPS (CHildren need AMazing ParentS) to ensure bright futures for children in foster care by promoting the highest quality foster parenting.

To achieve this goal, CHAMPS will work with state policymakers, child welfare administrators, and advocates to leverage research and spur policy reforms in up to 25 states over the next five years.

As spelled out in detail in a paper published in 2016 by the Annie E. Casey Foundation, 10 the reforms are aimed at:

Building a robust constituency network and enhancing the capacity of advocates to effectively push for quality foster parenting through a broad-based coalition equipped with the latest evidence and tools.
Reforming state policies, including changes to statutes, administrative codes, and regulations, to increase public and private agency capacity to support, engage, recruit, and retain foster parents. Policy approaches will vary by state, but will include steps to promote quality caregiving, ensure accountability and oversight, and create more effective partnerships between parents and agencies.
Promoting stronger federal policies that firmly embed the principle that children do best in families. Federal policy approaches might include fiscal incentives and greater state accountability measures to ensure the availability of trained and qualified foster parents to meet the needs of children and communities.
Changing the public narrative about foster parents to emphasize the vital role that they play in a child’s life. By leveraging survey data, as well as the voices of foster parents, youth who have experienced foster care, and other community leaders, the public will gain greater understanding and appreciation of foster parents.

The Center on Children and Families (CCF) at Brookings is pleased to announce its participation in the project as the research arm of the CHAMPs initiative.

With financial and advisory support from several foundations, CCF will examine four key issues that are well-aligned with the aims of the CHAMPS reforms outlined above.

First, we will conduct research on the quality of foster care offered by states. We are especially interested in research on how the quality of foster care can best be measured and on the relationship between quality measures and child progress and outcomes. Measures of the quality of foster care should correlate with, or even cause, the most important outcomes such high school graduation, attaining a post-high school degree or certificate, avoiding teen pregnancy, and avoiding delinquency and criminal involvement.

Second, we plan to examine the best ways to determine state accountability for their foster care systems, especially the capacity of states to conduct oversight and evaluation of the services they are offering. We will focus attention on how the federal government and the states now measure accountability and how the measures could be improved. Again, as with measures of the quality of foster care, measures of state accountability should be highly correlated with desirable child outcomes.

Third, we will explore ways to increase the American public’s understanding of the vital role played by foster parents and the great value of the services they provide to foster children. Increasing the visibility of foster parents and promoting a greater understanding of their vital role in preparing the nation’s most disadvantaged children for adulthood will increase the number of parents who are interested in the possibility of serving as foster parents as well as political support for public initiatives to improve foster care.

Fourth, as shown by a visit to the California Evidence-Based Clearinghouse for Child Welfare, 11 in recent decades program specialists and researchers have developed a number of programs capable of successfully treating the types of serious emotional and behavioral problems that afflict many of the children who wind up in foster care. The field needs to know more about these intervention programs and how foster parents can play an important role in improving the success of these programs in helping foster children. A special focus of our research will be figuring out how to adapt these treatment programs to the individual strengths and weaknesses of foster families so that the impact of the programs in reducing emotional and behavioral problems can be improved.

The Center on Children and Families at Brookings looks forward to playing a contributing role in the national movement to help states improve the quality of foster parenting for abused and neglected children through aggressive implementation of the CHAMPS initiative. There are few public policies for which the potential payoff in lives brightened is as promising as improvements in the nation’s foster care system.

Hyunil Kim et al., “Lifetime Prevalence of Investigating Child Maltreatment among US Children,” American Journal of Public Health , 107 (2017): 274-280.
U.S. House of Representatives Committee on Ways and Means, “Child Welfare,” in Green Book (Washington: Committee on Ways and Means, 2016).
Mark F. Courtney et al., “Midwest Evaluation of Adult Functioning of Former Foster Youth: Outcomes at Age 26” (Chicago: Chapin Hall at the University of Chicago, 2011).
Richard V. Reeves and Kimberly Howard, “The Parenting Gap” (Washington: Brookings Institution, 2013); Ariel Kalil, “Addressing the Parenting Divide to Promote Early Childhood Development for Disadvantaged Children” (Washington: The Hamilton Project, 2014); Michael E. Lamb, “Mothers, Fathers, Families, and Circumstances: Factors Affecting Children’s Adjustment,” Applied Developmental Science 12 (2012): 98-111.
Fred Wulczyn et al., “Within and Between State Variation in the Use of Congregate Care” (Chicago: Chapin Hall at the University of Chicago, June 2015); Annie E. Casey Foundation, “Every Kid Needs a Family: Giving Children in the Child Welfare System the Best Chance for Success” (Baltimore: Annie E. Casey Foundation, 2015); Richard P. Barth, “Institutions vs. Foster Homes: The Empirical Base for a Century of Action” (Chapel Hill, NC: Jordan Institute for Families, June 2002).
Mary Dozier et al., “Consensus Statement on Group Care for Children and Adolescents: A Statement of Policy of the American Orthopsychiatric Association,” American Journal of Orthopsychiatry 84 (2014): 219-225.
All placement estimates are taken from the Department of Health and Human Services, “The AFCARS Report: Preliminary FY 2015 Estimates as of June 2016,” No. 23, accessed June 10, 2017, https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport23.pdf .
Children’s Bureau, Child Welfare Information Gateway, “Kinship Caregivers and the Child Welfare System” (Washington: U.S. Department of Health and Human Services, Children’s Bureau, 2016), accessed June 10, 2017, https://www.childwelfare.gov/pubs/f-kinshi/ ; “Kinship Care,” Child Welfare Leagues of America, accessed June 10, 2017, http://www.cwla.org/our-work/advocacy/placement-permanency/kinship-care/ .
Annie E. Casey Foundation, “A Movement to Transform Foster Parenting” (Baltimore, MD: Annie E. Casey Foundation, 2016).
See California Evidence-Based Clearinghouse for Child Welfare, http://www.cebc4cw.org/ .

Children & Families

Center for Economic Security and Opportunity

Nariman Moustafa

October 20, 2023

Anusha Bharadwaj

September 29, 2023

Sophia Espinoza, Charlotte Wright, Kathy Hirsh-Pasek

July 18, 2023

Fatherhood in Foster Care: A Scoping Review Spanning 30 Years of Research on Expectant and Parenting Fathers in State Care

Published: 18 May 2022
Volume 39 , pages 693–710, ( 2022 )

Cite this article

Justin S. Harty ORCID: orcid.org/0000-0002-2770-6869 1 &
Kristen L. Ethier ORCID: orcid.org/0000-0002-2881-4626 2

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Over the past 30 years, there has been a surge of interest in understanding the experiences and outcomes of expectant and parenting foster youth. Despite the importance of understanding this unique population of foster youth, there remains a lack of research on fathers in foster care. Most studies of expectant and parenting foster youth focus on mothers in care, and studies that have examined fathers in care provide little insight compared to what we know about mothers. Furthermore, existing research on fathers in foster care is limited by underreporting, service engagement issues, lack of meaningful engagement data, and very little information on fathers’ involvement with their children. There is very little published research on the experience of fatherhood in foster care or on related outcomes for fathers in care such as residency with children, father engagement with children, coparental relationship quality, or the health and well-being of their children. While there have been over 60 studies and three reviews on expectant and parenting foster youth spanning roughly 30 years, the articles have primarily focused on empirical findings relating to mothers in foster care. Information on fathers in foster care has received little attention and is restricted to empirical studies. This scoping review aims to fill this gap by examining the available information on fathers in foster care. To this end, our scoping review explores empirical findings and knowledge from practice-, legal-, and policy-related literature related to fathers in foster care from peer-reviewed journal articles, reports, dissertations, white papers, and grey literature published between 1989 and 2021. Findings from 94 sources of evidence on expectant and parenting foster youth suggest that mothers in foster care are consistently the focus of the literature. If fathers in foster care are included in the literature, findings or guidance are often provided in the aggregate (e.g., parents in care). However, when aggregated, literature still focuses on mothers in care, or female pronouns are used to describe the larger expectant or parenting foster youth population. Many of the studies excluded fathers, and the primary exclusion rationale includes a lack of identified fathers in care, unreliable child welfare data on fathers, or high attrition of fathers in parenting services. In terms of information on fathers in foster care by the source of evidence, research papers often provided quantitative descriptions of fathers, practice papers focused on rights of fathers, legal papers centered on paternity establishment or paternal rights, and policy papers largely discussed the need for improved data tracking and interventions for fathers. More research is needed to support fathers in foster care as they transition out of care into early adulthood and young fatherhood.

Engaging Fathers in Child Welfare and Foster Care Settings: Promoting Paternal Contributions to the Safety, Permanency, and Well-being of Children and Families

Engaging At-Risk Fathers in Home Visiting Services: Effects on Program Retention and Father Involvement

Sandra McGinnis, Eunju Lee, … Rose Greene

“Foster Care is a Roller Coaster”: A Mixed-Methods Exploration of Foster Parent Experiences with Caregiving

Taylor Dowdy-Hazlett & Shelby L. Clark

Avoid common mistakes on your manuscript.

Introduction

Youth in foster care have an increased likelihood of becoming parents as compared to their non-foster care peers (Courtney & Dworsky, 2006 ). Parenting while in foster care is associated with a variety of risk factors for young parents and their children, including adverse outcomes in education (Courtney & Hook, 2017 ), employment (Dworsky & Gitlow, 2017 ), housing stability, mental health (Matta Oshima et al., 2013 ) and criminal justice involvement (Shpiegel & Cascardi, 2015 ), and intergenerational maltreatment (Dworsky, 2015 ). As such, young parents in foster care have garnered the attention and concern of scholars, policymakers, and child welfare practitioners, including 30 years of research on this population. Relatively little attention has been paid to the outcomes, experiences, and needs of young fathers in care. The lack of research on fathers in foster care may stem from limitations in survey and child welfare administrative data to accurately capture reports of males impregnating females or fathering a child when paternity is unreported, disputed, or unknown. Further, research indicates that many young fathers in foster care are dually impacted by child welfare and criminal justice involvement (Shpiegel & Cascardi, 2015 ), which may constrain researchers’ abilities to connect with young fathers in foster care for rigorous qualitative research. Furthermore, research on young fathers (e.g., adolescent, teenage) broadly indicates that young fathers have unique needs related to their delayed entry into the labor force, lower academic achievements, and decreased developmental readiness for paternal obligations, which may affect their ability to meet traditional fatherhood expectations (Johnson Jr., 1998 , 2001a , 2001b ).

There are three existing literature reviews on expectant and parenting youth in foster care, which collectively review research published between 1989–2017. Each of these reviews covers research that includes a sample of only young mothers or a sample of both young mothers and young fathers together. None of the three reviews covers research that includes a sample of only young fathers. Svoboda et al. ( 2012 ) examined literature on parenting youth in foster care published from 1989–2010, identifying common themes across the 16 quantitative and qualitative studies reviewed. The authors note variation across studies in reported rates of pregnancy and impregnation, ranging from 16 to 50% of youth in care who either became pregnant or impregnated someone while they were in foster care. Common themes across the studies include barriers and opportunities, diverse mental and physical health needs of parenting youth, the influence of traumatic life experiences on sexual development, the influence of poverty, and the disruption of relationships and living environments. Although nine of the sixteen studies included fathers in the sample, the authors did not identify any implications for research or policy related to young fathers in foster care. Connolly et al. ( 2012 ) conducted a meta-synthesis of qualitative studies published on expectant and parenting youth in foster care in the United States, Canada, and the United Kingdom. They identified risk factors, protective factors, and markers of resilience across 17 studies published between 2000–2010. The authors identified several themes related to what they identify as the experiences of young mothers in foster care, including (1) infants filling an emotional void (2) lack of consistent sexual education, (2) motherhood adversities, (4) mistrust of others and social stigma, (5) perception of motherhood as positive and stabilizing (6) internal strengths and wanting to do better, and (7) support contributing to positive motherhood. Interestingly, the Connolly et al. ( 2012 ) review focuses on the findings and implications of the studies solely for young mothers in foster care and their children. However, of the studies reviewed that are based in the United States, the majority included young fathers in foster care in the sample, but father-specific findings were not discussed. In the most recent literature review on this population, Eastman, Palmer, et al. ( 2019 ), Eastman, Schelbe, et al. ( 2019 )) reviewed 18 studies on young parents in care published between 2011 amd 2017. Of the studies reviewed, nine included fathers in the sample. Although the authors highlighted some of the findings on expectant and parenting males in care, no father-specific recommendations for child welfare policy, practice, or future research were made.

Across the three reviews, 19 studies included fathers in the sample. However, few studies reviewed identified implications specifically for young fathers and their children, and the existing reviews are similarly disengaged from father-related findings. As such, there are three notable gaps in current understandings of the research on young fathers in foster care. First, current reviews have not thoroughly analyzed the existing body of research published from 1989 and 2017 in terms of father-related findings, including some publications omitted from prior literature reviews. Second, additional research on expectant and parenting youth in foster care has been published from 2018–2021 and has yet to be reviewed for father-related findings. Third, none of the existing literature reviews include research exclusively focused on young expectant and parenting males in foster care. The objective of this scoping review is to address each of these gaps in order to identify the risks, experiences, and needs of young fathers in foster care with implications for child welfare policy, practice, and research. Furthermore, this scoping review seeks to explore in detail the available information on young fathers in foster care spanning the last 30 years. This 30-year span covers the oldest study (Polit et al., 1989 ) included in the first review of research on expectant and parenting foster youth by Svoboda and colleagues ( 2012 ) to the most recent studies reviewed in this scoping review (Dworsky et al., 2021 ; Martínez-García et al., 2021 ; Rouse et al., 2021 ; Shpiegel, Day, et al., 2021 ; Shpiegel, Fleming, et al., 2021 ).

This scoping review began with the establishment of a research team consisting of the two authors of this paper who have practice and research experience with expectant and parenting youth in foster care. We collaborated on identifying the research question for this scoping review, including target audiences, search terms, and databases to conduct the searches. The methodology we used for this scoping review was based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews framework (Tricco et al., 2018 ). We completed a detailed review protocol for our scoping review but did not register it. Registering scoping reviews is recommended but not required to reduce duplication of research and for transparency (Tricco et al., 2018 ). However, we choose not to register our scoping review protocol due to the simplicity of our inclusion criteria (i.e., research containing any findings or information on fathers in foster care). Due to the scarcity of research on fathers in foster care, we were not concerned with the duplication of a research review on this topic. However, if one were to occur, we would welcome the possibility of different conclusions or alternative sources of evidence on this topic. To ensure transparency, our review protocol can be obtained from the primary author upon request and we detail the methods of our scoping review in the next section.

This study is a scoping review of expectant and parenting fathers in foster care. However, we decided to include expectant and parenting mothers in foster care in this scoping review as well. Given that our decision may seem perplexing, we believe that our rationale for including mothers in foster care in this scoping review is warranted. Scoping review methodology is used for variety of purposes (Peterson et al., 2017 ; Pollock et al., 2021 ). Two primary purposes of a scoping review are to provide an overview of a field of research (Moher et al., 2015 ; Pham et al., 2014 ) and to identify gaps in existing literature (Arksey & O’Malley, 2005 ; Sucharew, 2019 ). Our scoping review aligns with these purposes in two ways. First, we aimed to provide an overview of the field of research on expectant and parenting foster youth, examining the extent of research done on fathers in foster care. Second, we aimed to identify gaps in existing literature on expectant and parenting foster youth as they relate to fathers in foster care. To achieve these two aims, we review literature on expectant and parenting foster youth broadly (e.g., literature including mothers, fathers, or both) to ascertain the degree to which fathers in foster care are included in research literature (e.g., main sample or comparison group) or white/grey literature (e.g., principal focus or related focus).

Research Question and Purpose

Our scoping review was guided by the research question, “What are the research findings on or guidance for working with expectant and parenting fathers in foster care?” The purpose of our review was to search, identify, and summarize the literature on fathering foster youth that is relevant to research, legal, policy, and practice audiences.

Eligibility Criteria

Documents were eligible for inclusion if they contained one or more of the following elements of information on expectant or parenting fathers in foster care: (1) research findings, (2) legal guidance, (3) policy guidance, or (4) practice guidance. We included documents if they were published between 1989 and 2021, written in English, based in the United States, and either peer-reviewed journal articles, reports, dissertations, white papers, or grey literature. We included documents if they used quantitative, qualitative, mixed-method, or art-based research methodologies. In addition to the eligibility criteria stated above, we included any peer-reviewed publications or report studies that included only pregnant or parenting mothers in foster care and studies in which the gender of the parent in foster care was not clearly stated (e.g., “parents in foster care,” “parenting youth in foster care”). We expanded the eligibility criteria of peer-reviewed publications and reports to include studies on mothers in care and studies that may include fathers in care for comparative purposes (e.g., obtain the proportion studies including fathers in care versus solely mothers in care). For white papers and grey literature, we excluded any documents that made ambiguous or minimal references to fathers in foster care (e.g., “services should include parents in care,” “services should include mothers and fathers in care”).

Information Sources and Search Strategies

To identify potentially relevant documents, we searched the following online bibliographic databases in May and June of 2021: Google Scholar, Google, ArticlesPlus, PubMed, EBSCO, Web of Science, ProQuest Dissertations & Theses, and HeinOnline. We used Google Scholar, Scite.ai, ConnectedPapers, and Dimensions.ai to conduct forward and backward citation searches. We searched Google Scholar, ArticlesPlus, PubMed, EBSCO, Web of Science, and HeinOnline for peer-reviewed research studies, reports, and legal publications. We searched ProQuest Dissertations & Theses for dissertation studies and searched Google for white papers, grey literature, and other reports not captured in earlier database searches. We developed and used a combination of the following Boolean search terms for each search to ensure that results were relevant to our research question and search: “adolesc*” OR “teen*” OR “young” OR “youth*” AND “father*” OR “mother*” OR “parent*” OR “expect*” OR “preg*” AND “in care” OR “foster care” OR “child welfare” OR “child protection” OR “child protective.” We searched databases for these Boolean search terms in the title, abstract, full-text, or keywords. The searches were conducted by both authors of this paper.

Selection of Sources of Evidence

Following the search, we conducted a two-phase selection process. In the first phase, we identified possible citations, collected citation data, uploaded citation data (e.g., title, author(s), journal, abstract, and DOI/URLs) into Zotero 5.0, and removed duplicates. In the second phase, we screened citations by assessing the citation data against the eligibility criteria for our review. We retrieved the online full-text of potentially relevant sources, read the text, and assessed the text against the inclusion criteria. We used different selection processes for each source of evidence that matched our eligibility criteria. For peer-reviewed publications and reports, we automatically included a study or report if they were reviewed in previous review studies (i.e., Connolly et al., 2012 ; Eastman, Palmer, et al., 2019 ; Svoboda et al., 2012 ). We also included any peer-reviewed publications and reports that met our eligibility criteria and were published but not reviewed in previous review studies (between 1989 and 2017), as well as peer-reviewed publications and report studies published after the 2017 eligibility year cut-off for the Eastman, Palmer, et al. ( 2019 ) and Eastman, Schelbe, et al. ( 2019 ) review (between 2018 and 2021). When peer-reviewed publications and report studies met our eligibility criteria, we conducted forward and backward citation searches to find additional studies for inclusion based on our eligibility criteria. We selected dissertations, white papers, and grey literature if the publications met our eligibility criteria and had distinct findings or guidance for fathers in foster care. Each author reviewed eligible studies for selection as sources of evidence. We resolved disagreements on publication selection through review and discussion.

Data Charting and Item Extraction

We developed and used a data-charting form to collect, track, and assess data variables to extract. We independently charted the data, discussed the results, and continuously updated the data-charting form in an iterative process based on information contained in the publications that varied based on the type of publication and target audience. We extracted data items from the publications included in our scoping review using a data extraction tool we developed. The data items we extracted from publications included specific details on the topic of the publication (e.g., expectant fathers, fathering, father rights), study sample (e.g., fathers, mothers, both), study context (e.g., research, policy, legal), research findings (e.g., for fathers, mothers, both), and implications (e.g., suggestions for future research, practice guidance).

Synthesis of Results

We grouped the studies by the type of publication and audience. We synthesized peer-reviewed research studies, report studies, and dissertations together for research audiences. We grouped legal studies together for law and advocacy audiences. Lastly, we grouped policy and practice-focused white papers and grey literature together for policy- and practice-related audiences. When we found reviews on pregnant, expectant, and parenting youth in foster care, we noted how many studies may have been missed or excluded from previous reviews and how many studies were published outside of year ranges covered in previous reviews. When we synthesize findings from peer-reviewed studies and report studies that were reviewed in previous review studies (Connolly et al., 2012 ; Eastman, Palmer, et al., 2019 ; Svoboda et al., 2012 ), we focus on synthesizing father-specific findings, study procedures, and implications.

As shown in Fig. 1 , after our initial search, we identified 160 sources of evidence. Thirty-six sources of evidence were duplicates of studies we found in our databases searches and studies we included from previous reviews on pregnant, expectant, and parenting youth in foster care (Connolly et al., 2012 ; Eastman, Palmer, et al., 2019 ; Svoboda et al., 2012 ) that met our eligibility criteria. Thirty-three sources of evidence were removed that did not meet eligibility criteria. We were then left with 127 sources of evidence that we reduced down to 93 after reviewing sources of evidence that did not meet eligibility criteria ( n = 18). During the review process, we added one source of evidence (grey literature) at the suggestion of a reviewer that we missed during the screening process. Of the 94 sources of evidence we included, 64 were peer-review or report studies, 1 was a dissertation, 21 were legal papers, and 8 were either white papers or grey literature. The selected articles highlighted six areas of interest regarding expectant and parenting male youth in foster care: (1) incidents of impregnation by males in foster care; (2) predictors and characteristics associated with fathering while in foster care; (3) risk factors of early fatherhood in care; (4) elements of fathering roles while in foster care; (5) legal rights of fathers in foster care; and (6) practice with fathers in care.

Identification and selection of sources of evidence

Review of Peer-Reviewed and Report Studies Reviewed in Previous Review Studies

The three previous reviews on expectant and parenting youth in foster care collectively reviewed 37 studies conducted between 1989–2017. Studies across these three reviews, which primarily focus on young expectant and parenting mothers in foster care, include fourteen studies that address pregnancy and birth incidence and various demographic characteristics of expectant and parenting youth in care (Combs et al., 2018 ; Courtney & Dworsky, 2006 ; Courtney et al., 2012 ; Dworsky, 2015 ; Dworsky & DeCoursey, 2009 ; Dworsky & Gitlow, 2017 ; Gotbaum et al., 2005 ; Krebs & de Castro, 1995 ; Leslie et al., 2010 ; Milbrook, 2012 ; Putnam-Hornstein & King, 2014 ; Putnam-Hornstein et al., 2016 ; Shpiegel & Cascardi, 2015 ; Shpiegel et al., 2017 ), six papers on sexual risk behaviors (Coleman-Cowger et al., 2011 ; Constantine et al., 2009 ; James et al., 2009 ; Matta Oshima et al., 2013 ; Polit et al., 1989 ; Zhan et al., 2019 ), six papers on child welfare placements and pregnancy (Carpenter et al., 2001 ; Kerr et al., 2009 ; King & Van Wert, 2017 ; Leve et al., 2013 ; Lieberman et al., 2015 ; Sakai et al., 2011 ), three papers on transition aged youth and parenting (Collins et al., 2007 ; Haight et al., 2009 ; Max & Paluzzi, 2005 ), two papers on mental health and substance use (Milbrook, 2012 ; Matta Oshima et al., 2013 ), and seven papers on parenting experiences (Aparicio, 2017 ; Aparicio et al., 2015 ; Budd et al., 2006 ; Love et al., 2005 ; Mena, 2008 ; Pryce & Samuels, 2010 ; Radey et al., 2016 ; Schelbe & Geiger, 2016 ). We revisited the studies in these reviews and analyzed them based on several factors: (1) inclusion of young fathers in foster care in the sample, (2) findings related to young fathers in foster care, (3) mention of fathers of children with a mother in foster care, and (4) mother-focused studies that either have exclusion criteria for fathers in care or (5) that make recommendations related to fathers in care. As shown in Table 1 , 22 of the 37 previously reviewed studies included expectant and parenting fathers in foster care in the sample. Among the remaining 15 studies that did not include expectant or parenting fathers in foster care in the sample, five studies discussed fathers of children with a mother in foster care or made father-related recommendations.

Nine of the fourteen previously reviewed studies on the incidence of pregnancies and births and characteristics of expectant and parenting youth in care included fathers in the sample. Three studies reported incidence of pregnancy or impregnation by gender (Combs et al., 2018 ; Courtney & Dworsky, 2006 ; Courtney et al., 2016 ), while one additional study reported aggregate pregnancy or birth incidence (Leslie et al., 2010 ). Among the studies that reported incidence of impregnation in the sample, rates of fathering a child while in foster care ranged from 13.8% (Courtney & Dworsky, 2006 ) to 22% (Combs et al., 2018 ). The majority of impregnation by males in foster care resulted in a live birth. None of the studies report the age or race of fathers in care specifically. However, Courtney and Dworsky ( 2006 ) reported that in the Midwest Study sample, by age 19, 13.8% of males had impregnated a female. In all studies conducted in Illinois that report racial demographics, African American youth are disproportionately more likely to become parents (Dworsky, 2015 ; Dworsky & DeCoursey, 2009 ; Dworsky & Gitlow, 2017 ), as more than 80% of parenting youth in each sample were identified as African American. In the CalYOUTH study, however, young parents were most likely to be of mixed race (Courtney et al., 2016 ).

Four studies address predictors of fathering a child while in foster care in the domains of placement type (Sakai et al., 2011 ), substance use treatment history (Coleman-Cowger et al., 2011 ), and mental health status (Matta Oshima et al., 2013 ), and other indicators of risk (Matta Oshima et al., 2013 ). Sakai and colleagues ( 2011 ) found that youth placed in kinship care were seven times more likely to become pregnant (females) or impregnate a female (males) than youth placed in traditional foster care. Males in substance use treatment with a foster care history, however, were less likely than their female counterparts to become expectant or parenting (Coleman-Cowger et al., 2011 ). On the other hand, Matta Oshima et al. ( 2013 ) found that males in foster care with a mental health diagnosis were significantly more likely to father a child than those without a diagnosis. Matta Oshima et al. ( 2013 ) indicated several predictors of becoming a father while in care in their analysis of longitudinal data from a study of 325 youth in care, including endorsing a substance use disorder, failing grades, and leaving care before age 19. Males who were not yet sexually active by age 17 were less likely to father a child between ages 17 and 19.

In addition to predictors of fathering among males in foster care, several studies illustrate characteristics of the population. Fathers in foster care are unlikely to reside with their children. For example, Courtney and Dworsky ( 2006 ) found that only 18.4% of fathers in the Midwest Study resided with a child. Further, fathers in care face adverse outcomes related to incarceration and housing stability. In their analysis of National Youth Transition Database (NYTD) data, Shpiegel and Cascardi ( 2015 ) found that 74% of fathers in care had an incarceration history, and one in three experienced homelessness. One study explored rates of employment among both mothers and fathers in foster care, indicating that mothers in care are more likely to be employed for one quarter than fathers in care, with no significant differences in the number of quarters worked or total earnings between genders (Dworsky & Gitlow, 2017 ). The CalYOUTH study presents the most robust findings on father-specific characteristics among youth in care. In that sample, one-fifth of males had ever gotten a female pregnant, nearly one-tenth had ever fathered a child, and all young fathers reported only having one child. At the time of conception, only 10% of fathers reported using contraception. Further, 20% of fathers reported that they did not want their female partner to become pregnant, while 20% expressed a strong desire for pregnancy (Courtney et al., 2016 ).

Scholars also consider risk factors associated with fathers in foster care. Although rates of child separation into foster care are higher among children born to young mothers in foster care, one study found that 2.8% of children born to fathers in care entered foster care (Dworsky & DeCoursey, 2009 ). Another study attributes this, in part, to the fact that most children born to a father in foster care reside with the other parent and maybe under less scrutiny than mothers in care (Dworsky, 2015 ). In addition to risks associated with child welfare involvement, Courtney et al., 2012 conducted a Latent Class Analysis to understand differences among transition-aged youth, with particular implications for understanding risk factors for young fathers in care. Fathers were most clearly represented in the “Struggling Parents” and “Troubled and Troubling” classes. Struggling parents, of which fathers represent approximately one-quarter of the sample, were more likely to reside with their child, more likely to be married than other classes, and have lower criminal justice involvement than other classes. On the other hand, males make up 75% of the Troubled and Troubling class, of which half are parents and none co-reside with their children. This class also included high rates of criminal justice involvement among males (Courtney et al., 2012 ). Findings from Courtney and colleagues ( 2012 ) demonstrate the unique experiences of fathers in foster care, which may be stressors in the transition to young adulthood and early fatherhood.

Four studies address aspects of fathers’ experiences and roles as fathers while in foster care. Collins et al. ( 2007 ) analyzed data from youth who re-entered care after age 18 in Massachusetts, with four parenting youth in the qualitative sample (n = 16). One father identified reuniting with his child as a goal of re-entering care. In their study of both young mothers’ and young fathers’ experiences in foster care, Love and colleagues ( 2005 ) suggest services targeting the unique needs of fathers in foster care, including addressing gendered double standards related to parenting that may place more parenting responsibilities on mothers. Schelbe and Geiger ( 2016 ) studied mothers and fathers in care as well but presented findings specific to fathers in care. Fathers (n = 12) expressed joy and pride in the fathering role, identifying a wide range of father involvement and engagement with their children. Findings from the CalYOUTH study also include findings on father involvement and engagement. Fathers in the study were more likely (58.7%) to reside with the child’s other parent compared to mothers. Fathers also reported high rates of equal involvement, with 87.7% of fathers reporting that they spent equal time with their children. Fathers also reported regularly routine activities with their children, including eating an evening meal, bathing, and putting their children to bed (Courtney et al., 2016 ). Fathers also may receive less support from caseworkers and other child welfare staff related to fathering. One study addressed caseworker approaches to serving fathers in foster care. Caseworkers reported that they were less likely to provide family planning guidance to males (23%) compared to females (34%) (Constantine et al., 2009 ).

In addition to studies that included fathers in the sample, five studies that did not include fathers in care mentioned fathers of children with a mother in care. In two of the studies, authors described relationships between mothers in care and their children’s fathers, indicating when mothers discussed residing with fathers and coparenting (Pryce & Samuels, 2010 ), as well as cases in which such relationships were both sources of volatility and support (Haight et al., 2009 ). Three other studies made recommendations for scholars and practitioners to increase knowledge about young fathers in care (Aparicio et al., 2015 ) and to attend to the importance of healthy coparenting relationships (Lieberman et al., 2015 ; Max & Paluzzi, 2005 ).

Review of Peer-Reviewed and Report Studies Not Reviewed in Previous Review Studies

Building on the father-related findings in studies covered in the three existing literature reviews on expectant and parenting youth in foster care, we conducted a new analysis of 28 studies not included in prior reviews. Six of the studies were published between 2007 and 2016 but were not included in the most recent review (Eastman, Palmer, et al., 2019 ). The additional 22 studies on expectant and parenting youth in foster care were published between 2017 and 2021. Of the 28 studies added to this review, only 8 included fathers in care in the sample. Like in the studies covered in prior reviews, this group of studies present findings related to fathers in care in several domains: (1) incidents of impregnation by males in foster care; (2) predictors and characteristics associated with fathering while in foster care; (3) risk factors; (4) elements of fathering roles while in foster care. Further, a new domain emerged in this group: (5) service provision.

Half of the studies including fathers in care in the sample addressed reported rates of impregnation (Combs et al., 2018 ; Gordon et al., 2011 ) and characteristics of fathers (Combs et al., 2018 ; Gordon et al., 2011 ; Melby et al., 2018 ; Rouse et al., 2021 ). Rates of impregnating a female were 27.5% (33% by age 21; Combs et al., 2018 ) to 49% (Courtney et al., 2007 ). In a study by Rouse and colleagues ( 2021 ), males reported having more sexual partners but were less likely to discuss sexual risk with child welfare staff than their female counterparts. When pregnancy occurred, 82.7 of expectant mothers reported including the father of their baby in decision making about whether or not to continue the pregnancy and parent. Further, they describe additional characteristics among fathers in care ( n = 11), including rates of unmarried cohabitation (72.7%), established paternity (33.3%), and several domains related to child support. Similarly, Gordon et al. ( 2011 ) presented a broad set of characteristics in their analysis of survey data on 32 fathers in foster care. They found that 50% of fathers had determined paternity status, 72% were enrolled in school, 50% reported involvement with their child, 44% had regular contact with their children, and 16% of children were child welfare involved. In the study by Combs et al. ( 2018 ), the mean age for males getting a female pregnant was 18, which was slightly higher than the mean age for females. Among males who impregnated a female, 63% resulted in a live birth, 13% ended in abortion, 11% were expectant at the time of interview, 87% of males were currently employed vs. 37% of females. Similar to earlier studies, new research indicates that sexual risk behaviors are associated with higher rates of impregnation among males, although males in foster care have lower rates of getting a female pregnant than rates at which females in care become pregnant (Zhan et al., 2019 ).

One study addresses how child welfare involvement influences fatherhood experiences. Manlove et al. ( 2011 ) found that limited placement options for fathers in foster care constrained involvement with their children. Further, child protective services (CPS) involvement created difficulties for fathers of children with mothers in foster care to be involved with or live with their children. The authors recommend that child welfare systems provide appropriate placements and services to promote responsible fatherhood. Further, Martínez-García et al. ( 2021 ) conducted a photovoice project with parenting foster care alumni regarding parenting during the COVID-19 pandemic. Fathers were represented in the domains of coparenting, reuniting with children, and the joys and challenges of fathering in the pandemic.

This more recent set of studies addresses service provision for parenting youth in care with more depth than previous research. Four studies address services for expectant and parenting youth in care. In their analysis of data from CPS workers, Leigh et al. ( 2007 ) found that services are less likely to be provided to young fathers in care than to mothers in the domains of prenatal care and counseling, parenting skill-building, and childcare. Services provided to fathers include parenting skills classes/fatherhood training, counseling, and job/skill training or vocational training. Further, another study of caregiver perspectives on parenting male and female youth in care around issues of sexuality demonstrated challenges in addressing sexual risk behaviors, identifying barriers to communication, and effective monitoring of sexuality with youth in foster care (Albertson et al., 2018 ). Finally, two publications on a pilot implementation study with young mothers in foster care presented implications for father engagement in services. Findings indicated that home visitors engaged fathers with children of young mothers in care in home visiting sessions, distributed father-specific materials, and provided support around co-parenting and relationship conflicts to approximately a quarter of families (Dworsky et al., 2021 ). More specifically, home visitors conducted 88 visits with 18 young mothers that addressed father involvement. Home visitors discussed working with clients around father incarceration and improving coparenting. The authors point out the importance that future work on home visiting services with expectant or parenting youth in care include fathers in care.

Several new studies on expectant and parenting youth in care omitted fathers from the sample. Of those studies, six discussed fathers of children with mothers in care or provided exclusion rationale. Half of these studies illustrated challenging aspects of relationships between young mothers in care and their children’s fathers (Bermea et al., 2019 ), including the complexities due to technology (Bermea et al., 2019 ) and reports of physical abuse towards children (Eastman, Palmer, et al., 2019 ; Eastman, Schelbe, et al., 2019 ). In their analysis of CPS case records for children with mothers in care, Eastman, Palmer, et al. ( 2019 ), Eastman, Schelbe, et al. ( 2019 )) found that few fathers were involved and supportive and that, in some cases, fathers were indicated as physically abusive towards the children. In another study of CPS involvement of children of mothers in foster care, Eastman and Putnam-Hornstein ( 2019 ) indicated that established paternity was used as a covariate in their analysis, but that fathers were excluded because paternity is difficult to identify using birth records. However, they identify that paternity establishment for fathers of children with a mother in care is a strong protective factor against generation CPS involvement and that future research should focus on the establishment of paternity among fathers in care and the effect it has on generation CPS involvement. In addition, Shpiegel and Cascardi ( 2018 ) studied young mothers in care but indicated a general need for research on fathers in foster care.

Review of Dissertations

We only identified one dissertation (Murray, 2016 ) that focused on fathers in foster care. However, the ages of the fathers ranged from 25 to 54 years of age–well past the age when fathers could have been in foster care. Since this was a qualitative study of the experiences of fathers with foster care histories, and the children they are reporting on could have been born while the fathers were in foster care, we decided to include it in our review. In her qualitative dissertation study of 10 fathers with foster care histories, Murray ( 2016 ) found that most fathers in her study were committed to their role as a father and were, or at least spent significant time being, involved in the lives of their children. However, some fathers experienced challenges with coparenting, substance use, single fatherhood, and child welfare involvement (of their children). While the findings around challenges to fatherhood in this dissertation study may not have direct connections to the foster care system, they are certainly reflective of similar findings on fathers in foster care shared in this review.

Review of Legal Papers

As displayed in Table 2 , we identified 21 papers covering a range of legal topics relating to expectant and parenting foster youth, including five papers on legal reproductive rights (Dudley, 2013 ; Manian, 2016 ; Moore, 2012 ; Pedagno, 2011 ; Wallis, 2014 ), ten papers on parental rights (Baynes-Dunning & Worthington, 2012 ; Benjamin et al., 2006 ; Garlinghouse, 2012 ; Harkness et al., 2017 ; C. C. Katz & Geiger, 2021 ; S. Katz, 2006 ; Pokempner, 2019 , 2020 ; Riehl & Shuman, 2019 ; Stotland & Godsoe, 2006 ), and six papers on legal representation in child welfare courts (Barry, 2017 ; Bonagura, 2008 ; Buske, 2006 ; Fines, 2011 ; Hirst & Jones, 2016 ; Horwitz et al., 2011 ). Among these legal papers on expectant or parenting foster youth, no papers focused solely on fathers in care, three papers made mention of expectant or parenting fathers in care (Benjamin et al., 2006 ; S. Katz, 2006 ; Pokempner, 2020 ), ten papers discussed expectant or parenting fathers and mothers in care together (Barry, 2017 ; Bonagura, 2008 ; Buske, 2006 ; Dudley, 2013 ; Harkness et al., 2017 ; Hirst & Jones, 2016 ; Horwitz et al., 2011 ; Pokempner, 2019 ; Riehl & Shuman, 2019 ; Stotland & Godsoe, 2006 ), seven papers focused solely on pregnant females or mothers in foster care (Baynes-Dunning & Worthington, 2012 ; Fines, 2011 ; Garlinghouse, 2012 ; Manian, 2016 ; Moore, 2012 ; Pedagno, 2011 ), and the parental context of one paper was difficult to ascertain (C. C. Katz & Geiger, 2021 ).

Among the three legal papers that mentioned fathers in foster care, two papers supplied legal guidance for fathers in care but did so in the context of mothers in care. Katz ( 2006 ) and Pokempner ( 2020 ) both state that fathers in foster care have the same rights as mothers in foster care, including placement with their child, access to parental services, and child-parent visitation for nonresident parents. Only one paper focused on legal guidance that was unique to fathers in foster care. Benjamin et al. ( 2006 ) discussed the importance of fathers in foster care to establish paternity for their children and the associated paternal rights of fathers in care who have established paternity, including their legal right to father-child visitation, child custody, and legal representation when their paternal rights are violated.

For the ten papers that discussed legal guidance for fathers and mothers in foster care together, most of the discussions were on the legal rights of parents in foster care generally but centered on mothers in care or used female gender pronouns when discussing parenting foster youth in the aggregate. None of these ten papers shared legal guidance specifically targeting fathers. For example, four of the ten papers (Barry, 2017 ; Bonagura, 2008 ; Hirst & Jones, 2016 ; Stotland & Godsoe, 2006 ) provide legal insight around parental rights while in foster care for parents in care generally, but only mothers in care are discussed when providing legal details or case examples. When references to fathers are made within these papers, the references are in the context of the father of a child with a mother in foster care, not specifically fathers in foster care. In six of the ten legal papers referencing “parents” in foster care generally, two papers (Buske, 2006 ; Harkness et al., 2017 ) only used female gender pronouns, and four papers (Dudley, 2013 ; Horwitz et al., 2011 ; Pokempner, 2019 ; Riehl & Shuman, 2019 ) used no pronouns at all. In another six papers that did not include discussions of fathers, nearly all discussions addressed legal issues commonly associated with female youth, such as pregnancy rights, pregnancy prevention, and reproductive rights. However, among the ten papers that included fathers in foster care but instead focused on mothers in foster care, the rationale for the focus on mothers in care included statements that “father’s involvement is often minimal” (Manian, 2016 , p. 157), “majority of parenting wards who seek to live with their children are female,” and “for convenience” (Stotland & Godsoe, 2006 , p. 2).

Review of Policy and Practice Literature

During our search for policy and practice literature discussing expectant and parenting foster youth, we found many reports, guides, and toolkits that only made passing references to fathers. While reviewing the literature for inclusion into this review, we decided to select exemplar resources that illuminated aspects of fatherhood in foster care not often discussed in research papers on expectant and parenting fathers in foster care. As displayed in Table 3 , resources that we selected for inclusion provide policy- and practice-related supports and guidance pertaining to fathers in care on topics such as data collection, policy directives, client rights, and future research. For example, a publication from Annie E. Casey Foundation ( 2019 ) recommends that data on expectant and parenting fathers in foster care may be improved by using methods to better track expecting fathers in foster care and record efforts to engage and support fathers in care. Publications from Children’s Defense Fund ( 2020 ) and Center for the Study of Social Policy ( 2019 ) detail how evidence-informed and promising practices can be leveraged to better support fathers in foster care through The Family First Prevention Services Act and Title IV-E prevention efforts. Furthermore, literature such as the reports by the Center for the Study of Social Policy (Harper Browne, 2015 ; Primus, 2017 ) uses existing fatherhood research to demonstrate how fathers in foster care can positively impact their children’s lives, be better served by father-focused foster care services, and effectively exercise their paternal rights in the child welfare system.

Strengths and Limitations

This scoping review has several strengths. One strength is that this is the first review to articulate the current state of literature on expectant and parenting foster youth as it relates to fathers in foster care. Our findings on the lack of available information on fathers in foster care demonstrate the need for further inquiry by researchers, legal representatives, policy makers, and practitioners on the outcomes, needs, and experiences of fathers in foster care. Another strength is that this review articulates gaps in practice-, legal-, and policy-related literature that should be further developed to improve our knowledge on fathers in foster care. Addressing these gaps in the literature will likely lead to improved research, better services, stronger legal representation, and more effective policies for fathers in foster care.

However, findings in this scoping review are subject to at least eight limitations. First, our scoping review may have missed some literature due to our search strategies and databases we used. Although we carefully chose key search terms and databases to conduct searches for this scoping review, eligible literature related to fathers in foster care could have been missed at screening. For example, we may have missed eligible literature that did not include our specific search terms, was not electronically searchable, or was not archived electronically in the databases we used. Second, our scoping review does not include literature published prior to 1989, written in a language other than English, and not based in the United States. While we chose search criteria that was most relevant to recent research conducted in the United States, this scoping review may lack historical, cultural, or geographical context that is relevant to understanding fathers in foster care. Third, our scoping review includes emerging themes and findings that were derived from only two researchers. While consensus was researched among key themes and findings by researchers with practice and research expertise with expectant and parenting foster youth, other researchers may find alternative themes or competing findings. Fourth, our scoping review lacks critical appraisal of included literature. While we comprehensively share themes from literature on fathers in foster care, we do not individually assess the quality of research evidence in peer-reviewed journal articles nor do we ascertain the validity of information contained in reports, dissertations, white papers, or grey literature. Fifth, terminology used across sources of evidence varied in conceptualization. For example, some studies use the term “fathered” or “paternity” to represent a male getting a female pregnant, a male who got a female pregnant resulting in a birth of a child, or both. Additionally, some sources used terms synonymously that have quite different meanings. For example, some sources used “expectant” with fathers to denote a male who impregnated a female but did not share findings related to this specific stage of fatherhood (e.g., fathers awaiting the birth of a child). We have tried to consistently interpret findings using consistent language (e.g., impregnation, expectancy, fathering, and paternity) but we may have misinterpreted findings where authors used ambiguous father-related terms. Sixth, ages of young fathers in foster care vary in the studies we reviewed. Studies included in our review focused roughly on ages 18–21 years, but some samples included fathers younger than 18 years old (i.e., not in extended foster care), between 18 years old and 21 years old (i.e., possibly in extended foster care), older than 21 years old (i.e., beyond the age of extended foster care) or all three. We were unable to assess the extended to which fathers' age (e.g., adolescent, early adult, or emerging adult), foster care status (e.g., in care, left care, or left care and returned to care), or extended foster care status (e.g., in extended foster care or not in extended foster care) affected the lived experience in young fathers in care. This limits our ability to understand how fathers' developmental status or foster care characteristics affects fatherhood in foster care. Furthermore, our findings, implications, and recommendations are based on findings that include fathers who are more likely to be in care, engaged with caseworkers, or open to sharing their experiences of being a father in foster care. Seventh, the race and ethnicity of young fathers in foster care vary in the studies we reviewed. While we share key findings by race and ethnicity when reported, there was a lack of findings or information focused on racial and ethnic minority fathers in care. The findings we share do not adequately shed light on the experience of fatherhood for racial and ethnic minority fathers in foster care. Eighth, our review does not include father-specific findings for single fathers, sexual minority fathers (SMF), gender minority fathers (GMF), or all three. The overwhelming parental structure in the studies we reviewed were father-mother (e.g., father in foster care did not give birth, mother gave birth). We did not identify any study that investigated single father parental structures (e.g., father, SMF, or GMF in foster care gave birth, adopted, or assumed guardianship; no coparenting father or mother) or father-father parental structures (e.g., father, SMF, or GMF in foster care gave birth, adopted, or assumed guardianship; other father did not give birth, adopt, or assume guardianship). Therefore, findings we review and recommendations we make are limited to father-mother parental structures.These limitations potentially undermine the validity of our themes, affect the generalizability of our findings, and may bias the recommendations we make for research-, practice-, legal-, and policy-related audiences.

The existing research on expectant and parenting fathers in foster care spans 30 years yet remains sparse both conceptually and methodologically. Research reporting the incidence of paternity among young fathers in care presents a broad range of rates, indicating challenges with accurate reporting of data. The current literature reports rates of impregnation ranging from 27.5 to 49%, with many rate estimates in between. Prevalence rates for expectant fathers in foster care are limited since current efforts to track and monitor fathers in care are limited to caseworkers and fathers’ self-reports, which are likely under counted. Furthermore, there are currently no mechanisms enforcing child welfare agencies to track and report father involvement in the lives of their children. This makes it difficult to determine the kinds of father-focused services to provide to young fathers in foster care. For much of the research on fathers in care, findings are provided in the aggregate, making it difficult to determine findings that are unique to fathers.

The lack of focused research on fathers in foster care is problematic since it gives little insight on how to best support and prepare a population of young fathers who are simultaneously preparing to leave the foster care system, preparing for adulthood, and entering young fatherhood. For example, there is a general lack of empirical research on outcomes of fathers in foster care during the transition to adulthood that may affect their ability to parent their children, such as educational attainment, employment rates, wages, housing stability, victimization, risky behaviors, or mental health issues. Furthermore, There is also relative lack of studies investigating outcomes of or differences between subgroups of fathers in foster care, such as residency with child, age of child, living arrangement with partner, racial/ethnic identity, or sexual minority status. Furthermore, few studies explore fatherhood in the context of direct or indirect father-child interaction theorized as components (e.g., engagement, accessibility, responsibility; Lamb, 2000 ) or tasks (e.g., positive engagement, warmth/responsiveness, control, indirect care, process responsibility; Pleck, 2010 ).

Despite the lack of research and knowledge about young fathers in care, research exists on child welfare involved fathers with children in the foster care system that may shed light onto fathers in foster care. For example, the child welfare system has historically ignored, undervalued, and failed to fully engage fathers as agents of change (Jaffe, 1983 ). Fathers who do engage with the child welfare system often face racial and ethnic experiences of racism and discrimination, particularly among Black fathers (Icard et al., 2017 ). For example, studies have attributed low father engagement among Black fathers to racialized perceptions and bias among White child welfare caseworkers, attorneys, and judges (Arroyo et al., 2019 ; Harris & Hackett, 2008 ). Studies also show that child welfare caseworkers’ can hold negative views of fatherhood roles, such as fathers not being beneficial to child welfare outcomes, not being as needed as mothers, and being harmful to families (Baum, 2017 ; Bellamy, 2009 ; Brewsaugh et al., 2018 ; Brown et al., 2009 ; Coakley, 2013 ; Dominelli et al., 2011 ; Lundahl et al., 2020 ; Scourfield, 2001 ).

Given that the child welfare system that struggles to track, engage, and meet the needs of fathers with children in the foster care system as well as young fathers in foster care, more rigorous research is needed to ensure fathers in care are fully supported as they transition out of care into young adulthood and early fatherhood. In alignment with the prevention goals of the Family First Prevention Services Act and Title IV-E, efforts to improve services targeting fathers in foster care may help break the cycle of intergenerational maltreatment of and foster care involvement. To this end, we would like to make the following recommendations considering the findings contained in our review. First, future research should examine ways to better track expectant fathers in care and collect information on diverse forms of father involvement for parenting fathers in care. The improved data on fathers in foster care may likely provide the insight needed to tailor services aiming to strengthen paternal bonds, increase father involvement, and further develop coparenting skills. Second, legal advocates and researchers should examine how the child welfare system affects the paternal rights of fathers in care. An understanding is needed of how the establishment of paternity can be both helpful and harmful to fathers in care, especially when a father encounters a rigid and punitive child support system. For example, the establishment of paternity among fathers in care can strengthen the rights of fathers in care but potentially weaken their ability to meet their paternal obligations or employment and education requirements of extended foster care. Third, policymakers and practitioners should explore how existing fatherhood policies, practices, and interventions may be leveraged in foster care settings to improve the child and family outcomes of fathers in foster care. Such efforts may be effective in interrupting the cycle of intergenerational maltreatment among fathers in foster care and break the cycle of foster care involvement for children born to fathers in foster care.

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Harty, J.S., Ethier, K.L. Fatherhood in Foster Care: A Scoping Review Spanning 30 Years of Research on Expectant and Parenting Fathers in State Care. Child Adolesc Soc Work J 39 , 693–710 (2022). https://doi.org/10.1007/s10560-022-00848-2

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When parents are unable, unwilling or unfit to care for a child, the child must find a new home. In some cases, there is little or no chance a child can return to their parents' custody, so they need a new permanent home. In other situations, children only need a temporary home until their parents' situation changes. In any case, the children need somewhere to stay until a permanent home is possible. Hundreds of years ago, providing this temporary home fell informally to families, neighbors and often to the church. As cities grew larger and more and more children in a community ended up in this unfortunate situation, government institutions took up much of the responsibility.

Over the past hundred years, the trend in North America and Europe has shifted away from orphanages and towards foster homes. The underlying philosophy of foster care is that children are better off, emotionally and psychologically, in a home environment, with someone filling the role of a parent. The logic is that with one or more foster parents taking care of a smaller number of children, the child should have more of the attention and love they need to grow into healthy adults. Today, there are roughly half a million U.S. children in the foster care system.

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What are the primary goals of foster care?
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New study finds that Black and Latinx youth online engagement can foster a positive sense of self

Building on data from a project led by USC Rossier professor Brendesha Tynes, Naila Smith is the lead author of a new research paper that examines how online spaces created by Black and Latinx youth benefit their ethnic-racial identity development.

Image of a hand typing on a laptop computer.

With social media use among many youth nearly constant, we often read reports of the adversities that young people encounter online, from impacts on their mental health to the dangers that meeting malicious strangers in real life can pose. While the negative effects of social media usage for teens should not be discounted, there are some benefits for Black and Latinx youth in particular as they navigate their ethnic-racial identity (ERI) online. Brendesha M. Tynes, Dean's Professor of Educational Equity at the USC Rossier School of Education, is a co-author of a newly published article led by Naila A. Smith, assistant professor of education at the University of Virginia, and supported by Daisy E. Camacho-Thompson, that shows how the race/ethnic- and civic-related online experiences of Black and Latinx adolescents are connected to their ERI development.

Black and Latinx youth tend to spend more time engaged online than their White peers, and they also spend more time than youth of other ethnic-racial groups making sense of what their ERI means to them and engaging civically and politically online. Exploring and seeking out information about one’s race/ethnicity, refining how one understands one’s race/ethnicity, and feeling positively or negatively about one’s race/ethnicity are factors in ERI development.

Research on Black and Latinx adolescents’ online experiences has shown that they do face additional risks such as online racial discrimination and hate and viewing traumatic racial content. Online social connection can help Black and Latinx youth cultivate a sense of belonging to a social group that may help them make meaning of their identity as they encounter some of the harms in online spaces. This newly published article builds on some of Tynes’ previous work about how content youth are exposed to online impacts their ERI exploration.

Using data from the Teen Life Online and in Schools Project (TLOS), which Tynes directs, Smith and her team found that youth who can establish relationships online with friends of the same race/ethnicity experience more adaptive outcomes over time, meaning that in fostering online relationships with same-age, same ethnic/racial group peers these young people can better cope with some of the harmful information that they encounter online.

Tynes’s TLOS data was one of the first datasets to investigate teens' online experiences across multiple years (three years) using both survey and interview data and a multi-racial sample of adolescents. While Tynes created the dataset, her collaborators and mentees led studies that were not previously included in the original proposal.

Smith’s research interests include the development of racial and ethnically minoritized youth over time. She was curious about youths’ experiences in the online space over time and sought to examine the role of socio-cultural resources and assets in the experiences of Black and Latinx youth.

“I was really interested in examining what factors contributed to ethnic-racial identity development, which is a sociocultural asset for Black and Latinx youth. In examining aspects of youths’ race- and civic-related online experiences and looking at how young people curate or create online spaces that meet their needs, we were able to show that there are these different ways that Black and Latinx adolescents are engaging online in their exploration of their world and their ethnic-racial background,” said Smith.

The study also found that earlier online activity is connected with ERI development one year later, meaning that race and civic-related online activities are important for young people’s feelings and behaviors in terms of their future ERI. Having a clearer idea of what their ERI means to Black and Latinx youth is associated with having better outcomes academically and mental health benefits.

“A major goal of the TLOS Project was to see what cultural resources youth bring to online spaces that might buffer them from some of the negative outcomes we might see that have been published in journals and in news articles. I wanted to paint a more holistic view of young people’s experiences online,” said Tynes. “Most of what we have published has been on the negative side, but I’m excited to have this manuscript focus on the positive experiences that young people are having online.”

Smith started her collaboration with Tynes because of her advocacy for students and her deep knowledge of youth development. The two met at an academic conference when Smith was a graduate student.

“I wanted to meet Brendesha specifically because she was the foremost scholar on the online experiences of Black and Latinx youth, and I wanted to develop my expertise in the role of the internet in youth development. Her tremendous productivity and creativity are built on deep knowledge of a wide range of fields that inform her innovation in thinking about how we can support Black and Brown youth in their development specifically in online spaces,” concluded Smith.

Smith and her co-authors want teachers and parents to know that Black and Latinx youth can benefit positively from the time they spend online, and that access to online information and experiences can support meaningful identity exploration. According to Smith, parents and teachers can help guide youth in their online ERI exploration and engage them in conversations about what they are learning to help them process the information that they are consuming. In schools where Black and Latinx youth may be in the minority or where they may not have access to materials in the curriculum that allow them to learn about their cultures and identities, supporting online activities around ERI is even more critical.

“With new laws banning certain books or talking about Black people’s history in the classroom in some states, people have to make an effort to make sure that kids are getting what they need to explore who they are,” said Tynes. “The digital literacy that young people need to sift through stereotypes and misinformation about their racial-ethnic group becomes more important in these places where the students cannot rely on their teachers to provide accurate information.”

The team’s findings may be used to support the creation of interventions to help adolescents create and curate online spaces where they can meet peers in their age range and ethnic/racial groups to help them with their relationship-building skills.

“Instead of the internet being a place where people are in constant danger, youth can craft spaces where their experiences are actually beneficial for their development, and these young people are doing that on their own,” said Tynes . “Parents and educators can support that exploration and provide guidance.”

Tynes is supporting that guidance by building a digital literacy and mental health intervention with a $4.6 million Transformational Research Award NIH grant. With the funds, Tynes seeks to research and provide adolescents with tools to cope with the negative messages they receive online and the skills to use digital media as a tool to excel in school. Tynes’s goal is to help youth thrive in their everyday lives as they navigate digital spaces. The newly designed, first-of-its-kind platform will have several modules and virtual reality experiences to help adolescents practice how to respond to some of their experiences online. The alpha version of this intervention is scheduled to launch in September 2024.

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What public k-12 teachers want americans to know about teaching.

Illustrations by Hokyoung Kim

At a time when most teachers are feeling stressed and overwhelmed in their jobs, we asked 2,531 public K-12 teachers this open-ended question:

If there’s one thing you’d want the public to know about teachers, what would it be?

We also asked Americans what they think about teachers to compare with teachers’ perceptions of how the public views them.

Related: What’s It Like To Be a Teacher in America Today?

A bar chart showing that about half of teachers want the public to know that teaching is a hard job.

Pew Research Center conducted this analysis to better understand what public K-12 teachers would like Americans to know about their profession. We also wanted to learn how the public thinks about teachers.

For the open-end question, we surveyed 2,531 U.S. public K-12 teachers from Oct. 17 to Nov. 14, 2023. The teachers surveyed are members of RAND’s American Teacher Panel, a nationally representative panel of public K-12 school teachers recruited through MDR Education. Survey data is weighted to state and national teacher characteristics to account for differences in sampling and response to ensure they are representative of the target population.

Overall, 96% of surveyed teachers provided an answer to the open-ended question. Center researchers developed a coding scheme categorizing the responses, coded all responses, and then grouped them into the six themes explored in the data essay.

For the questions for the general public, we surveyed 5,029 U.S. adults from Nov. 9 to Nov. 16, 2023. The adults surveyed are members of the Ipsos KnowledgePanel, a nationally representative online survey panel. Panel members are randomly recruited through probability-based sampling, and households are provided with access to the Internet and hardware if needed. To ensure that the results of this survey reflect a balanced cross section of the nation, the data is weighted to match the U.S. adult population by gender, age, education, race and ethnicity and other categories.

Here are the questions used for this analysis , along with responses, the teacher survey methodology and the general public survey methodology .

Most of the responses to the open-ended question fell into one of these six themes:

Teaching is a hard job

About half of teachers (51%) said they want the public to know that teaching is a difficult job and that teachers are hardworking. Within this share, many mentioned that they have roles and responsibilities in the classroom besides teaching, which makes the job stressful. Many also talked about working long hours, beyond those they’re contracted for.

“Teachers serve multiple roles other than being responsible for teaching curriculum. We are counselors, behavioral specialists and parents for students who need us to fill those roles. We sacrifice a lot to give all of ourselves to the role as teacher.”

– Elementary school teacher

“The amount of extra hours that teachers have to put in beyond the contractual time is ridiculous. Arriving 30 minutes before and leaving an hour after is just the tip of the iceberg. … And as far as ‘having summers off,’ most of August is taken up with preparing materials for the upcoming school year or attending three, four, seven days’ worth of unpaid development training.”

– High school teacher

Teachers care about their students

The next most common theme: 22% of teachers brought up how fulfilling teaching is and how much teachers care about their students. Many gave examples of the hardships of teaching but reaffirmed that they do their job because they love the kids and helping them succeed.

“We are passionate about what we do. Every child we teach is important to us and we look out for them like they are our own.”

– Middle school teacher

“We are in it for the kids, and the most incredible moments are when children make connections with learning.”

Teachers are undervalued and disrespected

Some 17% of teachers want the public to know that they feel undervalued and disrespected, and that they need more public support. Some mentioned that they are well-educated professionals but are not treated as such. And many teachers in this category responded with a general plea for support from the public, which they don’t feel they’re getting now.

“We feel undervalued. The public and many parents of my students treat me and my peers as if we do not know as much as they do, as if we are uneducated.”

“The public attitudes toward teachers have been degrading, and it is making it impossible for well-qualified teachers to be found. People are simply not wanting to go into the profession because of public sentiments.”

Teachers are underpaid

A similar share of teachers (15%) want the public to know that teachers are underpaid. Many teachers said their salary doesn’t account for the effort and care they put into their students’ education and believe that their pay should reflect this.

“We are sorely underpaid for the amount of hours we work and the education level we have attained.”

Teachers need support and resources from government and administrators

About one-in-ten teachers (9%) said they need more support from the government, their administrators and other key stakeholders. Many mentioned working in understaffed schools, not having enough funding and paying for supplies out of pocket. Some teachers also expressed that they have little control over the curriculum that they teach.

“The world-class education we used to be proud of does not exist because of all the red tape we are constantly navigating. If you want to see real change in the classroom, advocate for smaller class sizes for your child, push your district to cap class sizes at a reasonable level and have real, authentic conversations with your child’s teacher about what is going on in the classroom if you’re curious.”

Teachers need more support from parents

Roughly the same share of teachers (8%) want the public to know that teachers need more support from parents, emphasizing that the parent-teacher relationship is strained. Many view parents as partners in their child’s education and believe that a strong relationship improves kids’ overall social and emotional development.

“Teachers help students to reach their potential. However, that job is near impossible if parents/guardians do not take an active part in their student’s education.”

How the U.S. public views teachers

While the top response from teachers in the open-ended question is that they want the public to know that teaching is a hard job, most Americans already see it that way. Two-thirds of U.S. adults say being a public K-12 teacher is harder than most other jobs, with 33% saying it’s a lot harder.

And about three-quarters of Americans (74%) say teachers should be paid more than they are now, including 39% who say teachers should be paid a lot more.

Americans are about evenly divided on whether the public generally looks up to (32%) or down on (30%) public K-12 teachers. Some 37% say Americans neither look up to or down on public K-12 teachers.

A bar chart showing that teachers’ perceptions of how much Americans trust public K-12 teachers to do their job well is more negative than the general public’s response.

In addition to the open-ended question about what they want the public to know about them, we asked teachers how much they think most Americans trust public K-12 teachers to do their job well. We also asked the public how much they trust teachers. Answers differ considerably.

Nearly half of public K-12 teachers (47%) say most Americans don’t trust teachers much or at all. A third say most Americans trust teachers some, and 18% say the public trusts teachers a great deal or a fair amount.

In contrast, a majority of Americans (57%) say they do trust public K-12 teachers to do their job well a great deal or a fair amount. About a quarter (26%) say they trust teachers some, and 17% say they don’t trust teachers much or at all.

Related: About half of Americans say public K-12 education is going in the wrong direction

How the public’s views differ by party

There are sizable party differences in Americans’ views of teachers. In particular, Democrats and Democratic-leaning independents are more likely than Republicans and Republican leaners to say:

They trust teachers to do their job well a great deal or a fair amount (70% vs. 44%)
Teaching is a lot or somewhat harder when compared with most other jobs (77% vs. 59%)
Teachers should be paid a lot or somewhat more than they are now (86% vs. 63%)

In their own words

Below, we have a selection of quotes that describe what teachers want the public to know about them and their profession.

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A Systematic Review on Foster Parents’ Psychological Adjustment and Parenting Style—An Evaluation of Foster Parents and Foster Children Variables

Elisa mancinelli.

1 Department of Socialization and Developmental Psychology, University of Padova, Via Venezia 8, 35121 Padova, Italy; moc.liamg@aiagicralled (G.D.); [email protected] (S.S.)

2 Centre for Foster Care and Family Solidarity (Centro Affidi e Solidarietà Famigliare—Servizi Sociali del Comune di Padova), Via del Carmine 13, 35137 Padova, Italy

Gaia Dell’Arciprete

Silvia salcuni, associated data.

The current systematic review aimed to evaluate the variables influencing foster parents’ parenting stress, distress and parenting style, thereby supporting their adjustment and well-being as well as that of foster children. A PRISMA-guided search was conducted in three databases. Observational studies examining parenting stress, parenting distress (subsuming anxiety, depression and stress symptoms) and parenting style—all assessed through validated tools—were considered. A total of 16 studies were included, comprising N = 1794 non-relative foster parents (age range = 30–67 years). Results showed heightened parenting stress over time, both overall and compared to parents at large. Neither foster parents’ nor foster children’s socio-demographic characteristics significantly contributed to the increase in parenting stress; yet child-related stress and children’s externalizing problems were its main predictors. Foster parents’ couple cooperation was associated with reduced parenting stress. Moreover, the authoritative parenting style was associated with parental warmth, while the authoritarian style was associated with foster parents’ greater perceived burden, greater criticism and rejection toward the foster child. Evidence supports the mutual influence between foster parents and children. Foster care services should support foster parents’ needs within a concentric modular system, to ultimately provide better care for both foster parents and children.

1. Introduction

Non-relative foster parents are full-time—temporarily—figures providing a safe shelter for children and adolescents within the foster care system [ 1 ]. Foster parents take on the responsibility of caring and nurturing them, supporting their psychological adjustment and physical health, as well as ensuring proper schooling and education until they can either be reunited with their birth families, get adopted, or age out of foster care [ 1 , 2 , 3 ]. Family foster care is generally the preferred option to take care of this youth [ 4 , 5 , 6 ] and epidemiological data show that, as of 2016, about 790,000 children from industrialized countries, aged between 0 to 17 years, resided in foster care [ 7 ].

The foster parent role is complex and demanding and includes multi-level stressors that consistently exceed the ordinary challenges that parenthood poses [ 1 , 8 ]. Among the most commonly reported is the complexity of both the child welfare system and its policies and procedures [ 9 , 10 , 11 ]: Many foster parents report a series of unmet needs and dissatisfaction with children’s agencies, which they often describe as unresponsive to their request, not providing them with appropriate emotional support, financial assistance and proper training and not adequately including them in case planning and management [ 9 , 12 , 13 ]. A further stressor often reported is the relationship with foster children’s biological families [ 4 , 14 , 15 ], whose frequently displayed animosity or plain hostility can make scheduled visits highly stressful [ 15 ]; foster parents, for their part, might be concerned with the competency of biological parents, especially if their foster children are expected to return under their care, which they often regard as dysfunctional, hence the additional stressor [ 4 , 10 , 15 ]. In addition to all these challenges, foster children themselves might be an added source of stress [ 16 , 17 ]: As a matter of fact, they come from situations of maltreatment and neglect, and literature shows how early exposure to trauma, abuse and neglect has severe repercussions in several areas leading, for instance, to developmental delays [ 18 ], cognitive, emotional and behavioral problems [ 19 , 20 , 21 , 22 ], attachment-related difficulties [ 20 ] and even chronic medical health problems [ 18 , 23 ]. This, on the whole, identifies foster children as problematic children with special educational needs, particularly challenging to take care of, especially since foster parents often do not feel sufficiently trained to deal with such difficulties [ 11 , 24 , 25 ].

Non-relative foster parents are, though, to be distinguished from kin carers who, albeit playing the same role, present different characteristics and stressors, which must not be disregarded. Kinship caregivers are generally grandparents, aunts, uncles or cousins who take over the role of foster parents for the offspring of immediate or extended family members [ 26 ]. Differently from non-relative foster care, kinship care allows the preservation of the child’s blood ties, thus providing children with a more stable family context [ 27 ]; this, on the other hand, implies that kin carers need to contain and minimize the contact and negative influence of abusive birth parents upon the child to a greater extent compared to non-relative foster parents [ 28 ]. Moreover, from an institutional point of view, they are less closely monitored and regulated by state child-welfare departments than non-relative foster parents; this reflects in a heightened need of standards, guidelines and proper training [ 28 ] to help them deal with all the difficulties and issues of foster children, which nonetheless are scarcely provided by the welfare system [ 29 , 30 ]. Lastly, it is noteworthy that, overall, kin carers are configured as an heterogeneous group, whose characteristics and risk factors are more complex to account for [ 31 ]. This might limit findings’ generalizability to the broader foster-care population, thereby supporting the need to properly distinguish the population under investigation.

Everything considered, the experience of being a foster parent can take a toll on individuals’ overall well-being [ 8 , 11 ], putting them “at risk” of experiencing high parenting stress and distress, while also being more likely to suffer from mental and physical health issues [ 8 , 25 ], which might hinder their ability to provide consistent levels of care to children [ 11 ]. In this regard, parental distress describes an overall unpleasant emotional experience that parents have in relation to their child and their parental role, and subsumes symptoms of anxiety, depression and stress [ 32 , 33 , 34 ]. Differently, parenting stress refers to the specific stress that results from parents’ perception of a mismatch between the demands of parenting and their available resources [ 35 , 36 ]. Some studies [ 37 , 38 , 39 , 40 ] have highlighted how parenting stress and distress symptoms influence parenting practices and overall parenting style, which is noteworthy considering their relevance for aa foster placement’s success or disruption [ 4 ]. While parental practices are the specific behaviors and actions that parents enact when interacting with their children (e.g., helping them do their homework, asking them about their hobbies, etc.), parenting style regards parents’ overall attitude and behavior, which defines the emotional climate in which they raise their children [ 41 , 42 , 43 ]. Different parenting styles have been defined, with some regarded as less adaptive than others [ 41 , 42 , 43 , 44 ]: The authoritative parenting style is considered as the most adaptive and is characterized by clear boundaries and limits set for children by their parents, who nonetheless also display high sensitivity and emotional warmth; differently, the permissive parenting style, although also characterized by high sensitivity and warmth, foresees an indulgent parental behavior and overall lack of discipline, which renders it maladaptive. Further maladaptive parenting styles are the authoritarian and neglectful styles: The former is characterized by strict discipline and high demands but low levels of sensitivity and emotional support, whereas the latter is characteristic of parents who are neither emotionally involved nor set rules and demand discipline from children [ 41 , 42 , 43 , 44 ]. Bearing in mind the higher prevalence of psychosocial disturbances of foster children [ 23 , 29 , 45 ], research studies highlighted how more unfavorable parenting, characterized by harsh or inconsistent punishment and negative control, criticism and rejection, is associated with children’s emotional and behavioral problems [ 38 , 39 ]. In this regard, it is noteworthy that Lamb [ 46 ] showed that children’s adjustment is in little to no part determined by the family’s structure or the biological relatedness to parents, but is instead consistently affected by the quality of both parenting and the relationship between parents. As such, differences between foster mothers vs. fathers should be acknowledged, as the foster care situation may be handled and experienced differently by the two, even though most tasks seem equally shared between parental figures [ 47 ]. Notwithstanding this, differences in parenting and associated well-being and adjustment have been scarcely investigated within the foster-care context [ 6 , 47 , 48 ].

The intricate interplay between both foster parents’ and children’s behavior and well-being might be better understood through a transactional framework, which accounts for the dynamic processes of mutual influence embedded within families [ 49 ]. This specific theoretical framework states that family dynamics are not to be considered unidirectional, but rather bi- or, better yet, multidirectional and on several levels: Characteristics of individual members shape their relationships with others, but dyadic interactions within the family also have an impact on one another and are, in turn, influenced by family and contextual factors. These mutual influences, unfolding over time, continuously determine the specific family setup and functioning and thereby affect the development of children as well [ 50 , 51 , 52 ]. Consequently, a deeper understanding of the interplay between foster parents and children variables is relevant, as it could provide a more detailed perspective of the foster-care experience. This would, in turn, be an added source of information on which to base the support necessary to favor the well-being of the whole foster family nucleus. Accordingly, Kaasbøll and colleagues [ 3 ] argued that having a clearer understanding of all the micro- and macro-processes taking part in such a setting would be useful to develop and implement better trainings and interventions, specifically tailored to the needs and challenges of foster families. This would not only benefit foster parents in terms of specific parenting skills gained and overall enhanced well-being and satisfaction, but is expected to also have a positive impact on foster children’s adjustment and development, increasing chances of a successful placement and, thus, ultimately improving the broader foster-care system [ 3 , 8 , 25 ].

In light of all this, the current systematic review aims to identify variables associated with foster parents’ psychological adjustment, referring to parenting stress, parental distress (subsuming anxiety, stress and depressive symptoms) and parenting style. The intent is to shed light on which foster parents’ and/or foster children’s variables influence foster parents’ psychological adjustment and parenting style. This would provide insights relevant to adequately support and guide them within their foster parents’ role and, in so doing, promoting foster children’s adjustment and development as well.

2. Materials and Methods

The current systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 53 ]. The related protocol was approved in July 2021 and is available on PROSPERO (Registration Number: CRD42021261657). The PRISMA Checklist [ 53 ] is available within the supplementary materials (Table S1) .

2.1. Eligibility Criteria

2.1.1. study design and characteristics.

Observational studies of any design (e.g., cohort studies, case-control studies, case-series studies, cross-sectional studies) that were subject to peer-reviewing, published in academic journals and written either in English or Italian were included; reviews, intervention studies, dissertations, conference abstract, editorials and commentaries were excluded.

2.1.2. Participants

Eligible participants were non-relative, licensed foster parents; no restrictions were posed for age, gender, ethnicity, sexual orientation or marital status, for foster parents nor for children. Inclusion criteria were intentionally left broad to maximize information regarding the foster-care experience as considered on the whole.

Exclusion criteria were (1) being kinship foster parents; (2) being therapeutic or professional foster parents that had undergone specific and more advanced training; (3) being adoptive parents; (4) being foster parents from group homes; (5) being foster parents of children with disabilities or medical conditions; (6) including non-relative foster parents together with one or more of the abovementioned populations, thus not providing separate information as regards non-relative foster parents vs. the other types of caregivers (see the supplementary materials; Table S2 ). These exclusion criteria were enacted due to the specificity, in terms of characteristics and stressors, of each of the populations mentioned, which determine the need to differentiate them from the population of interest (i.e., non-relative foster parents).

2.1.3. Outcomes

The outcomes of interest were (1) parenting stress, (2) parental distress (referred to symptoms of anxiety, stress and depression) and (3) parenting style.

Outcomes had to be assessed with validated tools. Studies were excluded if they assessed none of these outcomes or if they did not use validated tools.

2.2. Search Strategy

Three electronic databases (i.e., Web of Science, PubMed and PsycINFO) were systematically screened in May 2021 using the following two research keys: (parenting) AND (foster care) AND (stress) AND (distress) AND (anxiety) AND (depression); (parenting) AND (foster care) AND ((stress) OR (distress) OR (anxiety) OR (depression)). Search terms were intentionally left broad to maximize the chances of identifying potentially eligible studies. No search restrictions were posed (e.g., no restrictions in terms of language or publication year, etc.); unpublished studies were not sought.

The title and abstracts of the studies resulting from the electronic search were screened independently by two authors (EM and GDA); potentially eligible studies were then read in full text by the same authors, to assess the fulfillment of the inclusion criteria. The whole process was carried out in a double-blind fashion, and any conflict or discrepancy that occurred in any phase was resolved by discussion or by consulting the third author (SS) until consensus was achieved.

2.3. Data Extraction and Management

Data extraction was independently performed by two authors (EM and GDA) and any disagreement was resolved by consulting the third author (SS). The data extracted were the study’s DOI, the first author’s name, publication year, the study’s geographical location, foster parents’ and children’s characteristics (e.g., age, gender, ethnicity, duration of fostering), outcomes of interest and assessment tools used.

2.4. Quality Assessment

The methodological quality of the included studies was independently assessed by two authors (EM and GDA) and any conflict was resolved by consulting with the third author (SS). The “Joanna Briggs Institute” (JBI) Critical Appraisal Tools for Systematic Reviews [ 54 ] were used. These comprise different checklists based on the specific study design, investigating their methodological quality and the degree to which the study has addressed potential biases through their study design, conduct and analyses performed. Being design specific, different JBI checklists were used according to the design of the included studies. These checklists do not provide a final quality score nor specific criteria to define the overall risk of bias of a study; therefore, judgment on the methodological quality and potential risk of bias of each study was assessed qualitatively, through discussion among the authors, and based on the responses (chosen between “Yes”, “No” and “Unclear”; “Not applicable” was reported where appropriate) given to each question of the checklists investigating the fulfillment of the criteria needed to reduce the studies’ risk of bias (see the supplementary materials; Tables S3–S5 ).

The JBI Checklists were not employed to assess studies’ eligibility.

3.1. Search Results

As shown in Figure 1 , the initial database search yielded a total of 12,245 studies. Upon removing duplicates, the first title and abstract screening of 12,179 papers was performed, resulting in a total of 121 studies selected for full-text screening. Then, 105 studies were excluded, in line with inclusion and exclusion criteria, and 16 studies were finally included. Excluded studies, with reasons for exclusion, are reported in the supplementary materials (Table S2) .

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PRISMA 2020 flow diagram.

3.2. Studies Characteristics

Studies’ characteristics are reported in Table 1 . The included studies were conducted between 2011 and 2020 and comprised a total of N = 1794 non-relative foster parents, whose ages ranged between 30 and 67 years; n = 2 studies did not report foster parents’ age [ 55 , 56 ]. Of all the included studies, n = 9 included foster mothers [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ] while n = 5 [ 66 , 67 , 68 , 69 , 70 ] showed a more homogeneous gender distribution among foster parents; n = 2 studies [ 55 , 56 ] did not report information on foster parents’ gender distribution. As shown in Table 1 , foster parents were mostly married, albeit n = 6 studies [ 55 , 56 , 62 , 64 , 68 , 69 ] did not report information on foster parents’ marital status. Only two studies [ 66 , 67 ] provided information on foster couples’ sexual orientation.

Studies’ characteristics.

Note. * Longitudinal study, whereby all descriptive information reported were collected at baseline; n.r. = not reported; n.a. = not applicable; F = females; M = males; FM = foster mothers; FF = foster fathers; FC = foster children; GCE = General Certificate of Education; GED = General Educational Development.

Around half of the studies [ 55 , 56 , 57 , 59 , 60 , 66 , 67 , 68 , 69 ] provided information on foster children, showing quite a homogenous gender distribution. Foster children were aged 23 months (i.e., almost 2 years) to 17.8 years. In two studies only [ 66 , 67 ], children were over 10 years of age. The duration of fostering was only reported in n = 8 studies [ 55 , 56 , 57 , 59 , 60 , 66 , 67 , 68 ] and ranged from 78.27 days (i.e., around 2 and a half months) to 87.3 months (i.e., over 7 years). Furthermore, n = 8 studies [ 55 , 56 , 57 , 59 , 60 , 66 , 68 , 69 ] investigated the effect of foster children’s psychosocial variables on either foster parents’ parenting stress or parental style, specifically focusing on children internalizing and externalizing problems. In this regard, as reported in Table 2 , n = 13 studies investigated parenting stress, n = 1 investigated foster parents’ distress referring to anxiety and depression symptoms and n = 2 explored parenting style.

Results summary.

Note. # Case-Control study; § Case-Series Study; ACEs = Aversive Child Experiences; BSI = Brief Symptoms Inventory; CBCL = Child Behavior Checklist; PSI = Parenting Stress Index; PSI-SF = Parenting Stress Index-Short Form; PSQ = Parental Stress Questionnaire; * the study only considered the PSQ’s Parental Stress subscale; PSS = Parental Stress Scale; RDS = Rules and Demands Scale.

Lastly, n = 3 studies [ 55 , 57 , 68 ] compared non-relative foster parents with biological parents raising their birth children outside the foster care system (hereafter “biological control parents”), one study [ 61 ] compared foster parents with kin parents and one study compared foster mothers with both kin carers (all females) and biological control mothers [ 62 ].

3.3. Outcomes’ Assessment Tools

As shown in Table 2 , parenting stress was assessed either through the Parenting Stress Index (PSI), its short form (PSI 4th edition Short Form [PSI-4-SF]) [ 36 ], the Parental Stress Scale (PSS) [ 71 ] or the Parental Stress Questionnaire (PSQ) [ 72 ]. Specifically, the PSI [ 36 ] is a self-report measure that assesses parents’ perceived parenting stress related to the relationship with their children, aged 1 to 12 years, considering both the levels of parenting stress and its main source. In this regard, there are two main stress sources evaluated through the PSI: The parental domain, which describes parents’ feelings associated with their role and experience as parents beyond the direct relationship with the child, and the child domain, which instead accounts for the child’s problematic behavior and the dysfunctional parent–child relationship. The PSS [ 71 ] was developed as an alternative to the PSI, which is indeed quite lengthy (i.e., 120 items); it assesses parenting stress by investigating parents’ feelings towards the positive and negative experiences linked to parenthood, referring to the parent–child relationship. Lastly, the PSQ [ 72 ] is another self-report measure that comprises a subscale named parental stress, which accounts for difficulties related to child-rearing and the parent–child relationship; the PSQ comprehends two further sub-scales related to parents perceived social support, both in general and provided by their partner specifically.

Anxiety and depression symptoms were instead evaluated through the anxiety and depression subscales of the Brief Symptom Inventory (BSI) [ 73 ], a brief self-report measure assessing the psychological symptoms experienced during the preceding week. Parenting style was assessed in both the included studies [ 66 , 67 ] through the Rules and Demands Scale (RDS) [ 74 ], a self-report measure that evaluates parents’ behavior and distinguishes specifically between the authoritative, authoritarian and permissive parenting style.

Lastly, the included studies [ 55 , 56 , 57 , 59 , 60 , 66 , 68 , 69 ] investigating the effect of foster children’s psychosocial variables on those of the foster parents’ used either the Strength and Difficulties questionnaire–Parent report (SDQ-P; [ 75 ]) [ 56 , 57 , 69 ] or the Child Behavior Checklist (CBCL; [ 76 ]) [ 55 , 59 , 60 , 66 , 68 ]; both tools are parent-reports.

3.4. Parenting Style among Foster Parents

Only two of the included studies investigated parenting styles in foster fathers and mothers [ 66 , 67 ], and they both found higher levels of the authoritative parenting style, as compared to the authoritarian and permissive styles. The authoritative parenting style is highly correlated with reduced criticism or rejection and heightened warmth and communication from parents toward the child, as well as with lower foster children’s impulsivity [ 67 ] and withdrawal symptoms [ 66 ]. Differently, the authoritarian parenting style correlated with a greater perceived burden on the parents’ part, as referring to the fostering situation, and with heightened criticism and rejection toward the child, but it did not correlate with parental warmth and communication [ 67 ]. The authoritarian parenting style was also strongly correlated with greater foster children’s behavior problems [ 66 , 67 ] and impulsivity [ 67 ]. As regards the permissive parenting style, it was not associated with any of the mentioned foster children nor foster parent variables, but instead only correlated with the other two parenting styles [ 67 ]; specifically, it was negatively correlated with the authoritative parenting style and positively correlated with the authoritarian one, albeit showing a small effect size in both cases (i.e., r < 0.20) [ 67 ].

In their study, García-Martín and colleagues [ 67 ] also attempted to identify at-risk placement profiles, accounting for both foster parents’ and foster children’s variables. Specifically, through k-mean cluster analysis (i.e., a partitional group analysis that allows the subdivision of a set of objects/participants into k groups based on their attributes), the authors identified three profiles, resulting from the differentiation of high, medium and low scores among the following correlated variables: Authoritative parenting styles, parental burden and foster children’s behavioral problems and impulsivity. It is noteworthy that, among the parental variables, the three profiles (high, medium and low “problem groups”) altogether only significantly differed in authoritative parenting style levels, while only the “high problems” profile showed significantly greater burden and criticism compared to the medium and low problems profiles, which instead showed comparable mean scores.

3.5. Parenting Stress and Distress Symptoms

3.5.1. parenting stress among foster parents—contextual and individual factors.

Most of the included studies investigated foster parents’ parenting stress ( Table 2 ), yet the associations between parenting stress and both foster parents and foster children’s socio-demographic data were only marginally assessed [ 58 , 59 , 60 , 63 , 68 , 69 ]. Results showed no association between parenting stress and foster parents’ age [ 58 , 59 , 60 , 69 ] nor with foster children’s age [ 59 , 60 , 68 , 69 ] or gender [ 69 ]. Moreover, no association was reported between parenting stress and the number of years spent as foster parents, nor with the number of children fostered [ 58 ]. No association was found between foster parents’ parenting stress and their occupational status or educational level [ 69 ]. As regards foster parents’ economic situation, no study evaluated the association between income and parenting stress, although one study highlighted foster parents that felt no concerns related to their economic situation (described as “I always have money left”) showed significantly lower parenting stress compared to those reporting even slight concerns [ 63 ].

Referring to foster parents’ marital status, only one study, conducted during the COVID-19 pandemic, specifically compared married and unmarried (comprising partnered, separated, widowed, divorced and never married) foster parents as regards their parenting stress levels, and showed significantly lower parenting stress among married foster parents [ 63 ]. They also reported a lower sense of being overwhelmed related to the fostering situation and its responsibilities, and greater perceived satisfaction with the foster parent role [ 63 ]. Moreover, research investigating foster parents’ relationships status and couple cooperation (e.g., married/in a committed relationship vs. single) [ 63 , 65 , 70 ] in association with foster parents’ parenting stress highlighted that the foster parents’ perceived social support has a protective factor toward increased parenting stress [ 69 ]; however, another study did not support such findings [ 68 ]. Notwithstanding this, path analysis results [ 65 , 70 ], specifically accounting for the association between the level of cooperation within the parental couple and parenting stress, showed that cooperation (which implies greater perceived helpfulness and shared responsibility in child-rearing between the parental couple) was associated with lower parenting stress [ 65 , 70 ]. Yet, when specifically accounting for gender differences related to the commonalities and interdependence between foster mothers’ and fathers’ parenting stress, actor–partner interdependence model (APIM) results showed that while foster fathers’ parenting stress was influenced both by their perceived level of a cooperating relationship and the foster mother’s stress, foster mothers’ parenting stress was influenced by their perceived level of a cooperating relationship only [ 70 ]. Gabler and colleagues [ 60 ] did not investigate gender differences in foster parents’ parenting stress but investigated the effect of the partner’s parenting stress on the one experienced by the parent classified as the “main caregiver”, regardless of them being the foster mother or father. Results of the cross-lagged panel analysis (i.e., a statistical analysis that allows one to control the mutual influence between the investigated variables across time) showed that the parenting stress experienced by the main caregiver at 12 months after child placement was significantly influenced by the partner’s stress levels at placement when controlling for the latter’s parenting stress levels at placement.

Beyond the role played by contextual variables such as social support or the responsibilities shared between spouses as regards foster parents’ parenting stress, the role played by individual factors, such as past personal traumatic experiences and resilience, has also been investigated [ 58 ]. In detail, the specific influence of past Adverse Childhood Experiences (ACEs, e.g., divorce, childhood abuse, neglect, domestic violence, parents’ substance abuse) on parenting stress [ 58 ], while also accounting for foster parents’ resilience, has been assessed. The authors showed that the number of ACEs was not associated with the current parenting stress level and instead highlighted the predictive and protective role of resilience on foster parents’ parenting stress. Specifically, they observed that high resilience resulted as the sole predictor of reduced parenting stress and, accordingly, was also associated with increased satisfaction toward the parental role, even when controlling for past ACEs, foster parents’ age, time as foster parents and the number of children fostered. Moreover, it has also emerged that foster parents who self-reported “excellent mental health” [ 63 ] experienced significantly lower parenting stress, felt less overwhelmed by the fostering situation and were more satisfied with the parental role, compared to foster parents who had reported “very good” or “good” mental health.

3.5.2. Parenting Stress and Distress—Foster Parents Compared to Biological Families and Kin Carers

As already mentioned, the role of foster parents implies additional challenges compared to parents at large, leading them to experience greater parenting stress [ 55 , 57 , 64 ], while the opposite result can be expected when considering parenting stress and distress experienced by non-relative foster parents vs. kin carers [ 61 ]. Accordingly, a recent study showed that foster parents, compared to kin carers, reported lower parenting stress levels, yet also lower satisfaction with their caregiving role [ 61 ]. In Harding and colleagues’ [ 61 ] study, differences between foster and kin carers were assessed, controlling for their time spent as carers, albeit not for contact with the biological parents of foster children, which was significantly greater among kin carers. Moreover, foster parents had received much greater support in terms of resources, access to services and support from the agency during the child’s stay [ 61 ]. Altogether, these differences in resource availability and contact with foster children’s biological parents might account for kin carers’ greater parenting stress compared to the foster parents. However, a study comparing female caregivers (i.e., non-relative foster mothers; biological control mothers; female kin carers) [ 62 ] showed that non-relative foster mothers experience significantly lower anxiety and depression symptoms compared to both female kin carers as well as biological control mothers. The finding whereby foster mothers experience fewer parental distress symptoms compared to biological control mothers [ 62 ] is in contrast with the greater parenting stress found among foster mothers compared to biological control mothers [ 55 ], while being in line with Gabler and colleagues’ [ 60 ] results. Specifically, significantly lower parenting stress emerged among foster parents as compared to normative data (i.e., assessed in parents at large), remaining stable throughout 12 months of child placement. However, the sample considered by Gabler et al. [ 60 ] had recently acquired the role of a foster parent, leading the authors to suggest that such contradicting results might have been given by a selection bias (i.e., more stressed parents are less likely to be chosen as foster carers) or from a bias resulting from an idealization of the newly acquired parental role, thus showing higher motivation and self-confidence, which dampened the negative impact of the stressors associated with the fostering situation. Nonetheless, in a previous study, the same authors [ 59 ] found no association between parenting stress and placement length.

Contradicting the above-reported results, there is further evidence that foster parents present increased parenting stress compared to biological control parents, both when compared concurrently to normative data from the general population [ 64 ] and longitudinally within a one-year timespan [ 55 ]. The evidence highlighting greater parenting stress among foster parents showed that such a difference, as outlined herein, was mostly caused by child-related stress rather than the stress resulting from the perception of the caregiving role itself. Bergsund and colleagues [ 57 ] longitudinally investigated the parenting stress experienced by foster parents vs. biological control parents, as assessed when children were 2 (T1), 3 (T2) and 8 (T3) years old. Through multiple mixed-effect models, the authors observed that, although foster and biological control parents differed in child-related stress at all time points when children had reached 8 years (T3), only foster parents showed significantly increased parenting stress associated with their parental role. Still, Bergsund et al.’s [ 57 ] results point to child-related stress as the main predictor of parenting stress among both foster and biological control parents, although showing a stronger predictive role among foster parents. On the other hand, controlling for children’s age and mental health issues and accounting for gender differences among parents, as reported above, a previous study observed greater parenting stress among foster mothers compared to biological control mothers [ 55 ] referring in particular to the stress associated with the caregiving role, thus beyond the parent–child relationship [ 68 ]. Differently, whereas foster and biological control fathers showed comparable parenting stress levels when foster children had been with their foster families for slightly longer than a year [ 68 ], throughout the second year of foster children’s placement, foster fathers showed higher parenting stress compared to biological control parents [ 55 ]. Coherently, Bergsund et al. [ 57 ] showed that while biological control parents’ parenting stress did not increase from when children were 2 to when they were 8, it increased among foster parents during the same timeframe [ 57 ].

3.6. Parenting Stress and Parenting Style and Their Association with Foster Children Psychosocial Symptoms

The gathered evidence showed a significant association between foster parents’ parenting stress and children’s psychosocial symptoms [ 55 , 56 , 57 , 59 , 60 , 68 , 69 ]. In particular, data from a longitudinal study [ 59 ] showed that greater internalizing and externalizing problems among foster children significantly correlated with increased parenting stress, both at placement and six months later. Yet, after controlling for the symptom level at placement, the association between children’s psychosocial symptoms and parenting stress at 6 months from placement was supported only for internalizing problems [ 59 ]. Moreover, performing a cross-lagged panel analysis, results showed that parenting stress and parental sensitivity significantly influenced foster children’s internalizing symptoms at placement when controlling for symptom level at placement. However, the opposite direction of this effect was not reported, thus highlighting that children’s internalizing symptoms did not influence foster parents’ parenting stress. Data from the same broad longitudinal project [ 60 ] also showed a significant association between parenting stress and children’s externalizing symptoms 12 months after their placement; yet, in line with previous findings [ 59 ], externalizing symptoms at placement did not significantly predict parenting stress at 12 months of placement, regardless of controlling for foster children’s age [ 60 ].

Lohaus and colleagues [ 55 , 68 ], in two separate studies, compared foster parents and biological control parents accounting for gender differences and the influence of children’s psychosocial symptoms on parenting stress. The two studies, which investigated the association between parental and children’s variables concurrently [ 68 ] and longitudinally [ 55 ], are part of the same broader project and thus share part of their sample. The first assessment occurred over one year from the children’s placement (M = 17.72 months; SD = 8.61) [ 55 , 68 ] while the two subsequent ones took place at 6-month intervals [ 55 ]. Regression analysis results [ 55 , 68 ] showed that children’s externalizing problems were the main predictors of both foster and biological control parents’ parenting stress, but findings regarding the effect of children’s internalizing problems on parenting stress were contradictory. In particular, in line with the above-mentioned evidence [ 59 ], Lohaus et al. [ 68 ] observed that children’s internalizing symptoms did not explain any additional variance related to both foster and biological control parents’ parenting stress, as assessed over about one year of placement; yet, throughout the second year of placement and onwards [ 55 ], the authors showed that foster children’s greater internalizing symptoms significantly predicted an increase in parenting stress among foster mothers specifically.

Investigating the time by group effect through cross-lagged panel analysis, Lohaus et al. [ 55 ] highlighted the bidirectional influence between children’s internalizing and externalizing symptoms and parenting stress at each time point. However, these bidirectional associations across the three assessment points were observed only among foster parents. In particular, the main finding was that greater foster children’s externalizing symptoms, assessed at the second time point, significantly predicted both foster mothers and foster fathers’ increased parenting stress at the third assessment (i.e., the third year of foster children’s placement), which was not the case for biological control parents. Furthermore, the authors [ 55 ] showed that foster mothers’ parenting stress measured about one year from placement (i.e., the first assessment) and foster fathers’ parenting stress levels assessed after about one and a half years from placement (i.e., the second assessment) significantly predicted increased externalizing symptoms among foster children at the third year of placement (i.e., the third assessment).

Foster children’s internalizing and externalizing symptoms also seem to be associated with foster parents’ parenting style, although only one of the included studies investigated such an association [ 66 ]. Specifically, Fuentes and colleagues [ 66 ] showed that only the authoritarian parenting style was significantly and positively correlated with both foster children’s internalizing and externalizing symptoms, showing a medium effect size (i.e., r < 0.33, p < 0.01; r = 0.38, p < 0.01, respectively), as well as with most of the CBCLS sub-scales (i.e., anxiety and depression symptoms, somatic problems, rule-breaking and aggressive behavior; effect sizes ranged between r = 0.25 and r = 0.40). Authoritative and permissive parenting styles were not correlated with either children’s internalizing or externalizing symptoms.

3.7. Quality Assessment of the Included Studies

Three JBI checklists—for cross-sectional, case-control and case-series studies—have been employed for the quality assessment of the included studies, based on their specific design ( Table 2 ). Detailed results of the quality assessment of each of the included studies, determined by whether or not the checklist’s criteria needed to reduce studies’ risk of bias were met, are reported in tabular form within the supplementary materials , comprising all checklist questions and related answers ( Tables S3–S5 ).

The Checklist for Cross-Sectional studies investigates sample inclusion criteria; the amount of information provided on participants and study setting; validity and reliability of the exposure measure (not applicable for any of the included studies); criteria used to measure the condition (i.e., being a non-relative foster parent); the presence of confounding factors; strategies to deal with confounding factors; validity and reliability of outcome measurement; and the appropriateness of statistical analysis.

Based on the qualitative critical judgment made on the overall methodological quality of the included cross-sectional studies, the main concerns identified regard inclusion criteria, which were reported only in few studies, and the identification and management of confounding factors, which were either not addressed or unclearly reported. Moreover, the sample characteristics reported were predominantly inconsistent. Nonetheless, most studies performed appropriate statistical analyses and all studies used valid and reliable tools to assess the outcomes of interest.

The Checklist for Case-Series studies investigates sample inclusion criteria; the reliability of the condition measurement (not applicable); the validity of the methods identifying the condition (not applicable); consecutive inclusion of participants (regarding the specificity of the inclusion process and time-line); completeness of the participant inclusion process; reporting of the demographic information; reporting of the clinical information; clarity of outcomes and the reporting of follow-up results; reporting of the presenting site(s)/clinic(s) demographic information; and the appropriateness of statistical analysis.

As per the above, the overall judgment made on the methodological quality of the two longitudinal case-series studies included raised some concerns, as neither inclusion criteria nor the site information was clearly reported, thus it was unclear whether the study had thoroughly explained participants’ inclusion process. However, overall sample characteristics were provided, statistical analyses were appropriate, and outcomes were reported.

The Checklist for Case-Control studies investigates the comparability of the groups being compared; the appropriateness of case-control matching; criteria for identifying cases and controls; validity and reliability of exposure measures (not applicable); the comparability of exposure measures between cases and controls (not applicable); the presence of confounding factors; strategies employed to deal with confounding factors; the validity and reliability of outcome assessment between cases and controls; the appropriateness of the exposure period length; and the appropriateness of statistical analysis.

Base on the overall judgment made, one of the two longitudinal case-control studies included raised some concerns [ 57 ] and the other [ 55 ] might be at high risk of bias since the majority of the evaluated criteria resulted as unclear or were not satisfied. Specifically, while in Bergsund and colleagues’ study [ 57 ] it was clear that groups were comparable, it was unclear in Lohaus and colleagues’ work [ 55 ]. Notwithstanding, in both studies, it was unclear or not reported whether the two groups being compared had been appropriately matched or if participants were included using the same criteria; moreover, Lohaus and colleagues [ 55 ] had identified confounding factors, which was unclear in Bergsund and colleagues’ work [ 57 ]. Neither of the two studies appropriately stated if and how they dealt with confounding factors. Still, both studies adequately assessed their outcomes of interest and the “exposure time” (i.e., if the child placement within the foster family had taken place from a sufficient time), and statistical analyses seemed suitable as well.

Taking into consideration both the results from the JBI tools (i.e., the fulfillment or non-fulfillment of the checklists’ criteria for each included study) and the following discussion among the authors of the current systematic review, it seems that, overall, the included studies have sufficiently satisfactory methodological quality and are not at high risk of bias; nonetheless, they raise some concerns on their overall quality, which, as outlined above, seems mostly undermined by their poor reporting of information.

4. Discussion

The current systematic review aimed to evaluate the variables contributing to foster parents’ psychological adjustment (i.e., parenting stress and parental distress) and parenting style, with the intent of gaining insights relevant to provide psychosocial support to foster parents, with implications on the foster child’s well-being and adjustment as well. To the authors’ knowledge, this is the first systematic review specifically focused on parenting stress, parental distress and parenting style among non-relative foster parents that also evaluates both foster parents’ variables and the influence of foster children’s demographic and psychosocial variables on foster parents’ adjustment and parenting style.

It is noteworthy that, among the included studies, only one [ 62 ] investigated distress variables (i.e., anxiety and depression symptoms), while most investigated foster parents’ parenting stress. In this regard, the evidence that emerged showed increased parenting stress over time among foster parents, both in general and compared to parents at large. Notably, findings highlighted child-related stress as the main source of parenting stress, as related to parent–child dysfunctional interactions as well as to children’s problem behavior. The reviewed evidence has also shown the significant influence of foster children’s psychosocial problems (i.e., internalizing and externalizing problems) on foster parents’ parenting stress, particularly highlighting the predictive role of children’s externalizing problems on overt and more aggressive behavior [ 77 ]. Foster children’s internalizing problems, such as withdrawal, and anxiety and depression symptoms [ 77 ], although showing an association with foster parents’ parenting stress, were, in general, less investigated compared to the externalizing problems [ 55 , 57 , 60 , 68 ], and findings were contradictory [ 55 , 59 ]. Nonetheless, it is noteworthy that children’s internalizing and externalizing problems were all assessed through parents’ reports; thus, they represent foster parents’ perception of foster children’s psychosocial problems. As such, it might be that it is the parental perception of the children’s disturbances, rather than the “objective” children’s psychosocial symptoms, that influences parents’ parenting stress and subsequent behavior. This, in turn, might further justify the greater influence of children’s externalizing symptoms compared to internalizing symptoms. The idea that foster parents’ parenting stress is influenced by their perception of children’s psychosocial problems is also supported by findings regarding the SDQ Parent version [ 75 ], which highlight how this tool can work as a proxy measure of foster parents’ parenting stress as assessed through the PSI-SF [ 36 , 56 ].

As regards parenting style, in line with the broader literature [ 78 , 79 , 80 , 81 ], the gathered evidence showed that the authoritative parenting style was associated with greater parental warmth and acceptance, as well as with better children’s outcomes, such as reduced withdrawal symptoms and reduced problem behavior [ 67 , 78 , 79 , 82 ]. Parents adopting an authoritative parenting style usually display a more collaborative approach with children, as they tailor expectations on the children’s characteristics [ 78 , 81 ]. This indeed favors children’s greater regulation capacities, in terms of greater anger regulation and prosocial behavior [ 83 ], which is noteworthy considering that children within the foster care system usually present greater emotional disturbances [ 45 , 52 , 57 , 84 , 85 ]. Still, evidence was contradicting, as Fuentes et al. [ 66 ] did not find an association between the authoritative parenting style and children’s psychosocial problems. Findings also stressed the strong and unfavorable influence of an authoritarian parenting style upon both foster parents’ and foster children’s adjustment [ 66 , 67 , 78 , 79 , 82 ], showing it to be associated with children’s increased internalizing and externalizing problems [ 66 ]. The association between the authoritarian parenting style and foster parents’ increased perceived burden [ 67 ] is also relevant, since, as reported above, foster parents show heightened parenting stress and need to face many stressors because of their fostering role.

Contextualizing the above-discussed findings within the transactional model of family dynamics [ 49 ], it should also be noted that increased foster parents’ parenting stress was indeed associated with increased psychosocial symptoms on the part of the foster child as well [ 57 , 59 , 69 ]. As such, it might be that when foster parents experience greater parenting stress, they become more authoritarian in an attempt to maintain a sense of control over the situation, but this has consequences for the child’s adjustment [ 86 , 87 ]. This is in line with evidence whereby foster parents experiencing strain are less attentive to children’s mental health and educational needs [ 16 ], showing particularly reduced parental abilities when children exhibit externalizing problems [ 37 ]. Parenting stress is indeed also associated with parental efficacy: They bi-directionally influence each other and are thought to generate from the same context, and are both associated with children’s behaviors, characteristics and relational qualities [ 40 ]. As such, it seems pivotal to provide foster parents with adequate training [ 3 , 88 ] for them to properly acquire and adaptively handle their role as foster parents, while concurrently providing them psychosocial support to reduce their parenting stress, thus buffering its consequences upon their parenting behaviors and attitudes in terms of their parenting style [ 66 , 67 ]. A recent meta-analysis [ 88 ] showed interventions’ efficacy in improving foster parents’ sensitivity, parenting attitude and dysfunctional discipline, as well as in reducing their parenting stress and children’s problem behaviors. Nonetheless, no significant effect was shown on children’s attachment security [ 88 ]. Moreover, there still seems to be no specific program that has shown superiority compared to others [ 89 ].

Overall, evidence from the current systematic review serves to further stress the importance and need to properly train foster parents and to support their psychosocial adjustment [ 3 , 88 ], as it may have repercussions on their parenting behaviors and style in general, with consequences on children’s adjustment and mental health as well [ 40 , 49 , 55 , 57 , 59 , 66 , 67 ]. Moreover, no association was found between either foster parents or foster children’s socio-demographic information and foster parents’ parenting stress, thereby suggesting and further underlining that child-related stress is indeed the greatest source of parenting stress overall. Notwithstanding, some protective factors relevant to better and further sustaining foster parents have emerged. In particular, when faced with less contextual stressors, such as having no economic concerns [ 63 ] or receiving more resources and support from the fostering services [ 61 ], foster parents reported reduced parenting stress. As such, foster care services should be attentive to being responsive to foster parents’ needs [ 3 , 64 , 65 ]. For instance, foster parents might benefit from greater monitoring of their interactions with foster children’s biological parents or from greater guidance in handling difficult situations with their foster children. This would allow the formation of a concentric modular support system. In more detail, it would favor the development of a concentric system, figuratively similar to a matryoshka, in which the fostering services function as “containers”, supporting foster parents’ practical and psychosocial needs. This would create a protective context around them, setting the bases to allow foster parents to properly care for children, functioning themselves as further “containers” for foster children’s needs, and possibly even for foster children’s birth parents [ 6 , 90 ]. Complementarily, the modular structure of such a system would allow and support the overall system’s cohesion and flexibility, thereby favoring the communication between the parts involved while buffering the effect of changes that might occur regarding the fostering project and the professional figures involved in it.

It is worth noting that being in a committed relationship and showing cooperation within the parental couple [ 63 , 65 , 70 ] was associated with reduced parenting stress. Couples’ cooperation allows the sharing of the burden and difficulties associated with the whole fostering situation as well as that associated with the rearing and supporting of foster children, who are likely to not only have already faced parenting challenges but also show increased emotional and psychosocial difficulties [ 45 , 52 , 57 , 84 , 85 ]. The reviewed literature does not allow one to draw sound conclusions on the differences between foster mothers and fathers; nonetheless, the general trend suggests that, although the parenting stress experienced by a partner might somewhat influence the other’s [ 60 , 70 ], foster parents seemed mostly self-influenced [ 4 , 70 ]. In this regard, interventions might need to be multi-level, to support greater and more harmonious cooperation within the parental couple [ 65 ] while sustaining the individual parent’s resources in parallel, beyond the parental couple. Indeed, one of the reviewed studies emphasized the protective role of resilience toward increased stress, further buffering the effect of past stressors and trauma upon current parenting stress levels [ 58 ]. This aspect is relevant regardless of foster parents’ relationship status since interventions fostering resiliency can be at the individual level [ 91 ] as well as at the family level [ 91 , 92 , 93 ]. In this regard, within a “family resilience perspective”, resilience interventions would support the overall coping capacities and adaptation of the family, favoring more positive and adaptive family dynamics as well as greater foster parents’ and children’s adjustment [ 92 , 93 ].

Notwithstanding, the reviewed literature should be interpreted with caution in light of the under-reporting of information that emerged from the quality assessment. As such, future studies should be attentive in thoroughly providing all necessary information, to allow studies’ replicability and reliability of findings. Because of this shared limit, together with the lack of investigation of parental distress and parenting style as compared to parenting stress, compelling conclusions cannot be drawn, particularly regarding the association between variables. Two of the included studies [ 65 , 70 ] specifically present a problematic aspect, which qualifies as a limit of the current review itself and, therefore, must be addressed. Namely, neither of these studies clearly stated if the sample was specific to non-relative foster parents (thus excluding kin carers) or not: While one [ 65 ] provided, in general, no information in this regard, the other [ 70 ] only addressed it by mentioning it among its limitations. Albeit studies that explicitly stated the inclusion of both non-relative and kin carers were excluded during the search process, the authors of the current systematic review chose to include these two studies, given that the absence of this information was not a clear non-compliance of inclusion criteria [ 65 , 70 ]. Besides, they could still be useful for investigating the interdependence of foster parents considered as a mutually influencing dyad, therefore contributing to provide a useful suggestion for future research.

Indeed, notwithstanding these limitations, findings that emerged from this review, along with their shortcomings, are useful to guide future studies. Notably, future research should be careful to properly account for and investigate the influence of socio-demographic information of foster parents and children upon their adjustment. Non-relative and kin carers should be more carefully distinguished, thereby addressing the differences between the two [ 61 , 62 ]. Moreover, since none of the reviewed studies considered siblings, future research should further investigate the whole foster family adjustment, possibly within a transactional framework, to properly account for the processes underlining family dynamics [ 49 ]. Lastly, the role played by institutions, and that of the foster care services directly in contact with the foster families and child, should be greatly accounted for and further investigated.

5. Conclusions

To conclude, the current systematic review supports the bi-directional association between foster parents’ and children’s psychosocial adjustment, in line with the transactional model of family dynamics whereby there are “mutual influence processes within families” [ 49 ] (p. 192). Notably, child-related stress and children’s externalizing problems emerged as the main predictors of increased foster parents’ parenting stress. Moreover, the authoritative parenting style was the most prevalent among the considered parenting styles, which is noteworthy considering the favorable implications of adopting an authoritative parenting style on children’s adjustment and the unfavorable implications associated with the authoritarian one.

Studies’ shortcomings have been highlighted and relevant insights have emerged, thus providing suggestions useful to guide future research and to develop interventions aimed at supporting both foster parents’ and children’s well-being. Foster care services should be attentive and responsive to foster parents’ needs, thereby supporting them in providing care and support to foster children, within a “matryoshka-like” system.

Supplementary Materials

The following supplementary materials are available online at https://www.mdpi.com/article/10.3390/ijerph182010916/s1 , Table S1: PRISMA 2020 Checklist; Table S2: List of excluded studies with reasons for exclusion; Table S3: Checklist for cross-sectional studies; Table S4: Checklist for case-series studies; Table S5: Checklist for case-control studies.

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Tracking Firm Use of AI in Real Time: A Snapshot from the Business Trends and Outlook Survey

Timely and accurate measurement of AI use by firms is both challenging and crucial for understanding the impacts of AI on the U.S. economy. We provide new, real-time estimates of current and expected future use of AI for business purposes based on the Business Trends and Outlook Survey for September 2023 to February 2024. During this period, bi-weekly estimates of AI use rate rose from 3.7% to 5.4%, with an expected rate of about 6.6% by early Fall 2024. The fraction of workers at businesses that use AI is higher, especially for large businesses and in the Information sector. AI use is higher in large firms but the relationship between AI use and firm size is non-monotonic. In contrast, AI use is higher in young firms although, on an employment-weighted basis, is U-shaped in firm age. Common uses of AI include marketing automation, virtual agents, and data/text analytics. AI users often utilize AI to substitute for worker tasks and equipment/software, but few report reductions in employment due to AI use. Many firms undergo organizational changes to accommodate AI, particularly by training staff, developing new workflows, and purchasing cloud services/storage. AI users also exhibit better overall performance and higher incidence of employment expansion compared to other businesses. The most common reason for non-adoption is the inapplicability of AI to the business.

This research paper is associated with the research program of the Center for Economic Studies (CES) which produces a wide range of economic analyses to improve the statistical programs of the U.S. Census Bureau. Research papers from this program have not undergone the review accorded Census Bureau publications and no endorsement should be inferred. Any opinions and conclusions expressed herein are those of the authors and do not represent the views of the U.S. Census Bureau. The Census Bureau has reviewed this data product to ensure appropriate access, use, and disclosure avoidance protection of the confidential source data (Project No. P-7529868, Disclosure Review Board (DRB) approval numbers: CBDRB-FY23-0478, CBDRB-FY24-0162, and CBDRB-FY24-0225). We thank Joe Staudt and John Eltinge for helpful comments. John Haltiwanger was also a Schedule A employee of the Bureau of the Census at the time of the writing of this paper. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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This paper is in the following e-collection/theme issue:

Published on 17.4.2024 in Vol 26 (2024)

This is a member publication of National University of Singapore

Comparing Open-Access Database and Traditional Intensive Care Studies Using Machine Learning: Bibliometric Analysis Study

Authors of this article:

Original Paper

Yuhe Ke 1 * , MBBS ;
Rui Yang 2 * , MSc ;
Nan Liu 2 , PhD

1 Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore

2 Centre for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore

*these authors contributed equally

Corresponding Author:

Nan Liu, PhD

Centre for Quantitative Medicine

Duke-NUS Medical School

National University of Singapore

8 College Road

Singapore, 169857

Phone: 65 66016503

Email: [email protected]

Background: Intensive care research has predominantly relied on conventional methods like randomized controlled trials. However, the increasing popularity of open-access, free databases in the past decade has opened new avenues for research, offering fresh insights. Leveraging machine learning (ML) techniques enables the analysis of trends in a vast number of studies.

Objective: This study aims to conduct a comprehensive bibliometric analysis using ML to compare trends and research topics in traditional intensive care unit (ICU) studies and those done with open-access databases (OADs).

Methods: We used ML for the analysis of publications in the Web of Science database in this study. Articles were categorized into “OAD” and “traditional intensive care” (TIC) studies. OAD studies were included in the Medical Information Mart for Intensive Care (MIMIC), eICU Collaborative Research Database (eICU-CRD), Amsterdam University Medical Centers Database (AmsterdamUMCdb), High Time Resolution ICU Dataset (HiRID), and Pediatric Intensive Care database. TIC studies included all other intensive care studies. Uniform manifold approximation and projection was used to visualize the corpus distribution. The BERTopic technique was used to generate 30 topic-unique identification numbers and to categorize topics into 22 topic families.

Results: A total of 227,893 records were extracted. After exclusions, 145,426 articles were identified as TIC and 1301 articles as OAD studies. TIC studies experienced exponential growth over the last 2 decades, culminating in a peak of 16,378 articles in 2021, while OAD studies demonstrated a consistent upsurge since 2018. Sepsis, ventilation-related research, and pediatric intensive care were the most frequently discussed topics. TIC studies exhibited broader coverage than OAD studies, suggesting a more extensive research scope.

Conclusions: This study analyzed ICU research, providing valuable insights from a large number of publications. OAD studies complement TIC studies, focusing on predictive modeling, while TIC studies capture essential qualitative information. Integrating both approaches in a complementary manner is the future direction for ICU research. Additionally, natural language processing techniques offer a transformative alternative for literature review and bibliometric analysis.

Introduction

The start of critical care as a medical subspecialty can be traced back to a polio epidemic during which a substantial number of patients needed prolonged mechanical ventilation [ 1 ]. Over time, the field of critical care has experienced significant growth and continual evolution. Research in this field has played a pivotal role in unraveling the complexities of numerous diseases and treatment modalities, driving substantial advancements in clinical practice over the past decades [ 2 ]. Groundbreaking studies have investigated critical areas such as sepsis, mechanical ventilation, acute lung and kidney injuries, intensive care unit (ICU) delirium, and sedation in critically ill patients [ 3 ].

These research studies have often been conducted in traditional ways such as prospective and randomized controlled trials [ 4 ], cohort and observational studies, clinical trials [ 5 ], and clinical and translational research [ 6 ]. These traditional methods have revolutionized patient care and improved outcomes significantly. For instance, the implementation of protocol-driven, goal-directed management of sepsis and appropriate fluid therapy has led to remarkable reductions in mortality rates [ 7 , 8 ], and these findings have been integral in developing evidence-based practice guidelines that are now the gold standard [ 9 , 10 ].

Despite their undeniable merits, traditional research methods in intensive care also come with several limitations [ 11 ]. Clinical trials are known for their high costs [ 12 ], stringent standardization requirements, and ethical oversight [ 13 ]. Data collection can be laborious, prone to human errors, and constrained in terms of quantity and granularity [ 14 ]. Moreover, obtaining patient consent for most randomized controlled trials in the ICU poses challenges [ 15 ], necessitating alternative consent models. These limitations have become increasingly apparent as medical complexity continues to grow exponentially [ 16 ].

The advent of electronic health records (EHRs) has heralded a new era in clinical research by facilitating the digitization of health care systems [ 17 ]. In this era of data science, a more integrated approach can be adopted, using machine learning (ML) algorithms to tackle the complexity of critical illness [ 18 ]. Open-access databases (OADs), such as the Medical Information Mart for Intensive Care (MIMIC) database [ 19 ] and the Philips eICU Collaborative Research Database (eICU-CRD) [ 20 ], have played a transformative role by enabling free data sharing.

The concept of free and open databases plays a pivotal role in promoting data sharing and advancing medical knowledge in accordance with the findable, accessible, interoperable, and reusable (FAIR) guiding principle. The FAIR principles, which emphasize that data should be findable, accessible, interoperable, and reusable, are essential for fostering a collaborative and transparent scientific research environment [ 21 , 22 ]. By removing barriers to access, free, and open databases allow researchers, regardless of their affiliations or resources, to contribute to and benefit from the collective pool of information. Accessibility fosters inclusivity and diversity in research, promoting a broader range of perspectives and approaches to medical challenges. This democratization of knowledge leads to a more equitable distribution of information. Researchers can now leverage these vast repositories of information for ML and artificial intelligence studies, marking a departure from traditional intensive care (TIC) research approaches.

Conducting a literature review [ 23 ] to investigate the disparities between traditional ICU research and studies based on open-access data sets holds significant importance as it provides a comprehensive understanding of the strengths and limitations of the latter. However, conventional methods of literature reviews and bibliometric analysis have their limitations, especially when dealing with large-scale literature due to computational complexity and the labor-intensive nature of manual interpretations [ 24 - 26 ]. To address these challenges, natural language processing (NLP) offers a promising avenue, while topic modeling techniques can be used to extract various topic themes from extensive data sets [ 27 , 28 ].

Built on the foundations of bidirectional encoder representations from transformers (BERT), BERTopic introduces a novel approach to topic modeling [ 29 , 30 ]. Unlike traditional unsupervised models like latent Dirichlet allocation, which rely on “bag-of-words” model [ 31 ], BERTopic overcomes the problem of semantic information loss, significantly enhancing the accuracy of generated topics, and providing more interpretable compositions for each topic, which greatly facilitates the classification of topics.

With the aid of BERTopic, this study aims to shed light on the disparities and commonalities between studies conducted through OADs and TIC research. By analyzing the overall trends and patterns in these 2 groups, we seek to identify knowledge gaps and explore avenues for complementary contributions between these research approaches.

Data Filtering

We performed an ML-based analysis of research abstracts in the Web of Science (WoS) database to automatically categorize the research papers to conduct this literature mapping analysis. There was no limit to the year of publication of the articles. The search query consisted of the following keyword to identify all the studies that were published under the umbrella of intensive care: (“ICU” OR “intensive care”). The search terms were deliberately left to be broad to cover broad spectrums of journals in the field.

The inclusion criteria were as follows: (1) written in English, (2) articles that had keywords related to intensive care, (3) articles that had the article type of “article” or “review.” We excluded articles with incomplete data fields (eg, title, abstract, publication year, and paper citation). The articles included were then further processed to identify if they were studies using OADs. These articles were labeled as “open-access database,” while the rest of the articles extracted were labeled as “traditional intensive care.”

The search used for this study was performed on January 18, 2023, from WoS. This generated 227,893 search results, which were subsequently reselected using Python. An advanced search from PubMed was done based on the broad search terms of ICU studies used from previous Cochrane ICU literature review [ 32 ] to ensure the accuracy of the results. The numbers corroborated with a discrepancy of 4.9% (227,893 WoS keyword search vs 239,748 PubMed ICU keyword search).

Selection Criteria for OADs

A title search using keywords from all currently existing OADs was conducted to identify OAD studies. These include (1) MIMIC [ 19 ], (2) eICU-CRD [ 20 ], (3) Amsterdam University Medical Centers Database (AmsterdamUMCdb) [ 33 ], (4) High Time Resolution ICU Dataset (HiRID) [ 34 ], and (5) Pediatric Intensive Care database [ 35 ]. We avoided including only keywords in the search and restricted the search years by the year that the OAD was made publicly available to reduce the inadvertent inclusion of incorrect articles due to keywords. For instance, the search term for OADs published with the MIMIC database included title keyword search with the terms (“MIMIC-IV” OR “MIMIC-III” OR “MIMIC-II” OR “MIMIC Dataset” OR “medical information mart for intensive care” OR “MIMIC IV” OR “MIMIC III” OR “MIMIC II”) in studies that were published after 2003. The title keyword search for the searches and the year of cutoff for each OAD are presented in Multimedia Appendix 1 .

Furthermore, to ensure the accuracy of the supervised keyword classification, a manual review of the classification by 2 critical care physicians was done for 100 articles from each category that were randomly selected. The review was done independently with the physicians labeling the extract publications into OAD and TICs. An accuracy of 99% was achieved on independent reviews, and full agreement was achieved after discussion on the discrepancy. The final results were matched with the supervised keyword classification.

We performed a bibliometric analysis by directly extracting publication details from the WoS database using Python (Python Software Foundation). The analysis involved assessing the number of articles published per year, calculating total citation counts, and identifying the top journals that published intensive care-related articles. Comprehensive results are presented in Multimedia Appendix 2 .

Data Analysis

Uniform manifold approximation and projection.

Uniform manifold approximation and projection (UMAP) is a manifold learning technique for dimension reduction, which can identify key structures in high-dimensional data space and map them to low-dimensional space to accomplish dimensionality reduction. Compared to other dimensionality reduction algorithms, such as principal component analysis [ 36 ], UMAP can retain more global features [ 37 ]. In this paper, we constructed a corpus consisting of abstract words from all studies. However, due to the massive size of the corpus, visualizing and analyzing the high-dimensional data to explore the differences in the vocabulary patterns between the OAD and TIC studies is a challenge. The UMAP package in Python, which implements the UMAP algorithm, was used to project the high-dimensional corpus to 4 dimensions. By cross plotting each dimension, we were able to investigate underlying differences in corpus distribution between OAD and TIC studies.

Topic modeling can help us explore the similarities and differences between research topics in OAD and TIC studies. Unlike conventional topic modeling models, BERTopic uses the BERT framework for embeddings, enabling a deeper understanding of semantic relationships [ 30 ]. The BERTopic model was implemented by the BERTopic package in Python and divided 146,727 studies into 30 topic IDs. We also performed latent Dirichlet allocation topic modeling through Python’s LdaModel package for comparison. Through the review of topic keywords by 2 critical care physicians, BERTopic exhibited superior accuracy and sophistication in topic identification, with enhanced interpretability and scientific rigor.

Consequently, the BERTopic model was used for the final analysis. Each of these topics was given a corresponding clinical research category. The overlapping categories were merged into topic families for easier comparisons. By using these advanced techniques, we were able to uncover hidden patterns and relationships within the literature and provide insights into the current state of intensive care research.

A total of 227,893 records were identified from the WoS database on January 18, 2023, of which 195,463 full records were subsequently processed. Records were excluded if they are not “article” or “review” or if they do not contain keywords related to intensive care. After exclusions, 145,426 articles were identified as TIC studies and 1301 articles were categorized as OAD ( Figure 1 ).

We examined the number of articles published per year to analyze the trends in TIC and OAD studies ( Figure 2 ). Over the past 2 decades, TIC studies have experienced exponential growth, culminating in a peak of 16,378 articles in 2021. A subsequent decline in the number of publications occurred in 2022, likely attributable to delayed indexing within the WoS database and a reduction in COVID-19–related studies as the pandemic stabilized [ 38 ]. In contrast, the first OAD study emerged in 2003, with its popularity experiencing a consistent upsurge since 2018. Nonetheless, the number of OAD publications remains markedly lower in comparison to TIC publications.

The OAD studies were published most frequently in new open-access journals such as Frontiers in Medicine , Frontiers in Cardiovascular Medicine , and Scientific Reports while the TIC studies were published most frequently in established journals like Critical Care Medicine , Intensive Care Medicine , and Critical Care ( Multimedia Appendix 2 ). Further analysis of keywords from the abstracts showed 2.4% (3492/145,426) TIC studies were meta-analyses or systematic reviews, while only 0.08% (1/1301) OAD study was in this category. There were 5.61% (73/1301) OAD studies, and 7.43% (10,799/145,426) TIC studies that had the keyword of “cost.” Examples of the data fields that are available within OADs such as MIMIC and eICU-CRD are listed in Textbox 1 . Some information fields such as end-of-life goals and values and health care provider psychology are not available within the current EHRs extracted for OADs.

Examples of information that is available in current OADs

Patient information: demographics and social set-up
Hospital context: admission time and discharge time, intensive care unit (ICU) and hospital admissions, and pre-ICU admission
Diagnosis: physician-curated ICU diagnosis and data-driven phenotypes
Intervention: medications, procedures, and organ support
Diagnostics: blood test, microbiology, and scans
Clinical texts: clinical notes and diagnostic reports
Physiological monitoring: basic monitoring and waveforms

Examples of information that is not readily available in current OADs

Patient information: family set up and visiting, financial information, and special populations
Hospital context: post-ICU discharge details, delayed admission or discharge, and health personnel psychology
Diagnosis: pre-ICU history and diagnosis requiring clinical symptoms
Intervention: indications for interventions, complications, and intraoperative and postoperative
Diagnostics: pathology photographs, imaging, and molecular or genetic studies
Clinical texts: patient narratives, end-of-life goals and patient value, and health personnel behavior
Physiological monitoring: advanced monitoring

The UMAP algorithm was used to project the high-dimension corpus to 4 dimensions and allowed exploration of the vocabulary patterns between the OAD and TIC studies ( Figure 3 ). The projection values are represented by the x-axis, while the densities are represented by the y-axis. The presence of considerable overlap between TIC studies and OAD studies suggests that they share a substantial number of common terminologies, which may correspond to similar research topics. Nonetheless, TIC studies exhibit a more extensive coverage than OAD studies, which may stem from broader research scope and extended research duration.

Subsequently, the BERTopic model was then used to generate 30 topic IDs ( Figure 4 ). The internal commonalities of each topic ID were reviewed by critical care physicians and assigned a specific subtopic in intensive care research. The model was able to automatically classify the topics with high interpretability and the topic components were interpreted with ease. For instance, components in topic ID 5 consist of, in decreasing order of weightage: “learning,” “model,” “machine,” “machine learning,” “models,” “data,” “prediction,” and “performance.” This topic was consequently labeled “predictive model” (topic ID 5 in Multimedia Appendix 3 ).

The overall topic distribution in TIC studies was more uniform, while the OAD studies tended to be concentrated on several topics including topic ID 2 (kidney injury), 5 (predictive model), and 13 (sepsis). Some topics that were missing in OAD studies included 6 (pediatrics care), 21 (viral infections), 23 (health personnel and psychology), and 28 (nutrition and rehabilitation).

The similarity matrix shows that there was little overlap between the topics ( Multimedia Appendix 4 ). To facilitate the interpretability of the categories, the overlapping topic IDs were merged to form the final 22 topic families ( Multimedia Appendix 3 ).

Topics such as “healthcare associated infection,” “thoracic surgeries,” and “pregnancy related” research were among the more frequently discussed 15 topics in TIC studies but have limited publications in OAD studies. The topics of “predictive model,” “obesity,” and “fungal infections” were popular in OAD studies but not the TIC studies. Overall, the topic distributions of the TIC studies were distributed more evenly with the topic family of sepsis accounting for a quarter of the studies, while publications in the OAD studies were heavily skewed toward the predictive model (>40%) and sepsis (>30%; Figure 5 ).

Principal Results

This study conducted a comprehensive review and bibliometric analysis of OAD and TIC studies. NLP was used to facilitate this large-scale literature review. Studies using OADs mainly concentrated on a few topics, such as predictive modeling, while TIC studies covered a wider range of topics with a more balanced distribution.

Advantages of OAD Studies

OAD studies offer several advantages that have contributed to their increasing popularity in intensive care research. The granularity of data and easy access to large-cohort databases, such as MIMIC [ 39 ], has enabled researchers to perform predictive modeling and conduct various secondary analyses efficiently [ 40 , 41 ]. This accessibility has provided valuable opportunities for exploring specific aspects of patient care, evident in studies investigating phenomena like “weekend effects” and circadian rhythms in ICU patients before discharge [ 42 - 46 ]. The vast amount of longitudinal and time series data available in OADs has also facilitated the implementation of complex ML and deep learning methods [ 47 ].

Limitations of OAD Studies

However, it is crucial to acknowledge the retrospective nature of OAD data, which inherently limits the assessment of confounding factors and the ability to draw strong causal conclusions. The observational design of OAD studies may result in lower-quality evidence according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework [ 48 , 49 ], and thus, the research from OAD studies has yet to be fully integrated into existing evidence-based guidelines, as exemplified by the omission of OAD studies in the 2021 sepsis guidelines [ 50 ]. Nevertheless, OADs remain a valuable resource for supplementing and complementing TIC studies, providing unique insights and enhanced predictive scores for intensive care settings.

Furthermore, approximately 50% of the studies using OADs published focused on predictive modeling. The increased usage of ML methods in predictive modeling has not been without critique. Some medical prediction problems inherently possess linear characteristics, and the selection of features may predominantly focus on already known strong predictors, leading to limited improvements in prediction accuracy with ML [ 51 ]. Additionally, interstudy heterogeneity poses a challenge in comparing results obtained from different ML models applied to the same data sets [ 52 ]. The ethical implications of relying solely on ML models to make high-risk health care decisions instead of involving clinical expertise are also relevant considerations [ 51 , 53 ].

While OADs provide comprehensive patient data, there are certain limitations in their ability to capture specific information essential for certain critical care research areas. Notably, data fields related to qualitative aspects such as ethics and end-of-life care [ 54 , 55 ], and health care personnel psychology [ 56 ] may be challenging, if not impossible, to obtain through OADs generated from EHRs. Consequently, TIC studies have played a pivotal role in addressing these limitations by capturing critical information that is integral to understanding ethical considerations, patient experiences, and health care provider psychology in intensive care [ 57 , 58 ].

Synergy Between OAD and TIC Studies

The synergy between OAD and TIC studies is a promising approach to enhance the comprehensiveness and robustness of intensive care research. OADs, with their large cohort sizes, can serve as external validation cohorts for ML models developed from TIC studies, potentially reducing the sample sizes required for prospective research. Furthermore, OAD studies can corroborate the results of TIC studies, benefiting from larger sample sizes and real-world data, thus providing more practical insights for implementation in intensive care settings [ 43 ]. The integration of OAD and TIC studies presents an opportunity to bridge the gaps in data availability and research methodologies, ultimately enriching the understanding and practice of critical care medicine.

Potential Impact of NLP

The usage of large language models such as BERTopic has proven to be a valuable tool for large-scale literature review and topic extraction [ 58 ]. This approach has enabled accurate, reliable, and granular topic generation, offering clinicians a more effective means of interpreting data compared to traditional bag-of-words models [ 59 ]. The potential of NLP to analyze scientific articles and identify trends and knowledge gaps holds promise for shaping the future of research in critical care medicine. As the volume of publications in critical care continues to grow and large language modeling continues to advance in health care [ 60 ], AI technology will be crucial in efficiently identifying and predicting emerging trends.

Future Directions

Future research in the field of critical care can explore novel applications of ML beyond predictive modeling. For instance, using ML to study patterns in how papers are cited, shared, and discussed on the web could help predict their potential impact on the scientific community. This analysis can aid in identifying highly influential papers and understanding the factors that contribute to their recognition. Additionally, investigations into methods for enhancing the interpretability and transparency of ML algorithms in critical care research would further facilitate the ethical and responsible use of AI technologies.

Strengths and Limitations

The study’s application of NLP-driven in analyzing scientific articles and identifying trends highlights the potential impact of AI technologies in streamlining literature reviews and identifying emerging trends more efficiently.

Another notable strength of this study is the usage of the WoS database, the world’s oldest and most extensively used repository of research publications and citations, encompassing approximately 34,000 journals [ 61 ]. The comprehensiveness of this database provides a robust representation of the literature in the field of intensive care research. Nevertheless, it is essential to acknowledge that some articles published in nonindexed journals might not have been captured, and future studies could benefit from considering additional databases to supplement our findings.

One other limitation lies in the classification of OAD and TIC studies, which may be subject to variations in the interpretation of keywords. However, we optimized the keyword combinations during the search process in the WoS database and implemented Python filtering techniques, resulting in a relatively high level of accuracy in our classifications. The number of studies was further corroborated with a manual search on PubMed and a review of the classifications of the studies was done by critical care physicians.

Although there were no specific language restrictions, the nature of the search term being in English inadvertently excluded valuable contributions from non-English research. This may potentially limit the generalizability of our findings to a broader international audience. In future investigations, the inclusion of articles from various languages could offer a more comprehensive and diverse perspective on intensive care research.

Conclusions

This study has provided valuable insights into the expanding landscape of intensive care research through a comprehensive bibliometric analysis of a large number of publications by leveraging NLP technologies. While OAD studies have demonstrated significant promise, it is essential to view them as a complementary approach rather than a replacement for TIC studies. The unique strength of TIC studies lies in their ability to capture crucial qualitative information, which is essential for comprehensive and ethical decision-making. The integration of both OAD and TIC studies offers a synergistic approach to enriching our understanding of critical care medicine and advancing patient care outcomes. As NLP technology continues to advance, it holds the potential to offer a feasible and transformative alternative for literature review and bibliometric analysis.

Acknowledgments

We thank Dr Nicholas Brian Shannon for assistance with the manual review of the supervised keyword classification. This work was supported by the Duke-NUS Signature Research Programme, funded by the Ministry of Health, Singapore.

Data Availability

The data sets generated during and/or analyzed during this study are available from the corresponding author on reasonable request. The complete set of code used in this study is readily available for download on GitHub [ 62 ].

Authors' Contributions

YK and NL played key roles in the conceptualization of the project. RY was responsible for formalizing the methodology and conducting data curation with the advisory of YK. YK contributed to the validation of the data, ensuring its relevance to the research objectives. RY took the lead in visualizing the data. Both YK and RY drafted the original manuscript. NL served as the project supervisor, overseeing the implementation, and providing valuable input in the writing, review, and editing phases.

Conflicts of Interest

None declared.

Search terms for open-access database (OAD) studies with the cutoff by the years of publications.

Top 20 journals ranked by total citation in which the open-access database and traditional intensive care studies were published. The average citation per article was obtained with the total citation/total number of articles. The citation counts were obtained from Web of Science.

Topic ID and topic family and the components and weightage in each of the categories.

Similarity matrix of 30 topics.

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GitHub. URL: https://github.com/YangRui525/Comparing-OAD-and-TIC-Studies

Abbreviations

Edited by A Mavragani; submitted 19.04.23; peer-reviewed by D Chrimes, S Pesälä; comments to author 14.07.23; revised version received 01.08.23; accepted 14.01.24; published 17.04.24.

©Yuhe Ke, Rui Yang, Nan Liu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 17.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

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