Children Who Return Home From Foster Care: A 6-Year Prospective Study of Behavioral Health Outcomes in Adolescence

Abstract

ABSTRACT. Objective. Returning children to their biological families after placement in foster care (ie, reunification) has been prioritized with legislation. Comprehensive studies of child behavioral health functioning after reunification, however, have not been conducted. This study examined outcomes for youth who were reunified after placement in foster care as compared with youth who did not reunify.Design. Prospective cohort. Setting. Children who entered foster care in San Diego, California, and who remained in foster care for at least 5 months.Participants. A cohort of 149 ethnically diverse youth, 7 to 12 years old, who entered foster care between May 1990, and October 1991. Seventy-five percent of those interviewed at Time 1 were interviewed at Time 2 (6 years later).Outcome Measures. 1) Risk behaviors: delinquent, sexual, self-destructive, substance use, and total risk behaviors; 2) Life-course outcomes: pregnancy, tickets/arrests, suspensions, dropping out of school, and grades; 3) Current symptomatology: externalizing, internalizing, total behavior problems, and total competence.Results. Compared with youth who were not reunified, reunified youth showed more self-destructive behavior (0.15 vs ؊0.11), substance use (0.16 vs ؊0.11), and total risk behavior problem standardized scores (0.12 vs ؊0.09). Reunified youth were more likely to have received a ticket or have been arrested (49.2% vs 30.2%), to have dropped out of school (20.6% vs 9.4%), and to have received lower grades (6.5 vs 7.4). Reunified youth reported more current problems in internalizing behaviors (56.6 vs 53.0), and total behavior problems (59.5 vs 55.7), and lower total competence (41.1 vs 45.0). There were no statistically significant differences between the groups on delinquency, sexual behaviors, pregnancy, suspensions, or externalizing behaviors. Reunification status was a significant predictor of negative outcomes in 8 of the 9 regression equations after controlling for Time 1 behavior problems, age, and gender.Conclusions. These findings suggest that youth who reunify with their biological families after placement in foster care have more negative outcomes than youth who do not reunify. The implications of these findings for policy and practice are discussed. Pediatrics 2001;108(1). URL: http://www.pediatrics.org/cgi/content/full/108/1/ e10; foster care, risk behaviors, child abuse, adolescence.ABBREVIATIONS. SD, standard deviation; CBCL, Child Behavior Checklist.C hildren entering foster care have high rates of emotional, behavioral, developmental, and physical health problems and are in need of many specialized services. [1][2][3][4][5][6] In one California study, children in foster care comprised Ͻ4% of Medi-Cal-eligible children, but accounted for 41% of all children who used Medi-Cal mental health services. 7 The limited long-term research on children in foster care suggests that they are at risk for continued difficulties, including not finishing high school, incarceration, and chronic problems with employment and housing....

Health Care Issues for Children and Adolescents in Foster Care and Kinship Care

“…Concerns about time in care need to be balanced, however, against the child's needs for physical and emotional safety and evidence suggesting that stable foster care placement may be a positive and therapeutic intervention for some children. 46,47 The importance of a competent, caring, nurturing, stable foster or kinship parent in supporting and advocating for a child's health and well-being cannot be stressed enough. Significant improvements in a child's health status, development, intelligence, school attendance, and academic achievement have been noted consequent to foster care placement.…”

Reunifying abused or neglected children: Decision-making and outcomes

“…A six-year follow-up of 149 children who entered care when they were 7-12 years old reported that those who remained in care were significantly less likely to display emotional or behavioural problems, including substance misuse, self-destructive behaviours and delinquency, than those who were reunified (Taussig, Clyman, & Landsverk, 2001). In contrast, a study of 353 children placed in care when aged 12 months or under, following investigation for maltreatment, concluded that outcomes at 66-month follow-up were better for children who were living with their parents at that point than for those in foster care (Lloyd & Barth, 2011).…”

RCT of a Mentoring and Skills Group Program: Placement and Permanency Outcomes for Foster Youth

“…For example, studies have found that reunification may place children at risk for adverse outcomes. 25,26 Therefore, although the current study's findings are encouraging, it will be important to understand the implications of these placement and permanency outcomes through longitudinal research that examines child well-being over time. 27 Although the study sample size was moderate and the study was conducted in only 2 US counties, the methodology strengthens the study' s generalizability.…”