Enhancing Placement Stability by Assessing and Intervening in Children’s Trauma Symptoms

Shelby L. Clark (University of Kansas) & Becci A. Akin (University of Kansas)

When controlling for demographic and case characteristics, children with clinically significant trauma symptoms had 46% higher odds of placement instability than those with less significant trauma symptoms.

Why Foster Care Placement Instability Matters

Why Foster Care Placement Instability Matters

Parents and child welfare practitioners alike know that stability is crucial; children thrive when they can form lasting relationships with key adults in their lives. For children in out-of-home child welfare placement, stability is even more imperative. Keeping children in consistent family environments facilitates connection to valuable services, encourages developmental progress, improves psychosocial adjustment and behavior,ⁱ and often prevents more intrusive interventions. Unfortunately, the protective effects of stable placements are even more apparent in their absence; when children are moved frequently, this instability is associated with increased rates of attachment disorders and behavioral problemsⁱⁱ and greater mental health costs.ⁱⁱⁱ Child welfare practitioners feel intense pressure to locate and maintain stable placements for a variety of administrative and even political reasons, but also because placement stability can lead to permanency,^iv the overarching goal of child welfare. To make the most positive difference in children’s lives, then, child welfare systems should prioritize policy and practice changes to facilitate placement stability.

What We Examined^vii

Traumatic experiences are part of the life histories of almost everyone in the child welfare system, but many factors infuence how someone responds to a traumatic event. For this study, we wanted to examine these diferences in response to trauma, as a possible contributor to diferential outcomes in child welfare. Using the Child Report of Post-Traumatic Stress assessment to measure self-reported trauma symptoms in a sample of 1,668 children ages 5 and older, we considered relationships between children’s trauma symptom scores and administrative records of foster care placements. We wanted to examine the efects of children’s manifest trauma responses—rather than an inventory of their experiences—on the success of the child welfare system’s eforts to create and sustain the stable placements so key to their later thriving. 

What We Found

Trauma Symptoms and Placement Instability

Results indicated what many child welfare practitioners likely expect intuitively: children with trauma symptoms above the clinical threshold experienced greater placement instability. Specifically, youth who had clinically significant trauma symptoms had 42% higher odds of placement instability than those with scores below the cutoff. Clearly, trauma symptoms have substantial effects on children’s trajectories in foster care.

Other Needed Child Welfare Reforms

Crucially, trauma’s legacies, including the symptoms that result, are not the only force affecting children’s outcomes. In this study, demographic variables significantly associated with higher odds of placement instability included being older, being male, being Black or another race other than White, and having any type of disability, while case characteristics associated with placement instability included having at least one prior foster care episode and being removed due to neglect or drug use (parent or child).

Crucially, Black youth had 73% higher odds of placement instability than White youth, even after controlling for demographics and clinically significant trauma symptoms.

These are children disproportionately subjected to damaging instability in their child welfare journeys and seriously inequitable outcomes within the very system tasked with helping them heal.

What It Means For Policy & Practice

Screening is the Starting Point

Trauma looms large in the histories that bring most children to the child welfare system. Reducing childhood trauma should be a priority for everyone who cares about children and about our collective future. Encouragingly, however, these findings suggest that suggest in reducing trauma symptoms—even post-trauma—may play a key role in the quest to achieve permanency. Of course, successfully intervening to address trauma symptoms begins with identifying who needs such intervention: those children whose trauma symptoms may disrupt foster care placements without adequate supports.^v It was concerning, then, that only 26% of youth in this study who should have been screened for trauma symptoms were screened. Child welfare practitioners and the systems where they work should strive to integrate trauma assessment and intervention into operating procedures, so that everyone who interacts with a child—foster parents, birth parents, courts, workers—can prepare for trauma symptoms that might manifest; only then can they competently work to interrupt symptoms’ effects on placement stability.

• While assessments often focus on screening for the number of traumatic events experienced, it may be more valuable to understand youths’ response to traumatic events—trauma symptoms and evidenced strengths/ resiliency.

• Future research should investigate whether trauma symptoms still predict placement instability when treatment is provided, or whether results found here stem from insufcient and/or inappropriate service response. In the search for better outcomes, we need to know whether clinically signifcant trauma symptoms remain related to placement instability despite intervention, or whether reforms can sever this link.

• Challenges in implementing trauma screening in child welfare services^vi must be acknowledged, and child welfare workers should be partners in reforms to address trauma symptoms more comprehensively.

This study reveals trauma symptoms as predictive of plac instability even while controlling for demographic and case characteristics. This underscores trauma screening and intervention as important steps toward addressing trauma’s influence on children’s trajectories in foster care—toward more stable placements today and better permanency outcomes for the future.

References

i Barber, J. G., & Delfabbro, P. H. (2003). Placement stability and the psychosocial well-being of children in foster care. Research on Social Work Practice, 13(4), 415–431.

ii Strijker, J., Knorth, E. J., & Knot-Dickscheit, J. (2008). Placement history of foster children: A study of placement history and outcomes in long-term family foster care. Child welfare, 87(5), 107–124.

iii Rubin, D. M., et al. (2004). Placement stability and mental health costs for children in foster care. Pediatrics, 113(5), 1336–1341.

iv Akin, Becci A. (2011). Predictors of foster care exits to permanency: A competing risks analysis of reunifcation, guardianship, and adoption. Children and Youth Services Review, 33(6), 999–1011.

v Clark, S. L., Palmer, A. N., Akin, B. A., Dunkerley, S., & Brook, J. (2020). Investigating the Relationship between Trauma Symptoms and Placement Instability. Child abuse & neglect, 108, 104660. https://doi.org/10.1016/j.chiabu.2020.104660.

vi Greeson, J. K. P., et al. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the national child traumatic stress network. Child welfare, 90(6), 91–108.

vii Kramer, T. L., et al. (2013). A statewide introduction of trauma-informed care in a child welfare system. Children and Youth Services Review, 35(1), 19–24. 

Citations

Clark, S. & Akin, B. (2023). Enhancing Placement Stability by Assessing and Intervening in Children’s Trauma Symptoms. Lawrence, KS: Center for Community Engagement & Collaboration, School of Social Welfare, University of Kansas.