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Foster Care Placement Improves Children's Functioning
Sarah McCue Horwitz, PhD;
Kathleen M. B. Balestracci, PhD;
Mark D. Simms, MD, MPH
Arch Pediatr Adolesc Med. 2001;155:1255-1260.
Objective To examine changes in reported functioning over a 12-month follow-up
period and predictors of those changes for a cohort of young children enrolled
in foster care.
Design Data came from a longitudinal follow-up of a cohort of young children
entering foster care in one Connecticut region. These data were originally
assembled to evaluate the effectiveness of a specialized set of services designed
to provide a baseline multidisciplinary assessment and ongoing monitoring
for young children entering foster care.
Setting and Participants From February 1, 1992, through July 31, 1993, all young children (N
= 120) entering foster care in one Connecticut region were enrolled in this
study. Children were assessed at entry into care and at 6 and 12 months after
entry. Participation rates exceeded 90% at each follow-up period.
Main Outcome Measures The principal outcome of interest for these analyses is 12-month functioning
as measured by the Vineland Adaptive Behavior Scale (VABS) scores completed
by their foster mothers.
Results At entry into foster care, children ranged in age from 11 to 76 months,
were evenly divided by sex, and had a mean VABS score of 79.5 signifying functioning
below the average range. At 6 months children gained an average of 7.87 points
on their VABS score. By 12 months children showed an average change of 9.65
points, for a mean VABS score of 94.5, well within the nationally normed average
range. The multivariate linear model predicting the 12-month VABS score showed
that, controlling for the baseline VABS score, when children who were abused,
older at placement, female, of African American ethnicity, spent more time
in foster care, and had fewer recommended services while in care, they were
more likely to show improvement on the foster mother–reported VABS evaluation.
Conclusions These results demonstrate that children's reported functioning improves
over the course of placement in foster care and that sociodemographic characteristics,
reason for placement, length of time in foster care, and fewer recommended
services at entry into foster care identified children who were more likely
to improve. These results argue for a careful examination of the foster care
environment to better understand which aspects of the environment contribute
to improved foster mother reported functioning. Such understanding will be
critical for the care and development of maltreated children.
From the Department of Epidemiology and Public Health (Drs Horwitz
and Balestracci), and The Child Study Center (Dr Horwitz), Yale University
School of Medicine; and the Institution for Social and Policy Studies, Yale
University (Dr Horwitz), New Haven, Conn; and the Department of Pediatrics,
Medical College of Wisconsin, Milwaukee (Dr Simms).
Corresponding author: Sarah McCue Horwitz, PhD, Department of Epidemiology
and Public Health, Yale University School of Medicine, 60 College St, Box
208034, New Haven, CT 06520-8034 (e-mail: patricia.krieger{at}yale.edu).
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