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3. Characteristics of OYFC Children
This chapter presents information that describes the children in the NSCAW One Year in Foster Care (OYFC) cohort. Characteristics used to portray these children include age, race and ethnicity, prior experiences of maltreatment, type of abuse precipitating the current placement, severity and duration of abuse, and cognitive and developmental functioning. All analyses, unless otherwise specified, include all OYFC children, even if they were found not to be in out-of-home care (OOHC) at the time of the interview. Analyses that examine differences between children in various out-of-home placement types, however, do not include the children who were no longer in care.
Comparisons by race and type of out-of-home care are of considerable interest because these characteristics are often part of discussions of child welfare program and policy design. Therefore, throughout the report, comparisons by race and type of out-of-home care are routinely presented. However, we do not possess evidence that race or type of OOHC actually cause a particular outcome; we simply present evidence relevant to whether race or type of OOHC are associated with differences in outcomes. In particular, our study design does not take into account selection issues that may affect which children get into different types of out-of-home placements. The OYFC children are almost evenly split between males and females (51% male).
3.1 Characteristics of Children in Foster Care One Year
How old are OYFC children?
The OYFC children range in age from late infancy (about 1 year) to just past 15 years old at the time of the interview. Figure 3-1 summarizes the distribution of children by age. Children aged 3 to 5 years old make up 17% of the OYFC group. Almost one-quarter (24%) are between the ages of 1 and 2 years, and just over a quarter (27%) are 11 or older. The average age of the OYFC children is 7, as is the median age (mode=1). Looking at average age by type of placement, the average age of children in non-kin foster homes is 6, as is the median age (mode=1); in kin-care settings, the average age is 7, with a median age of 6 (mode=1). Children in group homes have an average age of 10 and a median age of 11 (mode=13). Children in each of the three out-of-home placement types span the entire age range (1 to 15).
What race and ethnicity are OYFC children?
Figure 3-2 shows the distribution of the OYFC children’s race and ethnicity. With regard to race, the OYFC children consist primarily of African-American children and white children, who together make up 76% of the group (45% and 31%, respectively). American Indian/Alaskan Native and Asian/Hawaiian/Pacific Islander children make up 6% and 2%, respectively. Another 7% are identified as “other.”
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Because child welfare researchers traditionally use a blend of race and ethnicity as the way to distinguish children, we also made this distinction. To classify children for this analysis, ethnicity was considered before race, so that those children identified as Hispanic/Latino were classified as such regardless of their race.
Using these classifications, we find that 45% of children are black/non-Hispanic, 31% are white/non-Hispanic, 17% are Hispanic, and 7% are classified as “other” races (Figure 3-2). On the question about race, about half of these Hispanic children (9% of the total) had been classified as white. The remaining 8% of those classified as being of Hispanic ethnicity had been classified as black, American Indian, or other races.
3.2 Children’s Experiences
What prior experiences have these children had with child welfare services?
Because sampling a cohort of children with no prior maltreatment history was not possible, CPS histories were collected from child welfare workers. Although we do not have extensive data on children’s prior experiences with child welfare services, approximately 63% of OYFC children had at least one report of maltreatment prior to the one that resulted in this episode in foster care. Eighty-five percent of them had been removed from the home of their biological mother in this episode in foster care.
What types of maltreatment did children experience precipitating this placement in foster care?
The types of maltreatment involved in the placement of children into the episode in foster care that led to their inclusion in this study were classified using the modified coding scheme described by Manly, Cicchetti, and Barnett (1994) and used extensively by the LONGSCAN group (Runyan et al., 1988). The child welfare worker who was interviewed used information from the case record to classify the severity, the onset of the abuse, and type of maltreatment.
This approach has three major advantages over conventional means of gathering data on types of maltreatment from administrative records. First, it allows for more than one type of maltreatment to be indicated. Second, inclusion of the severity and duration of the maltreatment allows us to distinguish important differences among experiences of children with the same type of maltreatment. Third, the child welfare worker can describe the actual case characteristics rather than force the case to fit a category for court or administrative purposes.5 As a result, these maltreatment findings have more uniformity and specificity than exist in administrative records.
Child welfare workers were asked to identify the most serious type of abuse and any other types that were present. For the most serious type of abuse, they assigned a severity score ranging from 1 to 5, with 5 being the greatest and with each scale point tied to a specific action for that type of maltreatment. We also obtained information about the onset of the maltreatment and computed duration (the elapsed time since onset) for the most serious type of abuse.
What is the most serious type of maltreatment the children experienced?
Most OYFC children (60%) were placed in out-of-home care with the most serious type of maltreatment indicated as being neglect, with about half of these neglected through failure to provide and the other half through failure to supervise. Ten percent of the children suffered physical abuse, and 8% were identified as having sexual abuse as their most serious type of abuse. The remaining children experienced some other type of abuse or neglect (emotional, abandonment, moral/legal, or educational). In addition, 8% of the children were referred to child welfare services for reasons other than abuse/neglect (e.g., for mental health services or domestic violence). Even though these children had been classified as abused or neglected in the official CPS records—and, therefore, eligible for inclusion in the study—interviews with the child welfare workers indicated that other reasons were responsible for their entry into foster care. (These classifications as other occurred most often for the youngest and for the oldest children.) Table 3-1 provides overall distributions and Table 3-2 provides the detailed distributions by age category.
What is the relationship between age, race, gender, and type of alleged child abuse?
For the remainder of this report, we refer to five major categories of abuse and neglect when looking at abuse type and its relationship to other characteristics. Neglect was broken into two groups: failure to supervise (the abandonment cases were subsumed under this category) and failure to provide. Physical abuse and sexual abuse are two additional groups. The less common types of abuse (i.e., emotional, educational, and moral/legal maltreatment) were combined into a maltreated-other category. However, the maltreated-other category is not included in most analyses that employ an abuse type because the interpretation for this group is too difficult. These analyses also excluded cases with abuse types described as non-maltreated-other (signifying other reasons for placement, as discussed above), missing, and don’t know. Table 3-3 summarizes the distribution of the most serious abuse types following this recoding of the data. Using this reduced set of abuse types, we see that failure to provide and failure to supervise—two types of neglect—are by far the most common types of abuse among all age groups of children in foster care at one year.
There is a significant association between maltreatment type and age (X2= 34.18, p < .01). As shown in Figure 3-3, the greatest proportion of failure to provide is among children two years old and younger. Also, this youngest age group has the smallest proportion of sexual abuse as the most serious type of abuse/neglect.
There is a significant association between maltreatment type and race (X2 = 59.99, p < .001). As shown in Figure 3-4, Hispanic children are the most likely to be victims of physical abuse and the least likely to be victims of failure to provide. Black children have the highest proportions of failure to supervise as their most serious maltreatment type, and white children (and children of other races) have the highest proportions of sexual abuse.
There is not a significant association between maltreatment type and gender.
What subtypes of abuse do these children experience?
Child welfare workers were asked to rate the severity of the most serious subtype of abuse identified for each child, as well as when the abuse began. To accomplish this, child welfare workers responded to a slight modification of the Manly, Cicchetti, and Barnett (1994) instrument that has become the standard in the field. (See Stockhammer, Salzinger, Feldman, Mojica, and Primavera, 2001.) Using their instrument, respondents indicate all the types of maltreatment and the most serious type of maltreatment. For the most serious type, respondents were asked to choose among five categories of severity and to specify a length of time in days, weeks, months, or years that they believed the child had been subjected to the abuse. Details of most serious subtypes are presented in Table 3-4.
| Type of abuse/neglect | Total weighted percentage (95% CI) |
| Physical | 10 (7, 14) |
| Sexual | 8 (5, 12) |
| Emotional | 7 (5, 10) |
| Neglect (failure to provide) | 33 (27, 40) |
| Neglect (failure to supervise) | 27 (22, 31) |
| Abandonment | 7 (5, 10) |
| Moral/legal | 0.35 (0.1, 1) |
| Educational | 0.47 (0.1, 2) |
| Exploitation | 0 |
| Other | 8 (5, 12) |
| Total | 100 |
| Type of abuse/neglect | Age of child | Total | |||
|---|---|---|---|---|---|
| 1-2 | 3-5 | 6-10 | 11+ | ||
| Physical | 26 (17, 38) |
12 (5, 24) |
36 (23, 53) |
25 (14, 42) |
100 |
| Sexual | 2 (0.2, 12) |
15 (5, 37) |
45 (26, 64) |
39 (27, 53) |
100 |
| Emotional | 17 (5, 40) |
14 (5, 34) |
39 (26, 55) |
31 (14, 55) |
100 |
| Neglect (failure to provide) | 33 (27, 40) |
19 (13, 28) |
25 (18, 34) |
24 (17, 32) |
100 |
| Neglect (failure to supervise) | 18 (10, 30) |
20 (9, 39) |
38 (28, 50) |
24 (13, 41) |
100 |
| Abandonment | 18 (8, 37) |
16 (6, 38) |
31 (16, 51) |
35 (22, 50) |
100 |
| Moral/legal | 0 | 0 | 32 (4, 84) |
68 (16, 96) |
100 |
| Educational | 0 | 0 | 0 | 100 | 100 |
| Exploitation | 0 | 0 | 0 | 0 | 100 |
| Other | 56 (34, 76) |
4 (1, 11) |
11 (2, 38) |
30 (17, 48) |
100 |
| Abuse type | Percent (95% CI) |
| Physical maltreatment | 10 (7, 15) |
| Sexual maltreatment | 8 (5, 14) |
| Physical neglect-failure to provide | 36 (30, 43) |
| Physical neglect-failure to supervise | 37 (32, 41) |
| Other | 9 (6, 12) |
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As shown in Table 3-5, the categories of severity differed depending on the type of abuse. For example, for physical abuse the categories ranged from “dangerous act, but no marks indicated” to “hospitalized more than 24 hours, permanent disability, or disfigurement”; for physical neglect the categories ranged from “mild” to “grave”; and for sexual abuse the categories varied from “fondling” to “genital penetration.”
Of the OYFC children whose most serious type identified was the failure to provide, the most serious subtype was almost evenly distributed across inadequate receipt of medical, dental, and mental health care; lack of adequate food; and lack of adequate shelter. For 43% of those children in the neglect: failure-to-supervise category, being left unsupervised for periods of time was the most serious subtype. Almost one-quarter (23%) of the children in the category of failure to supervise had been abandoned by their caregivers. For OYFC children in the physical maltreatment category, the most serious subtype for nearly one-third (32%) was a hit or kick to the face, head, or neck. For those children in the sexual maltreatment category, the proportions were nearly evenly split between subtypes that included penetration or oral copulation and those that involved fondling, masturbation, or exposure to pornography.
| Abuse | Percent | 95% CI |
|---|---|---|
| Physical maltreatment | ||
| Hit/kick face/head/neck | 32 | 21, 46 |
| Burns | 15 | 7, 29 |
| Non-descript abuse | 12 | 6, 23 |
| Hit/kick buttocks | 9 | 2, 29 |
| Violent handling of child | 9 | 4, 20 |
| Hit/kick torso | 7 | 2, 21 |
| Other | 7 | 3, 17 |
| Hit/kick limbs/extremities | 3 | 1, 8 |
| Choking/smothering | 3 | 1, 9 |
| Shaking | 2 | 0, 6 |
| Sexual maltreatment | ||
| Fondling/molestation/other less severe | 39 | 20, 63 |
| Digital penetration | 21 | 11, 34 |
| Vaginal/anal intercourse | 17 | 9, 30 |
| Oral copulation | 15 | 7, 28 |
| Masturbation | 8 | 1, 38 |
| Physical neglect-failure to provide | ||
| Lacks adequate med/dent/mh coverage | 34 | 24, 46 |
| Lacks adequate food | 30 | 18, 47 |
| Lacks adequate shelter | 26 | 18, 37 |
| Lacks adequate hygiene | 7 | 3, 15 |
| Lacks adequate clothing | 2 | 1, 4 |
| Physical neglect-failure to supervise | ||
| Supervision | 43 | 31, 55 |
| Abandonment | 23 | 15, 32 |
| Substitute care arrangements unsafe | 18 | 14, 25 |
| Environment | 16 | 9, 27 |
| Most Serious Abuse Type and Severity Categories | Percent (95% CI) |
|---|---|
| Physical Abuse | |
| Dangerous act, but no marks indicated | 25 (14, 41) |
| Minor marks | 15 (6, 30) |
| Numerous or severe marks | 33 (20, 49) |
| Medical/emergency treatment; hospitalized for < 24 hours | 14 (7, 26) |
| Hospitalized more than 24 hours, permanent disability or disfigurement | 13 (6, 28) |
| Sexual Abuse | |
| Fondling/molestation (without genital contact) or other less severe type (e.g., exposure to sex or pornography) | 39 (20, 63) |
| Masturbation (requires genital contact) | 8 (1, 38) |
| Digital penetration of vagina or anus | 21 (11, 34) |
| Oral copulation (or adult or child) | 15 (7, 28) |
| Vaginal/anal intercourse | 17 (9, 30) |
| Failure to Provide^ | |
| (e.g., lack of adequate medical, dental, and mental health care) | |
| Mild (e.g., miss several medical/dental appointments, does not attend to mild behavior problem) | 2 (1, 5) |
| Moderate (e.g., seeks medical attention for minor illness, but does not follow through-like not finishing needed medicine) | 16 (12, 21) |
| Serious (e.g., does not seek medical attention, seeks treatment for non-minor illness but doesn't follow through, uses inappropriate treatment without consulting doctor, expectant mother uses alcohol or drugs with no FAS or drug symptoms) | 39 (33, 45) |
| Severe (e.g., does not seek or comply with medical treatment for potentially life-threatening illness or injury) | 27 (20, 36) |
| Grave (e.g., alcohol/drug abuse during pregnancy causes FAS or drug-addicted baby, child permanently disabled from inattention, does not seek professional help for child's life-threatening emotional problems like suicide/homicide) | 15 (9, 24) |
| Failure
to Supervise^^ (e.g., child left unsupervised for periods of time) Mild (e.g., failure to provide adequate supervision for short periods of time, or less than 3 hours, with no immediate source of danger in environment) |
10 (5, 20) |
| Moderate (e.g., failure to provide adequate supervision for several, or 3-8 hours, with no immediate source of danger in environment, or inadequate supervision) | 17 (10, 28) |
| Serious (e.g., failure to provide adequate supervision for extended periods of time, or 8-10 hours) | 19 (13, 26) |
| Severe (e.g., failure to provide adequate supervision for extended periods of time, overnight, or 10-12 hours) | 32 (21, 46) |
| Grave (e.g., failure to provide adequate supervision for more than 24 hours) | 23 (13, 37) |
| ^ The most commonly used severity scales for
failure to provide and failure to supervise were included as examples
in this table, although additional subtypes have their own specific
definitions of the various severity levels. ^^ Abandonment cases were not included in the severity analyses as this abuse type did not yield a severity rating. |
For children with multiple types of abuse, what are the additional types?
Research and practice has long shown that multiple types of abuse are common, but little is known about the combinations that exist for children who remain in foster care. Administrative records on child abuse and neglect typically fail to indicate more than one type of abuse. These survey data, with multiple types of abuse reported, allow us to reflect the substantially more complex reality these children experience.
As noted above, child welfare workers were asked to identify all of the types of abuse allegedly inflicted upon the sampled child in the episode resulting in placement. For the following analysis, we looked specifically at the presence of more than one of the following four main abuse types: physical abuse, sexual abuse, failure to provide, and failure to supervise. As shown in Table 3-6, 41% of OYFC children were victims of more than one of these four types of abuse. More specifically, almost one-third (32%) had experienced two; 8% experienced three; and 1% experienced all four of these abuse types prior to placement.
| Number of Main Abuse Types |
Percent | 95% CI |
|---|---|---|
| None | 4 | 3, 7 |
| One (physical abuse) | 6 | 4, 9 |
| One (sexual abuse) | 3 | 1, 7 |
| One (failure to provide) | 17 | 11, 24 |
| One (failure to supervise) | 27 | 23, 33 |
| Two | 32 | 28, 37 |
| Three | 8 | 5, 13 |
| Four | 1 | 1, 3 |
The analyses summarized in Table 3-7 look at OYFC children with one of the aforementioned abuse types as their most serious abuse type and examine which additional main abuse types they experienced. Of children whose serious physical maltreatment brought them into care, 33% also had caregivers who failed to supervise and 31% had caregivers who failed to provide. One percent of these victims of physical abuse were also victims of sexual abuse. Children with a most serious abuse type of sexual maltreatment seem especially likely to have also experienced another of the main types of abuse: nearly two-thirds were not adequately supervised; 33% were also physically abused, and 22% were not adequately provided for in some way.
Half (50%) of the children in the failure-to-provide category also had caregivers who failed to supervise them in some way. Ten percent of these children experienced physical abuse and 1% experienced sexual abuse. Finally, of those children in the failure-to-supervise category, 21% were also victims of some type of failure to provide, whereas 5% and 4%, respectively, were victims of sexual abuse and physical abuse.
| Abuse^ | Percent | 95% CI |
|---|---|---|
| Physical maltreatment | ||
| Sexual maltreatment | 1 | 0, 4 |
| Failure to provide | 31 | 22, 42 |
| Failure to supervise | 33 | 23, 45 |
| Sexual maltreatment | ||
| Physical maltreatment | 33 | 11, 64 |
| Failure to provide | 22 | 12, 35 |
| Failure to supervise | 63 | 46, 77 |
| Failure to provide | ||
| Physical maltreatment | 10 | 6, 16 |
| Sexual maltreatment | 1 | 0, 3 |
| Failure to supervise | 50 | 38, 63 |
| Failure to supervise | ||
| Physical maltreatment | 4 | 2, 8 |
| Sexual maltreatment | 5 | 2, 13 |
| Failure to provide | 21 | 16, 27 |
| ^ Most serious abuse types are listed first in each grouping. The three additional types of abuse for each are indented under these. |
What was the severity and duration of abuse?
Research linking the types of child abuse and neglect with longer-term outcomes often lacks information about the severity and duration of the abuse. These factors appear critical to understanding the long-term outcomes of maltreatment. Several investigators have examined severity and duration related to the risk of poor outcomes for physically abused and sexually abused children (e.g., Carrey, Butter, Persinger, and Bialik, 1995; Finkelhor and Browne, 1986). Little work has been done to examine the relationship between severity and duration in populations including neglected children, although Manly, Cicchetti, and Barnett (1994) examined a population of children who had experienced sexual abuse (with or without other types of maltreatment), physical abuse (with or without neglect), or neglect (alone). They found that the severity of the maltreatment, the frequency of Child Protective Services reports, the interaction between severity and frequency, and the chronicity of the maltreatment were significant predictors of children’s functioning. Although the exact mechanics for comparing the severity of abuse across types of abuse and for combining severity and duration have not been well developed (Cicchetti and Toth, 1995), this is a promising way to estimate the risk of developmental harm that arises from the experience of maltreatment.
The Maltreatment Classification System indicates when the abuse of a child began. Although it is not possible to determine the extent to which the abuse continued between the onset of the maltreatment and the current time (and it almost certainly was interrupted by placement in out-of-home care), it is possible to compute a score for the duration of time since the maltreatment began. To adjust for the fact that some children were quite young and that the duration of time since the maltreatment began was a major portion of their life, the onset date was subtracted from the child’s age at the time of the interview and then converted into a proportion of the child’s life (ranging from 0.02% to 100% of the child’s life).
Using the previously described data on severity and onset of abuse, we looked specifically at the children with one of the four main types listed above as their most serious type of abuse and calculated a “Severity x Duration (since onset) score” (SxD score). This score was computed by multiplying the reported severity of the abuse (ranging from 1, less severe, to 5, more severe) by the reported duration since the onset of the abuse. Using this method of calculation, the SxD score ranged from 0.0002 to 5, with a mean of 0.71. We then compared the SxD score across categories of various child characteristics, including age, race, out-of-home placement type, and most serious type of abuse. This provides an additional way to summarize the maltreatment experiences of children in the OYFC component.
How does severity and duration (SxD) of abuse vary by child characteristics?
From Table 3-8 we see that the child’s age is a significant factor in predicting his or her SxD score (F = 7.74, p<.001). Specifically, children 11 years and older have an SxD score (0.39) which is significantly lower than the mean SxD score for each of the three younger age groups, which confirm that the older children have not experienced maltreatment for the vast majority of their lives. There are no significant differences in SxD score by race. Although Hispanic children have the highest mean SxD score and children of “other” races have the lowest, these differences are not statistically significant.
When looking at the mean SxD scores by out-of-home placement type, we found a significant association (F = 3.29, p<.05). Specifically, children in kin-care settings have experienced significantly higher severity and duration of abuse (mean SxD score=0.96) than those in foster homes (mean=0.68) and group homes or residential programs (mean=0.53). And finally, the most serious abuse type is also significant in predicting a child’s SxD score (F = 3.65, p<.05). Specifically, children whose most serious abuse type was failure to provide have the highest mean SxD score (0.91), which is significantly higher than the mean SxD scores for children in the categories of physical maltreatment (0.60) and failure to supervise6 (0.52).
The utility of using these severity-by-duration scores across types of maltreatment is not certain. Although there is evidence that severity by duration is a factor in the impact of physical and sexual abuse (Carrey et al., 1995; Finkelhor and Browne, 1986; Stockhammer et al., 2001), there has been little effort to examine such relationships for children across types of maltreatment. This is particularly difficult because neglect most often is reported for younger children, and physical and sexual abuse are reported for older children. Further, since the maltreatment has very likely been interrupted by placement into foster care, the children in this sample would be likely to have had a different experience since the onset of the maltreatment than children who are just entering the child welfare system. Although nothing in this analysis would encourage us to argue that the highest severity score is equivalent across all types of maltreatment, the use of a consistent metric for coding severity does provide some rough way to determine if children of different ages and races are entering foster care with somewhat similar severity of exposure to at least one type of maltreatment.
| Child characteristics | Mean and SE of duration score^ | Mean and SE of severity score | Mean and SE of SxD score | F and p-value of group (re: SxD score) |
|---|---|---|---|---|
| Age | 7.74, p<.001 | |||
| 1-2 years | 0.26 (.04) | 3.89 (.17) | 1.01 (.19) | |
| 3-5 years | 0.26 (.06) | 3.15 (.25) | 0.81 (.18) | |
| 6-10 years | 0.24 (.02) | 3.06 (.16) | 0.76 (.10) | |
| 11+ years | 0.14 (.02) | 2.95 (.12) | 0.39 (.06) | |
| Race/Hispanicity | 0.79, p=.50 | |||
| Black | 0.21 (.03) | 3.17 (.10) | 0.69 (.10) | |
| White | 0.22 (.03) | 3.28 (.16) | 0.72 (.13) | |
| Hispanic | 0.23 (.03) | 3.02 (.23) | 0.79 (.14) | |
| Other | 0.18 (.05) | 3.55 (.30) | 0.49 (.12) | |
| Placement type | 3.29, p<.05 | |||
| Foster home | 0.20 (.02) | 3.29 (.10) | 0.68 (.09) | |
| Kin-care setting | 0.29 (.03) | 3.33 (.10) | 0.96 (.12) | |
| Group home/residential program | 0.17 (.04) | 3.40 (.43) | 0.53 (.14) | |
| Most serious abuse type | 3.65, p<.05 | |||
| Physical maltreatment | 0.25 (.04) | 2.75 (.19) | 0.60 (.10) | |
| Sexual maltreatment | 0.24 (.04) | 2.61 (.31) | 0.58 (.11) | |
| Failure to provide | 0.25 (.03) | 3.36 (.06) | 0.91 (.12) | |
| Failure to supervise | 0.16 (.02) | 3.40 (.13) | 0.52 (.09) | |
| ^Duration (since onset) score is the time which elapsed since the onset of maltreatment as a proportion of the child’s life age at time of interview. |
3.3 OYFC Children’s Living Situations
Does out-of-home placement type vary by child characteristics?
The survey data indicate that 44% of OYFC children were living in a foster home, about one-quarter (24%) were living in kin care, and 7% were living in a group home or residential program. However, one-quarter of the children (25%) went home after construction of the sampling frame but before they were interviewed; this may be attributable to timely one-year case review hearings followed by reunification. In Figure 3-5, type of placement was categorized as “not applicable” for these cases. When this group of children is excluded from the analysis, the distributions are adjusted to: foster home–58%, kin care–32%, group home–9%, other–1%.
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OYFC children in all age groups were more likely to be living in a non-kin foster home than in any other type of setting, with kinship care being the second most common placement type. As shown in Figure 3-6, almost three-quarters (73%) of OYFC children between 1 and 2 years old were living in a foster home. Almost none of the youngest children and only small proportions of children aged 3 to 5 and 6 to 10 years were living in group homes.
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OYFC children in all race groups except Hispanic were much more likely to be living in foster homes than in any other type of placement, with kinship care again being the second most common placement type. Hispanic OYFC children were living in foster homes and kin-care settings in nearly equal proportions. Furthermore, black and Hispanic OYFC children were less likely to be living in group homes than were children of white or other race/ethnicity groups. Figure 3-7 provides the detailed information.
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What is the most serious type of abuse by out-of-home placement type?
Foster homes were the placement type for one-half to over three-fifths of the children, and the most frequently used placement type, regardless of the most serious type of abuse they experienced. Although a larger proportion (22%) of the OYFC children whose most serious abuse type was sexual maltreatment were living in group homes compared with those experiencing other types of abuse, twice as many of these children were living in foster homes as group homes (Figure 3-8).
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8% of the OYFC children have asthma and four percent have severe allergies
-
almost 4% of the OYFC children reportedly have some sort of difficulty that began prenatally or at birth, such as low birth weight, fetal alcohol syndrome, or cerebral palsy
-
2% of the OYFC children reportedly have a neurological, endocrine, or blood disorder
-
12% have some unspecified health problem.
Immunizations were reported by caregivers to be up-to-date for almost all children in foster care for one year (99%). More than three-quarters (79%) had visited a dentist or hygienist in the last 12 months. Sixty-nine percent and 74%, respectively, had had recent vision and hearing tests. Twenty-nine percent had been seen in an emergency room or urgent care center for an illness or injury in the past year. The majority of children (92%) were insured by Medicaid or other state-funded program, while almost 7% were privately insured and just under one percent had no insurance.
Comparable estimates of health status and utilization among children in out-of-home care (not including group homes) are found in the National Survey of America’s Families (NSAF) (Kortenkamp and Ehrle, 2002). NSAF included children who were either placed by a child welfare agency in a relative’s home or living with nonrelative foster parents for other reasons. In a global rating of health, NSAF found that 10% of children were in poor or fair health, compared to 8% in the NSCAW sample. NSAF found that 37% of the children aged 3 to 17 years in foster care did not visit the dentist or hygienist in the past year, while only 21% of the children in NSCAW had not visited the dentist in the past year.
How does the cognitive and social development of young OYFC children compare with that of the general population?
Standardized cognitive and social measures, described in Section 2.5, were used to assess children’s functioning. We examined individual scores, as well as the proportion of scores indicating performance in the clinical or borderline range (when the measures had a borderline demarcation) according to published test criteria. When such criteria were not available (i.e., for the K-BIT, PLS-3, MBA, BDI, and the Vineland Screener: Daily Living Skills), a criterion of 2 standard deviations below the published test mean was used. Performance on developmental measures also is examined in relation to out-of-home placement type, abuse history, and the severity and duration (since onset) of abuse.
The cognitive domain of the Battelle Developmental Inventory (BDI) was administered to children aged 3 and under. A summary of results appears in Figure 3-9. The mean T scores for all subtests and for the total cognitive domain are approximately 1 standard deviation under the mean (mean=50, SD=10) for the normative group. Twenty-eight percent of the children to whom the BDI was administered have a T score on the total cognitive domain that is lower than 2 standard deviations below the mean (i.e., <30).
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| Note: As measured by the Battelle Developmental Inventory (BDI); mean of 50 and SD of 10 refers to normative group, not to study sample. |
What is the neurodevelopmental status of young OYFC children?
The Bayley Infant Neurodevelopmental Screener (BINS) was used to assess risk of developmental delay or neurological impairment in OYFC children aged 13 to 24 months. In Figure 3-10, the children’s scores are compared with normative clinical and nonclinical samples. OYFC children resemble the clinical sample of children much more than they do the normative sample. A total of 78% of OYFC children were categorized as medium or high risk, compared with 83% of the clinical sample and only 47% of the nonclinical sample.
[D] |
How do behavior problems compare with those of the general population?
Externalizing, Internalizing, and Total Problem Behaviors were measured using the Parent Report Form of the Child Behavior Checklist (CBCL). As shown in Table 3-9, the OYFC population almost always exhibits more clinical and borderline scores than does the normative sample. By definition, 17% of the normative sample was categorized as clinical/borderline. This compares with a range of 24% (for 2- to 3-year-olds) to 51% (for 4- to 18-year-olds) of the OYFC children on the Externalizing or Internalizing problem behaviors, and 26% and 47% of the OYFC children on the Total Problems scale.
What is the delinquency status of OYFC children?
Delinquent behavior of children 11 years of age and older was examined using the Delinquent Behavior subscale of the externalizing behaviors group of the CBCL-associated measures for teacher, caregiver, and youth self-report. Results appear in Figure 3-11. Caregivers were more likely to report that youth were in the clinical range, and youth were the least likely (38% versus 12%, respectively).
| Externalizing % (95% CI) |
Internalizing % (95% CI) |
Total problems % (95% CI) |
||
|---|---|---|---|---|
| Parent report | 24 | 28 | 26 | |
| 2 - 3 years | (15, 36) | (20, 39) | (16, 38) | |
| Norms | 17 | 17 | 17 | |
| Parent report | 51 | 34 | 47 | |
| 4 - 18 years | (44, 57) | (28, 39) | (38, 56) | |
| Norms | 17 | 17 | 17 | |
| Teacher report | 43 | 31 | 28 | |
| 5 - 18 years | (32, 56) | (21, 44) | (21, 36) | |
| Norms | 17 | 17 | 17 | |
| Youth report | 25 | 13 | 28 | |
| 11 - 18 years | (15, 38) | (9, 19) | (20, 37) | |
| Norms | 17 | 17 | 17 | |
| ^ Parent report measured by the Child Behavior Checklist (CBCL); teacher report measured by the Teacher Report Form (TRF); youth report measured by the Youth Self Report Form (YSR) |
[D] |
Items from the Self-Reported Delinquency (SRD) scale (Elliott and Ageton, 1980) were used to obtain information about the total number and frequency of delinquent acts engaged in during the previous six months. Over half of youth (52%) had committed at least one delinquent act. Behaviors range from nonviolent acts such as running away, property damage, and theft to violent acts such as aggravated assault and attempted rape. Of the 36 possible activities 29 are classified as nonviolent and 7 as violent. Youth report an average of 2.4 activities (SE =.4), with a range of 0 to 36. Youth consistently report more nonviolent (Mean=3.8, SE=.3) than violent acts (Mean=.5, SE=.1). The proportion of youth who have committed at least one violent or nonviolent act is also different, with youth far more likely to report commitment of a non-violent act in the past six months than a violent act (98% versus 28%). There are no significant differences between placement types for violent or nonviolent acts. This lack of association held true whether acts were categorized by the number or frequency of commitment of acts. For each behavior engaged in, youth were also asked about the frequency of each delinquent act (1 = ”once” to 5 = “5 or more times”). A total “delinquent acts” frequency score was computed by summing the scale score for frequency of the acts. With a possible score of 180 (36 behaviors x 5), the frequency scores range from 0 to 92, with a mean frequency score of 4.7 (SE =.8). This mean score may be translated as one delinquent act committed five or more times (1 x 5) or five delinquent acts committed once (5 x 1). After controlling for age, there are no significant differences in the delinquent acts score between children in the different placement settings. Frequency scores for violent (Mean=3.5, SE=.6) and nonviolent (Mean=3.8, SE=.7) acts are very similar.
How does the percentage of depressed OYFC children compare with the general population?
Children aged 7 years and older reported on their own depressive symptomatology using the Children’s Depression Inventory (CDI). Contrary to our expectations, only 7% of the children in foster care for one year score within the depressive range, compared with 9% of the normative sample (Kovacs, 1992). Because children in out-of-home care have had great upheaval in their lives, it was expected that they would be more depressed than average. Children in non-kinship foster care were much more likely than children in kinship care to report depression, 9% versus .5% (X(2) = 5.45, p<.05). There are no significant differences in depression among children of different gender or ages.
As a result of these unexpected findings, we compared the Youth Self-Report (YSR) Depression subscale for children aged 11 and older to CDI scores for children aged 11 and older. While the percentages were very similar—8% of YSR respondents and 7% of CDI respondents are classified as depressed—the normative rates for each measure are somewhat different. The CDI manual indicates that in a normal population 9% report as depressed, while the YSR indicates a rate of 5% who met the clinical cutoff for depression. The CBCL Depression subscale scores had only modest agreement with CDI scores (kappa = .40), and the proportion of children with a clinical score tended to be higher (p < .08) on the CBCL than the CDI. This cautions against firm conclusions about the level of depression among children in out-of-home care.
How do the verbal and nonverbal skills compare with the general population?
The Kaufman Brief Intelligence Test (K-BIT) measures verbal (i.e., vocabulary) and nonverbal (i.e., matrices) ability. Scores on each component are computed separately, as well as being combined into a total score. K-BIT scores for the OYFC children are shown in Figure 3-12. Average total scores for all ages are below the normed mean, but well within 1 standard deviation (100 is the mean, with a standard deviation of 15). Average scores on both components for all ages are within 1 standard deviation of the normed mean as well, with matrices scores tending to be higher than vocabulary scores. Average vocabulary scores are somewhat below the normed mean for children of all ages, suggesting that the scores do not fluctuate randomly around the mean. Some of this phenomenon may be attributable to the low-income status of children who enter foster care; low-income children tend to score below the mean on standardized tests of ability and achievement (McLoyd, 1998). Seven percent of OYFC children have a total K-BIT score lower than 2 standard deviations below the mean (i.e., <70), 9% have a verbal score at this level, and 6% have a matrices score at this level. These proportions are larger than the small percentage (2%) of the normative sample with scores less than 70.
[D] |
How do the language skills of preschoolers compare with those of the general population, and how do they vary by age?
The Preschool Language Scale-3 (PLS-3) was administered to children aged 1 to 5 years, with results as shown in Figure 3-13. The mean Auditory Comprehension, Expressive Communication, and Total scores for all ages are below the normed mean of 100 but well within 1 standard deviation (+/- 15). Thirteen percent of the children to whom the PLS-3 was administered have a total score lower than 2 standard deviations below the mean (i.e., <70). The mean scores are relatively similar across all ages, with the biggest difference between the 2-year-olds’ mean auditory score (88) and the 3- to 5-year-olds’ mean auditory score (95).
What is the level of social skills by age?
Caregivers’ perceptions of the social skills of children in their care were measured with the Social Skills Rating System (SSRS). Overall, children in foster care for one year have lower social skills in comparison with the normative sample, in which 16% were described as having low social skills, 68% average social skills, and 16% high social skills (Gresham and Elliott, 1990). Thirty-nine percent of OYFC children have SSRS scores in the “low” range. As indicated in Figure 3-14, children of all ages in foster care for one year were more likely to have low than high social skills.
[D] |
[D] |
At what level are the children’s daily living skills, and how do they vary by age?
The daily living skills domain of the Vineland Screener was administered to current caregivers of children aged 10 and younger. Results are presented in Figure 3-15. At least half of the children in each age group were rated as having adequate to high daily living skills as defined by the instrument (Sparrow, Carter, & Cicchetti, 1993), with this proportion increasing slightly in the higher age groups. But just as the 6- to 10-year-old age group had the highest proportion of children with adequate to high daily living skills, it also has the highest proportion (25%) with low daily living skills. The 3- to 5-year old age group had the lowest proportion (8%) of children with low daily living skills. Eighteen percent of OYFC children had low daily living skills as measured by the Daily Living Skills domain of the Vineland Screener.
[D] |
How do the reading and math skills compare with those of the general population?
The reading and mathematics sections of the Woodcock-McGrew-Werder Mini-Battery of Achievement (MBA) were administered to children aged 6 and older, with results as shown in Figure 3-16. The mean scores are just slightly below the normed mean of 100 and well within 1 standard deviation (+/-15). Six percent of OYFC children to whom the MBA was administered had a Reading score lower than 2 standard deviations below the mean (i.e., <70); 12% had a Mathematics score at this level. For both 6- to 10-year-olds and those 11 and older, the mean Reading score is slightly (but not significantly) higher than the mean Mathematics score. When we look across age groups, the 6- to 10-year-olds fared slightly better than those aged 11 and older on the Reading test, whereas mean scores for the Mathematics test are the same for the two age groups.
What are the overall indicators of clinical concerns and child social and cognitive development?
To get a better picture of the overall functioning of the children on these multiple developmental measures, we developed two aggregate measures of child social and cognitive development. The first overall measure calculates an aggregate tally and proportion of scores that each child had below the developmental and clinical cutting score (hereafter referred to as the “clinical cutting score”). This was achieved through use of the clinical cutting scores for standardized measures and statistical cutoff scores 2 standard deviations below the mean for the remaining measures. For each child, a clinical/nonclinical indicator was created for each measure, and the clinical sum and proportion are used in the analysis below. The second composite score computes z-scores for all the measures and then averages those across measures. The z-score has a mean of 0 and a standard deviation of 1.
[D] |
Included in the calculation of the proportion of clinical scores and in the total social and cognitive functioning z-score, as available, were
-
Battelle Developmental Inventory (BDI) (children age 4 and under),
-
Bayley Infant Neurodevelopmental Screener (BINS) (children under age 2),
-
Child Behavior Checklist—Total, Externalizing, and Internalizing (CBCL) (children age 2 and over),
-
Child Depression Inventory (CDI) (children age 7 and over),
-
Kaufman Brief Intelligence Test (K-BIT) (children age 4 and over),
-
Preschool Language Skills-3 (PLS-3) (children under age 6),
-
Social Skills Rating System (SSRS) (children age 3 and over),
-
Vineland Screener: Daily Living Skills section (children age 10 and under), and
-
Mini-Battery of Achievement (MBA) (children age 6 and over).
The age of the child—because measures were administered to children only of certain ages—and presence of valid scores determined which measures were included in the calculations for each child. Two standardized measures— the Teacher Report Form (TRF) and Youth Self Report (YSR)—were excluded, because they provided information for too few cases. Additionally, to include multiple measures of problem behavior when multiple measures of other types of functioning are not included would possibly create an artificially high proportion of clinical scores and z scores for children with problem behaviors. The result of the exclusion of these standard measures and other nonstandard measures of health, delinquency, and safety is that these scores do not provide a comprehensive picture of well-being. Still, they do provide a multidimensional assessment of children’s social and cognitive functioning, based on well-known measures from multiple sources of data. No other study on children in foster care includes this many standardized measures.
Standard scores are particularly useful when comparing performance on a variety of measures having different means and standard deviations. The aggregate cutting score provides a basis for contrasting how OYFC children fare when compared with children in the general population. The z-score composite provides a more sensitive measure of child social and cognitive development for comparisons among children in different types of placements.
What is the proportion of developmental or clinical cutting scores for OYFC children?
To clarify the overall level of functioning of children in foster care at one year, the proportion of clinical scores for each child was computed by dividing each child’s number of clinical scores by the total number of valid scores. As shown in Figure 3-17, about one-third of the children (34%) have no clinical scores, 30% have a proportion of 0.17 to 0.25, 22% have a proportion of 0.33 to 0.50, and 13% have a clinical score on more than half of the measures for which they have valid scores.
[D] |
Does the proportion of developmental or clinical scores vary by out-of-home placement type?
The proportion of poor developmental or clinical scores was compared by type of placement; the results appear in Figure 3-18. Children in group homes or residential programs tended, on average, to have higher proportions of clinical scores; children in kinship care had the lowest.
[D] |
Regression analysis also showed that children with higher proportions of clinical scores are more likely to be in group care. Statistical properties of the analysis are described in Table 3-10. This model, which included child age, child race/ethnicity, and proportion of clinical scores, confirmed that age is a significant contributor to being in group care, even after controlling for level of clinical problems. After controlling for these factors, race did not appear to be a significant factor in terms of the child’s placement type.
What is the level of social skills by age?
The caregivers’ perceptions of the social skills of children in their care were measured with the Social Skills Rating System (SSRS). Overall, children in foster care for one year have fewer social skills in comparison with the normative sample, in which 16% were described as having fewer social skills, 68% average social skills, and 16% more social skills (Gresham and Elliott, 1990). Thirty-nine percent of OYFC children have SSRS scores in the range categorized as “fewer social skills.” As indicated in Figure 3-14, children of all ages in foster care for one year were more likely to have fewer than more social skills.
Does the proportion of developmental or clinical scores vary by most serious type of abuse?
We investigated which children, based on abuse type, have the greatest likelihood of having a high proportion of scores in the “clinical” range on the developmental measures (Figure 3-19). Children with sexual abuse reported as the most serious abuse type tend to have a higher proportion of clinical scores than children in the other abuse categories.
We also conducted a more in-depth analysis via regression to determine more precisely what characteristics appear to contribute to a higher proportion of clinical scores. Variables included in the model were child age, child gender, child race/ethnicity, most serious abuse type, severity of abuse, duration of abuse, SxD score, and the number of “major” abuse types the child had experienced (0-4). Results appear in Table 3-11. The overall r-square for this model was 0.11.
| Group Care Placement (vs. Foster Home or Kin Care Setting) |
||
|---|---|---|
| OR | 95% CI | |
| Child age | ||
| 0-2 | 0.03*** | 0.00, 0.23 |
| 3-5 | 0.36 | 0.09, 1.38 |
| 6-10 | 0.48 | 0.17, 1.37 |
| 11+ | (reference group) | |
| Child race/ethnicity | ||
| Black | (reference group) | |
| White | 1.87 | 0.68, 5.20 |
| Hispanic | 0.59 | 0.11, 3.07 |
| Other | 2.26 | 0.62, 8.22 |
| Proportion of clinical scores | ||
| 0 | 0.23** | 0.07, 0.69 |
| .17 to .25 | 0.16* | 0.04, 0.68 |
| .33 to .50 | 0.25* | 0.08, 0.79 |
| .60 to 1 | (reference group) | |
| * p<.05, ** p<.01; *** p<.001; Cox and Snell pseudo-R-square is .10. |
[D] |
Age is a significant factor in predicting the proportion of clinical scores (F = 4.20, p<.01), with children aged 3 to 5 years having significantly lower proportions of clinical scores than children 11 years of age and older (p<.01). Although child race/ethnicity is not a significant factor overall (F = 2.47, p=.07), comparisons between individual race categories indicate that Hispanic children had significantly lower proportions of clinical scores than black/non-Hispanic children (p<.05). Since the children had been in care for one year, an identical regression with out-of-home placement type added as an independent variable was also performed to determine what effect, if any, placement type has on proportion of clinical scores. The results indicate that placement type does not contribute significantly to the proportion of clinical scores.
| Number of observations used in analysis | 358 | ||
|---|---|---|---|
| Multiple R-Square | 0.11 | ||
| Independent Variable | Beta Coeff. | P-Value | |
| Child age (ref=11+) | |||
| Overall | F=4.20 | <0.01 | |
| 1-2 | -0.09 | 0.10 | |
| 3-5 | -0.10 | <0.001 | |
| 6-10 | -0.03 | 0.57 | |
| Child gender (ref=Female) | |||
| Overall | F=0.42 | ||
| Male | -0.03 | 0.52 | |
| Child race/ethnicity (ref=Black/non-Hispanic) | |||
| Overall | F=2.47 | 0.07 | |
| White/non-Hispanic | -0.04 | 0.18 | |
| Hispanic | -0.08 | <0.05 | |
| Other | -0.02 | 0.70 | |
| Most serious abuse type (ref=Sexual) | |||
| Overall | F=0.97 | 0.41 | |
| Physical | -0.10 | 0.15 | |
| Failure to provide | -0.10 | 0.13 | |
| Failure to supervise | -0.06 | 0.39 | |
| Severity of abuse (ref=3) | |||
| Overall | F=1.07 | 0.35 | |
| 1-2 (least severe) | 0.02 | 0.68 | |
| 4-5 (most severe) | 0.06 | 0.15 | |
| Duration (since onset) of abuse (continuous) | F=0.85 -0.10 |
0.36 | |
| Severity x duration score (continuous) | F=2.25 0.07 |
0.14 | |
| Number of 4 main abuse types suffered (ref=0-1) | |||
| Overall | F=1.79 | 0.17 | |
| 2 | 0.02 | 0.60 | |
| 3-4 | 0.08 | 0.06 | |
What is the overall z-score for each OYFC child, and does it vary by placement type or abuse type?
To further test the relationship between severity and duration of abuse and developmental outcomes, each child’s score on each of the developmental measures was converted to a z-score. The use of this standard score complements the use of clinical cutting scores, because it is sensitive to the range of scores that fall below the clinical range and does not simply aggregate all variation into a single “nonclinical” category. In that way, averaging standard scores provides a more sensitive index of performance.
The overall z-scores were plotted to determine the distribution of these scores, and they appear to be normally distributed, ranging from –2.15 to 1.72 (Figure 3-20). The mean overall z-score is 0.01.
[D] |
Comparing overall z-scores by out-of-home placement type, children in group homes have the lowest mean (lowest is worse), whereas children in kin-care settings have the highest mean (Figure 3-21). Differences between children in kin care settings and children in foster homes and group homes are significant at the p<.001 level.
Comparing overall z-scores by abuse type, children for whom sexual abuse is the most serious abuse type had the lowest mean (Figure 3-22). The differences in mean overall z-scores between children with a most serious abuse type of sexual maltreatment and children with a most serious abuse type of physical maltreatment or failure to provide are significant (p<.05 and p<.01, respectively).
[D] |
[D] |
What are the overall “social” and “cognitive” z-scores for each OYFC child, and do they vary by placement type or abuse type?
As a supplement to our analysis of the overall z-scores, we separated the standardized measures used for the overall z-score (with some exceptions as noted below) into two groups: those that generally focused on “social” abilities and those that focused on “cognitive” abilities. We created an overall social z-score and an overall cognitive z-score, and then looked at the correlations among the scores within each group, as well as the correlation between each score and its corresponding overall score (i.e., social or cognitive). In this way we could be confident that the measures in each group correlated adequately, thus producing reliable overall z-scores. The final measures included in each overall z-score were as follows:
Overall social z-score
-
Social Skills Rating System (SSRS),
-
Child Behavior Checklist—Externalizing and Internalizing (CBCL), and
-
Vineland Screener: Daily Living Skills section.
Overall cognitive z-score
-
Kaufman Brief Intelligence Test (K-BIT),
-
Mini-Battery of Achievement (MBA),
-
Preschool Language Skills-3 (PLS-3), and
-
Vineland Screener: Daily Living Skills section.
Note the following differences from these measures and what was included in the all-inclusive overall z-score: the BDI and BINS were not included, as this analysis only examines children 4 years of age and older (because of the lack of independent cognitive and social measures for the younger children); the CBCL total score was not included given its high correlation with the CBCL externalizing and internalizing scores (r=.91 and .86, respectively); and the CDI was not included as it does not correlate well with measures in either the social or cognitive domain. Also of note, the Daily Living Skills section of the Vineland Screener was included in both the overall social and cognitive z-scores, as it correlates well with measures in both domains.
Across all children 4 years of age and older, the overall cognitive scores spanned a wider range than the overall social scores, with a minimum of –3.01 and a maximum of 2.32; the overall social scores ranged from –1.92 to 1.95. The overall cognitive scores were also skewed a little lower, with a mean of –0.02, whereas the mean overall social score was 0.00. There was no significant difference between the mean overall cognitive and social z-scores for the total OYFC population.
With regard to social and cognitive z-scores by out-of-home placement type for children aged 4 and older, the pattern for each of these overall scores emulates that of the all-inclusive overall z-score, in that children in group homes have the lowest means whereas children in kin care settings have the highest means (Figure 3-23). For the cognitive z-scores, differences between children in kin care settings and children in foster homes and group homes are significant at the p<.01 level. For the social z-scores, the differences are significant at the p<.05 level. Comparing the overall social and cognitive z-scores within placement types as the figure illustrates, children in both foster homes and kin care settings have higher cognitive than social scores, whereas children in group homes have higher social than cognitive scores. The difference between mean social and cognitive z-scores is not significant for any of the three placement types.
From the perspective of most serious abuse type, as with the all-inclusive overall z-score the overall social and cognitive z-score means are lowest for children with a most serious abuse type of sexual maltreatment (Figur