Postplacement adaptation was studied in 106 families with a member living in a residential facility. Respondents reported on three broad areas of functioning: involvement with the member in placement, well-being, and perception of placement advantages and disadvantages. Although respondents readily reported both pros and cons of placement, more than 90% concluded that, on balance, the living arrangement was an advantage for themselves, the child, and other family members. Families with children under age 15, contrasted with families of adolescents and adults, visited more often, reported the highest stress and caretaking burden, as well as the lowest marital adjustment and advantage to placement. Families of adults, for whom living away from the natural home is normative, seemed to have adapted well postplacement.
Editor in charge: Steven J. Taylor
In our society, living apart from the family is atypical for a child but normative for an adult. When a person has mental retardation, however, the living situation often has been the opposite of what is normative. Many children have been placed into residential programs, and many others who remained at home have continued to live there as adults. As we enter the 21st century, there is an overarching emphasis on normalizing the lives of persons with disabilities; for children, this means supporting the family in keeping the child at home (Taylor, Lakin, & Hill, 1989). We now find many fewer children with mental retardation placed. Between 1977 and 1997, the number of children and youth in state mental retardation/developmental disabilities (MR/DD) agency-financed, licensed, or operated residential settings decreased by 72% to 25,842 (Lakin, Anderson, & Prouty, 1998). At the same time, and also consistent with societal norms, many more persons with mental retardation leave home for more independent living as young adults. The number of adults in MR/DD facilities doubled from 1977 to 1997, to 314,381 (Lakin et al., 1998).
Family researchers have studied how parents make the decision to place a child and how families remain involved following placement (Blacher & Baker, 1994a; Cole, 1986; Cole & Meyer, 1989). As placement of children has become rarer, the placement process has involved more lengthy decision-making that takes place over several years (Blacher, 1990; Hanneman & Blacher, 1998) and typically is put into motion by increased difficulties in managing the child physically or emotionally at home (Tausig, 1985). Launching of young adults, on the other hand, is increasingly expected, is seen as a positive step toward greater independence, and is supported by professionals in service agencies. Following placement, or transition out of the family home, many parents are maintaining high involvement with their sons and daughters, especially when the residential facility is not too distant (Baker, Blacher, & Pfeiffer, 1993; Stoneman & Crapps, 1990).
Yet, family researchers have paid scant attention to how the parents and the family as a whole adjust to the change. This would seem a critical question to ask and it is the focus of the present paper. This is the point of intersection of two primary family research traditions: the study of (a) stress and coping in the presence of a family member who has a handicap and (b) out-of-home placement. It seems likely that the consequences of placement will differ for families of children and adults, for families who recently placed and those who placed a long time ago, and for families of residents with mental retardation, mental disorder, or both. Thus, we examined family adjustment as it relates to child age, length of time in placement, and diagnosis.
The evidence about parental well-being following placement is equivocal. Several investigators have examined the relationship of caretaking burden to place of residence. In one study (McDermott, Valentine, Anderson, Gallup, & Thompson, 1997), older caretakers' expressions of worry and responsibility for their offspring's care did not differ according to whether the family member lived at home or in an out-of-home placement. By contrast, Hayden and Heller (1997), differentiating between children and adults, found equally high levels of caretaking burden in parents of children living in placements and at home, but less caretaking burden in parents of adults in placement versus home. Seltzer, Greenberg, Krauss, and Hong (1997), in a study that was designed to examine this issue, found a decrease in caretaking burden for parents of adults from pre- to postplacement.
The evidence about family satisfaction with the decision to place is less equivocal, but limited. Almost 40 years apart, Caldwell and Guze (1960) and Eisenberg, Baker, and Blacher (1998) studied siblings in families whose child with mental retardation lived at home or in placement. In both studies, although siblings of children living at home strongly favored home as the best place for their brother or sister to be, siblings of children in placement equally strongly favored that placement. We conducted a longitudinal study of families who had placed their child into a community facility, assessing their views of outcomes 1 year (Baker & Blacher, 1993), 2 years (Blacher & Baker, 1994b), and 3.5 years postplacement (Blacher, Baker, & Feinfield, 1999). When asked in the 1-year interview about advantages of placement, all mothers reported some benefit to themselves. In this interview, however, the authors did not ask about disadvantages. Subsequently, at 2- and 3.5-years postplacement, parents were asked about life changes since placement. Seven areas were included, and parents were asked to assess each as better, unchanged, or worse. More than two thirds of the respondents said “better” for five areas (family recreation, sibling adjustment, relationships with other children, family social life, and relationship with spouse) and about half said “better” for the other two areas (other relationships and job-related stress); very few said “worse.” At 3.5 years postplacement, all but one of 53 families indicated an average positive life change (Blacher et al., 1999).
The focus of the present study was to more directly assess the postplacement adjustment of families, namely, whether they now viewed placement as the better or worse alternative. We studied a different sample of families, with offspring living in one of three large residential facilities. The sample was quite diverse, including families of children and adults in placement, who had diagnoses of mental retardation and/or mental illness, and wide variability on demographic indicators. In a written questionnaire battery, we obtained measures of respondents' involvement, stress, and caretaking burden as well as specific examples of advantages and disadvantages of the placement in reference to the child, themselves, their spouses, siblings, and the family as a whole.
Participants were family members of residents in three large treatment centers in California, Arizona, and Florida in 1992. An immediate family member and correct address could be identified for 298 residents. A staff member completed a Client Data Sheet (see later discussion) for each of these clients. In the same month the family was sent a Family Involvement Survey (see later discussion); this survey was returned with usable data by respondents from 163 families, and 153 of them indicated a willingness to complete additional measures. Three months later we sent the Family Well-being Survey to these 153 families; 106 respondents (69%) returned surveys with usable data.
Respondents, then, were 106 adults designated as the primary careprovider for a family member in residential placement. There were 73 mothers (M age = 49.9 years, standard deviation [SD] = 11.1), 24 fathers (M age = 52.4 years [SD = 12.3], 7 siblings, and 2 grandparents. The mean resident age was 23.8 years (SD = 12.7), although the range was from 5.3 to 61.2. For some analyses, we classified residents into four approximate age quartiles: child (< 15 years, n = 26), adolescent (15 to 19.9, n = 28), young adult (20 to 26.9, n = 27), and adult (> 27; n = 25). The residents' mean age at first placement was 13.3 (SD = 5.3, range = 1 to 39). Their mean number of placements was 2.4 (SD = 1.9, range = 1 to 10). Diagnostic classification followed DSM criteria (American Psychiatric Association, 1994), categorizing residents as having Axis 1 mental disorder only (n = 28); Axis 2 mental retardation, borderline intellectual functioning, or pervasive developmental disorder only (n = 48); or dual diagnosis (both Axis 1 and Axis 2 disorders) (n = 29). The mean time since initial placement was 10.5 years (median = 5.8), although this ranged from a few months to 48 years.
The families were fairly high in socioeconomic status, with 45% of mothers and 60% of fathers having graduated from college (M years of college = 2.7 and 3.2, respectively). Families lived far from the placement; for most, the one-way travel time ranged from 90 minutes to over 4 hours. Table 1 shows other resident and family demographics.
We contrasted the present sample, who responded to both surveys (n = 106), with the remaining families (n = 192), who had responded to only one or neither survey, on demographic and involvement variables assessed on the Client Data Sheet. The groups did not differ on child variables (age, IQ, behavior problems), but families in the present sample had significantly higher socioeconomic status (SES) and were more likely to be European American. Although the two groups did not differ on distance of the facility from home, the families in the present sample were significantly higher on every involvement variable assessed (visiting, taking the child home, phoning, and participating in activities). Thus, our respondents were a selected sample of families with greater resources and involvement than were the nonrespondents.
Client Data Sheet (Baker et al., 1993). The Client Data Sheet includes 17 items on the demographic characteristics of the child and family and on behavioral dimensions of family involvement. These latter include frequency of visits to the child and frequency with which the family took the child on visits home, scored as follows: 0 (does not visit), 1 (1 to 2 per year), 2 (3 to 6 per year), 3 (about 1 per month), 4 (every other week), and 5 (weekly or more often). This measure also includes diagnostic information, which was subsequently coded with high reliability into three categories: mental retardation alone, mental disorder alone, or dual diagnosis (Baker et al., 1993). Each Client Data Sheet was completed by a staff member who knew the particular child well and who had access to information in logs and medical records.
Family Involvement Survey. This questionnaire has been thoroughly described in a previous paper (Baker, Blacher, & Pfeiffer, 1996). Two sections were relevant to the present study. The Demographics section contains 15 questions, supplementing information obtained from the Client Data Sheet: family member's age at first placement; number of placements; relation to respondent; mother's and father's age, ethnicity, education, occupation and employment; respondent's marital status; and family income. The Involvement section has questions about involvement identical to those on the Client Data Sheet. In this sample, family reports agreed highly with staff reports on the Client Data Sheet for visits home, r(103) = .76, p < .001, and visits to the facility, r(103) = .72, p < .001. An additional item is: “If my child were home, life in the family would be (5) a lot better, (4) better, (3) the same, (2) difficult, (1) a lot more difficult.” The Family Involvement Survey was sent to the parents' home, to be completed by the mother or father, unless another family member was identified as primary careprovider.
Family Well-Being Survey. This survey was a battery of separate measures assessing dimensions of family well-being. (The actual title on the questionnaire was Family Involvement Survey II). Four parent well-being measures are of interest here. An individual item assessed respondent's health, rated on a 4-point scale (poor to excellent). An individual item from the Marital Adjustment Test (Locke & Wallace, 1959) provided an overall estimation of marital happiness (7-point scale, ranging from very unhappy to perfect). Two complete scales were included.
Burden Scale (Zarit, Reever, & Bach-Peterson, 1980). This scale, measuring the subjective burden of caregiving, has 29 items, each rated 0 (not at all true), 1 (somewhat true), or 3 (extremely true). Positively worded items (“I feel useful in my interactions with my child”) are recoded. The total score can range from 0 to 58, with higher scores reflecting greater perceived burden of caregiving. An alpha of .91 has been reported by Seltzer, Krauss, and Tsunematsu (1993); for the present sample, alpha was .88.
Questionnaire on Resources and Stress-F Factor I. (Friedrich, Greenberg, & Crnic, 1983). Factor I of the QRS-F includes 20 true/false items that assess family stress. Although the scale was developed for families with a member who has mental retardation, it is applicable to families of members with mental disorder as well. The total score can range from 0 to 20, with higher scores reflecting greater perceived stress; alpha for the present sample was .90.
Advantages and disadvantages: Open-ended. The final section of this survey covers “the advantages and disadvantages of having your child in a residential placement.” The open-ended advantages page begins with the following statement: “First think about the advantages of your child living out of the home—advantages to your child, to you, and to brothers and sisters. List as many as you like.” Under each heading (e.g., advantages to my child), there were three numbered spaces for responses. The next page (disadvantages) was structured in the same way. We subsequently listed these open-ended responses and derived categories. These categories appear in Table 2. A research assistant, trained in the coding system, then classified responses into these categories. Reliability between the research assistant and the first author was determined for a subsample of 29 families (27% of the sample). Reliability was the number of category or subcategory scores on which raters agreed divided by the total scores assigned. The raters agreed on the classification of 81.5% of the advantages and 87.3% of the disadvantages.
Advantages and Disadvantages Scale. Following the open-ended section was a question with a 6-point Likert Scale and the following instruction:
Putting the advantages and disadvantages together, what do you think about your child living out of home? For each person listed below, please tell us whether your child's out-of-home placement is a (1) Strong Disadvantage—disadvantages far outweigh advantages, (2) Disadvantage, (3) Slight Disadvantage, (4) Slight Advantage, (5) Advantage, (6) Strong Advantage—advantages far outweigh disadvantages.
Ratings were made for the following: my child, me, my spouse (if applicable), siblings (if applicable), and the whole family.
We examined three domains of postplacement family functioning: (a) continuing involvement with the family member in placement; (b) health, marital adjustment, stress, and caretaking burden; and (c) perceived advantages and disadvantages to placement. We related each of these domains to the age of the resident, diagnosis (mental retardation and/or mental disorder), and length of time since the initial placement.
Involvement With the Family Member in Placement
Table 3 shows the extent of family involvement with the child in placement. The tabled frequencies are based on the respondents' reports in the Family Involvement Survey. The modal family was visiting the child at the facility 3 to 6 times a year and taking the child home for a visit 3 to 6 times a year. Almost two thirds of respondents (64.8%) reported that they were satisfied with their level of involvement; all of the remaining respondents except one reported that they desired more involvement.
Respondents who lived greater distances from the facility were less likely to visit or bring the family member home for a visit, rs(103) = −.46 and −.64, respectively, ps < .001. Beyond distance, visitation was also related to resident age, diagnosis, and length of stay. Older residents were visited at the facility less frequently, r(103) = −.33, p < 01, but age did not relate to visits home, r = −.09. Residents diagnosed with mental retardation were less likely to be visited at the facility, r(102) = −.22, p < .05, and less likely to make visits home, r(102) = −.24, p < .05. Residents in placement longer were visited at the facility less frequently, r(103) = −.34, p < .001, but time in placement did not relate to visits home, r = −.08. These significant correlates of visits were considered in a stepwise regression, with distance entering first (20% of variance) and child age entering next (8%). Visits at the facility were most frequent for residents who lived closer and who were children.
Fully 91% of respondents rated their health as good (45%) or excellent (46%). Of married respondents, 84% rated their marriage as “happy” or better. We considered Burden and QRS-F Stress separately because they are meant to be different constructs and are usually considered separately in the literature. However, they were highly correlated in this sample, r(102) = .77, p < .001. The mean Burden score was 19.4 (SD = 9.0) and the mean QRS-F Stress score was 8.0 (SD = 5.4).
Child age related negatively to Burden scores and Stress scores, rs(103) = −.51 and −.41, respectively, ps < .001, but positively to marital adjustment, r(71) = .24, p < .05. The child's diagnosis of mental retardation was unrelated to any well-being measure. The length of time in placement related negatively to Burden scores and Stress scores, rs(103) = −.46 and −.34, respectively, ps < .001. Thus, both stress and caretaking burden were lower when the family member was older and had been in placement longer.
Well-Being: Advantages and Disadvantages of Placement
Table 2 summarizes respondents' statements about advantages and disadvantages of placement “for the child.” Virtually all respondents (97%) stated advantages related to services the child received in the residential treatment facility, especially new opportunities for learning and growth, opportunities for social development, and professional care (e.g.,“Consistent discipline,” “She's around others to play with them,” “His medical problems are monitored 24 hours”). Many respondents (43%) also mentioned positive changes they had seen in the child's feelings and/or behavior, such as being happier or more productive (e.g.,“Feels independent,” “She has better self-esteem,” “Learned to control self”).
Most respondents also noted disadvantages to the child of living elsewhere, most notably the lost advantages of family life. Here, the loss is stated from the child's perspective and is most often noted as losing contact and sharing with the family. (e.g.,“He loses his sense of belonging to a normal family unit,” “He loses the growing up together experiences with his sister,” “Not being with her parents”). About a third of respondents remarked, often quite poignantly, on the child's negative feelings, especially of rejection, desertion, loneliness, and anger (e.g.,“She feels unwanted and lonely sometimes. She needs a little more emotional stroking than she gets in a residential setting,” “He feels pushed out of the home—dropped off and ignored. Resents being out of home. Angry”). A smaller number of respondents indicated specific disadvantages of the placement itself, such as deficiencies in direct care and poor peer role models.
Table 2 also summarizes respondents' statements about advantages and disadvantages of placement “for me.” Virtually all respondents readily noted advantages, with 86% reporting increased peace of mind and/or reduced negative feelings, such as stress, burden, or guilt (e.g.,“Peace of mind knowing her needs are met,” “I'm not constantly worried or angry,” “I'm happy and relieved over my child's happiness”). Another common theme (43% of respondents) was that placement had made it possible for them to pursue personal interests, typically related to education, career, or self-development (e.g.,“I have time to concentrate on my job,” “Free time. A chance to attend school,” “Freedom to work on myself”). A theme noted by about a third of respondents was an improvement in family relationships or increased harmony (e.g.,“The household's not always in crisis mode”). Also, about a third of respondents commented on their reduced burden of care.
Most respondents (75.5%), however, also reported at least one disadvantage “for me” of placement. The most common theme was unease about not being able to fulfill the role of a parent—not being there to provide care and guidance in daily activities. Although some such unavailability would be the case with any placement, this theme may be stronger in the present sample, where the average family lived so far from the placement facility (e.g.,“I'm not there to comfort him,” “I don't get to see her grow up,” “Can't instill values long distance”).
About a third of the respondents indicated negative emotions, such as guilt and worry (e.g.,“Guilt because I couldn't fix it,” “I feel guilty and mixed up when he visits,” “Worry about whether she is ok”). Also, despite the previously noted reduction in personal stress, placement also brought new stress for some families, including the time involved in visitation, costs related to placement, and uncertainties of the service system (e.g.,“Constant stress about the state cutting funds, with disastrous results if he came home”).
Table 2 also summarizes advantages and disadvantages of placement “for brothers/sisters” in those families with siblings. Respondents most often reported that siblings, like themselves, had increased peace of mind or reduced negative feelings (e.g.,“She is calmer,” “Less stress”). About a third noted reduced burden of care and increased time for the sibling to pursue his or her own interests (e.g.,“Less responsibility,” “Better able to work on academics,” “Daily plan not ruined/cancelled”). Respondents often noticed that relationships had improved between the sibling and others in his or her life. No disadvantages were stated in about half of the families with siblings. In the others, the respondent noted the same disadvantages to siblings as to themselves: missing child and unable to share in daily activities (e.g.,“She can't act as a role model,” “Loss of shared experiences”).
Overall Perception: Advantages and Disadvantages Scale
On the single item asking how life in the family would be if the child were home, most respondents indicated a lot more difficult (52%) or difficult (37%). Only 3 respondents indicated that life would be better. Consistent with this, Table 4 shows the percentage of respondents who chose each alternative on the Advantages and Disadvantages Scale. Weighing all of the effects of placement, about 60% of respondents scored it as a strong advantage for each referent. Over 90% scored some degree of advantage in reference to the child (94.3%), myself (93.3%), siblings (91.8%), my spouse (95.9%), and the family (92.3%). Figure 1 shows a graphic representation of benefits to myself; the distribution for each of the other referents was quite similar. There were 7 respondents who perceived, on balance, a disadvantage for myself. Yet, only 1 of them indicated that life in the family would be “better” if the child were home. The five scores on the Advantages and Disadvantages Scale did not relate significantly to the resident's age, diagnosis, or length of time in placement, with two exceptions: Advantages “for me” was higher with older residents, r(102) = .22, p < .05, and with the mental retardation diagnosis, r(101) = .24, p < .05.
Resident Age Categories and Family Well-Being
We further examined the relationship of resident age to the family functioning variables, with ANOVAs across the four age groupings. Because resident age and length of time in placement were highly related, r(103) = .90, p < .001, we covaried the time in placement variable. These comparisons are shown in Table 5. Time in placement did not relate significantly to any of the tabled variables. With time in placement covaried, family involvement scores did not differ by resident age. Respondent marital adjustment significantly increased with increasing resident age, whereas child caretaking burden and stress scores significantly decreased with increasing resident age. Most notably, families with children, contrasted with the three older groupings, reported the lowest marital adjustment and highest burden and stress. The advantage/disadvantage scores differed by age category for advantages to me; stronger advantages to placement were perceived by careproviders for adults, with the highest advantage reported for the young adult group. For the variables with marginal overall Fs (advantage to siblings and family), the greatest advantage to placement was also reported in families with young adults.
Predicting Advantages/Disadvantages Scores
To explore the global perception of advantages/disadvantages further, we correlated advantages “for me” with six child demographic variables (age, behavior problems, IQ, mental retardation diagnosis, psychiatric diagnosis, length of time in placement), four family demographics (socioeconomic status, income, total siblings, distance from the placement), two family involvement scores (visits to the facility and home), and four well-being scores (health, marital adjustment, burden, and stress). As noted, the great majority of respondents reported advantages or strong advantages to placement, so there was little variance in the advantages “for me” score. Nonetheless, there were seven significant correlations. Respondents who perceived lower advantages to placement had children who were younger, r(102) (child age and advantages to me) =.22, p < .05, with greater behavior problems, r(102) = −.21, p <.05, without a mental retardation diagnosis, r(101) = −.24, p < .05, and fewer siblings, r(101) =−23, p < .05. Respondents who perceived lower advantages reported lower marital adjustment, r(70) = .29, p < .05, more stress, r(101) = −.31, p < .01, and greater burden, r(101) = −.25, p < .05. We conducted a stepwise regression analysis on advantages to me, with p to enter set at .05 and the preceding variables with significant univariate relationships considered; we excluded marital adjustment because including only married respondents would greatly reduce the sample. Stress entered first (9.5% of variance), followed by mental retardation diagnosis (4.1% additional variance) and behavior problems (3.7% additional variance), for a total of 17.3% variance explained. Respondents who perceived less advantage to placement were experiencing greater stress and were more likely to have family members without mental retardation but with behavior problems.
Overall, these respondents with child and adult family members in residential placement demonstrated good postplacement adjustment. For the most part, they stayed involved with the family member and reported good health, positive marital adjustment, and reasonably low stress and caretaking burden. On balance, they saw placement as “for the better” for themselves and for others in the family.
We can discuss only indirectly the issue of whether stress and caretaking burden decrease with placement because all of our family members had already been placed at the time we obtained measures. The Zarit Burden Scale has been used by a number of investigators and provides some basis for comparison. In our sample, burden scores decreased with increasing child age, from 26.0 in our youngest group (age 14 and younger) to 12.6 in our oldest group (age 27 and older). These differences likely reflect both the decreased caretaking burden for all families as children become adults and the greater length of out of home placement for older offspring. The mean age for our young adult and adult subsamples combined was 33.1 years, and their mean burden score was 15.6, much lower than the burden scale standardization sample mean of 31.0 and lower than several authors have reported for families of adults with mental retardation living at home. Freedman, Griffiths, Krauss, and Seltzer (1999) found that mothers of co-residents with a mean age of 32.9 reported burden scores of 28.7 and 28.5 at two assessments taken 4.5 years apart. Seltzer and Krauss (1989), with a sample similar to Freedman et al.‘s (mean child age of 34.7), reported a mean burden score of 29.1. Our finding of lower scores for respondents with adult family members in placement is consistent with Heller et al.'s (1997) finding of lower burden in families with an adult in placement versus at home, although not with McDermott et al.'s (1997) finding of no difference in burden for placement versus home groups. Our findings are also consistent with Seltzer et al.'s (1997) findings of decreased maternal burden from pre- to postplacement. The general thrust of these research findings is that parents' perception of caretaking burden is lighter when their adult son or daughter with mental retardation is no longer living at home.
When asked to weigh the consequences of placement, all but a few respondents indicated that, on balance, the placement was an advantage to themselves, the child, and to other family members. Yet, respondents reported both advantages and disadvantages to placement. Almost all respondents spoke about specific benefits provided by the residential program for the child as well as the psychological benefits to themselves, including increased peace of mind, reduced stress, and greater freedom to pursue interests. These benefits, however, were not without a price, because most respondents also noted disadvantages, particularly related to the child's being absent from daily family life and to the related emotional responses in the child and respondent alike.
Our respondents were family members of persons in large residential facilities. We cannot assume that our findings about impact of placement would generalize to family members of individuals in smaller group homes or other kinds of living arrangements. Although this issue requires more study, we expect that the advantages would be similar and that some disadvantages (e.g., those related to distance) would be reduced. The primary advantages reported by the present participants were very similar to those reported in our earlier study of families with children, the majority of whom lived in small group homes (Blacher & Baker, 1994a). Also, a recent study of mothers' reported life changes after their child or adult with autism moved away from home, mostly into community residences or more independent arrangements, found advantages and disadvantages similar to those reported by our family members (Seltzer, Krauss, & Shattuck, 2000). Fully 91% of mothers noted increased free time and about half felt less fatigue, though many also expressed feelings of loneliness.
Family members' well-being following placement was related to the age of the child and to the child's level of functioning. Respondents with younger children reported more visits to the child, greater caretaking burden and stress, lower marital adjustment, and lower advantages to placement than did those with older adolescents or adult offspring. Indeed, family members of adults living away from the parental home reported very low levels of burden and practically all reported that the placement was, on balance, for the better. These age-related findings are consistent with the societal and professional pressures to keep children at home and to move adults to greater independence. Families of residents with mental retardation reported fewer visits to the facility or visits home than did those of residents with average intelligence but mental disorder. However, the residents' diagnosis did not relate to respondents' well-being or the advantage/disadvantage score. Length of time in residential treatment did not relate to our postplacement indicators when resident age was controlled for.
There are several limitations on interpreting the findings imposed by the characteristics of our sample. Typical of voluntary samples, the families who returned the survey were more likely to be European American and higher SES. Moreover, they were more involved with the child and placement than those who did not; thus, we cannot know how our findings would generalize to other, less involved, families. Also, our respondents were predominantly parents, so we cannot say to what extent other relatives would report similar impacts. Our sample included only 9 other relatives (7 siblings and 2 grandmothers), not enough to address their reactions separately. However, we do note that these other relatives reported visiting less often, lower stress and burden, and greater advantage of placement to the family. Their family member in placement was, however, significantly older, so these differences are consistent with the general age-related trends that we found. The impact of placement on relatives, especially siblings, is a relatively unexplored area that is of increasing importance as people with mental retardation are living longer and more of these individuals now outlive their parents (Braddock, 1999).
The finding that respondents perceived placement to be, on average, “for the better,” should not be surprising for several reasons. First, those families who feel strongly that it will be disadvantageous if the family member lives elsewhere will be less likely to seek a placement; moreover, if they do make such a decision, they will be more likely subsequently to take the family member back home. Studies of postplacement adjustment, then, have samples of families who have placed and continued the placement. Second, as noted, there is a strong professional push at the present time for adults with disabilities to live as independently as possible. Thus, launching an adult family member is socially supported, indeed encouraged. However, the strong advantages our respondents with children and adolescents in placement also reported occurred despite professional pressures to keep the child at home.
Third, some authors have understood families' acceptance of placements by invoking Festinger's (1957) psychological theory of cognitive dissonance, which argues that if one's attitudes and actions are discrepant, the result is dissonance, which is unpleasant and motivates people to work to bring these into balance. One way is to change either the attitude or the behavior. Thus, if one has doubts about placement but has placed a son or daughter, then to reduce dissonance he or she can either end the placement or alter beliefs, emphasizing benefits and downplaying reservations. Although our respondents cited both advantages and disadvantages, they attached higher valence to the former. Reducing dissonance through attitude change results in a general acceptance of the status quo. Siblings of children with mental retardation living at home see home as the best place for their sibling with mental retardation, whereas siblings of placed children see out-of home placement as best (Caldwell & Guze, 1960; Eisenberg et al., 1997). Latib, Conroy, and Hess (1984) found that parents of institutionalized residents strongly favored the institution; 6 months after a forced relocation to the community, these same parents strongly favored community placements.
Another way of reducing dissonance is by adding consonant elements, other factors that help to explain the actions. For example, parents of children with mental disorder who have become dangerous to themselves or others may have perceived that they had less of a say about the child's placement. Consequently, they would not experience as much dissonance if they held negative attitudes about the placement. In our sample, parents of children with mental disorders but no mental retardation evaluated the consequences of placement as less advantageous.
Caregivers have further options, however. One is to be accepting of the child's living more independently but to entertain doubts about the specific placement and to seek a more suitable placement. Studies of community residences typically do not report the considerable movement of clients from one residence to another. Altman and Cunningham (1993), in a national survey, reported that one resident in six changed living arrangements during the year studied. In the present sample, the average child had already lived in 2.6 placements (range = 1 to 10) including the present one, and the average adult had lived in 2.2 placements (range = 1 to 8). Seltzer et al. (2000) found that 18% of parents whose son or daughter lived away from the parental home did not view the present placement as appropriate. Their description of more appropriate placements, rather than considering a return home, were typically of settings affording greater independence.
Yet another option for reducing dissonance is to maintain high involvement with the family member in placement and, thus, be able to view the child as less isolated from family life. We have found high and continuing involvement in several samples of families studied, especially when the placement facilities are closer to home than were the ones in the present sample. As expected, we have found more frequent visits to children, especially in the initial years after placement. Out-of-home placement of children is not normative, and it appears to engender more perceived disadvantages than does the launching of young adults. Family involvement in residential placement is, then, important not only for the member in placement but also for the whole family. It is essential that residential facilities be open to family visits and participation and keep families well-informed about opportunities for involvement (Blacher & Baker, 1992).
NOTE: Data collection was supported by a grant from the Devereux Foundation to the authors. We appreciate the assistance of Steven Pfeiffer, Rebecca Shepherd, and the site coordinators Kristen Schmidt, Kathy Gulje, Kathy Fernberg, and Sonia Ghali. Analysis and manuscript preparation was supported by National Institute of Child Health and Human Development (NICHD) Grant HD21324, Jan Blacher, principal investigator. Requests for reprints should be sent to the first author.
Authors: Bruce L. Baker, PhD, Professor of Psychology, Department of Psychology, 1282A Franz Hall, Box 951563, University of California, Los Angeles, Los Angeles, CA 90095-1563 (email@example.com). Jan Blacher, PhD, Professor of Education, School of Education, Sproul Hall, University of California, Riverside, Riverside, CA 92521-0001 (firstname.lastname@example.org).