Frequent Foster Home Shuffles Worsen Child Behavior; Study Highlights Need for Early Intervention to Encourage Stable Home Placements

02/7/2007

PHILADELPHIA, Feb. 7 /PRNewswire/ -- For children in foster care, living in a stable home has a beneficial effect, independently of their behavior problems when they start foster care.

Children who enter foster care with many behavior problems are less likely to have problems only 18 months later, if they are placed in a stable home. Conversely, among children who begin foster care with fewer apparent behavior problems, those who are moved more frequently are more likely to have subsequent problems than children in more stable placements.

These are findings of a study published in the February issue of Pediatrics.

"It seems to be common sense, and in fact has been borne out in previous research, that frequent placement changes have a negative influence on healthy outcomes for foster children," said study team leader and pediatrician David M. Rubin, M.D., director of Research and Policy for Safe Place: Center for Child Protection and Health at The Children's
Hospital of Philadelphia. "However, we did not previously know how much of the effect was from unstable placements and how much was from a child's pre-existing behavior problems."

"Half of the children entering foster care already have serious behavioral and mental health problems," added Dr. Rubin, "and many people in the child welfare field have argued that these pre-existing problems caused children to experience frequent moves and unstable foster care placements. We designed our study to separate the effect of a child's
baseline problems from their subsequent placement stability and health outcomes."

"We found that, even after considering the multitude of problems children may have when entering foster care, a stable home contributes greatly to improving their behavioral outcomes," said Dr. Rubin. "Our results confirm that one of the best interventions we can make for children in foster care is to find them stable homes as quickly as possible and help them to make healthy, secure attachments."

The researchers analyzed data from the National Survey of Child and Adolescent Well-Being, a nationally representative study of children who were referred to child welfare agencies for maltreatment in 1999 and 2000. From a sample of 729 children who entered continuous foster care, the study team compared the child's behavioral well-being at baseline with outcomes after 18 months of out-of-home care. The children ranged in age from infancy to 15 years old.

Using a combination of temperament scores (for children under age two), a child behavior checklist, birth parent characteristics and each child's maltreatment history, the researchers estimated whether each child was at low, medium or high risk for subsequent unstable placements. These predictions were based on baseline information when the child entered foster care.

After 18 months in foster care, half of the children studied were "early stabilizers," experiencing a long-lasting home placement within 45 days of entering the foster care system. Another 19 percent of the children received a long-lasting placement later than 45 days, while 28 percent did not achieve a long-lasting placement.

In the group predicted to be at low risk of instability, early stabilizers had a 22 percent risk of behavioral problems, compared to a 36 percent risk of behavioral problems among children in unstable placements. The different rates, said the study team, revealed that unstable placement increased the risk of behavior problems by 63 percent, even in children with fewer problems to begin with.

Among children in the high-risk group, where behavioral problems after 18 months were higher for everyone, instability still had a large effect. High-risk children with early stability had a 47 percent risk of behavior problems, compared to a 64 percent risk in high-risk children with unstable placements -- amounting to a 36 percent increase in the risk of behavior problems due to instability.

The most important implication of the study, said Dr. Rubin, is the impact of intervening early in the foster care process to encourage stable placements for children. "Better integration of efforts by child welfare systems, healthcare practitioners and government agencies can improve placement stability for these vulnerable children, and early intervention
may have important longer-term benefits."

Dr. Rubin's co-authors were Amanda O'Reilly, M.P.H., and Xianqun Luan, M.S., of Children's Hospital, and A. Russell Localio, J.D., M.S., of the University of Pennsylvania School of Medicine.

About The Children's Hospital of Philadelphia: The Children's Hospital
of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's
Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In
addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Contact: Gina Marchiondo
Phone: (267) 426-6054
Marchiondo@email.chop.edu