The Association between Adverse Childhood Experiences, Placement Setting Type and Placement Stability for Children in out-of-Home Placemen

Background/Purpose: For children in foster care (FC), placement setting type and placement stability have been shown to be significantly associated with a child’s likelihood of experiencing reunification (e.g. Webster, Barth & Needell, 2000). Additionally, children in FC are at heightened risk of experiencing adverse childhood experiences (ACEs) compared to their peers without FC encounters. Despite the relevance of ACEs for this population, a scarcity of research exists for examining children’s ACE exposure and its association with placement setting type and placement stability. This study sought to fill this gap by investigating the impact of cumulative ACE exposure on FC placement setting type and placement stability.

Methods: The sample comprised 2,998 children, between 6-18 years old, who entered FC between October 2015 and July 2019 in one Midwestern state. The study examined 19 ACEs: 14 were self-reported by the child (obtained from a screening administered at the time children entered FC), and 5 were obtained from state administrative data. ACEs included exposure to: physical, sexual and emotional abuse; domestic and neighborhood violence; and parental mental health and substance use issues, among others. Cumulative ACE exposure was categorized as: 1-5 ACEs, 6-9 ACEs, and 10+ ACEs. Multivariate logistic regression models were conducted to examine the association between cumulative ACEs, placement setting type (family-type setting=1; non-family-type setting=0), and placement stability (placement stability≤3 placements; placement instability≥3 placements). Covariates included: race, biological sex, age at FC entry, siblings in FC, and placement setting type (covariate for placement stability analysis).

Results: Twenty-two percent of the sample reported 1-5 ACEs, 41% reported 6-9 ACEs, and 37% reported 10+ ACEs. The majority (86%) of the sample was placed in a family-type setting with 43% experiencing placement instability. Cumulative ACE exposure significantly predicted placement setting type and placement stability, or rather placement instability. Children with 10+ ACEs had a 77% increased odds (OR=1.77, p=.001) of being placed in a non-family type placement setting (e.g., institution, independent living, etc.), compared to their counterparts with 1-5 ACEs. Children with 6-9 ACEs and 10+ ACEs had a 50% (OR=1.50, p=.000) and 28% (OR=1.28, p=.021) increased odds, respectively, of experiencing placement instability, when compared to children with 1-5 ACEs.

Conclusion/Implications: High cumulative ACE exposure rates were observed among this FC sample, corroborating previous research, though limited. Results showed that increased cumulative ACE exposure significantly influenced a child’s FC placement setting type and placement stability. These findings are noteworthy for two reasons. First, previous literature has reported non-family type settings, including institutions, emergency shelters, and supervised independent living arrangements, increase a child’s likelihood of experiencing multiple placements and decrease the likelihood of reunification. Second, placement instability has been shown to not only decrease a child’s likelihood of reunification but significantly influence a child’s likelihood of negative health and well-being outcomes including substance use and risky sexual behaviors. Considering this study’s results in light of existing research and accumulating evidence on negative consequences of ACEs, practice and policy strategies may be needed to proactively address children’s experiences of adversity and trauma as they enter FC.