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David M. Rubin, MD, MSCE; Kevin J. Downes, MD; Amanda L. R. O'Reilly, MPH; Robin Mekonnen, MSW; Xianqun Luan, MS; Russell Localio, PhD

Arch Pediatr Adolesc Med. 2008;162(6):(doi:10.1001/archpedi.162.6.550).

Objective  To examine the influence of kinship care on behavioral problems after 18 and 36 months in out-of-home care. Growth in placement of children with kin has occurred despite conflicting evidence regarding its benefits compared with foster care.

Design  Prospective cohort study.

Setting  National Survey of Child and Adolescent Well-Being, October 1999 to March 2004.

Participants  One thousand three hundred nine children entering out-of-home care following a maltreatment report.

Main Exposure  Kinship vs general foster care.

Main Outcome Measures  Predicted probabilities of behavioral problems derived from Child Behavior Checklist scores.

Results  Fifty percent of children started in kinship care and 17% of children who started in foster care later moved to kinship care. Children in kinship care were at lower risk at baseline and less likely to have unstable placements than children in foster care. Controlling for a child's baseline risk, placement stability, and attempted reunification to birth family, the estimate of behavioral problems at 36 months was 32% (95% confidence interval, 25%-38%) if children in the cohort were assigned to early kinship care and 46% (95% confidence interval, 41%-52%) if children were assigned to foster care only (P = .003). Children who moved to kinship care after a significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset.

Conclusions  Children placed into kinship care had fewer behavioral problems 3 years after placement than children who were placed into foster care. This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care.

Author Affiliations: Pediatric Generalist Research Group (Drs Rubin and Downes, and Mss O’Reilly and Mekonnen), Safe Place: The Center for Child Protection and Health (Dr Rubin and Mss O’Reilly and Mekonnen), and Divisions of General Pediatrics (Dr Rubin and Mss O’Reilly and Mekonnen) and Biostatistics (Mr Luan), Children's Hospital of Philadelphia and Departments of Pediatrics (Dr Rubin) and Biostatistics and Epidemiology (Dr Localio), University of Pennsylvania School of Medicine, Philadelphia.

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