As children come into contact with CW, important decisions are made regarding appropriate intensity of CW involvement. Developmental issues are an increasing policy concern in this population. Results from this nationally representative sample provide information regarding the relationship between intensity of CW involvement and patterns of developmental change in young children (ages 12–47 months) referred to CW. Main findings include: (1) few differences between intensity of CW involvement and changes in overall child developmental and behavioral status over time, (2) overall improvement in developmental/cognitive and language scores over time, but not as a function of intensity of CW involvement, (3) few changes in adaptive behavior or behavior problems over time, and (4) a positive relationship between the home environment and change in language/communication and adaptive behavior standard scores over time.
In general, children in the CW system showed improvement in developmental/cognitive, and language domain scores over the 15-month time period, but these gains were not consistently related to any specific intensity of CW involvement. Multivariate models indicated no differences in developmental change as a function of intensity of CW involvement. These data are observational in nature, and therefore causal relationships cannot be determined. However, there were many similarities between the three groups at baseline, and limited differences in change over time by intensity of CW involvement even when controlling for baseline developmental level, age, maltreatment type, gender, and the home environment. Therefore, some suggestions regarding the general relationship between intensity of CW involvement and change in development over time will be discussed.
These findings are consistent with previous studies reporting that foster care does not have a negative effect on child functioning, but does not facilitate development either (Maluccio & Fein, 1989
; Minty, 1999b
). However, our results contrast with other findings that do show improvements for young children in foster care; most notably improved adaptive functioning (Horwitz et al., 2001
). There are several possible explanations for the differences between the present study and the results of Horwitz and colleagues. First, only the daily living skills subscale of the Vineland Adaptive Behavior Scales was employed in NSCAW, while children in the Horwitz study also received the communicative and social skills subscales. Second, our sample included a slightly younger subset of children. It is possible that older children show greater improvement in adaptive skills when in foster care due to more consistent service provision in schools (e.g., better attendance) or some other factor. Third, the NSCAW sample represents a national, rather than a local, target population and there may be different patterns of development in some communities than others. In particular, the foster care environment provided in Connecticut may have facilitated development of children in out-of-home care. These improvements would be consistent with research examining specialized foster care, which indicates improvements in development for young children in specialized care in comparison with children in typical foster care environments (Fisher et al., 2000
; Fisher, Ellis, & Chamberlain, 1999
). In the NSCAW sample, all types of foster care providers were included. Perhaps something about the home environment provided a rationale for the provision of services. Recent research has documented that CW programs vary widely in the amount of training and support provided to out-of-home caregivers (Hurlburt et al., 2007
). The specific services received by children in this study were not examined as service use was not the focus of this paper. However, a detailed examination of the relationship between specific services and the development of young children known to CW would be an important future research emphasis.
The HOME-SF scores were positively related to change in both language and adaptive behavior status, and therefore may play a role in improving developmental status for children in CW. These data are consistent with previous studies finding an association between family environment and outcome (Hauser-Cram et al., 2001
; Kelly & Booth, 2002
) and lend support to the idea that studies examining high quality foster care may find improvements in child developmental functioning whereas a national sample of usual foster care may not. Children in out-of-home care did have higher HOME-SF scores than children remaining at home with services. Scores for children at home with no services were similar to scores for children placed out-of-home. The quality of the home environment may be especially important for children entering CW with more considerable delays. If improved quality of care is a major factor in development, greater attention must be paid to the training and support given to caregivers in all home situations in order to ensure appropriate environments for at-risk children.
There was a key exception to these main findings in the developmental/cognitive domain. Models indicated a significant interaction between intensity of CW involvement and BL scores. In comparison with children remaining at home with comparably low scores, children in out-of-home care who had low scores at BL exhibited less positive change over time. The difference was most dramatic for children with very low BL scores. Possibly children with fewer cognitive/developmental abilities have greater difficulty with changing environments, while children with higher skills are less affected and perhaps even stimulated by a new or improved environment. We cannot rule out other factors such as living arrangement changes, service use, and prior involvement in CW that may play some role in this interaction. The patterns were very similar for children placed out-of-home, and those remaining at home with services. This may indicate that the children at home with services are similar to those placed in out-of-home care, and those remaining at home with no services may have additional differences in their environment that make their developmental change during this time period differ.
Although the children’s developmental/cognitive and language scores improved over time, scores remained lower than normative levels on the assessments. We do not think that the increase in developmental/cognitive and language scores can be interpreted as regression to the mean. If there had been regression to the mean we would have expected to see children with scores at either extreme at BL have less extreme scores at FU. Regression to the mean cannot explain overall group changes, either decrements (e.g., adaptive behavior for toddlers) or improvements (such as language changes for preschoolers), nor can it explain interactions between baseline scores and intensity of CW involvement (Bland & Altman, 1994
; Pomerleaua et al., 2005
These same improvements were not seen for adaptive behavior, nor was a reduction in behavior problems evident. This could be due to the relative strength seen in adaptive behavior. That is, children, on average, were scoring in the average range in this area (except BL scores for children in out-of-home care) and continued to score in the average range at FU. Similarly, on average, behavior problem scores were in the typical range. It may be that behavioral difficulties commonly found in children with CW involvement manifest themselves as children reach school age.
As with all research, these analyses have their limitations. It can reasonably be questioned whether it is possible, or advisable, to compare the developmental outcomes of children placed out-of-home with those of children remaining in their homes with or without supportive CW services. It is likely that there are important differences in level of maltreatment, caregiver competence and overall safety of the environment between the homes of origin for children remaining at home and those placed in out-of-home care. In fact, these data indicate increased levels of abandonment and neglect in children in out-of-home care, especially when compared to children remaining at home with no services. However, developmental/cognitive levels were quite similar to children remaining at home with CW services. Given that our research questions focused on change in development over time, not absolute differences, and that we were specifically interested in the potential impact of out-of-home care, comparing children across intensity of CW involvement is appropriate. Interestingly, the results of this study do not reveal any differential changes as a function of intensity of CW involvement, despite the fact that children removed from their homes are also known to have much higher probability of receiving developmental services than children remaining at home (Stahmer et al., 2005
). As a comparison group, the children remaining at home can be seen as a conservative comparison group, in the sense that one might have expected greater improvements over time for children in out-of-home care. Another limitation is the lack of examination of service use in this specific sample. Inclusion of the amount of services provided may have affected the model and should be examined in future research. This study suggests that the developmental status of children in contact with CW does tend to improve over time, but not differentially for children placed in out-of-home care. Our interests are not in suggesting that children should remain in their homes, but to understand whether, on average, intensity of CW involvement seems to be contributing positively to child development.
Overall, younger children in contact with CW show deficits in functioning during the toddler years, with some recovery in development and communication skills during preschool years. Therefore, when examining the progress of very young children in CW, it is important to utilize a comparison group to account for changes over time that occur in measurement of developmental abilities across home situations. Further examination of changes as children reach school age will be important in understanding how early development may affect later functioning in this at-risk group.
Children with limited cognitive capacity may need special attention upon transition to foster care. Children with developmental delay are more likely to be placed out-of-home, therefore foster care providers may need additional support to facilitate development in this population. Additional training for biological parents and foster care providers (including those providing kinship care) in encouraging development in children with delays is important for attainment of critical developmental skills (Fisher et al., 1999
Data indicate intensity of CW involvement, on average, is not likely to differentially affect developmental and behavioral progress although the home environment does. Facilitating development in children in out-of-home care may require supportive, enriched care environments (Minty, 1999a
). Given that a majority of children known to CW remain at home, improving both in-home and out-of-home care environments may have the greatest effect on improving the well-being of children known to CW. Future research might focus on specific support and parent training programs that facilitate child well-being and can be implemented in CW environments.