Methods: The study sample consists of 500 youths having only out-of-home placements over the course of the NSCAW study. It includes children who: 1) had been in out-of-home care for the entire 36-month study period, and 2) were 2-15 years old at baseline (due to age sensitive measures). We restricted our sample to youth in continuous out-of-home placement as variability with regard to different types of living arrangements over time confound inferences about the relationship between placement change and behavior problems. We used a cross-lag design and path analysis to examine reciprocal effects of behavior problems and placement change between study waves (between W1-W3, and W3-W4). The CBCL caregiver report was used to estimate behavior problems in the clinical range, using T scores to assess the full range of behavior problems. Placement data was based on caseworker's casefile reviews. NSCAW has a variable that captures each sequential placement over the study period, allowing for the creation of a count of placements between each wave. We conducted a series of analyses to examine effects of behavior problems on placement change and placement change on behavior problems, and two sets of analyses to examine the moderating effects of age and gender.
Results: Behavior problems predicted placement change consistently. In contrast, we found only isolated effects of placement changes on subsequent behavior problems. More specifically, both externalizing and internalizing behavior problems at W1 significantly predicted placement changes between Waves 1-3 with small effect sizes. Externalizing and internalizing behavior problems assessed at W3 also significantly predicted placement changes between Waves 3-4; the effect size for externalizing problems was similar to that for the association between Waves 1-3, but slipped below the 0.2 threshold for a “small” association between internalizing problems at W3 and placement changes by W4. Placement changes between Waves 1-3 predicted externalizing behavior problems at W3 but not internalizing problems. Placement changes between Waves 3-4 did not significantly predict behavior problems at Wave 4. Age and gender had some moderating effects. Generally, the relationship between behavior problems and placement changes was moderated by older age (11-16) and male gender. Few moderating effects were found with regard to the effect of placement change on behavior problems.
Conclusions: Findings point to the importance of screening for and treating internalizing and externalizing behavior problems. Findings also have implications for the recruitment and training of foster parents who are generally not well equipped to cope with youth behavior problems. Findings need to be carefully considered within the approach's limitation and prevalent conceptual models guiding child welfare practice, e.g., attachment theory.