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Analysis of a National Sample of Children in the Child Welfare System

Christina Sakai, MD; Hua Lin, PhD; Glenn Flores, MD

Arch Pediatr Adolesc Med. 2011;165(2):159-165. doi:10.1001/archpediatrics.2010.277

Objectives  To comprehensively assess family services, health, and health care outcomes for US children in kinship care vs foster care.

Design  A 3-year prospective cohort study.

Setting  National Survey of Child and Adolescent Well-Being.

Participants  The sample consisted of 1308 US children entering out-of-home care following reported maltreatment.

Main Exposure  Kinship care vs foster care.

Main Outcome Measures  Baseline caregivers' support services and the children's behavioral, mental health, and health service use outcomes 3 years after placement.

Results  Kinship caregivers were more likely than foster caregivers to have a low socioeconomic status but reported significantly fewer support services (caregiver subsidies, parent training, peer support, and respite care). Kinship care was associated with a lower risk ratio (RR) of continuing behavioral problems (RR = 0.59; 95% confidence interval [CI], 0.41-0.80), low social skills (RR = 0.61; 95% CI, 0.40-0.87), mental health therapy use (RR = 0.45; 95% CI, 0.27-0.73), and psychotropic medication use (RR = 0.46; 95% CI, 0.24-0.82) but higher risk of substance use (RR = 1.88; 95% CI, 0.92-3.20) and pregnancy (RR = 4.78; 95% CI, 1.07-17.11).

Conclusions  Kinship caregivers received fewer support services than foster caregivers. Children in kinship care fared better with behavioral and social skills problems, mental health therapy use, and psychotropic medication use. Adolescents in kinship care may be at higher risk for substance use and pregnancy.

Author Affiliations: Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center (Drs Sakai, Lin, and Flores) and Children's Medical Center (Drs Sakai and Flores), Dallas.

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