Understanding placement stability in treatment foster care

Introduction. Over 500,000 children are currently in foster care in the United States. Studies of children in treatment foster care (TFC) suggest that foster placement stability while in TFC is associated with positive outcomes for the child, including less emotional and behavioral problems and improved child-foster family relationships. Objective. We analyzed the associations between parental (domestic violence, parental illicit drug use, alcoholism, mental health disorders, and incarceration) and child risk factors and the rate of placement change while in TFC. Methods. Data from 138 children enrolled in TFC were extracted from a research database. The children's mean age was 8.6 years (SD 3.7). The majority of the children were African American (84.7%) and male (65.2 %). Clinicians documented the child's functional status on School/Work Role Performance, Home Role Performance, Community Role Performance, Behavior Toward Others, Moods/Emotions, Self-Harmful Behavior, and Thinking subscales of the Child and Adolescent Functional Assessment Scale. Results. Older children experienced a higher rate of placement change (Relative Risk [RR] 1.14, p=0.02). The rate of placement change was lower for children with a history of parental illicit drug use (RR 0.51, p=0.01). Children with higher Moods/Emotions subscale scores had higher rates of placement change (RR 1.06, p=0.00). Data suggested that parental mental health disorders were associated with higher placement change rates (RR 2.0, p = 0.057). Conclusion. Parental risk factors and mood impairment play a significant role in placement stability for children in TFC. Providing integrated mental health and case management services may improve the child's placement stability.