Influence of Cumulative Adverse Childhood Experiences on Reunification for Children in Foster Care

Background/Purpose: Available research has revealed children in foster care (FC) are at amplified risk of experiencing cumulative adverse childhood experiences (ACEs). Though separate bodies of research exist for ACEs and FC, an ample amount of research has demonstrated an extreme overlap in negative outcomes between ACEs and FC involvement, including: substance use, suicidality, early pregnancy, homelessness, poorer educational outcomes, and experiencing impoverishment, among others. The purpose of this study was to examine the influence of cumulative ACE exposure on the likelihood of reunification for children in FC.

Methods: The study’s sample included 2,998 children in foster care between October 2015 and July 2019 for one Midwestern state. Children between 6 and 18 years old who self-reported childhood ACE exposure on 1-14 adversities were eligible for the study (obtained from a screening administered at the time children entered FC). An additional five ACEs were obtained from state administrative data. In total, 19 ACEs were included (e.g., physical abuse, sexual abuse, abandonment, bullied/discrimination, neighborhood violence, etc.). Cox proportional hazard regression, an event history technique, was utilized to examine a child’s likelihood of and time to reunification, comparing children with 1-5 ACEs, 6-9 ACEs, and 10+ ACEs. Five covariates were included in the Cox regression model: race, biological sex, age at FC entry, siblings in FC, and placement setting type.

Results: No children reported 0 ACEs; 653 (22%) reported 1-5 ACEs, 1,223 (41%) reported 6-9 ACEs, and 1,122 (37%) reported 10+ ACEs. As a child’s cumulative ACE exposure increased, their likelihood of reunification decreased. Children who reported 6-9 ACEs were 28% less likely to reunify (HR=.72, p=.024) when compared to children with 1-5 ACEs. Children in the highest ACE category, 10+ ACEs, were 42% less likely to reunify (HR=.58, p=.000) than their counterpart with 1-5 ACEs. Other significant predictors of reunification included: race, age at FC entry, siblings in FC, and placement setting type. Being non-white (HR=.79, p=.027), older than 10 years at FC entry (HR= .29 - .24, p=.003 - .011, varied by age category), having sibling(s) in FC (HR=.48, p=.000), and being placed in a non-family-type setting (HR=.50, p=.000) all decreased the likelihood of reunification. Further, analyses of time to reunification showed children with 1-5 ACEs reunified noticeably sooner (50% reunified at median= 710 days) than children with 6-9 ACEs (50% reunified at median=1,531 days).

Conclusion/Implications: The exclusively FC sample reported extremely high rates of cumulative ACEs with 99.6% reporting 2+ ACEs. Findings revealed that increased cumulative ACE exposure among children in FC significantly impedes the likelihood of reunification, and slows the time to reunification. Further, children who were non-White, older than 10 years at FC entry and had siblings in FC were significantly less likely to experience reunification. Results support the notion that even among an already vulnerable population, there exists certain subgroups of children who may be disproportionately susceptible to negative FC outcomes. Future research is necessary to examine the intersectionality and implications of cumulative ACEs among children who experience FC.