Children who live with relatives may have fewer behavioral problems than those in foster care

Children who leave their homes because of maltreatment appear to have fewer behavioral problems three years later if they are placed with relatives than if they are placed in foster care, according to a report in the June issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

In the last two decades, increasing numbers of children are being raised by relatives other than their birth parents in an arrangement known as kinship care, according to background information in the article. In 2005, more than 2.5 million children were living with relatives. "The growth in kinship care is the result of a sustained effort to improve permanency for children since the Adoption and Safe Families Act of 1997," the authors write. "Since then, child welfare agencies have increased efforts to place children with kin despite scant and conflicting evidence of improved outcomes for children in kinship care compared with children in general foster care."

To better understand the experiences and outcomes of children in these two types of care, in 1996 Congress mandated that the Department of Health and Human Services conduct the National Survey of Child and Adolescent Well-Being. David M. Rubin, M.D., M.S.C.E., of The Children's Hospital of Philadelphia, and colleagues analyzed data from 1,309 children participating in the survey who entered out-of-home care following a report of maltreatment between 1999 and 2000. At the beginning of the study and again at 18 months and at 36 months later, interviews were conducted with children, caregivers, birth parents, child welfare workers and teachers.

Of the participating children, 599 were initially placed in kinship care. A total of 710 entered foster care; of those, 17 percent moved to kinship care after at least one month in foster care. After controlling for a number of other factors, including the stability of the placement and the child's risk for behavior problems at the time of removal from the home, 32 percent of children entering kinship care directly had behavioral problems 36 months later, compared with 39 percent of children who moved from foster care to kinship care and 46 percent of children who stayed in foster care.

Children in kinship care were also less likely to change placements frequently—when assessed at 36 months, 58 percent of them were found to have achieved a sustained placement or were reunified with their parents, compared with 32 percent of those in foster care. Fifty-eight percent of those who began in foster care but transferred to kinship care were in a sustained placement or reunified with their parents after 45 days, compared with 40 percent of those who stayed in foster care. "Placement stability is a common goal of child welfare systems and has consistently been shown to result in better outcomes for all children living in out-of-home care," the authors write.

"This finding supports efforts to maximize placement of children with willing and available kin when they enter out-of-home care," they conclude. "When kinship care is a realistic option and appropriate safeguards have been met, children in kinship care might have an advantage over children in foster care in achieving permanency and improved well-being, albeit with the recognition that their needs will remain great, exceeding those of children who have not experienced child maltreatment."