Identifying Subgroups of High-Risk Youth Based on Psychosocial Functioning upon Entry into out-of-Home Care

Background and Purpose: Youth involved in the child welfare system are at increased risk for maladaptive psychosocial functioning; however, not all youth experience clinical-level psychosocial problems. Early identification of youth who may be at risk for maladaptive psychosocial functioning is critical to be able to provide services, stabilize foster placements, and promote positive permanency outcomes (e.g., successful reunification). Indeed, a focus of the state child welfare system in which the current study took place is the identification of “high acuity youth” that experience complex problems such as adoption disruption, nontraditional placement, and placement instability. The current study had two primary aims: (a) to identify distinct subgroups of youth based on their psychosocial functioning scores upon entry into out-of-home care and (b) to examine whether there are differences in high acuity status based on subgroup membership.

Methods: Through partnership with a state’s child welfare agency, we used data from 6,345 adolescents (12-17 years; M = 14.88, SD = 1.61) who entered OOHC between 2016-2022 and received psychosocial screening. Sum scores for each of the eight screening assessments (adverse life events, PTSD symptoms, emotional problems, conduct problems, hyperactivity problems, peer problems, prosocial behavior; and substance use) were computed; these scores were used as indicators in the latent profile analysis. Higher scores indicated worse functioning for all except for prosocial behavior. To achieve the study aims, we conducted latent profile analysis in Mplus and used the BCH approach to include high acuity status as a distal outcome. Standard model fit indices were used to identify the best fitting model.

Results: We identified four subgroups of psychosocial functioning: low adverse life events/average psychosocial functioning (Class 1, 24%). moderate conduct and prosocial problems (Class 2, 29%); moderate emotional, peer, and PTSD problems (Class 3, 28%); and moderate emotional and PTSD problems/high or very high conduct, hyperactivity, peer, prosocial, substance use problems (Class 4, 19%). Although few youth were categorized as high acuity (n = 240, 3.8%), there were significant differences in high acuity status based on subgroup membership. Youth in Class 1 were less likely to be characterized as high acuity compared to all other subgroups (estimated proportional differences: 0.02-0.04, ps<.05). Youth in Class 2 were less likely to be characterized as high acuity compared to Class 3 or Class 4 (estimated proportional differences: 0.02, ps<.05). There were no significant differences in the likelihood of being characterized as high acuity between Class 3 or Class 4 (estimated proportional difference: 0.01, p=.58).

Conclusions and Implications: The findings indicate that youth psychosocial functioning at time of entry into out-of-home care can help to identify high acuity youth who are at higher need of services. Of particular interest are emotional, peer, and PTSD problems and youth who have elevated scores across multiple assessment domains. Future work should examine whether youth at increased risk upon entry into out-of-home care receive appropriate services to address psychosocial functioning and/or how to improve the mental health service pipeline for this at-risk population.