Mental Health Outcomes for Youth in Foster Care Placed with Kin and Siblings: An Intersectional Approach

Background and Purpose: Youth in foster care, particularly adolescents, are at risk for high levels of internalizing and externalizing symptoms (McCrae, 2009; Heflinger et al., 2000). If untreated, these mental health needs may lead to serious emotional and behavioral disorders in adulthood (Pecora et al., 2009). Foster youth placed with relatives or siblings are less likely to experience mental health challenges; and federal and state policies prioritize kin and sibling placement (Bell & Romano, 2015; Winokur, et al., 2014). However, research has not examined the joint influence of kinship and sibling placement on mental health outcomes for foster youth. Utilizing quantitative data from a longitudinal study of early-to-mid adolescent foster youth, the current study is the first to examine the intersection of kinship and sibling placement over time in relation to mental health outcomes.

 

Methods: Study data are derived from the Supporting Siblings in Foster Care Study (SIBS-FC), an NIMH-funded experimental test of a sibling intervention for foster youth (McBeath et al., 2014). 328 siblings (164 dyads) in foster care were universally recruited from Oregon Department of Human Services. Sibling pairs were randomly assigned to participate in the SIBS-FC intervention or receive community-as-usual services. At baseline, the mean age for older and younger siblings was 13.1 (SD=1.4) and 10.7 years (SD=1.75), respectively. The outcome variable was measured via the total score of the Child Behavior Checklist (CBCL; Achenbach, 1991); CBCL data were gathered four times (at 0, 6, 12, and 18 months) from foster parents of youth participants.

Measures of kinship and sibling placement were as follows: A 3-category variable was developed to identify youth who had never been placed with kin, placed with kin intermittently, or always placed with kin over the first 12 months of the study. A similar categorical variable was developed for sibling placement. These variables were combined into a 9-category variable, with categories reflecting the possible range of kin and sibling co-placement experiences of youth.

Multivariate OLS regressions with robust standard errors were conducted to examine the influence of relative and sibling co-placement on CBCL total scores at 12-months and 18-months, controlling for age, race/ethnicity, gender, and treatment group.

 

Results: At 12-months and as compared with youth that were never placed with kin or sibling(s), youth who were sometimes placed with kin and sometimes placed with sibling(s) (β=-0.26, p<0.001), sometimes placed with kin and always placed with sibling(s) (β=-0.17, p<0.05), and always placed with kin and sibling(s) (β=-0.43, p< 0.001) had lower CBCL scores. At 18-months and using the same referent group, youth who were always placed with kin and sibling(s) had lower CBCL scores (β=-0.35, p<0.001).

Conclusion and Implications: These findings suggest that, among youth in foster care, the protective effects of relative and sibling placement are strengthened when they are experienced simultaneously and consistently over time. Albeit associational, this study highlights the need for additional research unpacking the factors contributing to the sustainment of kin and sibling co-placements.