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5. Children's Development, Functioning, and Behavior
Whereas previous NSCAW findings (U.S. Department of Health and Human Services Administration for Children and Families [U.S. DHHS ACF], 2003) and other research have described the behavior of children in foster care (e.g., Landsverk, 1997), little is known about the well-being of children at the entrance into the child welfare system (CWS). This chapter discusses the well-being of children involved with CWS by examining a variety of measures designed to assess physical, cognitive, and emotional development. These data offer long-awaited information about the functioning of children, nationally, as they first enter child welfare services. The purpose of this chapter is to provide a broad overview of child well-being. (Future NSCAW reports will delve into various aspects of well-being in more detail.) The analysis begins with a description of the well-being of younger children—their physical attributes as well as their performance on several standardized measures—and then describes the cognitive functioning, adaptive and social functioning, and emotional and behavioral well-being of older children.
A child's involvement with CWS can affect and be affected by his or her well-being, so we pay careful attention to how children within the system differ from children in the general population, as well as how they differ from one another. Although well-being indicators such as physical growth, mental health, and involvement in delinquent activities may be closely tied to safety or permanency, the findings here are meant simply to describe the functioning of the children at baseline; more detailed analyses, and particularly longitudinal analyses, will be needed to begin to better describe the associations among features of safety, permanence, and well-being. presented for informational purposes.
NSCAW data collection utilizes numerous standardized measures of children's functioning. Multiple measures are included to be sure that the important developmental domains are covered for each age group. Further, these measures provide some level of comparability, via standardized scores, with populations on which the measures were normed and, for some measures, scores that indicate that a child is “at risk” or in a “clinical” range. In concept, this allows us to compare the NSCAW sample with children in the general population. This comparability is restricted, however, by the characteristics of the populations that have been used to norm the instruments. Insofar as the NSCAW populations may be incomparable to instrument norms because they reflect children from a different era, racial/ethnic group, or income group, results must be viewed with some caution. The measurement package also includes measures made for, or adapted to, NSCAW. These include extant measures tailored to fit the requirements of computerized administration in NSCAW; time constraints also led to additional modifications. These adaptations have been detailed in Chapter 2 but are noted again to ensure the optimal interpretation of data from these NSCAW-specific measures.
We begin with a description of the standardized measures for the youngest children. After describing the performance of the children on each of the measures, we routinely compare children on the basis of age, race/ethnicity, and service setting. At times, when age is closely circumscribed by the measure and there is reason to look at possible differences in gender, we also compare scores for girls and boys. We compare children on the basis of race/ethnicity because of the ongoing and important debate about the role of race in receiving child welfare services. Understanding baseline differences in performance will help us to understand changes that may or may not occur, which may also help us understand some of the dynamics leading to greater and longer involvements in child welfare services for Black families.
Because some of the debate about racial differences centers on the cultural appropriateness of assessments, we have made an effort to examine this issue. Although it is beyond the scope of this report to review the scholarly literature on the application of these measures with children of different ethnic groups, we have endeavored to understand whether NSCAW field representatives (i.e., interviewers) had different results when they were assessing children who were culturally similar or different to them. For those measures that required a substantial amount of rater involvement (i.e., the BDI and BINS), we tested to see if children or households had substantially different scores depending on whether they were rated by African American, White, or Hispanic interviewers. These findings are provided below.
Presumably, children are selected into various child welfare service conditions or settings because of differences in their characteristics and service needs; it is informative, then, for service planning and policy making purposes, to be able to describe these potential differences. Generally, the results for a given measure are presented in order to distinguish between children residing in five service settings: in-home following the investigation (with and without child welfare services) and those placed out-of-home (and currently in nonkinship foster care, kinship care, or group care). Interpreting comparisons between the two in-home placement conditions and comparisons based on placement types is complex. Because a median of 150 days passed between the beginning of the investigations from these most recent maltreatment allegations and the interviews in which the standardized measures were obtained, the child may have been in several different service settings prior to the assessment. Similarly, there might have been a change in whether or not a child's case was open. These “mixed” experiences with service settings limit the precision of the comparisons presented in the data tables.
Because race/ethnicity, service setting, and age are sometimes associated, the treatment of each measure concludes with a multivariate analysis that controls for a few background characteristics to explain the performance on the measure. These analyses are by no means intended to control for all possible explanations of the developmental measure and are only intended to confirm whether or not the bivariate relationships hold despite the associations between the variables of concern. We have also added gender to these analyses because—although not correlated with race or age—there is compelling developmental literature about the association between gender, risks (e.g., child maltreatment) and protective factors (e.g., services), and development.
Evidence from smaller, localized studies often shows that abused and neglected children are at risk for many untoward outcomes, including elevated rates of delinquency, sexual activity, and substance abuse. The relationships among types of maltreatment, onset of maltreatment, and onset of high-risk behaviors and the association between receipt of services and the reduction of risk of untoward outcomes are complex, and a full exploration of them is beyond the scope of this report. A thorough description of the relationships among these phenomena at entrance into CWS will provide the basis for understanding what services may be needed, from the earliest months of child welfare involvement.
5.1 Well-Being of Young Children
One of the ways that abuse and neglect manifests in children is through delayed or unusual physical development. Concerns about a child's development may be the rationale for the child abuse investigation or may be associated with the decision about service provision. This is likely to be particularly true for infants and very young children because their growth occurs at a faster rate than in later years, and growth problems can more rapidly become a threat to their safety and well-being. Studies have shown that neglect and certain physical attributes such as below-normal weight gain (i.e., failure to thrive) are associated with delayed cognitive development in younger children (Mackner, Starr, & Black, 1997), as well as behavior problems and poor school functioning in older children (Kerr, Black, & Krishakumar, 2000). Maltreatment may also be associated with deficits in cognitive, emotional, and behavioral development. Children with a history of abuse or neglect are at risk for developmental delays (Singer et al., 2001) and behavior problems (Toth et al., 2000).
Emotional regulation is another aspect of the well-being of young children. Temperament is typically understood to be an intrinsic characteristic that shapes parent-child interaction from the first days of life (Seifer & Schiller, 1995). At later ages, the caregiver-child relationships that the child has experienced may also influence the child's temperament. These social experiences can, ultimately, be reflected in the child's biological and psychological make-up (Perry et al., 1995). A child's temperament has been shown to be somewhat predictive of future conduct, especially for boys with high activity levels and low levels of fear in infancy (Colder, Mott, & Berman, 2002).
This section presents information on the well-being of young children involved with CWS as it relates to physical, cognitive, and behavioral development. Bivariate and multivariate analyses include comparisons by age, gender, race/ethnicity, and service setting. Some comparisons to national norms are presented as well.
5.1.1 Height, Weight, Body Mass Index, and Head Circumference
Height, weight, and head circumference were obtained for children aged 3 and younger, while body mass index (BMI) is calculated only for children aged 2 to 3 years. (Utilizing BMI to screen children younger than age 2 for growth is not recommended by the Centers for Disease Control and Prevention [CDC].)
Height
Average height percentiles for children aged 3 and younger involved with CWS are presented in Table 5-1. In general, children in this population fall slightly below the 50th percentile with regard to height. One-year-olds are significantly shorter for their age than are children less than 1 year of age and children 2 to 3 years of age. The difference between 1-year-olds and children less than 1 year old is most exaggerated in the out-of-home subpopulation (p < .001). Bivariate analyses did not reveal any significant height differences based on gender, race/ethnicity, or child setting. A regression that controlled for age, gender, race/ethnicity, and child setting confirmed these results.
| Characteristic | TOTAL | Setting | |||||||
|---|---|---|---|---|---|---|---|---|---|
| In-Home | Out-of-Home | ||||||||
| No Services | Services | TOTAL In-Home | Foster Care | Kinship Foster Care | Group Care | TOTAL Out-of-Home^ | |||
| Mean/ (SE) | |||||||||
| Age | < 1 | 50.7 a (3.7) |
57.1 (5.7) |
38.8 (2.9) |
50.9 (4.3) |
44.6 (3.4) |
57.4 (6.7) |
--- | 50.2 c (4.5) |
| 1 | 38.5 b (3.6) |
40.3 (4.6) |
36.7 (4.8) |
39.5 (3.8) |
39.7 (7.0) |
22.2 (5.0) |
--- | 30.2 (5.6) |
|
| 2-3 | 53.0 (3.8) |
55.6 (4.2) |
46.7 (5.7) |
52.9 (3.8) |
40.1 (8.4) |
66.7 (10.7) |
--- | 53.8 (8.8) |
|
| Gender | Male | 45.7 (3.0) |
47.0 (3.7) |
42.6 (4.1) |
45.6 (3.0) |
40.4 (5.1) |
55.7 (12.0) |
--- | 46.2 (6.7) |
| Female | 50.1 (3.3) |
53.7 (4.3) |
41.4 (4.0) |
50.5 (3.6) |
45.3 (4.5) |
50.0 (7.0) |
--- | 48.1 (5.1) |
|
| Race/ Ethnicity | Black | 43.8 (3.5) |
43.9 (5.4) |
40.4 (5.0) |
42.6 (4.0) |
44.1 (6.0) |
56.9 (10.3) |
27.6 (21.5) |
49.7 (6.7) |
| White | 51.1 (2.8) |
54.4 (3.9) |
42.8 (3.2) |
51.0 (3.0) |
41.5 (6.1) |
61.7 (10.0) |
--- | 52.0 (7.4) |
|
| Hispanic | 49.3 (3.9) |
54.8 (4.5) |
36.4 (5.2) |
52.0 (4.3) |
41.3 (7.7) |
31.6 (8.1) |
--- | 37.0 (4.3) |
|
| Other | 40.1 (7.3) |
31.8 (9.2) |
58.2 (10.9) |
39.3 (8.9) |
41.0 (8.0) |
48.2 (25.0) |
--- | 44.5 (11.0) |
|
| TOTAL | 47.8 (2.4) |
50.2 (2.8) |
42.1 (3.1) |
47.9 (2.4) |
42.3 (3.7) |
52.5 (7.6) |
31.2 (20.6) |
47.1 (4.7) |
|
|
a Height percentiles are lower for 1-year-olds than for children less than 1 year of age (t = 2.8, p < .01) (back) b Height percentiles are lower for 1-year-olds than for children age 2 to 3 (t = -2.7, p < .01) (back) |
Weight
As with height, the mean weight of children involved with CWS is close to the 50th percentile (Table 5-2). An exception appears for children in group care who, on average, fall in the 20th percentile. This is significantly lower than children in nonkinship foster care and kinship foster care. Care should be taken in interpreting these results, however, as the sample size of children in group care was very small for this analysis (n = 11).
| Characteristic | TOTAL | Setting | |||||||
|---|---|---|---|---|---|---|---|---|---|
| In-Home | Out-of-Home | ||||||||
| No Services | Services | TOTAL In-Home | Foster Care | Kinship Foster Care | Group Care | TOTAL Out-of-Home^ | |||
| Mean/ (SE) | |||||||||
| Age | < 1 | 53.4 (1.8) |
53.0 (3.0) |
55.1 (2.4) |
53.7 (2.2) |
54.4 (3.5) |
51.2 (3.3) |
--- | 52.6 (2.5) |
| 1 | 50.8 (3.2) |
51.7 (4.5) |
48.4 (5.3) |
50.9 (3.7) |
50.2 (7.0) |
48.8 (4.3) |
--- | 49.6 (3.8) |
|
| 2-3 | 55.6 (2.5) |
58.3 (2.9) |
52.2 (4.9) |
56.5 (2.7) |
51.5 (6.2) |
48.4 (11.4) |
--- | 48.5 (6.7) |
|
| Gender | Male | 52.9 (2.4) |
54.1 (3.4) |
49.4 (4.3) |
52.7 (3.0) |
53.7 (3.6) |
56.1 (8.2) |
--- | 53.8 (4.3) |
| Female | 54.4 (2.3) |
56.0 (3.7) |
55.4 (3.7) |
55.8 (2.8) |
51.3 (4.5) |
45.0 (5.9) |
--- | 47.3 (3.9) |
|
| Race/ Ethnicity | Black | 50.3 (3.7) |
55.4 (4.3) |
44.2 (5.1) |
51.3 (3.8) |
51.4 (5.9) |
40.6 (8.0) |
19.3 (10.0) |
45.8 (5.5) |
| White | 57.3 (2.1) |
58.6 (3.4) |
55.3 (2.7) |
57.7 (2.5) |
54.0 (5.3) |
57.5 (7.2) |
--- | 54.6 (5.0) |
|
| Hispanic | 50.8 (4.4) |
49.0 (6.3) |
58.2 (5.2) |
50.5 (5.5) |
55.9 (3.3) |
48.9 (3.4) |
--- | 52.5 (2.1) |
|
| Other | 55.0 (6.7) |
51.6 (10.1) |
64.9 (10.2) |
56.1 (8.0) |
45.9 (6.4) |
52.9 (7.6) |
--- | 49.9 (5.0) |
|
| TOTAL | 53.6 (1.6) |
55.0 (2.5) |
51.9 (2.4) |
54.1 (1.9) |
52.7 (2.9) |
49.6 (4.5) |
20.4 (9.6) |
50.6 (2.8) |
|
To expand on bivariate findings, a regression analysis of weight percentile, controlling for child age, gender, race/ethnicity, and setting, was run. Group care was used as the reference group for the setting variable in this model as it displayed the most striking differences from the other settings in the bivariate analysis and warranted confirmatory multivariate analyses. Results of the model confirmed the significant differences between children in group care and those in other out-of-home placement types, and further revealed that the mean weight percentile of children in group care is also significantly lower than that of children remaining at home, both without services (p < .001) and with services from the child welfare agency (Table 5-3). For all setting comparisons, children in group care are lower by approximately 30 percentile points.
| Characteristic | Beta Coefficient (SE) | |
|---|---|---|
| Age | 2-3 | (reference group) |
| <1 | -2.07 (2.76) | |
| 1 | -5.21 (3.93) | |
| Gender | Female | (reference group) |
| Male | -1.29 (3.44) | |
| Race/ Ethnicity | White | (reference group) |
| Black | -6.78 (4.14) | |
| Hispanic | -6.89 (5.17) | |
| Other | -2.65 (7.60) | |
| Child Setting/Services | Group care | (reference group) |
| In-home, no services | 32.69 (9.14)^^_i | |
| In-home, services | 29.21 (9.34)^_i | |
| Foster home | 31.37 (9.47)^^_ii | |
| Kinship care | 27.27 (8.35)^_ii | |
|
Multiple R2 is .02 |
Neither the bivariate nor the multivariate analysis indicated any significant differences in weight percentile based on child age, gender, or race/ethnicity.
Failure to thrive (FTT) in young children can be defined as weight below the 5th percentile (Drotar & Robinson, 2000; English, 1978; Raynor & Rudolph, 1996), although other definitions also consider the trajectory of weight loss. Overall, for the young children in this study, 11% meet this criterion of weight lower than 95% of all children. Although the proportion of children below the 5th percentile varies from 8% to 15% for various age, gender, race/ethnicity, and setting subpopulations in our study group, there are no significant differences within any of these characteristics. (Of young children in group care, 52% meet the FTT criterion; however, as mentioned previously, the sample size is extremely small.)
Body Mass Index
Body Mass Index (BMI), which takes both weight and height into account, is often considered a more accurate way to assess physical development and identify individuals who should be considered “overweight” or at risk for being overweight. CDC considers a child with a BMI between the 85th and 95th percentiles to be at risk of being overweight, and a child with a BMI greater than the 95th percentile to be overweight. Although expert guidelines do not exist to identify a child who is underweight, CDC indicates that analogous cutoffs may be used (i.e., less than the 5th percentile = underweight; 5th to 15th percentile = risk for underweight (Kuczmarski et al., 2000). A child with a BMI between the 16th and 84th percentile would be considered at an appropriate weight for their height.
In general, the mean BMI for 2- to 3-year-olds involved with CWS is close to average, with a few exceptions. As seen in Table 5-4, children in kinship foster care average a BMI percentile of just 32. This is significantly lower than the 61(st) percentile that is the average for children in nonkinship foster care. In addition, Hispanic children in out-of-home care average a significantly higher BMI percentile than Black children in out-of-home care.
| Characteristic | TOTAL | Setting | |||||||
|---|---|---|---|---|---|---|---|---|---|
| In-Home | Out-of-Home | ||||||||
| No Services | Services | TOTAL In-Home | Foster Care | Kinship Foster Care | Group Care | TOTAL Out-of-Home^ | |||
| Mean/ (SE) | |||||||||
| Age | 2 | 54.8 (3.4) |
56.8 (4.4) |
56.1 (4.5) |
56.6 (3.3) |
61.9 (7.7) |
26.1 (8.9) |
--- | 46.6 (11.6) |
| 3 | 51.3 (4.8) |
52.9 (5.8) |
50.9 (7.4) |
52.3 (5.1) |
59.0 (11.9) |
37.7 (14.7) |
--- | 39.9 (11.5) |
|
| Gender | Male | 51.4 (5.5) |
54.3 (7.0) |
47.9 (7.4) |
52.1 (5.5) |
66.1 (5.4) |
28.3 (11.0) |
--- | 46.4 (12.0) |
| Female | 54.6 (4.1) |
54.4 (5.7) |
61.7 (5.2) |
56.4 (4.3) |
52.0 (11.7) |
35.4 (13.5) |
--- | 40.8 (10.5) |
|
| Race/ Ethnicity | Black | 46.9 (7.0) |
56.0 (7.7) |
36.2 (8.3) |
48.8 (7.3) |
45.7 (11.9) |
18.5 (12.1) |
--- | 31.2 b (11.1) |
| White | 54.8 (4.1) |
55.4 (5.7) |
61.3 (4.1) |
57.5 (3.9) |
60.0 (11.7) |
30.8 (10.9) |
--- | 35.2 (10.7) |
|
| Hispanic | 57.8 (8.0) |
53.8 (10.2) |
78.3 (8.5) |
56.6 (9.2) |
--- | 35.5 (15.8) |
--- | 64.5 (7.3) |
|
| Other | 53.8 (7.2) |
38.5 (8.7) |
67.3 (12.1) |
48.5 (7.7) |
--- | --- | --- | --- | |
| TOTAL | 52.8 (3.5) |
54.4 (4.1) |
53.2 (4.6) |
54.0 (3.4) |
61.4 a (6.7) |
31.8 (9.1) |
--- | 44.1 (8.8) |
|
|
a BMI percentiles are higher for children in nonkinship foster care than for children in kinship foster care (t = 2.9, p < .01) (back) |
A regression controlling for child age, gender, race/ethnicity, and setting confirmed the differences in child setting found through the bivariate analyses. Kinship foster care was used as the reference group for the setting variable because, as with group care in the previous analysis, it displayed the most striking differences from the other settings in the bivariate findings. The model confirmed that the difference in mean BMI percentiles for children in kinship care and children remaining at home and not receiving child welfare services is significant, with children in kinship care having lower BMIs by over 20 percentile points (Table 5-5). Significant differences were not found with regard to any of the other characteristics examined.
| Characteristic | Beta Coefficient (SE) | |
|---|---|---|
| Age | 3 | (reference group) |
| 2 | 3.58 (5.16) | |
| Gender | Female | (reference group) |
| Male | -3.98 (6.56) | |
| Race/ Ethnicity | White | (reference group) |
| Black | -8.90 (7.31) | |
| Hispanic | 2.07 (8.76) | |
| Other | -1.08 (8.90) | |
| Child Setting/ Services | Kinship care | (reference group) |
| In-home, no services | 23.05 (9.06) *_i | |
| In-home, services | 23.12 (9.30) | |
| Foster home | 28.68 (11.36) *_ii | |
|
Multiple R2 is .04 |
Using CDC definitions, only 41% of children aged 2 to 3 years involved with CWS are at an appropriate weight for their height. The remaining 59% are almost evenly split between being at risk for or overweight and being at risk for or underweight—about twice the expected rate in the general population. When we narrow the examination to children who are underweight or overweight, 17% of the children in this population are overweight—over 3 times the proportion that would be expected in the general population. Similarly, 15% of the children in this population are underweight—again, 3 times the proportion that would be expected in the general population. No significant differences were found with regard to the weight status variable based on child age, gender, race/ethnicity, or setting.
Head Circumference
The relationship between head circumference and development is complex, although Strathearn et al. (2001) recently showed a significant association between neglect, delayed cognitive development, and head growth among low birth weight babies. Specifically, the study indicated that low birth weight infants whose neglect was substantiated (as compared with infants who were not neglected) had a significantly smaller head circumference at 2 and 4 years but not at birth. In general, average head circumference for children aged 3 and younger in the population of children involved with CWS is somewhat below the 50th percentile. Most comparisons between types of service settings showed no differences, although children in nonkinship foster care have particularly small head circumferences, with a mean at the 37th percentile. This is significantly smaller (p < .001) than children in kinship care, whose mean is at the 57th percentile (Table 5-6).
| Characteristic | TOTAL | Setting | |||||||
|---|---|---|---|---|---|---|---|---|---|
| In-Home | Out-of-Home | ||||||||
| No Services | Services | TOTAL In-Home | Foster Care | Kinship Foster Care | Group Care | TOTAL Out-of-Home ^ | |||
| Mean/ (SE) | |||||||||
| Age | < 1 | 43.9 (3.1) |
42.9 (5.6) |
44.5 (2.9) |
43.5 (3.9) |
43.6 (3.1) |
46.9 (6.3) |
--- | 45.1 (3.5) |
| 1 | 45.2 (3.8) |
46.9 (4.8) |
40.7 (5.2) |
45.5 (4.0) |
25.0 (5.6) |
57.6 (8.5) |
--- | 42.5 (8.8) |
|
| 2-3 | 47.9 (3.9) |
43.3 (5.2) |
55.4 (6.5) |
47.2 (4.1) |
33.9 (4.4) |
77.2 (10.5) |
--- | 51.9 (11.2) |
|
| Gender | Male | 45.7 (3.0) |
43.4 (4.5) |
51.7 (4.8) |
45.9 (3.3) |
33.8 (3.3) |
63.7 (9.9) |
--- | 45.1 (6.0) |
| Female | 45.4 (3.3) |
46.6 (4.7) |
40.6 (3.8) |
45.0 (3.7) |
42.3 (5.8) |
51.1 (4.5) |
--- | 47.2 (3.7) |
|
| Race/ Ethnicity | Black | 45.6 (3.1) |
44.4 (6.2) |
47.2 (6.2) |
45.4 (3.6) |
44.6 (4.8) |
48.9 (7.9) |
--- | 46.1 (4.3) |
| White | 44.6 (3.3) |
44.4 (4.4) |
43.3 (4.1) |
44.1 (3.4) |
26.2 (6.2) |
66.9 (9.9) |
--- | 48.4 (9.0) |
|
| Hispanic | 50.3 (5.8) |
53.4 (8.7) |
46.3 (4.2) |
52.1 (7.4) |
36.2 (4.4) |
52.8 (10.5) |
--- | 43.9 (5.2) |
|
| Other | 37.2 (8.6) |
25.4 (8.1) |
70.1 (12.7) |
36.0 (10.3) |
40.9 (6.2) |
46.5 (8.2) |
--- | 43.3 (5.4) |
|
| TOTAL | 45.6 (2.2) |
45.0 (3.1) |
46.6 (3.1) |
45.4 (2.4) |
37.2 a (2.6) |
56.5 (5.8) |
--- | 46.1 (3.9) |
|
|
|
Multivariate analyses controlling for child age, gender, race/ethnicity, and setting confirmed the differences between nonkinship and kinship foster care discussed above. Nonkinship foster care was used as the reference group for the setting variable to further explore the apparent differences between children in this setting and those in other settings. The model further indicated that children in nonkinship foster care also have smaller head circumferences on average than children remaining at home and receiving child welfare services, although the difference was just 10 percentile points as opposed to the 19 percentile difference between nonkinship and kinship foster care. There is a tendency for children in nonkinship foster care to also have smaller head circumferences than children remaining at home with no services (p = .03). Significant differences were not found with regard to any of the other characteristics examined (Table 5-7).
| Characteristic | Beta Coefficient (SE) | |
|---|---|---|
| Age | 2-3 | (reference group) |
| <1 | -4.28 (4.25) | |
| 1 | -2.49 (5.27) | |
| Gender | Female | (reference group) |
| Male | .84 (4.38) | |
| Race/ Ethnicity | White | (reference group) |
| Black | 1.23 (4.43) | |
| Hispanic | 6.35 (6.70) | |
| Other | -6.65 (9.03) | |
| Child Setting/ Services | Foster home | (reference group) |
| In-home, no services | 7.87 (3.94) | |
| In-home, services | 9.74 (3.82) *_i | |
| Kinship care | 19.24 (6.00) *_ii | |
|
Multiple R2 is .02 |
In summary, the physical attributes of younger children involved with CWS, as detailed through measurements of height, weight, BMI, and head circumference, are similar to that of the general population, with some exceptions. Further analysis would be helpful to determine why 1-year-olds appear to be at smaller height percentiles than both their younger and older counterparts. In addition, although this analysis revealed that children in group care are at significantly lower weight percentiles than children in other settings, analysis on a larger sample size is necessary to confirm this. With regard to BMI, children in kinship foster care tend to be in lower percentiles. And while children in nonkinship foster care have above average BMIs, they have smaller head circumferences than children in other settings. Overall, the findings suggest that children in out-of-home placements tend to be at greater risk than the general population in terms of physical growth and development. This would be consistent with other findings (e.g., Barth & Blackwell, 1998) of high rates of deaths from congenital abnormalities among children in out-of-home care. Ultimately, the greatest value of the growth measures may be their use in looking at children who continue to have extreme scores over time or who drop from the normal range into the extreme sector.
5.1.2 Risk of Developmental Delay or Neurological Impairment: The Bayley Infant Neurodevelopmental Screener
The Bayley Infant Neurodevelopmental Screener (BINS) was used to assess the risk of developmental delay or neurological impairment in children from 3 to 24 months old. The results are shown in Table 5-8. More than half (53%) of all children from 3 to 24 months old whose families were investigated for maltreatment are classified by BINS as high risk for developmental delay or neurological impairment. This is very similar to the 56% of the clinical sample that was assessed with BINS and received this classification, as reported by the test publisher (Aylward, 1995). This is significantly higher, on the other hand, than the 14% of the normative nonclinical sample that was classified as high risk. Service setting is not significantly related to BINS scores.
| Race/ Ethnicity | Total Risk a | In-Home Risk b | Out-of-Home Risk | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Low | Moderate | High | Low | Moderate | High | Low | Moderate | High | |
| Percent / (SE) | |||||||||
| Black | 7.8 (2.4) |
33.5 (4.5) |
58.7 (4.7) |
8.7 (2.8) |
32.1 (5.3) |
59.2 (5.6) |
5.2 (1.7) |
37.8 (5.0) |
57.0 (4.7) |
| White | 20.8 (3.3) |
36.7 (4.5) |
42.5 (3.6) |
21.2 (3.8) |
38.0 (5.0) |
40.8 (4.0) |
17.4 (5.0) |
28.0 (6.7) |
54.6 (6.4) |
| Hispanic | 15.9 (7.2) |
27.6 (6.3) |
56.6 (7.2) |
18.3 (7.9) |
27.4 (7.4) |
54.3 (8.1) |
5.0 (3.3) |
28.4 (6.5) |
66.5 (6.1) |
| Other | 13.4 (6.5) |
12.9 (4.5) |
73.7 (8.8) |
11.9 (7.1) |
14.3 (5.6) |
73.8 (9.9) |
21.2 (9.4) |
6.1 (2.9) |
72.7 (8.9) |
| TOTAL | 15.4 (2.5) |
32.0 (2.8) |
52.6 (2.9) |
16.5 (2.9) |
32.4 (3.3) |
51.1 (3.4) |
9.9 (2.1) |
30.3 (2.8) |
59.8 (2.2) |
|
|
Risk of developmental delay or neurological impairment as measured by BINS does differ when looking at the child's race/ethnicity. Both overall and within the in-home subpopulation, BINS categorizes a significantly higher proportion of Black children than White children as high risk. Conversely, BINS categorizes a significantly higher proportion of White children than Black children as low risk, both overall and within the in-home subpopulation.
Despite the bivariate results, a logistic regression modeling high risk of developmental delay or neurological impairment that controlled for gender, race/ethnicity, and child setting did not find a significant difference between Black and White children with regard to the proportion rated as high risk by BINS; in these analyses, there was only a tendency (p = .02) for Black children to be more likely to be categorized as high risk. The model did reveal a significant difference between White children and children of other races/ethnicities, with children of other races/ethnicities more likely to be categorized as high risk. The model confirmed bivariate results that child setting does not predict whether or not a child is at high risk and further indicated that gender is not a predictor (Table 5-9). Although the odds ratio (OR) and 95% confidence interval (CI) for children in foster care does not overlap with children living at home with no services, this difference (p = .04) does not meet the stricter test of significance at the p < .01 level that we have assumed for this study due to the many tests that we are conducting.
| Characteristic | OR | 95% CI | |
|---|---|---|---|
| Gender | Female | (reference group) | |
| Male | .82 | .47, 1.45 | |
| Race/ Ethnicity | White | (reference group) | |
| Black | 1.90 | 1.10, 3.27 | |
| Hispanic | 1.77 | .95, 3.28 | |
| Other | 3.55 * | 1.35, 9.29 | |
| Child Setting/ Services | In-home, no services | (reference group) | |
| In-home, services | .98 | .61, 1.58 | |
| Foster home | 1.89 | 1.03, 3.49 | |
| Kinship care | .86 | .57, 1.30 | |
| Group home | 4.93 | .49, 49.74 | |
|
Cox and Snell pseudo-R2 is .05 |
Because of the subjective elements involved in BINS, we checked to determine if raters were consistent in their ratings of children, regardless of the race/ethnicity of the child and rater. White children were found to receive significantly lower scores from Hispanic interviewers than from White interviewers (p < .001). There was also a trend toward Black interviewers' scoring White children higher than did Hispanic interviewers (p = .03). Hispanic children were found to receive significantly lower scores from Black interviewers than from either Hispanic interviewers or White interviewers. Finally, children of other races/ethnicities were found to receive significantly lower scores from Black interviewers than from Hispanic interviewers (p < .001). There were no significant differences with regard to how Black and White interviewers scored Black or White children, which are the interviewer/child, race/ethnicity combinations that account for the majority of the NSCAW interviews. 16
To summarize, more than half of infants under the age of 2 years who are involved with CWS are at high risk for development delay or neurological impairment according to their assessment on BINS. This is far larger than the proportion of children this age at high risk in the general population. Further, assuming that the BINS is capturing risk equally across racial/ethnic groups, the findings indicate that Black infants under the age of 2 years who are involved with CWS may have a tendency to be at particularly high risk for developmental delay or neurological impairment.
5.1.3 Early Cognitive Development: The Battelle Developmental Inventory
The cognitive domain of the Battelle Developmental Inventory (BDI) was used to assess cognitive development in children aged 3 and younger. The results are shown in Table 5-10. In general, the mean T scores for the total cognitive domain for children whose families were investigated for maltreatment are close to one standard deviation under the normed mean (Mean = 50, SD = 10). Thirty-one percent of all children aged 3 and younger whose families were investigated for maltreatment have a T score on the total cognitive domain of the BDI that is lower than two standard deviations below the normed mean (i.e., < 30). Service setting is not significantly related to BDI scores. In addition, bivariate analyses indicated that mean BDI scores do not differ based on race/ethnicity.
| Race/ Ethnicity | TOTAL | Setting | ||||||
|---|---|---|---|---|---|---|---|---|
| In-Home | Out-of-Home | |||||||
| No Services | Services | TOTAL In-Home | Foster Care | Kinship Foster Care | Group Care | TOTAL Out-of-Home^ | ||
| Mean/ (SE) | ||||||||
| Black | 41.6 (1.2) |
40.4 (2.0) |
41.4 (1.3) |
40.8 (1.5) |
43.7 (1.9) |
49.0 (3.5) |
39.1 (2.8) |
45.8 (1.9) |
| White | 42.3 (1.1) |
41.9 (1.6) |
42.5 (1.0) |
42.1 (1.2) |
43.4 (2.2) |
39.3 (3.4) |
--- | 41.8 (2.2) |
| Hispanic | 39.7 (1.4) |
37.8 (1.4) |
42.7 (2.6) |
38.6 (1.5) |
46.4 (1.4) |
43.5 (2.0) |
--- | 45.0 (1.5) |
| Other | 43.6 (1.9) |
43.5 (2.5) |
45.4 (4.3) |
44.0 (2.2) |
41.9 (2.3) |
37.1 (4.8) |
--- | 40.4 (2.6) |
| TOTAL | 41.6 (0.9) |
40.8 (1.1) |
42.3 (0.9) |
41.2 (1.0) |
44.2 (1.0) |
43.3 (2.1) |
40.6 (3.3) |
44.0 (1.2) |
BDI also includes subscales, each of which is also normed with a standard T distribution (Table 5-11). The mean score combined with the standard error fails to reach the test norm of 50 for any measure indicating that, on average, scores are substantially suppressed. The proportion of children with scores lower than two standard deviations below the mean (i.e., less than 30) ranges from 26% for Conceptual Development to 48% for Reasoning and Academic Skills.
Because of the subjective elements involved in scoring BDI, as with BINS, we checked to see if raters were consistent in their ratings of children, regardless of the race/ethnicity of the child and rater. Although there were some differences on the subtest scores, 17 there were no inconsistencies noted based on child and interviewer race/ethnicity when looking at the total BDI score.