[3550.2] Mental Health Outcomes among Child Welfare Investigated Children: In-Home Versus Out-of-Home Care
Anne-Marie Conn, Moira A. Szilagyi, Aaron Blumkin, Peter G. Szilagyi. U of Rochester, Rochester, NY; Starlight Pediatrics, Rochester, NY.
BACKGROUND: Over the past decade, child welfare has focused on alternatives to out-of-home (OOH) placement (e.g., foster care). Subsequently, in-home services, such as parent training, have increased and more children investigated for maltreatment have remained in-home. Little is known about the effect on mental health (MH) of maintaining vulnerable children in-home vs placing them in OOH care.
OBJECTIVE: Evaluate MH outcomes among children investigated by child welfare who remained in-home and those placed in OOH care, and determine if MH problems improve more in one setting over another.
DESIGN/METHODS: We examined the National Survey of Child and Adolescent Well-Being II (NSCAW II), a national probability longitudinal survey of children aged 0 to 18 years who were investigated by child welfare. We used the Child Behavior Checklist (1.5-18 yr) to compare changes in MH functioning for children who remained in-home with parent training vs those placed in OOH care (a) at baseline (3-6m after placement decision), and (b) 18m later. We compared the prevalence of MH problems (baseline vs 18m) within each placement using bivariate analysis, stratified by age. We also used propensity score matching to pair children based on demographics, adverse childhood experiences (ACE) and MH treatment use, followed by T-tests to compare changes in mean scores between in-home vs OOH care groups.
RESULTS: Baseline: Among the sample of 1469 children, 26% of both the in-home (n=541) and OOH (n=928) groups had MH problems. MH Problems at 18m follow-up (all ages): MH problems increased among children in-home (to 29%) but decreased among OOH care (to 24%), although neither change was statistically significant. MH problems in OOH care group by age: 3-5yr-- MH problems increased (10% to 18% at 18m follow-up, p=0.03); 6-10yr-- MH problems decreased (34% to 17%; p = 0.004); 11-18yr-- MH problems remained stable (32% to 33% p = 0.93). Propensity score analysis: Children matched on demographics, ACEs, and MH treatment use (n=301) showed no differences in the 18 month change in scores between in-home vs OOH care.
CONCLUSIONS: Children who remained in-home with services had more MH problems 18 months following placement, while children in OOH care had fewer, particularly among school-aged children. However, propensity score analysis was inconclusive. Further studies are needed to delineate the impact of placement decisions for children involved with child welfare.
First Author is a Fellow in Training
Session: Presidential Plenary: 2013 APA Presidential Plenary (1:30 PM - 5:15 PM)
Date/Time: Monday, May 6, 2013 - 1:45 PM
Room: Ballroom B - Walter E. Washington Convention Center
Course Code: 3550