A narrative review of stability and change in the mental health of children who grow up in family-based out-of-home care

Abstract

The present review sought to address the following questions: What evidence is there that long-term, family-based out-of-home care (OOHC) has a general, population-wide effect on children’s mental health such that it is generally reparative or generally harmful? Does entry into long-term OOHC affect children’s mental health, as evidenced by prospective changes over the first years in care? And, is the reparative potential of long-term, family-based OOHC moderated by children’s age at entry into care? Fourteen studies were identified for review. We found no consistent evidence that family-based OOHC exerts a general, population-wide effect on the mental health of children in care; or that entry into care has an initial effect on children’s mental health; or that children’s age at entry into care moderates their subsequent mental health trajectories. Instead, several longitudinal studies have found that sizable proportions of children in care manifest meaningful improvement in their mental health over both short- and long-term time frames and that similarly sizable proportions experience meaningful deterioration in their mental health. Rather than asking whether long-term, family-based care is generally reparative or harmful for the development of previously maltreated children, future investigations should instead focus on identifying the systemic and interpersonal characteristics of care that promote and sustain children’s psychological development throughout childhood—and those characteristics that are developmentally harmful (i.e., for which children is the experience of care beneficial, and for which children is it not?). The review concludes with recommendations for the design of improved cohort studies that can address these questions.

Mental Health Symptom Profiles of Adolescents in Foster Care

“…The Looking more closely across the 11 profiles, we can see that none of them include clinical range CBCL affective problems or anxiety problems. This is unsurprising given that previous surveys have consistently found that children and adolescents in care are reported with lower internalizing difficulties relative to other difficulties on general measures such as the CBCL and SDQ (Goemans et al, 2015;Tarren-Sweeney & Goemans, 2019). However, it is notable that Profiles #7 and #11 are characterized by clinical-level ACA dissociation / trauma symptoms alongside sub-clinical CBCL anxiety problems.…”

Assessing students in foster care for autism spectrum disorders

“…School professionals may be hesitant to assess a child in foster care for ASD because of the presence of recent trauma exposure. There may be an over‐reliance on the perspective that the negative effects of trauma on development may dissipate over time in a stable environment and that a child's symptoms may be significantly different in a year or two (Dubowitz et al, 2016; Tarren‐Sweeney & Goemans, 2019). However, while some children who experience trauma demonstrate improvement over time, others do not.…”

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study

“…Previous literature reviews and meta-analyses examining the development of youths' mental health problems in out-of-home care have found that general behavioral problems were stable during foster care [14,15]; no evidence was found that growing up in care is generally ameliorating or detrimental for children who enter care [16]. In jurisdictions where children predominantly enter care following severe and persistent maltreatment, a child's age at entry https://doi.org/10.1192/j.eurpsy.2022.…”