Children with Physical Disabilities in the Child Welfare System: The Influence of a Co-Occurring Diagnosis

Background and Purpose: Children with disabilities are over-represented in the child welfare system. These children have been shown to experience higher rates of abuse and neglect than their non-disabled peers. Additionally, research has shown that compared to their non-disabled peers, children with disabilities are disproportionately more likely to be placed in out-of-home care. However, there is relatively little research focusing on the outcomes for children with disabilities as they progress through the child welfare system. Complicating the issue, children with disabilities within the child welfare system are often grouped together according to presumed behaviors, or lack thereof. However, grouping children with disabilities could mask some of the unique characteristics associated with a particular diagnosis, thereby obscuring individual differences that may affect outcomes. The aim of this study is to explore differences in outcomes between children with a physical disability in conjunction with a second co-occurring disability.

Methods:  This study used data from the Adoption and Foster Care Analysis and Reporting System (AFCARS). AFCARS is the national data reporting system used by child welfare agencies. The data contain 101 variables which include information on the child, his/her biological family, as well as information on the foster care family. These data also contain information on a child’s disability, according to definitions and examples provided in the AFCARS User’s Guide. The sample consisted of 2,048 children who were identified as having a physical disability diagnosis who exited the foster care system in 2013. The outcome variable was length of time in out-of-home placement. The variable of interest was the presence of a second, co-occurring disability. Descriptive statistics were run including gender, race/ethnicity, number of removals from the home, and the number of changes in placement.

Results: Descriptive results show there were more males (55%) than females (45%), with a median age of 9.5 years. Black children were likely to spend more time in care (B=281, p<.001) than other races. Findings also indicate having a second diagnosis is significantly related to the amount of time a child with a physical disability spends in out of home placement. Co-occurring disabilities found to increase time in care include: visual/hearing impairment (B= 301, p<.001), intellectual disability (B= 228, p<.01) and other diagnosed condition (B= 219, p<.001). However, children with a second diagnosis of emotional disturbance are likely to spend 312 fewer days in care (B= -112, p<.001).

Conclusion and Implications: Results indicate age and number of placement settings, as well as the presence of a co-occurring disability have a significant effect on the outcomes for children with physical disabilities. Interestingly, the effects of gender were not shown to have a significant effect in this study. Results from this study help to illustrate the negative, compounding effects a co-occurring disability can have on an already vulnerable group of children. As social work moves forward towards embracing the Grand Challenges, further research is needed to explore the unique needs of these vulnerable children in order to better understand how to serve them in the child welfare system.