Mediation and Moderation of out-of-Home Placement in the Association between Maltreatment and Offending: A Systematic Review

Background and Purpose: The long-term association between childhood maltreatment and subsequent offending has been well documented. Although nearly 400,000 maltreated children receive either in-home or out-of-home service in the United States every year, the role of these services in the association between maltreatment and offending remains. Additionally, although maltreated children placed in out-of-home care have a difference placement experience, including a different type or number of placements, research that investigates patterns offending behavior by different placement characteristics is sparse. This systematic review addresses this gap in the literature by examining the current literature on the mediating and moderating roles of out-of-home placement in the maltreatment-offending association.

Methods: A systematic review was conducted using the PRISMA guidelines. PsycINFO, PubMed, Criminal Justice Abstracts, Social Work Abstracts, and Social Sciences Citation Index were searched to identify studies that met the following inclusion criteria: (1) had a sample of current or former youth in out-of-home care; (2) contained a sample with a history of maltreatment before being placed in care; and (3) examined offending outcomes measured at ages 11-35. The initial database search yielded 404 records. After duplicates were removed, 272 abstracts were screened independently by primary and secondary reviewers. Conflicting results were reconciled by the third reviewer. After the initial screening, 66 full-text articles were assessed for eligibility and 53 were excluded due to the lack of mediation or moderation analysis, resulting in 13 articles. After harvesting references of a review paper identified in the screening, 2 additional studies were included. A total of 15 articles were included in this review. All included studies were reviewed for risk of bias and confounding using the RTI Item Bank.

Results: Of the 15 included studies, ten (66%) examined offending behavior during adolescence (before age 19), four (27%) examined offending during young adulthood (ages 19-35), and one examined both. A total of 10 studies that examined the mediation of out-of-home placement revealed inconsistent findings. Some studies showed greater offending outcomes for maltreated youth placed in foster care compared to those remained at home, while others found no difference or mixed findings for different type of offenses. In terms of moderation, the included studies examined the following characteristics of placement: type of placement (n=6), number of placement (n=4), age at first placement (n=6), and neighborhood associated with placement (n=1). Studies showed that more restricted care, more number of placement, those placed at later age, and placement with greater ethnic heterogeneity in the neighborhood are associated with greater offending. The included studies showed high (n=3), medium (n=9), and low (n=3) risk of bias.

Conclusions and Implications: This review found no evidence of different offending behavior between maltreated youth placed in care and those who remained at home. A major implication for practice is the need to focus on reducing and preventing maltreatment, regardless of type of services. For maltreated youth removed from their home, efforts need to be made to place them in less restricted care and reduce the number of placements.