Comparing Developmental Outcomes of Infants in Foster Care Who Were Adopted, Reunified, or in Long-Term Foster Care Five Years Later

Background: Infants are perhaps the most developmentally vulnerable age group entering child welfare services (CWS). Prior research has amply demonstrated that maltreatment during infancy is associated with higher risk of developmental delays. Approximately 100,000 infants enter CWS annually, most for neglect. Despite the numerically substantial number of infants and well-established developmental significance of infancy and early childhood, no research exists comparing the developmental outcomes of maltreated infants placed into foster care who were returned home, were adopted, and remain in long-term foster care (LTFC) in the United States. We believe that this is the only prospective study done comparing outcomes for children placed into foster care with three different subsequent outcomes.

Methods: The sample is drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), the first nationally representative study of children involved with CWS. Total sample size is 436 infants, aged birth to 12 months, who entered CWS and initially placed into foster care. Data were collected at baseline and 18, 36, and 66 months post-baseline from the child, current caregiver, CWS caseworker, and case file. Developmental outcome measures were the Pre-School Language Screener (PLS-3), Vineland Adaptive Behavior Screener, Kaufmann Brief Intelligence Test (K-BIT), and all four subscales of the Woodcock-Johnson; applied math (WJA), basic math (WJC), basic letters/words (WJL) and passage completion (WJP). Linear regression models for each standardized developmental outcome were created using dummy codes for setting with LTFC as the reference and controls for poverty, demographics, and maltreatment experience. Using full information maximum likelihood estimation allowed cases with missing data to be included. Weights and complex sample design variables were applied to all analyses.

Results: Being adopted added 7 and 9 standardized points on the WJP and PLS-3, respectively compared to LTFC peers while adding 6 and 9 standardized points higher on WJA and WJC, respectively. Reunification with family added 6 standardized points on the WJP and 13 standardized points on the WJC compared to peers in LTFC. Effect sizes using Cohen's f2 were medium sized for WJA (.139) and WJP (.211) subscales and large for the PLS-3 (.350) and WJC (.423) subscale. Groups did not score significantly differently on the K-BIT, WJL, or Vineland. These differences in outcomes occurred despite a significantly (÷2=4.04 (2); p<.01) larger number of infants in the adopted group being rated as high developmental risk using the Bayley Infant Neurodevelopmental Screener at baseline.

Conclusions: Overall, the evidence clearly indicates infants who remain in LTFC are demonstrating poorer developmental outcomes as they reach school-age than their peers who were adopted or reunified. Policy-makers and practitioners in child welfare, early intervention, and education should consider more intensive support for foster parents to improve developmental outcomes and adhere to CAPTA guidelines requiring all infants entering CWS receive a referral for early intervention services. These findings also raise critical additional questions about the value of foster care vs. returning home. Barriers to reunification and adoption for young children should be further researched to clarify why some children languish in foster care after five years.