Investigating the Relationship between Trauma Symptoms and Placement Instability for Children in Foster Care

Background/Purpose:  Children in foster care often experience multiple traumas, including the trauma of being removed from their homes (Conradi et al., 2011). Trauma symptoms may be connected to poor outcomes, such as mental health or behavioral problems (Kisiel et al., 2009), which can increase the risk of placement instability while in foster care (Beyerlein & Bloch, 2014; Chamberlain et al., 2006). Further, research suggests that placement stability may be important for improved child well-being (Rubin et al., 2007). As part of a federal initiative to address trauma in child welfare, this study investigated the relationship between trauma symptoms and placement stability for children in foster care. Specifically, the research question was: Do children with clinically significant trauma symptoms have increased placement instability?

Methods: The sample included 2,181 children who entered one Midwestern state’s foster care system between November 2015 and March 2019, and who had at least one trauma symptom assessment completed within 120 days of entering care. The study’s primary data sources comprised the state’s child welfare administrative data and assessment data from the state’s providers of foster care. The Child Report of Post-Traumatic Stress (CROPS) assessment was used to measure the trauma symptoms present in the child. Multiple logistic regression tested whether having a trauma score at or above the clinical cut-off (>=19; Greenwald, & Rubin, 1999) was related to placement instability (i.e., >=3 placements for a single episode; Children’s Bureau, 2017), while controlling for child’s age, race, Hispanic ethnicity, gender, disability status, and number of siblings in out-of-home placement.

Results: Overall, children had a mean of 4.4 (SD=6.4) placements and a mean trauma assessment score of 19.3 (SD=10.8). On average, children with clinically significant trauma scores had 4.9 placements (SD=6.9); whereas children whose trauma scores were below the clinical cut-off had a mean of 3.9 placements (SD=5.6). Logistic regression analysis showed that children whose trauma scores met or exceeded the clinical cut-off had increased placement instability (F= 13.12, p < .001). When controlling for demographic factors, having a trauma assessment score at or above the clinical cut-off was associated with nearly 40 percent higher odds of having placement instability (OR= 1.40, p = .001).

Conclusion:Results showed that placement instability was relatively high and that overall mean on trauma symptoms was above the clinical cut-off, indicating prominence of trauma symptoms. Additionally, we found that children with clinically significant trauma scores upon entry into foster care have greater placement instability than children whose trauma scores fall below the clinical cut-off. Given that placement stability is associated with improved child well-being (Rubin et al., 2007), child welfare practices and system structures that will address children’s trauma and other behavioral health needs are necessary. This study adds to the growing literature on the need for trauma-informed child welfare practices and treatments, especially in out-of-home placement settings. Future research should continue to investigate strategies and interventions that improve trauma symptoms and placement stability as well as other long-term outcomes for children and their families.