The Prevalence of Adverse Childhood Experiences among Children in Foster Care and the Associated Impact on Placement Setting, Stability and Reunification: An Ecological-Transactional Perspective
Research shows a strong and cumulative relationship between adverse childhood experiences (ACEs) and risky adult behaviors, mental health disorders, diseases, and health status across the lifespan. Traumatic childhood experiences, including exposure to ACEs and being removed from biological families, affect developmental and well-being outcomes for these vulnerable populations. Children involved with the child welfare system (CWS) have experienced at least one traumatic adverse event, with the majority having complex histories of exposure to adversity. Extant research on children in foster care reveals that children ever placed in out-of-home care are more likely to have mental health and behavioral issues, less likely to graduate high school, and experience a variety of adversities, including: socioeconomic disadvantages, family instability, to live in low income neighborhoods, and exhibit more complex symptomology due to increased exposure to traumatic events. Minimal research has explored the magnitude of ACE exposure among children in foster care. This dissertation broadens the application of Cicchetti and Lynch’s (1993) ecological-transactional model of child maltreatment to all forms of adversity and links several theories to provide a dynamic and holistic framework for considering how individual factors interact with other ecological determinants in the etiology of cumulative ACE exposure among children in foster care. Application of this dynamic theoretical framework was used to examine the prevalence of cumulative ACE exposure among children in out-of-home care and to understand the effect cumulative ACE exposure has on a child’s placement setting type, placement stability, and likelihood of reunification. A nonexperimental longitudinal design was utilized to observe 2,998 Kansas children in out-of-home placement between October 2015 and July 2019. To encompass case and child characteristics along with ACE exposure rates, Kansas administrative child welfare data was linked with evaluation data from the Kansas Assessment Permanency Project. Bivariate and multivariate logistic regression models were estimated to gauge the impact of cumulative ACE exposure on a child’s placement setting type and placement stability. Cox proportional hazard models were conducted to evaluate the impact of cumulative ACE exposure on a child’s likelihood of reunification. It was hypothesized that children in out-of-home placement would experience greater levels of adversity and that higher cumulative ACE exposure would result in a decreased likelihood of experiencing a family-type placement setting, placement stability, and reunification. Results revealed that Kansas children in out-of-home placement, compared to national and state averages from 2017-2018, experienced extremely high rates of cumulative ACE exposure. Children in this study who reported 10+ ACEs were 77% more likely to be placed in a non-family-type placement setting, 28% more likely to experience placement instability, and approximately half as likely to experience reunification when compared to their counterpart with 1-5 ACEs, while controlling for child and case characteristics. Other significant predictors of a child’s out-of-home experience included: race, biological sex, age at episode start, siblings in out-of-home placement, placement setting type, and number of placements, although significance and effect sizes varied by outcome variable. Findings indicated extensive overlap of predictor variables and outcomes, indicating that the same child and case characteristics increased a child’s odds of being placed in a non-family-type placement setting, experiencing placement instability, and not exiting care to reunification. These findings are discussed in-depth for each outcome variable. To achieve the fruitfulness of the framework presented in this dissertation, future research is needed to test for interactions between such child-level and microsystem variables to determine if there are true multiplicative effects, indicating that certain child traits, case characteristics, and microsystem adversities have multiplicative attributes, above and beyond their main effects on the outcome variables. One of the primary practice implications for this dissertation is that improving a child’s out-of-home placement experience, specifically the likelihood of timely reunification, requires immediate and proactive attention to cumulative ACE profiles of children in out-of-home care. Given that the paramount goals of the child welfare system are to enhance the safety, permanency, and well-being of children in care, then researchers, educators, and policy-makers must recognize the syndemic-nature of cumulative ACEs among this extraordinary vulnerable population.
Social work, ACEs, Adverse Childhood Experiences, Foster Care, Reunification
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