In a study of 5,557 children in California who entered care between 1988 and 1989 and who remained in care 8 years later,

• males were about 33% more likely than females to experience placement instability (defined as children who had 3 or more moves after the first year in care);
• children entering care as toddlers were about 1 and ¾ times more likely than infants to be moved 3 or more times (after moves in their first year);
• African American children were 25% less likely than White children to be moved 3 or more times after the first year

In a large study of placement disruption using 3 large samples, age was the only demographic factor found to be related to placement stability.

Medium level of evidence

In a study of 99 disrupted adolescent placements, Latino (n=10) and African American (n=14) adolescents had lower than average rates of disruption, while white adolescents (n=65) had average disruption rates and Asian adolescents (n=5) had 100% disruption rates.

Data analysis. Compare placement stability rates (either by using a data system or by reviewing cases) for the following groups:

• Very young children (0-3), young children (5-12), and older children (12-18).
• White children and children of color (make a combined variable). Then compare African American, Native American, Asian American, Hispanic/Latino, and White children, respectively.
• Male children vs. female children.

Behavioral needs. Some studies have linked greater placement instability for older children and males to the presence of more externalizing(aggressive/oppositional) behaviors among males and adolescents. Treatment or therapeutic foster care may be the best option for these kids. Also, caseworkers need to carefully choose foster families who can tolerate and effectively deal with problem behaviors. Mental health treatment will likely also be needed.

Best workers. Identify workers who show success in facilitating stable placements. Have them join an advisory group to improve placement stability outcomes for these children and their families.

Recruitment. Carefully targeting recruitment of the right foster and fost-adoptive families for children in need of placements will pay off in the end with higher placement stability rates. If not already established, create formal interagency coordinating mechanisms to facilitate stable placements. Use (and if necessary, create) specialized programs tailored to the needs of your hardest-to-place populations. For example, use treatment foster care for children with histories of severe abuse or neglect, or who demonstrate internalizing behaviors (depressive symptoms, self-harming behaviors, suicide attempts) or externalizing behaviors (delinquency, aggressive behaviors, abuse-reactive behaviors). Consider using group care to stabilize placements during particularly difficult developmental periods (adolescence, for example).

In a study of 5,557 children in California who entered care between 1988 and 1989 and who remained in care 8 years later,

• children removed for reasons other than neglect (e.g. physical & sexual abuse) were 25% more likely to experience placement instability (defined as children who were moved 3 times after their first year).

In a large study of placement disruption, unmet behavioral health needs were by far the biggest cause for placement moves. This finding is supported by several other studies.

In the same study above, children in stable placements (compared to those whose placements disrupted) were:

• more likely to receive therapy
• rated as less delinquent and oppositional/ aggressive (by foster parents and caseworkers).
  

Individualized assessment. Careful, thorough assessment and prompt, appropriate treatment, especially for children with behavioral problems, can markedly reduce placement moves.

Prompt appropriate treatment. Ensure that children entering care with either neglect or abuse histories receive prompt, appropriate mental health treatment for trauma issues. Foster care placement, and particularly multiple moves, can increase posttraumatic stress and reactive attachment symptoms.

Treatment foster care. To maintain an adequate number of trained, treatment foster care families, allocate sufficient funds for a comprehensive treatment foster care program or contract with local agencies who provide treatment foster care. Children with severe abuse and neglect histories (or children who demonstrate aggressive or delinquent behaviors or self-harming behaviors) should be placed with parents who understand neglect, post traumatic stress, and trauma reenactment symptoms and who can manage these symptoms and problem behaviors without resorting to punitive parenting styles or disrupted placements.

Staff and parent training. Make sure that staff and foster or adoptive parents understand symptoms of posttraumatic stress (including identification with the aggressor and trauma reenactment), and ways to manage aggressive or delinquent behavior. Staff must understand the child's symptoms and behaviors sufficiently to explain to foster parents why the child reacts to certain things, people the way s/he does. Foster and adoptive parents need to be given a clear, realistic idea of a child's potential behavior from the very beginning of the placement to avoid further stigmatizing the child. Some behaviors may be very difficult for staff to talk about and for parents to manage (children acting out sexually with other children, for example). Children with these behaviors may need specialized treatment. Ensure that staff can facilitate the most appropriate referrals, treatments, and placements based on an understanding of the child's mental health needs.

In a study of 5,557 children in California who entered care between 1988 and 1989 and who remained in care 8 years later,

• children with more than one move during the first year in care experienced significantly greater placement instability than children with one or less than one move in the first year of care.
  

Careful First Placement. Target program improvement efforts toward making the first placement the permanent placement. According to Webster, et al.:

"Improved efforts must be made in determining the optimal placement setting for a child during the critical first months of placement. This should include a more in depth assessment and profile of placement setting attributes, an accurate and complete inventory of all available placement homes and most importantly, an easily accessible means for caseworkers, managers, and administrators to obtain that information. Such efforts could come about in the service of programmatic procedures (e.g. alerting casework supervisors whenever movement out of a second placement is considered)."

In a study of 5,557 children in California who entered care between 1988 and 1989 and who remained in care 8 years later,

• children placed in kinship care had fewer placement moves than children in non-kinship care.

Medium level of evidence

In an evaluation of a large demonstration project, the availability of subsidized guardianship increased permanency rates for children in care.

Kinship Care. Somewhat controversial among practitioners, kinship care is becoming widely used in child welfare. Research indicates that 1/3 of all children in out-of-home care are in kinship care. Overall, children placed with relatives experience fewer placement moves and overall, greater placement stability. Concerns about the use of kinship care include 1) discrepancies in subsidies paid to kinship carers 2) some studies indicating that some children of color have worse outcomes when placed in kinship care vs. other placements-mostly due to neighborhood effects, and 3) length of time in placement -- since family members are less likely to adopt their relative children.

Address these issues by 1) paying equal subsidies to kinship carers as non-kinship carers; 2) careful home studies; 3) family conferencing to allow birth parents to resolve ambivalence about termination of parental rights; and/or 4) increase use of subsidized guardianship for family members who would prefer this to adoption. If these issues can be addressed, consider increasing the use of kinship care in your agency, unit, county, or state.

Two studies compared subsidized to non-subsidized adoptions and guardianships and found that subsidized placements reduced placement disruptions.

If possible, provide adoption and guardianship subsidies to promote placement stability.

Attitude and training of caseworkers has been found to influence placement stability.

Medium level of evidence

In one study of caseworker training, children whose workers had more training in separation experienced more disruptions in placement.

Training. Ensure that caseworkers have adequate training to accurately assess a child's functioning and needs and to connect adoptive parents with appropriate resources to manage problem behaviors, etc.

Go to the University of Illinois School of Social Work website for an excellent and comprehensive guide to placement stability that includes directions for caseworkers and casework supervisors:

http://cfrcwww.social.uiuc.edu/respract/toolpages/respract5.htm

Numerous studies have demonstrated the link between school achievement and placement stability.

Evaluate Education.
Go to the University of Illinois website: http://cfrcwww.social.uiuc.edu/respract/toolpages/respract5.htm for information on how to:

• Assess the educational deficits and strengths of the child.
• Help locate and enroll the child in developmental preschool programs or age-appropriate mentoring or after-school programs.
• Assess adequacy of educational services being offered to child.
• Inform prospective care provider about child's developmental and educational history and discuss their ability to meet the child's educational needs.