Research on the harmful effects of institutionalization across child functioning domains, especially on infants and young children, is well documented, as is the capacity for recovery following family foster care (FFC) placement. Despite this, in Portugal in 2020, only 3% of all out-of-home children were in FFC. Seeking to respond to the European calls-to-action for deinstitutionalization, the 2019 Portuguese law has reinforced non-kinship FFC as the alternative care measure for children up to the age of 6. As a result, massive recruitment, training, and selection of foster families began in the Lisbon Area.
This system shift to FFC is challenging – e.g., it requires highly specialized services to meet foster family and child needs, and thus ensure sustainability. Child Welfare Practice Models (CWPMs) can be part of the solution, by strengthening consistency and quality in child welfare (CW) practice. As Portugal was lacking a proper model, a new CWPM – i.e., Modelo Integrado de Acolhimento Familiar (MIAF; Integrated Model of Family Foster Care) – was recently developed, covers the FFC full continuum, from the recruitment, selection, assessment and training of foster families (module 1) to foster care placement and child transition to a permanent solution (module 2). After the promising results of a first pilot, this proposal proceeds with MIAF's ongoing initial implementation process, based on cutting edge literature on social innovation and process evaluation.
Both process (i.e., fidelity) and outcome evaluations should precede effectiveness testing and full implementation of a CWPM, allowing for timely improvements. Research on process evaluation suggests that it takes time for an innovation to be adopted and that identification of the multi-level factors (e.g., caseworkers’ burnout, unsupportive leadership) that can act as barriers for the successful implementation of a CWPM is crucial. Especially for an innovation in FFC in Portugal, such as MIAF, where evidence suggests FFC is negatively perceived by stakeholders.

Research on outcome evaluation remains scarce, yet is critical to ascertain if a CWPM is producing the intended outcomes, if not, what adjustments are needed. The first year of placement is challenging for foster parents (FPs). They may exhibit elevated distress and a decreased in the quality of care, which eventually affect child outcomes. Such difficulties appear to be explained, at least in part, by child (e.g., behavior problems) and FPs’ factors (e.g., mental health) at time placement. Thus, exploring if MIAF is able to mitigate the impact of such risk factors on foster family pathways, and thus on children, would both add to the state of the art and sustain the promising of the model.

The current proposal aims to conduct a mixed-method and quasi-experimental study in three new territories and FFC agencies, to examine if the MIAF is: 1) being implemented with fidelity (process evaluation); and 2) producing the intended outcomes in terms of family wellbeing and relational care and child safety, stability, and wellbeing, buffering the effects of putative early child and FPs’ risks (outcome evaluation).

For process evaluation, we will assess fidelity and acceptability (e.g., enablers and barriers) of each of the modules of the MIAF, considering the perspectives of the MIAF providers (40 caseworkers and team leaders) and the foster families at: 1 month following the implementation of module 1; after 3, 6, 9 and 12 months of experience implementing Module 2 (providers) or placement (FP); and 1 month following a child transition to a permanent solution. Fidelity checklists, acceptability questionnaires and semi-structured interviews will be use. For outcome evaluation, a quasi-experimental research design will be employed for children up to 6 years of age and their FP: 50 FP and children receiving the MIAF (experimental group) will be compared to matched pairs (child age and sex) receiving the standard FFC (comparison group). We will collect data on 1) child safety, stability, and well-being (e.g., development, emotional/behavioral functioning, attachment disorders), and 2) FP wellbeing (e.g., mental health) and quality of relational care (e.g., sensitive responsiveness) at: 1, 3, 6, 9 and 12 months of placement.

This project benefits from a multidisciplinary team, of researchers and CW staff, from distinct social disciplines, and encloses a dissemination plan targeting multiple audience. This will contribute to add to prior research in this field, but also to strengthen practice and inform policy in a critical stage of desinstitucionalization in the country.

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