Rates of meaningful change in the mental health of children in long-term out-of-home care: A seven- to nine-year prospective study

Children residing in long-term out-of-home care have high rates of clinical-level mental health difficulties. However, the stability of these children's difficulties throughout their time in care is uncertain. This paper reports estimates of the seven- to nine-year stability of carer-reported scores on the Child Behavior Checklist (CBCL) and Assessment Checklists for Children (ACC) and Adolescents (ACA) for 85 children in long-term foster or kinship care. Prospective score changes on the CBCL total problems and ACC-ACA shared-item scales were assigned to one of four change groups: 'sustained mental health'; 'meaningful improvement'; 'no meaningful change'; and `meaningful deterioration'. On each of the two measures, more than 60% of children manifested either sustained mental health or meaningful improvement in their mental health, while less than a quarter showed meaningful deterioration. Mean mental health scores for the aggregate sample did not change over the 7-9 year period. Findings discount the presence of a uniform, population wide effect suggesting instead, that children's mental health follows several distinct trajectories. Rather than asking whether long-term care is generally therapeutic or harmful for the development of previously maltreated children, future investigations should focus on the questions "...what are the systemic and interpersonal characteristics of care that promote and sustain children's psychological development throughout childhood, and what characteristics are developmentally harmful?" and "...for which children is care therapeutic, and for which children is it not?"