The Moderating Role of Adverse Childhood Experiences (ACEs) on the Mental Health Impact of an Efficacious Intervention for Children in Foster Care

Background and Purpose: 

Youth with a history of maltreatment and foster care placement are at risk for a host of mental health, behavioral, and social problems, resulting in adverse life-course outcomes. Fostering Healthy Futures (FHF) is an evidence-based preventive intervention designed to promote prosocial development and reduce mental health problems among preadolescent children who have been maltreated and placed in out-of-home care. Children in foster care have often been exposed to myriad adverse childhood experiences (ACEs), such as abuse, neglect, chronic living instability, and community violence, all of which are associated with deleterious effects on mental health functioning. The current study sought to examine whether children’s exposure to ACEs moderated the impact of the FHF preventive intervention on mental health outcomes.

Methods:

Baseline and 6-month post-intervention mental health data were collected from 156 9- to 11-year-old racially/ethnically diverse children (50.7% female) as part of a randomized controlled trial of the FHF program, a mentoring and skills group intervention for children recently placed in foster care due to maltreatment. ACEs were measured with a multi-informant (i.e., children, caregivers, teachers, and child welfare records) index, which included exposure to violence, being removed from a single parent home, being the victim of physical and/or sexual abuse, and number of caregiver and school transitions. Mental health outcomes included internalizing problems and trauma symptoms using the Child Behavior Checklist, Teacher Report Form, and Trauma Symptom Checklist for Children.

Results:

The intervention and control groups did not differ on baseline ACE exposure or mental health functioning. Across conditions, significant, positive relationships were found between ACEs and baseline mental health problems (r=.18-.48). Significant moderation effects were observed in regression models predicting post-intervention symptoms of posttraumatic stress (b = 4.62, SE = 1.33, p < .001) and dissociation (b = 3.78, SE = 1.33, p < .01). In probing these interactions, children in the FHF intervention who were exposed to relatively fewer ACEs evidenced better outcomes on posttraumatic stress and dissociation post-intervention relative to the control group. Children in the intervention group exposed to the highest number of ACEs, however, appeared no different than their high-risk counterparts in the control group. Although results indicated that ACEs did not significantly moderate the impact of the intervention on other outcomes, the pattern of findings was similar.

Conclusions and Implications:

Children in out-of-home care are typically exposed to an accumulation of adverse experiences, placing them at high risk for poor mental health outcomes without successful intervention. FHF is a contextually-relevant intervention that has demonstrated positive effects with a high-risk population for which there are few evidence-based interventions. This study adds to a growing body of literature on whether evidence-based practices are efficacious for children exposed to the highest levels of risk. The study’s findings will be placed within the context of the need for the development of more tailored interventions, thereby reducing adverse outcomes for all vulnerable youth. Understanding who is likely to achieve maximum benefit from evidence-based interventions has important implications for both policy and practice.