The Impact of Placement Stability on Behavioral Well-being for Children in Foster Care

Abstract

Objective-Although prior research has demonstrated that frequent placement changes can negatively impact outcomes of children in foster care, it is equally possible that a child's baseline attributes may impact both their capacity to achieve placement stability and their subsequent wellbeing. The goal of this study was to disentangle the effect of a child's baseline problems at entry into foster care on subsequent placement stability and behavioral outcomes in order to separate out the direct impact of placement stability on behavioral problems of children in foster care.Design/Methods-Using a sample of 729 children who entered continuous foster care in the National Survey of Child & Adolescent Well-Being (NSCAW), placement stability over the first 18 months in out-of-home placement was categorized as: early stability (permanency or stable placement within 45 days); late stability (permanency or stable placement beyond 45 days); and unstable (never achieving permanency or stability). A propensity score predicting a child's likelihood of placement instability based on their baseline attributes was divided into categories identifying each child as low, medium, or high-risk for placement instability. These risk categories were then added to a logistic regression model to examine the independent association between placement stability and behavioral well-being using the Child Behavioral Checklist (CBCL) and Temperament Scores from the National Longitudinal Survey of Youth.Results-Weighted analyses revealed that half (52%) of the children achieved early stability; 19% achieved later stability; and 28% remained unstable. Early stabilizers were more likely to be young (p=0.02), have normal baseline behavior (p=0.07), have no prior history with Child Protective Services (p=0.03), and have birth parents that did not have serious mental or behavioral problems (p=0.09). After accounting for baseline attributes, stability remained an important predictor of wellbeing at 18 months. Children with unstable placements were more likely to have behavior problems

Adverse Childhood Experiences and Psychosocial Well-Being of Women Who Were in Foster Care as Children

“…Current institutional policies and practices of the child welfare system often prevent many children from experiencing continuity of care while in foster care. 89 In a US study, Rubin, et al 90 noted that 70% of multiple placements while in foster care were because of child welfare administration demands and issues related to new staff. The current study found that adults who were in foster care as children reported high rates of maltreatment during foster care.…”

Children in nonparental care: health and social risks

“…Annual rates of placement change across children in foster care are estimated to be between 0.55 and 0.62, with some children changing placements multiple times per year (40,41). Placement instability has been associated with hypothalamicpituitary-adrenal axis dysregulation (42), internalizing and externalizing behavior problems (43,44), and increased emergency department use (38). Notably, these increased negative symptoms and behaviors appear to contribute to placement instability as well (43).…”

RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth

“…3 Research has identified several child, family, and system characteristics that predict placement instability and failure to achieve timely permanence for children in foster care: being older, being placed in care with a nonrelative (versus a relative), and having a prior history of removal, placement instability, and/or residential treatment. [4][5][6][7][8][9][10][11][12][13] One of the most robust predictors of negative placement and permanency outcomes is a child's behavioral and mental health problems. [7][8][9][10]12,13 Although it is widely believed that placement changes are harmful and that permanency is beneficial for children involved in the child welfare system, it has been difficult to establish empirically the relationship between placement characteristics and child well-being, in part because many studies have not controlled for children' s baseline functioning.…”

“…[4][5][6][7][8][9][10][11][12][13] One of the most robust predictors of negative placement and permanency outcomes is a child's behavioral and mental health problems. [7][8][9][10]12,13 Although it is widely believed that placement changes are harmful and that permanency is beneficial for children involved in the child welfare system, it has been difficult to establish empirically the relationship between placement characteristics and child well-being, in part because many studies have not controlled for children' s baseline functioning. A handful of studies that have controlled for baseline functioning have found that placement instability increases behavior problems, especially for children with high numbers of placement changes, 12,14 but that early behavior problems also predict later behavior problems, after controlling for placement changes.…”

“…[7][8][9][10]12,13 Although it is widely believed that placement changes are harmful and that permanency is beneficial for children involved in the child welfare system, it has been difficult to establish empirically the relationship between placement characteristics and child well-being, in part because many studies have not controlled for children' s baseline functioning. A handful of studies that have controlled for baseline functioning have found that placement instability increases behavior problems, especially for children with high numbers of placement changes, 12,14 but that early behavior problems also predict later behavior problems, after controlling for placement changes. 5,14 Most of the preventive interventions that have been effective in increasing placement stability and permanency have incorporated parent management training forfosterand biological parents.…”