Children's Stability and Well-being Study

Stoneleigh Fellow: David Rubin, 2007-2012

In an attempt to more accurately understand and increase awareness of the complex repercussions of placement instability for children in foster care, David has been partnering with the behavior and wellness program from Philadelphia's Department of Human Services and Philadelphia's behavioral health system to undertake the nation's first longitudinal study of children in foster care specifically focused on gathering detailed information at every change of placement. 

Through a rigorous analysis of the many areas of a child's life, the research team will not only provide the benchmarks for the foster care system to measure their performance, but also determine which of these factors have the most impact on placement stability or well-being for children in foster care.

The project has received substantial start-up funding from the National Institute of Child Health and Development, the William Penn Foundation, and the Stoneleigh Foundation.

Project Goals

The goal of this five-year project is to better understand the impact of various transitions on the children's lives while identifying the factors that both positively and negatively impact a child's well-being, as measured by their behaviors and their performance upon entering Philadelphia's school system. Armed with this information, the hospital and City of Philadelphia are hoping to improve local service interventions and positively affect the well-being of the city's most vulnerable children. Furthermore, because the problems facing Philadelphia's child welfare system are emblematic of the problems facing other large cities in the country, it is likely that the results of this study will have significant relevance to other regions as they struggle with quality improvement objectives to improve placement stability, and ultimately permanency, for children entering out-of-home care.

Project Method

David's team has been enrolling a sample of 400 children, ages three to eight, who are entering out-of-home care in Philadelphia. Information is being collected during an 18-month follow-up period through interviews with caregivers and case workers every time a child changes placement, or every six months if no movement has occurred. This will enable David's team to capture the variability that occurs for foster children -- variability in well-being, in placement settings, in caregivers, in schools, in religious institutions, in caseworkers/agencies, in access to health care -- that may occur with every placement change.

Using longitudinal methods of analysis, it will be possible to more accurately measure how a child's well-being changes from moment-to-moment in foster care as measured by the Child Behavioral Checklist (CBCL), Adjustment Scales for Children and Adolescents (ASCA) and Adjustment Scales for Preschool Intervention (ASPI); temperament scales; and educational outcomes provided by the KIDS database available through the Schools of Education and Social Work at the University of Pennsylvania.  In addition, it will also be possible to identify those factors that direct children toward placement stability, reunification, or adoption.

Furthermore, with the assistance of an advisory board comprised of professionals throughout the city and regionally who work with children in foster care, David has identified a core set of study variables that represent potential targets for intervention that will either improve placement stability for children, or for those children who continue to move, may promote resiliency in their downstream outcomes. These factors include continuity in a child's caseworker, experience of the caseworker, continuity in school system placement, continuity in religious institution, continuity of a mentor/role model in a child's life, health and well-being of caregivers, caregiver experience as a foster care parent, and timely access to mental health and continuous health services.

Use of the Results

The advisory board is receiving interim progress reports and recommendations on a yearly interval, and at the conclusion of the study, the results will be presented to administrators at the Department of Human Services and the city's behavioral health system along with a strategic report of actionable recommendations to improve service delivery to children in the child welfare system. It is the hospital's desire that those factors felt to be most important for future service interventions will be integrated into the city's data collection system to support new performance goals and interventions for future children entering the foster care system.