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Child sexual abuse remains a problem in society, often resulting in the long-term placement of children in the foster care system. In Kentucky, children placed in foster care due to sexual abuse spent more time in care when compared with children removed for any other reason (AFCARS, 2013). Given the cost of long-term foster care placement in both human and eco-

nomic terms, few studies have specifically explored if any factors help to predict why this vulnerable population spends signifi- cantly more time in foster care. The overarching goal of this exploratory study was to use binary logistic regression to investi- gate whether any child demographic or environmental character- istics predicted the discharge of a child placed in Kentucky’s foster care system for child sexual abuse. Results indicated that children in the most rural areas of the state were over 10 times more likely to be discharged from foster care during the federal fiscal year than those residing in the most urban areas. Given this stark reality, a focus must be allocated in understanding this phenomenon. Future research must examine whether the results speak to the necessity of systematic improvement in urban areas or if they are illustrating a unique strength found in rural areas.

Child Sexual Abuse and the Impact of Rurality on Foster Care Outcomes: An Exploratory Analysis

Austin Griffiths Western Kentucky University

April L. Murphy Western Kentucky University

Whitney Harper Western Kentucky University

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In federal fiscal year (FFY) 2014, 3.6 million child abuse and neglectreferrals were made alleging the maltreatment of 6.6 million children in the United States. Of these, approximately 3.2 million (48.5%) received either an investigation or alternative response, resulting in 702,208 (21.6%) victims of maltreatment (U.S. Department of Health and Human Services, 2016). A majority (75.0%) of these children suf- fered neglect, followed by physical abuse (17.0%), sexual abuse (8.3%), other types of abuse (6.8%), and psychological abuse (6.0%) (U.S. Department of Health and Human Services, 2016). Approximately one-fourth of all cases investigated by child protective services are sub- stantiated (Walsh & Mattingly, 2012), resulting in difficult decisions about whether or not the child can remain safe in their current home environment. At times, decisions are made to seek court intervention and children are placed in foster care. While many studies have con- sidered factors pertaining to reasons for placement, little to no research has been published on factors impacting the length of stay in placement specifically for children experiencing sexual abuse. Child abuse is costly, in both economic and human terms. Wang

and Holton (2007) have estimated the annual financial cost of child abuse and neglect was $103.8 billion. However, this annual calculation of direct costs from hospitalizations, mental health services, child wel- fare services, and law enforcement is a conservative estimate, only accounting for the costs related to the victims (Wang & Holton, 2007). Although the economic costs associated with child abuse and neglect are substantial, it is essential to recognize the prevailing “intan- gible losses” that can impact the individual, such as pain, suffering, and reduced quality of life. Although difficult to quantify, these losses may represent the largest component of violence against children and should be taken into account when allocating resources (Miller, 1993). Seeking insight into areas to improve the foster care system and its

relationship with the young lives depending on it, it is important to explore any factors that may explain longer stays in foster care and if any variables can be found that help children to achieve timely permanency.

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According to Child Welfare Information Gateway (2013), children who have been sexually abused have had both their physical and emotional boundaries violated, possibly resulting in a lack of trust and safety (Wang & Holton, 2007). The adverse consequences for children’s devel- opment often are evident immediately, encompassing multiple domains including physical, emotional, social, and cognitive. These children experience significant disruptions in normal development, often having a lasting impact and leading to dysfunction and distress well into adult- hood (Hall & Hall, 2012). The purpose of this study was to specifically examine child sexual abuse in the state of Kentucky. The research ques- tion guiding this study was exploratory in nature and aimed to identify any factors that may influence the probability of whether a child who was placed in foster care for sexual abuse in the state of Kentucky will be discharged from the child welfare system.

Literature Review Although the substantial reports of child sexual abuse are dishearten- ing, they must be understood in context. For example, the aforemen- tioned only reflects the children who have been placed in foster care. Further, not all abuse is reported. If child sexual abuse does get reported, child welfare practitioners often find that it is “easier” to protect a child by meeting a different standard of evidence in court (e.g. neglect). Doctors and other health professionals may question whether CPS intervention is likely to benefit the children and their families or instead cause harm. Levi and Portwood (2011) found that it is factors such as these that introduce significant variability in reporting and are also compounded by the absence of a clear standard to report suspect- ed child abuse. Nonetheless, child sexual abuse does occur and, accord- ing to Townsend and Rheingold (2013), about one in 10 children will be sexually abused before the age of 18. Although systematic chal- lenges continue to limit the possibility of accurately quantifying the occurrence of child sexual abuse, individuals continue to be impacted by the consequences of this behavior.

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Investigating disparities in child maltreatment is important. Dispari- ties in foster care have been well documented when it comes to race (Derezotes, Poertner, & Testa, 2004; Font, 2013; Putnam-Hornstein, Needell, King, & Johnson-Motoyama, 2013; Summers, 2015; Wells, 2011); however, regional location may also matter. Specifically, do the distinct differences of living in a rural community provide valuable insight when compared with the life experiences of living in an urban area? Although one may posit that both rural and urban areas can be fraught with common risk factors of abuse (e.g. family stressors, men- tal health problems, alcohol dependency, history of family violence), the Carsey Institute Report (Walsh & Mattingly, 2012) identified important substantiation differences emerging between rural and urban areas in the United States. Higher income children (that is, in families with incomes greater than 200 percent of the federal poverty level) in rural areas are significantly more likely to have a report sub- stantiated than they are in urban places. Older children in rural places are more likely to have a report substantiated (35%) than those in urban areas (23%) (Walsh & Mattingly, 2012). Children in rural areas whose caregivers are either experiencing active domestic violence or have cognitive impairments are more likely to have a case substantiated than similar urban children (Walsh & Mattingly, 2012). Child sexual abuse remains a problem in society, often resulting in

the long-term placement of children in the foster care system. The crit- ical examination of the child’s demographic and environmental charac- teristics may provide insight into understanding what predicts longer placements in foster care for children who have experienced sexual abuse, and if any factors can help to predict a timely discharge from care. This study will specifically focus on exploring these variables in Kentucky, as this state’s regional differences may help to further iden- tify any prevailing concerns for consideration related to this challenge.

Child Sexual Abuse in Kentucky Kentucky Revised Statute (KRS) 600.020 defines a child as being maltreated when “his or her parent, guardian, person in a position of

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authority or special trust, as defined in KRS 532.045, or other person exercising custodial control or supervision of the child…commits or allows to be committed an act of sexual abuse, sexual exploitation, or prostitution upon the child; creates or allows to be created a risk that an act of sexual abuse, sexual exploitation, or prostitution will be com- mitted upon the child” (KRS 600.020 (1)(a)(5-6)). There are several terms inherent in this definition that warrant further explanation. Child sexual abuse “includes but is not necessarily limited to any con- tacts or interactions in which the parent, guardian, person in a position of authority or special trust…uses or allows, permits, or encourages the use of the child for the purposes of the sexual stimulation of the per- petrator or another person” (KRS 600.020 (58)). Sexual exploitation “includes but is not limited to a situation in which a parent, guardian, person in a position of authority or special trust…allows, permits, or encourages the child to engage in an act of obscene or pornographic photographing, filming, or depicting of a child as provided for under Kentucky law” (KRS 600.020 (59)). Child sexual abuse is unique, often eliciting a visceral public

response. The specifics of such an act, complicated by the perception of a trusted caretaker willingly taking the innocence of an underage victim, generally create an overwhelmingly adverse community reac- tion. However, it continues to happen. There were 22,269 children maltreated in FFY 2014 with 3.9% being victims of sexual abuse in the state of Kentucky during FFY 2014 (U.S. Department of Health and Human Services, 2016).

Foster Care in the United States

Foster care is temporary, a step in the process of achieving permanency for children who have experienced maltreatment. In FFY 2014, there were 415,129 children in foster care in the United States (Child Welfare Information Gateway, 2016), with 7,506 children specifically from the state of Kentucky (Annie E. Casey Foundation, 2016). Conditions influencing high levels of foster care placement speak to the current

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climate of poverty, inequality, and social injustice in America. Macro- level challenges faced by social systems, such as child welfare, perpetuate family violence and delinquent behavior, resulting in broken families and communities (Agnew, Matthews, Bucher, Welcher, & Keyes, 2008; Snyder & Merritt, 2014). When placed in out-of-home care, families are obligated to work with protective service agencies to iden- tify the prevailing high-risk behaviors and develop a plan to minimize the potential for reoccurrence. A prominent federal law guiding child welfare practice is the

Adoption and Safe Families Act (ASFA) of 1997 (P.L. § 105-89). ASFA directs the development of the child’s permanency plan, contin- gent upon timelines and the safety of the child. According to ASFA, the five options for permanency are: return to parent, adoption, referral for legal guardianship, permanent placement with a fit and willing rel- ative, and other planned permanent living arrangement. This federal law was enacted to implement a consistent system of oversight to expe- dite permanency and keep children from becoming “lost” in the system. When children are placed in foster care, the initial goal is return to

parent (reunification). However, ASFA allows the agency to request to change the child’s permanency goal after placement in foster care for 15 of 22 months or through the uncommon finding of “reasonable efforts” before meeting this timeframe. For example, if a child was placed in foster care due to child sexual abuse, the agency is mandated to work to reunify the family. After 15 months, the agency can petition the court to change the child’s formal permanency goal to adoption. If this formal request is granted, the agency can now move toward termi- nating parental rights, which opens new avenues for the child’s perma- nency. With the clear and unquestionable ramifications of not making expedient progress to reunify the family, ASFA guides practice and shapes the social landscape of this country. States receiving Title IV-E funds are obligated to comply with federal guidelines largely due to ASFA. Federal oversight creates a culture of compliance, influencing procedures and policies when agencies work with families and children. Given this reality, compliance with continuous federal evaluation is a

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Figure 1. Conceptual framework

driving force behind service delivery and agency program implementa- tion. Acknowledging the varying interests and the critical importance of children staying in foster care, it is valuable to understand any factors that may contribute to a child’s stay in foster care.

Conceptual Framework

Research has identified factors influencing foster child outcomes for decades. However, differences in research purpose may create a chal- lenge when attempting to generalize the findings. It is suspected that a number of variables may influence the outcomes of children in foster care, including child demographic characteristics, permanency charac- teristics, and environmental characteristics (McDonald, Poertner, & Jennings, 2007; Akin, 2011; Snowden, Leon, & Sieracki, 2008; Sinclair & Wilson, 2003; Smith, Stormshak, Chamberlain, & Whaley, 2001). Few studies have specifically examined factors leading to children who have experienced sexual abuse resulting in longer placements in the foster care system. If one can better understand the factors that predict

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discharge from foster care for this unique population, one can inform practice and policy reducing time in placement for these children. As a result of the wide range of focus in the literature, this study exam- ined the impact of the child’s demographic characteristics, permanency characteristics, and environmental characteristics on length of stay in foster care for children who have experienced sexual abuse in the state of Kentucky in the FFY 2013 (see Figure 1).

Child’s Demographic Characteristics

Age matters, as the older a child gets the less likely they are to exit to any type of permanency (Barth, 1997). In a longitudinal study, Connell, Vanderploeg, and colleagues (2006) found that a child’s age was the primary characteristic associated with risk in placement change, as the older a child gets the more likely they were found to have a change in placement. Furthermore, a common finding is that as a child’s age increases, their probability of being adopted significantly decreases (Snowden, Leon, & Sieracki, 2008; Connell, Katz, Saunders, & Tebes, 2006). Age as a risk factor in increasing days in care is an important variable to consider with this population. Race and ethnicity are critically important factors, especially

related to the experience of minority populations in foster care. Becker, Jordan, and Larsen (2007) found that non-white children were less likely to exit foster care successfully than white children. Also, Barth (1997) found that the reunification of African American children was less likely than that of White or Latino children. Further, African American children were found to be less than half as likely to achieve permanency as a White child (Kemp & Bodonyi, 2002). When considering the specific permanency option of adoption, African American children were found to be notably less likely to be adopted than Latino or White children (Barth, 1997). The impact of a child’s sex does not appear to be as clearly under-

stood. When studying factors associated with the speed of reunification, Fernandez and Lee (2011) found no difference when considering the

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child’s sex. In a six-year study with 3,873 children, Barth (1997) found no sex based effects when examining the likelihood of a child being adopted or remaining in long term care. Also, Becker, Jordan, and Larsen (2007) did not find sex as a significant predictor when exploring variables that contribute to a successful exit from foster care. On the contrary, Kemp and Bodonyi (2002) found boys to be 32% less likely to achieve permanency than girls. Harris and Courtney (2003) also found that boys were significantly less likely than girls to achieve reunification.

Permanency Characteristics

Permanency characteristics have long been posited to influence the experience and the outcome of children in foster care. Specifically relat- ed to child sexual abuse, Connell, Katz, Saunders, and Tebes (2006) uti- lized a longitudinal study and found that children who were placed in foster care for child sexual abuse had a consistent delay in establishing permanency. Additionally, Nalavany, Ryan, Howard, and Smith (2008) found that children with pre-adoptive histories of sexual abuse were at a greater risk of difficulties related to permanency (adoption disruptions, inconsistent parental commitment, moves while in care). Regardless of the child’s permanency outcome, individual level difficulties may be apparent for children who have been placed in foster care for child sex- ual abuse. For example, Yampolskaya, Armstrong, and McNeish (2011) studied risk factors for foster children in Florida and found a significant association between being placed in care for sexual abuse and involve- ment with the juvenile justice system.

Environmental Characteristics

Environmental characteristics, such as geographic location, remain an important consideration in child welfare literature. However, the impact of one’s geographic location has been conflicting. In their study, Glisson and colleagues (2000) found that children residing in urban areas of Tennessee were 50% more likely to be discharged from the system than those

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children residing in rural counties. On the other hand, Becker and col- leagues (2007), found that rurality may serve as a protective factor. Given the importance of a child’s environment on outcomes and the uncer- tainty of its impact, it is an important factor to consider in any model. It is understood that children who have been sexually abused repre-

sent a unique population with specific challenges and critical needs. Yet, previous research focuses on the child’s reason for removal as an independent and predictive variable, rather than as population for the sample. There are a number of studies that examine the effects of child sexual abuse on future adjustment (e.g., depression, sexual abusing own children, etc.). However, no studies were located that explicitly exam- ined children who were placed in foster care by the court due to child sexual abuse and the impact on foster care outcomes (i.e., discharge).

Method

Procedure

This exploratory study utilized secondary data, Adoption and Foster Care Analysis and Reporting System (AFCARS), obtained from the National Data Archive on Child Abuse and Neglect (NDACAN). AFCARS is a federally mandated reporting system that requires each state to electronically submit semi-annual data for the purposes of pol- icy development and state foster care and adoption analysis. It contains case specific information on children who are covered by the protection of the Social Security Act (Title IV-B/E). This study was reviewed and approved by the University’s Institutional Review Board (IRB). Data were taken from the 2013 AFCARS Foster Care file, which was

composed of all children in foster care in the United States in the fed- eral fiscal year (FFY) of 2013 (October 1, 2012 through September 30, 2013). Data were downloaded into the Statistical Package for the Social Sciences (SPSS), Version 23. In order to address the aforemen- tioned research question, only child sexual abuse cases in the state of Kentucky were selected for inclusion in this study.

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Measures

Outcome Variable

The outcome variable in this study was whether a child had been dis- charged from foster care at the end of the FFY 2013. This was deter- mined using the “Discharge Reason” variable in the AFCARS dataset. Ultimately, this variable was recoded using a dichotomous coding structure (i.e., 0 = not discharged; 1 = discharged).

Predictor Variables

Predictor variables fell into two main categories: (a) child demographic characteristics; and (b) environmental characteristics. Demographic characteristics included the child’s sex, race/ethnicity, and age. Child’s sex was recoded into a dummy variable (1 = female) where males served as the reference category. Child’s race/ethnicity was recoded into a dummy variable (1 = non-minority) where minority served as the reference category (see Table 1 for included groups). Child’s age was a continuous variable and represented the child’s age on the first day of the FFY 2013. Number of placement settings was also a con- tinuous variable representing the number of placement settings during the current foster care episode. Environmental characteristics included the rural/urban continuum

code. The rural/urban continuum code was an ordinal variable ranging from 1 (Metro) to 9 (Rural); therefore, higher scores would be indica- tive of more rural settings.

Analysis

Data were downloaded into the SPSS, Version 23. Descriptive statis- tics were conducted to describe the sample included in this analysis. Then, a binary logistic regression was conducted in order to determine the probability of discharge for children who experienced sexual abuse in the state of Kentucky during FFY 2013.

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Results

Sample Characteristics

There were 430 children who entered foster care as a result of sexual abuse in the state of Kentucky during the FFY 2013. Of the 430 chil- dren included in this analysis, a majority (67.7%) were female (n = 291) and Caucasian (77.0%, n = 331). The child’s age on the first day of the FFY 2013 ranged from 0 to 18, with an average of 10.6 (SD = 4.8). Number of placement settings for children in foster care as a result of child sexual abuse ranged from 1 to 24, with an average of 2.9 (SD= 3.2) (see Table 1). With regard to rurality, almost half (49.7%) resided in metro areas (n = 214), 34.0% resided in non-metro areas (n = 146), and 16.3% resided in rural areas (n = 70) (see Table 1).

Logistic Regression

A binary logistic regression was conducted in order to determine the likelihood of a child being discharged from foster care within FFY 2013. Block 0 reported that 158 (36.7%) children had been discharged and 272 (63.3%) were still in foster care at the end of FFY 2013 in Kentucky. The initial -2 Log Likelihood score was 565.519 and the overall percentage correctly classified was 63.3%. Adding the predic- tors (i.e., sex, race, age, number of placements, rural/urban continuum) produced a lower -2 Log Likelihood of 531.536 and the Omnibus Chi- Square score represented a statistically significant difference between Block 0 and Block 1 (X

2 = 33.983, p < .001). Further, the Hosmer and

Lemeshow test indicated a goodness of fit between the predictor vari- ables and the dependent variable (X

2 = 12.153, p = .145).

Overall, results indicated that there were four statistically significant predictors of discharge from foster care (i.e., race, age, rural/urban con- tinuum, number of placements). Sex was the only predictor that was not a statistically significant predictor of discharge. Results indicated that Caucasian children were about half as likely to be discharged from foster care than non-white children (OR = 0.544, p = .015). For every

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Table 1. Sample Characteristics

Variable f (%) Range M (SD)

Child Characteristics:

Sex

Male 139 (32.3)

Female 291 (67.7)

Race/Ethnicity

Non-Hispanic (NH) White 331 (77.0)

NH Black 43 (10.0)

NH American Indian/Alaskan Native 1 (0.2)

NH Hawaiian/Other Pacific Islander 1 (0.2)

NH More than One Race 13 (3.0)

Hispanic 34 (7.9)

Race/Ethnicity Unknown 7 (1.6)

Child Age

On First Day of FFY 2013 0–18 10.6 (4.8)

Number of placement settings 1–24 2.9 (3.2)

Environmental Characteristics:

Rural/Urban Continuum Code

Metro: > 1 million population 109 (25.3)

Metro: 250K – 1 million population 50 (11.6)

Metro: < 250 K population 55 (12.8)

NonMetro: Urban > 20K pop; Adjacent 14 (3.3)

NonMetro: Urban > 20K pop; Non-adjacent 13 (3.0)

NonMetro: Urban 2.5K – 20K; Adjacent 63 (14.7)

NonMetro: Urban 2.5K – 20K; Non-adjacent 56 (13.0)

Rural or < 2.5K population; Adjacent 24 (5.6)

Rural or < 2.5K population; Non-adjacent 46 (10.7)

Outcome Variable: Discharge

Discharge Reason

Not applicable (i.e., discharged) 272 (63.3)

Reunified with parent, primary caretaker 68 (15.8)

Living with other relative(s) 37 (8.6)

Adoption 18 (4.2)

Emancipation 32 (7.4)

Guardianship 1 (0.2)

Transfer to another agency 2 (0.5)

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Table 2. Regression Coefficients for Predictors of Probability of Discharge (N = 430)

Predictor B Wald Odds Ratio p-value

Constant -1.033 8.257 0.356 .004**

Female -0.078 0.122 0.925 .727

White -0.609 5.861 0.544 .015*

Age 0.049 4.729 1.050 .030*

Rural/Urban Continuum 0.167 18.917 1.182 .000***

Number of Placements -0.102 5.972 0.903 .015*

* p < .05, ** p < .01, *** p < .001

Discussion

The impact of child abuse and neglect are not only debilitating to the victims and their families, but also society. Although the economic costs associated with child abuse and neglect are substantial, it is essential to recognize that it is impossible to calculate the impact of the pain, suffering, and reduced quality of life that victims of child abuse and neglect experience. Children in Kentucky’s foster care sys- tem for sexual abuse spent more time in foster care when compared to

1-year increase in a child’s age, they were slightly more likely to be dis- charged from foster care (OR = 1.050, p = .030). There was an inverse relationship between number of placements and probability of dis- charge from foster care. As the child’s number of placements increased, his or her odds of being discharged from foster care decreased (OR = 0.903, p = .015). Lastly, for every one-unit increase on the rural/urban continuum (i.e., more rural), children were 1.182 times more likely to be discharged from foster care (OR = 1.182, p < .001). Thus, children in the most rural areas of the state were more than 10 times more likely to be discharged from foster care than those children in the most urban areas of the state.

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children removed for any other reason. Children in foster care for child sexual abuse were in care for an average of 573.82 days compared to an average of 494.44 days for any other type of maltreatment (F = 1.608, p = .004). Seeking insight into areas to improve the foster care system and its relationship with the young lives depending on it, it is impor- tant to explore any variables that may help us to better understand what contributes to a longer stay in foster care and what helps children achieve permanency. The overarching goal of this study sought to unravel this complex

situation and explore the experiences of Kentucky children placed in foster care for child sexual abuse. This study supports the argument that rurality may in fact be a protective factor, as indicated by Becker and colleagues (2007). This is an interesting finding in that most rural areas offer few services and have fewer resources for families. In fact, Belanger and Stone (2008) found that rural areas have reduced service availability and accessibility, which negatively impacted outcomes for children and families involved with the child welfare system. Interestingly, both race and age exhibited contradictory results

compared to the literature. There is a plethora of literature that reports that Caucasian children are more likely to exit care than minority chil- dren (Barth, 1997; Kemp & Bodonyi, 2002; Becker, Jordan, & Larsen, 2007); however, this study suggested that Caucasian children were less likely to exit care compared to minority children. This may have been a result of the unequal sample size with respect to race. The majority of the sample were Caucasian (n = 331, 77.0%), which may have impacted the results. With regard to age, literature suggests that as children get older, they are less likely to be discharged from care (Barth, 1997; Connell, Katz, Sanders, & Tebes, 2006; Snowden, Leon, & Sieracki, 2008); however, this study suggested the opposite. This may be due to the cross-sectional nature of this study and the fact that this study was looking at a snapshot of children in care dur- ing FFY 2013. Thus, both race and age results should be interpreted with caution.

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Limitations

A primary limitation in utilizing secondary data is the possibility of inconsistencies in the methods used for data collection, reliability issues, and missing data. Administrative data may not effectively facil- itate the evaluation of the research question, as the researcher has no control over the questions asked. Additionally, an important consider- ation when evaluating the applicability of the findings is that the data is cross-sectional, and although the child may have left foster care there is no way to tell if their return/exit was successful as they may have had been placed back into foster care. Future research should focus on examining whether the child’s discharge from foster care was permanent and successful. A longitudinal study would fortify the find- ings from this study, as re-entry is always a risk and a reality. Finally, to get a comprehensive grasp of the rural and urban aspect to this study, it would help if each child’s county of residence was identified.

Implications for Research and Practice

Children in Kentucky’s foster care system as a result of sexual abuse are more likely to exit care if they reside in more rural areas. Given this stark reality, future consideration should be given to exploring why this occurs and exploring the need for any potential avenues for systematic improvement in metropolitan areas. For example, Kentucky’s court approved and preferred gold standard of treatment for perpetrators of child sexual abuse providers (i.e., Sex Offender Risk Assessment Advisory Board) are almost exclusively located in the state’s most urban areas, are very expensive, and are prohibitively lengthy. In practice, frontline social workers see this as a significant barrier when developing treat- ment plans with those living and working in Kentucky’s rural areas. However, the findings of this study suggest that this logistical concern may be irrelevant. Or is it? Are kids leaving care sooner in rural Kentucky because the system has no services to offer? Future research should evaluate the success and participation rates of such specialized

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programs, and determine whether their completion actually results in any difference related to a child’s permanency. If not, there may be pro- found implications related to child welfare policy and practice. Considering the evident differences, are there strengths to be iden-

tified when examining the child welfare system in Kentucky’s most rural areas? Or, are the findings more about the prevailing issues in Kentucky’s metropolitan areas? The child welfare system in Kentucky functions quite differently in its two metropolitan areas (i.e., Louisville and Lexington). Specifically, the court systems are unique and the child welfare workforces in these locations are highly specialized. In rural Kentucky, workers are primarily “generalist” and operate within a smaller court system with familiar and local faces. Does the “rurality” of professional social work practice make a difference? Of additional con- sideration, Kentucky suffers from the national problem of high child welfare worker turnover. Worker turnover deeply affects families and communities by hindering the timeliness and effectiveness of services (GAO, 2003). Future efforts should investigate the current climate of employee retention in Kentucky and its empirical relationship to serv- ice outcomes for foster children in different areas of the state. The findings of this study highlight the need for a better under-

standing of how location impacts length of stay for children who expe- rienced sexual abuse. Future research must examine whether the results speak to the necessity of systematic improvement in urban areas or if they are illustrating a unique strength found in rural areas. For exam- ple, in 2013, Kentucky terminated a majority of the Kinship Care Program, which was in place to provide financial support for relatives taking legal custody of children and eliminating the need for placement in state foster care. Has this financially driven policy change hindered relative placement as the primary option for discharging children from the state foster care system? In the end, children who have been sexu- ally abused are in need of thorough and consistent services and any effort made into achieving their safety and stability should be a primary duty of this country. Any efforts made to identify avenues for improve- ment are worth the time and energy, as children’s lives depend on it.

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References

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Akin, B. A. (2011). Predictors of foster care exits to permanency: A competing risks analy- sis of reunification, guardianship, and adoption. Children and Youth Services Review, 33(6), 999–1011.

Annie E. Casey Foundation. (2016). Children in Foster Care. Retrieved from http:// datacenter.kidscount.org/data/tables/6243-children-in-foster-care?loc=1&loct=2# detailed/2/2-52/false/869,36,868,867,133/any/12987

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