What impacts placement stability?

When children are removed from their families and placed in foster care, child protective services has a duty to ensure that they are placed in safe, stable, and nurturing homes with caregivers – ideally kin – who acknowledge and are equipped to help them process the trauma they have experienced. This brief explores the importance of placement stability and the challenges that inhibit it. For information about a range of promising approaches that help maintain placement stability, see How can we improve placement stability for children in foster care?

The importance of placement stability

Child development research tells us that children need consistency, predictability, and attachment to a caring adult to thrive. This is especially true for children in foster care, who have experienced trauma leading up to and including removal from their home, as well as the trauma of ongoing separation from family. Children in out-of-home care need stable adult connections to support their well-being. These secure attachments are best formed in stable placements that help young people maintain connection with their family and community, and transition into permanency without delay.

Placement stability has a positive impact on all three goals of the child protection agency: safety, permanency, and well-being. The possibility of safety risks increases with every move; permanency is delayed when a child experiences multiple placements; and well-being is affected in many ways, including poorer educational outcomes and increased behavioral and mental health issues. The trauma that accompanies placement changes puts children at risk for negative outcomes such as aggression, delinquency, and depression.2 Multiple placements have also been found to lead to delayed permanency, academic difficulties, and challenges developing meaningful attachments. 3,4 Too often, placement changes are blamed on youth and, specifically, behavioral challenges, when in reality such changes are often due to systemic factors such as inadequate, inaccessible, and fragmented services and supports.

The Indian Child Welfare Act (ICWA), passed by Congress in 1978, recognized the importance of keeping children connected to their families, communities, and culture. The values and spirit embedded in ICWA form the basis of child welfare best practice for all, emphasizing the importance of preventing removal whenever possible, and in cases where children are removed, reinforcing the importance of placement stability.

Placement stability by the numbers

Across the country, placement stability continues to be a challenge for most child protection agencies. Among children in care for two years or longer in 2020, 59% experienced three or more placements.5 Black/African American children face disproportionately low placement stability, making prioritizing placement stability one strategy to reduce harm to Black/African American children in the child welfare system.6

Children experience more placements the longer they linger in foster care. According to the Children’s Bureau’s Child Welfare Outcomes Data, the majority of children in foster care for less than 12 months experience no more than one or two placements.7 However, this proportion varies significantly by state/territory, and the number of placements increases as children stay in care longer.

Placement stability also impacts a child’s chances for permanency through reunification, adoption, or guardianship,8 and the longer a child remains in care, the less likely they are to be reunified. The National Survey of Child and Adolescent Well-Being found that 54% of children in out-of-home care for six months to one year reunified, compared to 47% in care 13 to 24 months, and only 26% in care 25 or more months.9

When we make the monumental decision to intervene and remove a child from their home, we have a responsibility to ensure that we’ve placed them in a safe, stable, and healing environment, and that they are better off in this new setting than they would have been had they remained with their family of origin.

– David Sanders, Executive Vice President of Systems Improvement, Casey Family Programs

Factors associated with placement stability

Research has identified a range of placement characteristics, resource parent characteristics, birth family characteristics, child characteristics, and organizational factors that are associated with placement stability.

Placement and resource family characteristics

Initial placement type is a critical factor in achieving placement stability. Children who are initially placed with relatives are the least likely to experience placement changes, while children first placed in group or residential settings experience a higher number of moves on average.10,11 It is important to note, however, that disruption can still occur in kin placements, underscoring the importance of providing support to kin caregivers.12

Placement moves may also be influenced by the race of the resource family, the number of children living in a resource home, and whether children are placed with siblings. A national study of racial matching in foster placements suggests that placing children in same-race resource homes increases the likelihood of placement stability.13 Evidence also suggests that placement stability is less likely for children living in homes with three or more other children in care,14 but more likely for children who are placed with a sibling.15,16,17 Rimy Morris, alumnus of foster care, said, “Kids in the house can make or break placements. I’ve been in homes with some who were super amazing and caring and loved me and I’ve been in placements where I’ve been treated poorly.”

A recent meta-analysis found that resource parent quality, including cooperation with birth parents, experience, parenting skills, and support received, is a predictor of placement stability.18 A recent systemic literature review found that access to support systems and attentiveness to the caregiver-child relationship were the two most frequently reported caregiver factors associated with placement stability.19 For example, resource families that have a solid network of social support are likely to have fewer placement disruptions.20

Child and family characteristics

Numerous studies have shown that Black/African American children21 and older youth22,23,24 experience less placement stability, as do children who are medically complex.25 Children whose parents had substance use disorders are more likely to experience placement instability than children who are removed for other reasons, potentially because parental substance use may increase the amount of time children spend in care overall, which in turn increases the potential for placement disruption.26

While existing research has not led to consensus about whether children’s behavioral and mental health needs lead to multiple placements or vice versa, one study in a Midwestern state found that children identified as having “behavioral problems” in their administrative case record generally experience less placement stability than their peers.27,28,29 Children who experience clinically significant trauma symptoms also experience less placement stability,30 with placement stability decreasing as the number of cumulative adverse childhood experiences (ACEs) increases.31

Placement stability is a must, not an option.

– Lisa Myles, foster and adoptive parent

Organizational factors

Caseworkers, therapists, lawyers, Court Appointed Special Advocates, and others involved in a child’s case can affect placement stability. Caseworker turnover has been linked to more time spent in out-of-home care,  which is linked to poorer placement stability. Staff turnover during critical junctures in a child’s placement may result in resource parents losing the support they need to maintain a child’s placement and can negatively impact children’s behavior. The depth of a caseworker’s cultural competency and understanding of children’s needs may also contribute to placement stability.

People think a placement change is just a change of housing. Community isn’t just place; it’s people. You’re changing schools or you may have to quit extracurriculars or a job. When you feel like you’ve lost everything, you live life like you have nothing to lose. You behave a certain type of way because it’s like, ‘Well, what else could you all do to me? What else could I possibly lose?’

– Rimy Morris, alumnus of foster care and past member of the Indiana Youth Advisory Boardt

1 Content of this brief was informed by consultation with members of the Knowledge Management Lived Experience Advisory Team on December 12, 2022, and January 6, 2023. This team includes youth, parents, kinship caregivers, and foster parents with lived expertise of the child welfare system who serve as strategic partners with Family Voices United, a collaboration between FosterClub, Generations United, the Children’s Trust Fund Alliance, and Casey Family Programs. Members who contributed to this brief include: Matthew Darnall, Marquetta King, Aleks Kort, Rimy Morris, and Lisa Myles.
2 Mishra, A. A., Schwab-Reese, L. M., & Murfree, L. V. (2020). Adverse childhood experiences associated with children’s patterns of out of home placement over time and subsequent negative outcomes during adolescence. Child & Youth Care Forum, 49(2), 247–263. https://doi.org/10.1007/s10566-019-09526-4
3 Clemens, E. V., Klopfenstein, K., Lalonde, T. L., & Tis, M. (2018). The effects of placement and school stability on academic growth trajectories of students in foster care. Children and Youth Services Review, 87, 86–94. https://doi.org/10.1016/j.childyouth.2018.02.015
4 Dubois-Comtois, K., Bussières, E.-L., Cyr, C., St-Onge, J., Baudry, C., Milot, T., & Labbé, A.-P. (2021). Are children and adolescents in foster care at greater risk of mental health problems than their counterparts? A meta-analysis. Children and Youth Services Review, 127, 106100. https://doi.org/10.1016/j.childyouth.2021.106100
5 State-level data on placement stability found on the Children’s Bureau website were used to calculate this national average. Placement data from Maryland was not available.
6 Foster, E. M., Hillemeier, M. M., & Bai, Y. (2011). Explaining the disparity in placement instability among African-American and white children in child welfare: A Blinder–Oaxaca decomposition. Children and Youth Services Review, 33(1), 118–125. https://doi.org/10.1016/j.childyouth.2010.08.021
7 State-level data on placement stability can be found on the Children’s Bureau website separately for children in care less than 12 months, children in care at least 12 months but less than 24 months, and children in care for 24 months or longer. These state-level data were used to calculate national averages. Placement data from Maryland was not available.
8 Connell, C.M., Vanderploeg, J.J., Flaspohler, P., Katz, K.H., Saunders, L., & Tebes, J.K. (2006). Changes in placement among children in foster care: A longitudinal study of child and case influences. Social Services Review, 80(3), 398-418. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204626/
9 Families who reunify should receive post-permanency services to decrease the risk of re-entry into out-of-home care.
10 Konijn, C., Admiraal, S., Baart, J., van Rooij, F., Stams, G.-J., Colonnesi, C., Lindauer, R., & Assink, M. (2019). Foster care placement instability: A meta-analytic review. Children and Youth Services Review, 96, 483–499. https://doi.org/10.1016/j.childyouth.2018.12.002
11 Osborne, J., Hindt, L. A., Lutz, N., Hodgkinson, N., & Leon, S. C. (2021). Placement stability among children in kinship and non-kinship foster placements across multiple placements. Children and Youth Services Review, 126, 106000. https://doi.org/10.1016/j.childyouth.2021.106000
12 Sattler, K. M. P., Font, S. A., & Gershoff, E. T. (2018). Age-specific risk factors associated with placement instability among foster children. Child Abuse & Neglect, 84, 157–169.
13 LaBrenz, C. A., Kim, J., Harris, M. S., Crutchfield, J., Choi, M., Robinson, E. D., Findley, E., & Ryan, S. D. (2022). Racial matching in foster care placements and subsequent placement stability: A national study. Child and Adolescent Social Work Journal, 39(5), 583–594. https://doi.org/10.1007/s10560-022-00831-x
14 Noonan, K., Mekonnen, R., Zlotnick, S., & O’Reilly, A. (2009). Securing child safety, well-being, and permanency through placement stability in foster care. Evidence to Action, 1, 1–12. http://policylab.chop.edu/evidence-action-brief/securing-child-safety-well-being-and-permanency-through-placement-stability
15 Font, S. A., & Kim, H. W. (2022). Sibling separation and placement instability for children in foster care. Child Maltreatment, 27(4), 583–595. https://doi.org/10.1177/10775595211012482
16 Konijn (2019).
17 Waid, J., Kothari, B. H., Bank, L., & McBeath, B. (2016). Foster care placement change: The role of family dynamics and household composition. Children and Youth Services Review, 68, 44–50. https://doi.org/10.1016/j.childyouth.2016.06.024
18 Konijn (2019).
19 Vanderwill, L. A., Salazar, A. M., Jenkins, G., Larwelle, J., McMahon, A. K., Day, A., & Haggerty, K. (2021). Systematic literature review of foster and adoptive caregiver factors for increasing placement stability and permanency. Journal of Public Child Welfare, 15(4), 487–527. https://doi.org/10.1080/15548732.2020.1760176
20 Leathers, S. J., Spielfogel, J. E., Geiger, J., Barnett, J., & Vande Voort, B. L. (2019). Placement disruption in foster care: Children’s behavior, foster parent support, and parenting experiences. Child Abuse & Neglect, 91, 147–159. https://doi.org/10.1016/j.chiabu.2019.03.012
21 Foster, E. M., et al. (2011).
22 Jedwab, M., Xu, Y., Keyser, D., & Shaw, T. V. (2019). Children and youth in out-of-home care: What can predict an initial change in placement? Child Abuse & Neglect, 93, 55–65. https://doi.org/10.1016/j.chiabu.2019.04.009
23 Rock, S., Michelson, D., Thompson, S., & Day, C. (2015). Understanding foster placement instability for looked after children: A systematic review and narrative synthesis of quantitative and qualitative evidence. British Journal of Social Work, 45, 177-203.
24 Sattler, K. M. P., Font, S. A., & Gershoff, E. T. (2018). Age-specific risk factors associated with placement instability among foster children. Child Abuse & Neglect, 84, 157–169. https://doi.org/10.1016/j.chiabu.2018.07.024
25 Seltzer, R. R., Johnson, S. B., & Minkovitz, C. S. (2017). Medical complexity and placement outcomes for children in foster care. Children and Youth Services Review, 83, 285–293. https://doi.org/10.1016/j.childyouth.2017.11.002
26 Jedwab (2019).
27 Jedwab (2019).
28 Leathers (2019).
29 Rock (2015).
30 Clark, S. L., Palmer, A. N., Akin, B. A., Dunkerley, S., & Brook, J. (2020). Investigating the relationship between trauma symptoms and placement instability. Child Abuse & Neglect, 108, 104660. https://doi.org/10.1016/j.chiabu.2020.104660
31 Liming, K. W., Akin, B., & Brook, J. (2021). Adverse childhood experiences and foster care placement stability. Pediatrics, 148(6), e2021052700. https://doi.org/10.1542/peds.2021-052700
32 Ryan, J. P., Garnier, P., Zyphur, M., & Zhai, F. (2006). Investigating the effects of caseworker characteristics in child welfare. Children and Youth Services Review, 28(9), 993-1006.