Placement and Outcome in Maltreated Children: Are there differences between children who are placed and those who remain at home?

Background: There has been a trend in child welfare agencies to reduce the number of maltreated children being placed in out of home care. This policy assumes that children who remain with birth parents will fare better than those placed in foster care. In previous work, we found that children's functioning on standardized measures did not differ by placement type shortly after entry into the system. In this study we sought to build on those findings by evaluating how these children fared over time based on their placement type and/or change in placement. Specifically we wanted to learn if children who remained in foster care deteriorated over time vs those who stayed with birth parents and how a change in placement (foster care to biological parents vs. biological parents to foster care) would affect functioning.

Methods: A gender-balanced, ethnically diverse sample of 249 maltreated adolescents was assessed at two time points separated by 18 months. The mean age of the sample was 10.9 years at the first measurement point. Adolescents completed the Children's Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Youth Self-Report (YSR) aggression and delinquency scales at both time points. Maltreated youth were divided into four groups: those residing with a biological parent at both time points, those in foster or kin care at both time points, or those who changed placement (biological to foster and foster to biological). Stability of mean symptom levels for aggression, delinquency, depression and anxiety were evaluated across the two time points for each group. These trends were then analyzed to see if they were the same for all groups.

Results: Children who remained in the same placement over time improved or showed no deterioration in each of the symptom levels. Those in stable foster care placements experienced less anxiety over time and had a trend toward improvement in depression. Children who returned to biological placements from foster or kin care experienced an increase in aggression but were stable in all other symptom areas. There were no differences between the groups on the CDI or the YSR aggression scale. There was a difference on the YSR delinquency measure indicating that children who returned to biological homes experienced an increase in delinquency while those who transitioned into foster care experienced a decrease. A trend on the MASC suggested that those returning to biological care fared worse than those who were stable in their biological residence.

Implications: These findings support the goal of permanency in placement. Children in stable placements did not deteriorate on any measure and there were improvements in several areas. There was no evidence that children in foster care deteriorated over time; in fact they had more improvement in symptom levels than other groups. This study indicates a need for more research on what factors in foster care lead to children's improved functioning. It highlights the importance of stability for children and the need to make careful decisions about placement at the outset of intervention.