The Impact of Kinship Care on Behavioral Well-being for Children in Out-of-Home Care

Objective—To examine the influence of kinship care on behavioral problems after 18 and 36 months in out-of-home care. Growth in placement of children with kin has occurred despite conflicting evidence regarding its benefits compared to foster care. Design—Prospective cohort study Setting—National Survey of Child & Adolescent Well-Being, October, 1999-March, 2004 Participants—1,309 children entering out-of-home care following a maltreatment report Main Exposure—Kinship vs. general foster care Main Outcome Measures—Predicted probabilities of behavioral problems derived from Child Behavior Checklist scores Corresponding Author and Reprint Request Author: David M. Rubin, M.D., M.S.C.E. Children's Hospital of Philadelphia 34th Street and Civic Center Blvd. Attn: CHOP North—3535 Market, Room 1533 Philadelphia, PA 19104 Phone: (215) 590−3815 Fax: (215) 590 −0426 Email: [email protected]. Author Contributions: Dr. Rubin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Rubin, Downes, O'Reilly, Luan, Localio. Acquisition of data: Rubin, Luan. Analysis and interpretation of data: Rubin, Downes, O'Reilly, Mekonnen, Luan, Localio. Drafting of the manuscript: Rubin, Downes, O'Reilly, Mekonnen, Localio. Critical revision of the manuscript for important intellectual content: Rubin, Downes, O'Reilly, Mekonnen, Luan, Localio. Statistical analysis: Rubin, Downes, O'Reilly, Luan, Localio. Obtained funding: Rubin. Administrative, technical, or material support: Rubin, O'Reilly, Mekonnen, Luan. Supervision: Rubin, O'Reilly, Localio. Role of the Sponsor: The sponsors had no role in the design and conduct of the study, nor the collection, management, analysis, interpretation of data, nor the preparation, review, or approval of the manuscript. The authors have indicated no financial relationships relevant to this article to disclose. Financial Disclosures: The authors have indicated no financial relationships relevant to this article to disclose. NIH Public Access Author Manuscript Arch Pediatr Adolesc Med. Author manuscript; available in PMC 2009 March 11. Published in final edited form as: Arch Pediatr Adolesc Med. 2008 June ; 162(6): 550–556. doi:10.1001/archpedi.162.6.550. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript Results—Fifty percent of children started in kinship care, and 17% of children who started in foster care later moved to kinship care. Children in kinship care were lower risk at baseline and less likely to have unstable placements than children in foster care. Controlling for a child's baseline risk, placement stability, and attempted reunification to birth family, the estimate of behavioral problems at 36 months was 32% (95% CI 25%−38%) if children in the cohort were assigned to early kinship care and 46% (95% CI 41%−52%) if children were assigned to foster care only (p=0.003). Children who moved to kinship care after significant time in foster care were more likely to have behavioral problems than children in kinship care from the outset. Conclusions—Children placed into kinship care had fewer behavioral problems three years after placement than children who were placed into foster care. This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care.