Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder.

Importance: The burden of the US opioid crisis has fallen heavily on children, a vulnerable population increasingly exposed to parental opioid use disorder (POUD) in utero or during childhood. A paucity of studies have investigated foster care involvement among those experiencing parental opioid use during childhood and the associated health and health care outcomes. Objective: To examine the health and health care outcomes of children experiencing POUD with and without foster care involvement. Design, Setting, and Participants: This population-based cohort study used nationwide Medicaid claims data from January 1, 2014, to December 31, 2020. Participants included Medicaid-enrolled children experiencing parental opioid use-related disorder during ages 4 to 18 years. Data were analyzed between January 2023 and February 2024. Exposure: Person-years with (exposed) and without (nonexposed) foster care involvement, identified using Medicaid eligibility, procedure, and diagnostic codes. Main Outcomes and Measures: The main outcomes included physical and mental health conditions, developmental disorders, substance use, and health care utilization. The Pearson χ2 test, the t test, and linear regression were used to compare outcomes in person-years with (exposed) and without (nonexposed) foster care involvement. An event study design was used to examine health care utilization patterns before and after foster care involvement. Results: In a longitudinal sample of 8 939 666 person-years from 1 985 180 Medicaid-enrolled children, 49% of children were females and 51% were males. Their mean (SD) age was 10 (4.2) years. The prevalence of foster care involvement was 3% (276 456 person-years), increasing from 1.5% in 2014 to 4.7% in 2020. Compared with those without foster care involvement (8 663 210 person-years), foster care involvement was associated with a higher prevalence of developmental delays (12% vs 7%), depression (10% vs 4%), trauma and stress (35% vs 7%), and substance use-related disorders (4% vs 1%; P < .001 for all). Foster children had higher rates of health care utilization across a wide array of preventive services, including well-child visits (64% vs 44%) and immunizations (41% vs 31%; P < .001 for all). Health care utilization increased sharply in the first year entering foster care but decreased as children exited care. Conclusions and Relevance: In this cohort study of Medicaid-enrolled children experiencing parental opioid use-related disorder, foster care involvement increased significantly between 2014 and 2020. Involvement was associated with increased rates of adverse health outcomes and health care utilization. These findings underscore the importance of policies that support children and families affected by opioid use disorder, as well as the systems that serve them.

Receptive and expressive vocabulary performance in 2- to 5-year-olds in care: The role of different care types and temperament.

The detrimental role of institutionalization in children's development has prompted the introduction of alternative care types designed to offer more personalized care. The current study aimed to test whether children in alternative care types (care villages, care homes, and foster care) performed better on vocabulary than those in institutions. The role of temperament, specifically perceptual sensitivity and frustration, and the interaction between temperament and care types on vocabulary performance were also explored. The study involved 285 2- to 5-year-old children from different care types, and they were assessed through receptive and expressive vocabulary tests and temperament scales. The results of the linear mixed model revealed that children in alternative care types exhibited significantly higher vocabulary scores compared with those in institutions. Moreover, perceptual sensitivity showed a positive association with receptive and expressive vocabulary skills and seemed to act as a protective factor by mitigating the lower vocabulary scores in institutions. Frustration moderated vocabulary outcomes differently for children in institutions and foster care, aligning with the diathesis-stress model and vantage sensitivity theory, respectively. The findings emphasize the positive role of alternative care types in vocabulary performance and the importance of children's temperamental traits in this process.

Disrupted family reunification: Mental health, race, and state-level factors.

The children's mental health landscape is rapidly changing, and youth with mental health conditions (MHCs) are overrepresented in the child welfare system. Mental health is the largest unmet health need in child welfare, so MHCs may affect the likelihood of system reentry. Concerns regarding mental health contribute to calls for expanded supports, yet systems contact can also generate risk of continued child welfare involvement via surveillance. Still, we know little about how expanded supports at the state-level shape child welfare outcomes. Using the Adoption and Foster Care Analysis Reporting System (AFCARS), we examine the association between MHCs and system reentry within 36 months among youth who reunified with their families in 2016 (N = 41,860). We further examine whether this association varies across states and White, Black, and Latinx racial and ethnic groups via two- and three-way interactions. Results from multilevel models show that, net of individual and state-level factors, MHCs are associated with higher odds of reentry. This relationship is stronger for youth in states that expanded Medicaid by 2016 and with higher Medicaid/CHIP child participation rates. The results also show evidence of the moderating role of state-level factors, specifically student-to-school counselor ratio, diverging across racial and ethnic groups. Our results suggest a need for systems of care to better support youth mental health and counteract potential surveillance.

Specialized programs employing different models of care delivery work collaboratively to address the health care needs of children in foster care.

Specialized knowledge and skills applicable to caring for children in foster care include guidelines developed to address this population's special health care needs, cross-system collaboration, and helping families cope with the health impacts of trauma. This paper begins with a review of the special health care needs of children in foster care and relevant guidelines. We discuss different models of health care delivery that can be employed to meet the special health care needs of children in foster care. We then provide examples of two programs employing different models of care that work collaboratively to deliver care to children in foster care in our community.

National training and development curriculum training program impact on placement, permanency, and stability.

BACKGROUND: Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized. OBJECTIVE: Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC). PARTICIPANTS AND SETTING: Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri. METHODS: This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis. RESULTS: With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different. CONCLUSIONS: Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.

The unanticipated side effects of an attachment intervention: Parents ask higher quality questions.

Research suggests foster children are at risk for poor language skills. One intervention, attachment and biobehavioral catch-up (ABC), was shown to successfully improve not only young foster children's attachment to their parents, but also their receptive vocabulary skills (Bernard et al., 2017; Raby et al., 2019). Given that language acquisition is intricately linked to parents' sensitive interactions with their children, we ask whether the ABC intervention also improves the quality of parents' talk addressed to children. We test whether the ABC intervention results in more conversational turns between parents and their children. Crucially, we also look within these conversational turns, assessing the number and types of questions that parents ask children. Results suggest that parents who received the ABC intervention do not have more conversational turns or ask higher numbers of questions, compared to parents who received the control intervention. Rather, parents in the ABC group ask a higher proportion of child-led and restatement questions, and a lower proportion of parent-led and pedagogical questions, compared to the control. Additionally, the higher proportion of child-led questions were related to higher parental sensitivity scores. Together, these results suggest that an intervention originally designed to improve children's socioemotional outcomes had positive benefits for the quality of conversations between parents and children. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities.

Importance: Youth with intellectual and developmental disabilities (I/DD) are more likely to be placed in foster care than other youth. Examining the clinical and sociodemographic characteristics of youth with I/DD in the foster care system is critical for identifying disparities and understanding service needs. Objective: To produce a population-level analysis of youth with I/DD in foster care that examines differences in rates of foster care involvement based on race, ethnicity, age, and sex. Design, Setting, and Participants: This cross-sectional study involved all individuals with I/DD 21 years and younger enrolled in Medicaid through foster care in 2016 via data from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) for all 50 US states and Washington, DC. As a key insurer of I/DD services and foster care, Medicaid claims offer a timely population-level analysis. Youth with I/DD were grouped into diagnostic subgroups: autism spectrum disorder (ASD) only, intellectual disability only, or ASD and ID. The data analysis took place from July 2022 to September 2023. Exposure: TAF data contain Medicaid enrollment information by month with a binary indicator of foster care involvement, and eligibility files identify race, ethnicity, age, and sex. Main Outcomes and Measures: The period prevalence of foster care involvement was determined among I/DD youth by diagnostic subgroups using an intersectional approach across race, ethnicity, age, and sex. Logistic regression examined associations between risk for foster care involvement and race, ethnicity, age, and sex. Results: A total of 39 143 youth with I/DD had foster care involvement in 2016. Black youth (adjusted odds ratio [aOR], 1.37; 95% CI, 1.28-1.47) and females (aOR, 1.18; 95% CI, 1.1-1.27) had increased likelihood for foster care involvement. The likelihood for foster care involvement increased with age in all groups relative to the age group 0 to 5 years old. Conclusions and Relevance: This study found that among youth with I/DD, Black youth and females faced higher risk for foster care involvement, and the likelihood of foster care involvement increased with age. There is an urgent need for research that focuses on addressing system-level factors that drive increased risk. Understanding the specific health needs of Black and female youth with I/DD is critical to ensure the formation, implementation, and monitoring of equitable delivery of health services.

Sexual abuse and disclosure concerns of youth in foster care.

BACKGROUND: Youth in foster care have higher lifetime rates of sexual abuse victimization than their peers who are not in foster care. This sexual abuse occurs before, during, and after their placement. Yet there is a dearth of qualitative research focused on the characteristics of the abuse and the disclosure experiences of youth in foster care. OBJECTIVE: We aimed to understand potential barriers to disclosure for youth who were abused while in foster care. PARTICIPANTS & SETTING: Our study used anonymous, archival data of 143 one-on-one chat sessions on the US based National Sexual Assault Online Hotline (NSAOH) with youth currently living in foster care who sought help for sexual abuse. METHODS: Hotline staff summarized youth's disclosure experiences and barriers using an assessment that included open-ended responses. We used thematic analysis to code text segments. RESULTS: Youth in foster care most often discussed that the abuse was being perpetrated by a foster family member (66 %). Disclosure barriers included concerns for physical safety, not wanting to move placements, not trusting the system to keep them safe, and not wanting to disclose again after previously receiving a negative reaction to their disclosure. CONCLUSIONS: Youth in foster care who seek help for sexual abuse while in the foster care system have unique barriers to disclosure. This study underscores the need for more qualitative research with youth in foster care and includes safety recommendations and implications for training and education of those who work with youth in foster care.

Left behind? Educational disadvantage, child protection, and foster care.

BACKGROUND: Current educational policies for children involved with the Child Protective Services (CPS) system focus largely on the minority of children currently in or aging out of foster care, and target school stability and college access. OBJECTIVE: The present study investigates the nature of secondary (high school) education performance and attainment and post-secondary (college) enrollment among youth with prior or current CPS contact and their low-income, but not CPS-contacted, peers. METHOD: Following a cohort of over 63,000 high school students in Wisconsin, we use CPS investigation and placement records, and public school records to evaluate associations between CPS involvement and educational attainment. RESULTS: CPS-contacted youth have lower educational performance and greater academic challenges than their low-income peers. Youth aging out of care are uniquely disadvantaged with regard to on-time high school completion but complete high school and enroll in college at equal or higher rates than reunified youth. Across all groups, 55-75 % of those who graduated on time with "basic" or above English and math skills enrolled in college. Foster care experiences, such as time in care and placement instability, were not consistently associated with educational outcomes. CONCLUSION: Efforts to improve secondary education experiences are needed to bolster college and career pathways for disadvantaged youth.

Rates of out-of-home care among children in Canada: an analysis of national administrative child welfare data. / Taux de placement des enfants hors de leur foyer familial : analyse des données administratives nationales du système de protection de l'enfance au Canada.

INTRODUCTION: As a part of the public health approach to child welfare, data about children placed in out-of-home care are needed to assess population trends, understand drivers of social and health inequities, and examine outcomes for children and families. We analyzed administrative data from Canada to describe the population of children in out-of-home care, and estimate and compare rates of out-of-home care by province/territory, year, sex/gender, age group and placement type. METHODS: We conducted a cross-sectional analysis of point-in-time data from all provinces and territories for the period 2013/2014 to 2021/2022. We used frequencies and percentages to describe the population of children (and youth up to age 21 years) in out-of-home care and estimated overall and stratified rates and rate ratios. RESULTS: An estimated 61 104 children in Canada were in out-of-home care on 31 March 2022. The national rate of out-of-home care was 8.24 children per 1000 population. Rate variations by province/territory were substantial and changed over time. Rates were highest among males and children aged 1 to 3 and 16 to 17 years. Foster homes were the most common type of placement, although kinship homes accounted for an increasing share. CONCLUSION: This analysis demonstrated that administrative data can be used to generate national indicators about children involved in the child welfare system. These data can be used for tracking progress towards health and social equity for children and youth in Canada.

Systematic Review of the Evaluation of Foster Care Programs.

OBJETIVE: The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians. METHOD: The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions. RESULTS: A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified. CONCLUSIONS: (1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

OBJETIVO: El objetivo es realizar una síntesis exhaustiva que contribuya a determinar qué instrumentos y variables son las más adecuadas para evaluar programas de acogimiento familiar (familias extensas, ajenas y profesionalizadas), incluyendo en esta evaluación a los niños, sus familias acogedoras, sus familias de origen y a los profesionales y técnicos del acogimiento familiar. Método: La revisión sistemática incluyó estudios aleatorizados, cuasialeatorizados, longitudinales y con grupo control dirigidos a evaluar intervenciones de acogimiento familiar. RESULTADOS: Se identificaron 86 estudios, 138 instrumentos de evaluación, 18 constructos y 73 equipos de investigación independientes. CONCLUSIONES: (1) aunque el objeto de las evaluaciones sean los niños, habitualmente los informantes son las personas a cargo de sus cuidados, con lo que se debe hacer un esfuerzo por involucrarlos de forma más participativa; (2) el funcionamiento psicosocial, el comportamiento o la parentalidad son elementos transversales en la mayor parte de evaluaciones, sin embargo la calidad de vida y el afrontamiento no están suficientemente bien incorporados; (3) deben priorizarse instrumentos prácticos (breves y fáciles de aplicar y corregir), de amplio uso y con garantías científicas para asegurar la comparabilidad y fiabilidad de las conclusiones; (4) debe avanzarse en la investigación de modelos de evaluación en todas las modalidades de acogimiento familiar, ya sea en familias ajenas, extensas o especializadas.

The point of view of children in residential and foster care on their health: A comparative study / Le point de vue des enfants en foyer et famille d'accueil sur leur santé : étude comparative

Although it is a major issue, the health of children and adolescents in care is still mainly explored on the basis of information provided by adults in French studies. This study therefore aims to make up for the lack of studies integrating the young people's own point of view and to explore certain aspects of health, as reported by the children and adolescents themselves, by comparing the health of children in care with that of children in the general population. The sample consists of 477 children in care (versus 23,672 who are not). The data were collected through a cross-sectional survey conducted by UNICEF France between October 2020 and March 2022 among 25,300 children and adolescents aged 6 to 18 who responded to a paper or online self-administered questionnaire. The main results of this study confirm the existing findings concerning the much greater health care needs of children and adolescents placed outside their homes (foster families, children's homes) compared to their peers. In particular, they underline greater psychological suffering linked to their life histories, health risk practices, sexual violence, and suicidal risk. The discussion addresses the complexity of the issues associated with their health and underlines the importance of taking into account the child's own point of view.

Bien qu'elle constitue un enjeu majeur, la santé des enfants et adolescents pris en charge au titre de la protection de l'enfance reste majoritairement explorée à partir d'éléments renseignés par les adultes dans le cadre des études françaises. Cette étude vise ainsi à pallier le manque d'études intégrant le propre point de vue des jeunes et à explorer certains aspects liés à la santé, tels que les enfants et adolescents peuvent eux-mêmes en rendre compte, en comparant la santé d'enfants accueillis en foyer ou famille d'accueil à celle d'enfants de la population générale. L'échantillon est constitué de 477 enfants placés (versus 23 672 qui ne le sont pas). Les données ont été recueillies dans le cadre d'une enquête transversale réalisée par l'UNICEF France entre octobre 2020 et mars 2022 auprès de 25 300 enfants et adolescents de 6 à 18 ans ayant répondu à un questionnaire papier ou en ligne auto-administré. Les principaux résultats de cette étude confirment les constats existants concernant les besoins de soins de santé beaucoup plus importants des enfants et des adolescents placés hors de leur domicile (famille d'accueil, foyer) comparativement à leurs pairs. Ils soulignent notamment une plus grande souffrance psychologique liée à leurs histoires de vie, les pratiques constituant un risque pour la santé, les violences sexuelles et le risque suicidaire. La discussion aborde la complexité des enjeux associés à leur santé et souligne l'intérêt de prendre en compte le point de vue de l'enfant lui-même.

Cardiovascular Disease and Risk Factors in Individuals With a History of Out-of-home Care.

BACKGROUND: Exposure to childhood out-of-home care (foster family and residential care) is associated with an increased risk of ill-health and disability in adulthood, but the risk for cardiovascular disease has not previously been studied longitudinally. METHODS: This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 881 731 of whom 26 310 (3.0%) had a history of out-of-home care. The study population, born 1972 to 1981, was followed from age 18 to age 39 to 48 years for hospitalizations and death. RESULTS: After adjusting for year of birth and maternal education, individuals with a history of childhood out-of-home-care experienced a doubling of the risk for coronary disease (hazard ratio; 95% confidence interval: 2.05; 1.74-2.41) and stroke (hazard ratio 1.85; 1.59-2.15), compared with the general population, with similar estimates for men and women. Women with a history of out-of-home care had a more than doubled risk for cigarette smoking in early pregnancy, with a relative risk of 2.26; (2.18-2.34) and a moderately increased risk for gestational diabetes relative risk 1.49 (1.19-1.86). There was marked attenuation (40% to 90%) in effect estimates for disease and risk factors after further control for cohort members educational achievement at age 15-16 years. CONCLUSIONS: A history of childhood out-of-home care was associated with a doubled risk of early cardiovascular disease events. Cigarette smoking and educational underachievement were the main identified risk factors.

Youth Reported Perpetrators of Victimization Within a Foster Care Sample.

Maltreatment type, severity, and chronicity are predictors of poor youth outcomes, yet youth reported perpetrators of abuse have gone largely unstudied. Little is known about variation in perpetration across youth characteristics (e.g., age, gender, placement type) and abuse features. This study aims to describe youth reported perpetrators of victimization within a foster care sample. 503 youth in foster care (ages 8-21 years) reported on experiences of physical, sexual, and psychological abuse. Follow up questions assessed abuse frequency and perpetrators. Mann-Whitney U Tests were used to compare central tendency differences in number of perpetrators reported across youth characteristics and victimization features. Biological caregivers were commonly endorsed perpetrators of physical and psychological abuse, though youth also reported high levels of peer victimization. For sexual abuse, non-related adults were commonly reported perpetrators, however, youth reported higher levels of victimization from peers. Older youth and youth residing in residential care reported higher numbers of perpetrators; girls reported more perpetrators of psychological and sexual abuse as compared to boys. Abuse severity, chronicity, and number of perpetrators were positively associated, and number of perpetrators differed across abuse severity levels. Perpetrator count and type may be important features of victimization experiences, particularly for youth in foster care.

Delivery and Impact of Foster Parent Training: Similarities and Differences for Relative and Non-Relative Foster Parents.

Literature on the delivery and impact of foster parent training, such as the Nurturing Parenting Program (NPP), is sparse, particularly for relative foster parents. This study investigates (a) how NPP referral, initiation, and completion rates vary between relative and non-relative foster parents, (b) reasons for not initiating NPP, and (c) changes in parenting attitudes and behaviors for relative and non-relative foster parents after participating in NPP. The study analyzed data from the Illinois Birth to Three (IB3) study for 722 relative and 397 non-relative foster parents of children ages three and younger. Relative and non-relative foster parents had similar NPP referral and initiation rates, but relatives had significantly lower completion rates. Content analysis of case notes for 498 cases showed that relative foster parents more frequently noted barriers (e.g., childcare, transportation) to NPP initiation. Among NPP completers, both groups reported similar levels of improvements in parenting attitudes and behaviors at the end of NPP, but a pattern of lower scores was observed for relative foster parents. The findings suggest a need for more support for foster parents, particularly relative foster parents.

Developmental trajectories of socio-emotional outcomes of children and young people in out-of-home care - Insights from data of Pathways of Care Longitudinal Study (POCLS).

BACKGROUND: There has been a limited understanding of the longitudinal trajectory and determinants of socio-emotional outcomes among children in out-of-home care (OOHC). OBJECTIVES: This study aimed to examine child socio-demographics, pre-care maltreatment, placement, and caregiver factors associated with trajectories of socio-emotional difficulties of children in OOHC. PARTICIPANTS AND SETTING: The study sample (n = 345) included data from the Pathways of Care Longitudinal Study (POCLS), a prospective longitudinal cohort of children aged 3-17 years who entered the OOHC system in New South Wales (NSW) Australia, between 2010 and 2011. METHODS: Group-based trajectory models were used to identify distinct socio-emotional trajectory groups based on the Child Behaviour Check List (CBCL) Total Problem T-scores completed at all four Waves 1-4. Modified Poisson regression analysis was conducted to assess the association (risk ratios) of socio-emotional trajectory group membership with pre-care maltreatment, placement, and caregiver-related factors. RESULTS: Three trajectories of socio-emotional development were identified: 'persistently low difficulties' (average CBCL T-score changed from 40 to 38 over time), normal (average CBCL T-score changed from 52 to 55 over time), and clinical (average CBCL T-score remained at 68 over time) trajectories. Each trajectory presented a stable trend over time. Relative/kinship care, as compared with foster care, was associated with the "persistently low" socio-emotional trajectory. Being male, exposure to ≥8 pre-care substantiated risk of significant harm (ROSH) reports, placement changes, and caregiver's psychological distress (more than two-fold increased risk) were associated with the clinical socio-emotional trajectory. CONCLUSIONS: Early intervention to ensure children have a nurturing care environment and psychological support to caregivers are vital for positive socio-emotional development over time among children in long-term OOHC.

Influence of placement stability on developmental outcomes of children and young people in out-of-home care: Findings from the Pathways of Care Longitudinal Study.

BACKGROUND: Placement stability is an important indicator of the functioning of an out-of-home care system. Previous research suggests that frequent placement changes have a negative impact on the outcomes for children and young people in out-of-home care. OBJECTIVE: This paper examines the association between placement stability in out-of-home care and children's socio-emotional, cognitive and physical health outcomes. PARTICIPANT AND SETTING: The Pathways of Care Longitudinal Study (POCLS) is the first large-scale prospective longitudinal study of children in out-of-home care in Australia. The sample consists of any study child who participated in any of the first three waves of the POCLS interview. METHODS: Unweighted data from the first three waves of the POCLS interview and administrative data was used. A measure of placement stability was developed that accounted for both number of placements and length of time in care. Mixed effect modelling was used to examine the link between placement stability and children's developmental outcomes. RESULTS: Placement stability was found to have a significant association with socio-emotional, cognitive (non-verbal) and physical health (gross and fine motor skill) development. A number of other factors were also found to be associated with positive development. CONCLUSIONS: The findings support the existing evidence that placement stability is an important factor for children's development. Other factors including placement type, carer wellbeing and carer support are also important for positive development. Appropriate policy and practice intervention to support children and families to improve placement stability is fundamental to achieving positive developmental outcomes for children in out-of-home care.

Trajectories for children and young people who experience out of home care: Examining the influences of pre-care characteristics on later wellbeing and placement stability.

BACKGROUND: Interplay of risk and protective factors influence longer-term outcomes for children in out-of-home care. PARTICIPANTS AND SETTING: Pathways of Care Longitudinal Study (POCLS) data were used to explore how child and birth family factors interact to influence wellbeing and placement stability over time. METHODS: Cluster analysis identified three groups of children differentiated on demographic characteristics on entry in care. Latent growth curve modelling was used to compare changes in children's cognitive functioning, socio-emotional wellbeing, and health over time. RESULTS: There were cluster differences in trajectories for cognitive and socio-emotional outcomes, but not for health. Children who were older at entry to care (mean 7.6 years) showed the poorest socio-emotional and cognitive functioning at Wave 2, and despite improvements by Wave 4, the poor starting point may explain why their cognitive functioning scores never catch up to children entering care younger (mean 1.5 years). Younger on entry children who also tended to come from less socio-economically disadvantaged backgrounds showed the most positive cognitive and socio-emotional functioning over study waves, and cognitive functioning for these children improved at a steeper rate than the other clusters. Children with multiple characteristics associated with risk of poorer outcomes showed little improvement in cognitive functioning over time, and the poorest socio-emotional wellbeing by Wave 4. Placement changes between waves were lowest for children who entered care younger. CONCLUSIONS: This study explicates the role of early risk and protective factors on subsequent trajectories for children in care. Understanding how early risk and protective factors impact longer term wellbeing may help to better target placement and support for cohorts of children with different presentations at entry to care.