Foster Care Can Spark Modest Improvements in Child Well-Being, New Research Shows

For decades, com­mu­ni­ties have inter­vened to help chil­dren who have been abused and neglect­ed, even with­out clear data to know which inter­ven­tions, if any, have worked. Accord­ing to new research from Kids Insight, a non­prof­it grantee of the Casey Foun­da­tion, the well-being of many chil­dren in fos­ter care improves while in cus­tody. How­ev­er, a minor­i­ty of kids still strug­gle and agen­cies need to find inno­v­a­tive approach­es to effec­tive­ly meet their needs.

Kids Insight used the Treat­ment Out­come Pack­age (TOP) ques­tion­naire, an assess­ment tool on child well-being, in Col­orado, Ohio, North Car­oli­na and Delaware to mea­sure how kids, on aver­age, were doing when they entered care com­pared to how they were far­ing at defined points after spend­ing time in care.

“The insights pro­vid­ed by TOP are pret­ty amaz­ing,” says Tracey Feild, direc­tor of Casey’s Child Wel­fare Strat­e­gy Group. ​“While improve­ments are small, they exist and in many cas­es are sta­tis­ti­cal­ly significant.”

Casey is work­ing with Kids Insight to adapt TOP to child wel­fare after two decades of use in men­tal health set­tings in 30 states. 

TOP scores for 655 chil­dren ages 3–13 showed sta­tis­ti­cal­ly sig­nif­i­cant improve­ment for those who strug­gled with resilience and eat­ing issues. Mean­while, out­comes are trend­ing in a pos­i­tive direc­tion for depres­sion, sep­a­ra­tion anx­i­ety, sui­ci­dal­i­ty, lack of assertive­ness and violence.

“Resilience is an impor­tant qual­i­ty for kids,” says David R. Kraus, TOP devel­op­er and chief sci­en­tif­ic offi­cer of Kids Insight. ​“Kids who are not resilient may be chal­leng­ing. They may strug­gle to get along, fol­low rules and share their lives with oth­ers. For teens in child wel­fare sys­tems, the chal­lenges are dif­fer­ent. These kids have more behav­ior-based issues. They are more like­ly to act out.”

“Help­ing kids recov­er from feel­ing sui­ci­dal? It would be hard to over­es­ti­mate the val­ue of doing that,” says Kids Insight Pres­i­dent Dara Menashi. ​“When you spend $6,000 to $20,000 per child on fos­ter care, or $36,000 to $90,000 on group or ther­a­peu­tic fos­ter care, you want to know it is help­ing young people.”

In the com­mu­ni­ties where TOP is being used, ​“We are not only see­ing what helps chil­dren’s well-being improve, we are see­ing which kids real­ly aren’t being helped — and that is valu­able infor­ma­tion to which we need to pay imme­di­ate atten­tion,” Feild says. 

“Kids under 12 who are in child wel­fare set­tings look pret­ty sim­i­lar to kids in the gen­er­al pop­u­la­tion with one strik­ing dif­fer­ence: They lack resilien­cy,” Kraus says. ​“For teens in child wel­fare, the chal­lenges are dif­fer­ent. These kids have more behav­ior-based issues. They are more like­ly to act out.”

At the same time, accord­ing to their social work­ers, 75% of kids whose TOP scores were tal­lied — near­ly 2,500 kids over­all — had no or just one behav­ioral prob­lem, with lit­tle vari­ance among chil­dren liv­ing in dif­fer­ent set­tings, fos­ter homes ver­sus res­i­den­tial set­tings, for example.

“Our data indi­cate that we need to look close­ly at the 48% of kids in res­i­den­tial cen­ters who have no cur­rent seri­ous behav­ior prob­lems,” Menashi says.

Adds Feild, ​“One has to won­der why they are in these set­tings rather than in fam­i­ly fos­ter care, which research shows is bet­ter for them developmentally.”

A key ben­e­fit of TOP’s well-being data is the abil­i­ty to iden­ti­fy fix­able prob­lems, such as reduc­ing place­ment dis­rup­tions. Teens with high­er lev­els of act­ing out expe­ri­ence fre­quent moves, TOP data show. ​“That should chal­lenge all of us to fig­ure out how to stop that cycle,” Feild says. ​“Chil­dren and teens with depres­sion is anoth­er group we need to pay more atten­tion to. TOP indi­cates that many of them improve while in care. But 16% to 18% dete­ri­o­rate. That’s a red flag. We must act.”