National Survey of Child and Adolescent Well-Being: Foster Care Changes in Relation to Internalizing and Externalizing Problems

Many foster children experience multiple placements. Although multiple placements tend to be associated with elevated levels of behavioral and emotional problems, it is not clear whether changes in placements increase problems or vice versa. To test predictive pathways between number of placements and children’s problems, Aarons et al. (2010) used data for 500 foster children participating in the National Survey of Child and Adolescent Well-Being (NSCAW). Ranging in age from 2 to 15 years, the children were initially assessed with the CBCL at an average of about 5 months after the onset of child welfare investigations and again 18 months and 36 months after the initial assessment. The children were in out-of-home care for the entire 36 months. Cross-lag path analyses showed that high CBCL Internalizing and Externalizing scores significantly predicted changes in foster home placements from baseline to 18 months, with medium effect sizes. In addition, high Internalizing scores at 18 months predicted increased placement changes from 18 to 36 months, with a small effect size. Placement changes did not predict increases in either Internalizing or Externalizing scores from baseline to 18 months, but did predict increases in Externalizing scores from 18 to 36 months, with a medium effect size. Because high Internalizing and Externalizing scores predicted foster home changes but foster home changes also predicted increases in Externalizing scores from 18 to 36 months, Aarons et al. recommended “focusing on helping children manage their behavior, providing training for caregivers to respond effectively to child behavioral problems, and the development of strategies to increase placement stability” (p. 76).

Reference: Aarons, G. A., James, S., Monn, A.R., Raghavan, R., Wells, R.S., & Leslie, L. K. (2010). Behavior problems and placement change in a national child welfare sample: A prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 70-80.