Changes in Foster Parent Physical and Mental Health: Testing the Interaction of Caregiver Age and Child Behavioral Problems

Background and Purpose: Caring for children who have been traumatized and separated from their parents may exert an emotional and physical toll on the new substitute caregiver. Yet, we know little about how healthy these aging caregivers are or how this changes over time. A large majority of foster parents, particularly grandparents who are kin placement, are over the age of 50. The purpose of this study is to examine the changes in foster parent physical and mental health over time dependent on caregiver age and child behavior. We hypothesize that child behavioral problems, both externalizing and internalizing, will be associated with a decrease in caregiver physical and mental health functioning over time, and this decrease will be sharper for parents over 60.  

Methods: Data were derived from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II), which sampled cases from CPS investigations that were closed between February 2008 and April 2009 nationwide. The Short Form Health Survey was used to assess both physical and mental health problems. Only cases where the child was placed in a family foster care setting post CPS investigation were used in this study (n=964). Placement was considered kinship if the primary caregiver identified as biologically related to the child. The caregiver reported Child Behavioral Checklist was used to assess child social competence and behavioral problems. Ordinary least square regressions were used to examine the association between child behavioral problems, caregiver age, and mental or physical health changes over time. To measure this change, health scores at baseline were entered into the model as a type of lag variable to test change in scores from wave 1 to wave 2 as a function of child behavior and caregiver age while still controlling for covariates from baseline.

Results: Caregivers who were 60 years and older reported decreased physical health over time compared to caregivers younger than 40 (b = -6.15, p<.05). An increase in externalizing child behaviors was associated with an improvement of caregiver physical health over time (b = 0.14, p<.05).  An interaction between increased child externalizing problems and caregiver age over 60 resulted in improved caregiver physical health over time (b = 0.38, p<.05). Caregiver mental health decreased over time if the child displayed either externalizing or internalizing behavioral problems, and this was worse for caregivers over 60 years (b=-0.37, p<.01).    

Conclusions and Implications: Our hypothesis that child behavioral problems would have a detrimental effect on caregiver mental health, especially if the caregiver was over 60, was confirmed.  While we hypothesized that behavioral problems would universally harm caregiver health, we found an opposite relationship between caregiver physical health and externalizing behavioral problems of children, especially if that caregiver was over 60.  This is not completely unexpected as active children may be more likely to express aggression and antagonism.  These behaviors apparently stimulate physical activity in caregivers and, over time, improves physical health.