Describing the Role of Key Youth-Reported Relationships in Supporting Behavioral Health

Background and Purpose: Young people in foster care can struggle with disrupted family networks and relational difficulties, which can exacerbate behavioral health challenges (Yates & Grey, 2012). In addition, child welfare system factors contribute to foster placement instability and caseworker turnover, which can prevent consistent support and monitoring of foster youth behavioral health. While child welfare researchers have identified the critical importance of stable, multidimensional support networks in maintaining youth well-being, there are difficulties in assessing the presence of such youth support networks as part of routine child welfare practice (e.g., Author, 2018). Therefore, this study explores the degree to which a few brief indicators of youth-perceived satisfaction with key support relationships may serve as proxy measures to predict a range of behavioral health challenges.

Methods: This secondary study analyzed data from an intervention RCT conducted with youth in foster care in the Pacific Northwest (N=233; mean age=16.19[SD=.64], 54% female, 64% non-white, 20% Hispanic). Quantitative analyses explored associations between youth-reported Likert indicators of relationship quality with caseworkers and foster parents (“How good is your relationship with...”), satisfaction with family contact (“How happy do you feel with the amount of contact you have with your birth family right now?”), and multiple clinical behavioral health measures. Initial examination of bivariate correlations was followed by k-means cluster analysis to classify youth by the three key relational indicators; resulting classifications were used to analyze mean differences on foster parent-reported Child Behavior Checklist (CBCL) measures of internalizing and externalizing behaviors, and the Child Report of Post-traumatic Stress symptoms (CROPS).

Results: Multiple correlations emerged between relational indicators (e.g., with foster parent(s) and with caseworker, Spearman’s rho=.207, p<.01) and with behavioral health symptoms (e.g., foster parent relationship and internalizing symptoms, rho=.195). Analysis classified youth into four clusters comprising those with the lowest means for satisfaction with family contact (Cluster 1, 16% of sample), foster parent relationship quality (Cluster 3, 27%), and caseworker relationship quality (Cluster 4, 27%), where Cluster 2 (30%) reflected high ratings overall. Classification predicted rank order on youth-reported post-traumatic stress (Kruskal-Wallis H=10.848, p=.013), foster parent-reported internalizing (H=9.734, p=.021) and externalizing (H= 14.576, p=.002) behaviors, and overall behavioral health (H=12.436, p=.006), with Cluster 1 youth being most symptomatic, followed by Cluster 3. Follow-up tests were statistically significant for four (anxious/depressed, attention problems, rule-breaking, and aggression) of the eight CBCL subscales.

Conclusions and Implications: Results suggest that simple indicators of youth-reported satisfaction with family contact, as well as the quality of important relationships with current foster care guardians, can predict behavioral health symptoms. Specifically, the degree to which youth are unhappy with their level of family contact is most predictive of symptom scores. Therefore, child welfare practice may benefit from ongoing assessment of youth perspectives on their amount of contact with family members, as well as their satisfaction with caseworkers and foster parent relationships, as this may reveal increased behavioral health risk.