Infants in Out-of-Home Care

(Originally published April 2011)

Infants, up to age 1, continue to be placed in out- of- home care at much higher rates and to remain in care longer than older children. A recently published Chapin Hall study (Wulczyn, et al, 2011) of first entries- into- care in 14 states that belong to the Multi-State Foster Care Data Archive found that 4.1 infants per 1000 were placed in out- of- home care in 2008 compared to 0.9 per 1000 older children.

Nationally, the entry- into- care rate for children 0-17 has declined in recent years; however, for the 14 states in Chapin Hall's study, the first time entry rate of infants in 2008 was higher than the comparable entry rate for this age group in 2000, and more infants entered out- of- home care in 2008 than in 2000. African American infants in first placements entered out- of- home care at almost three times the rate (17.5 per 1000) of White infants (5.9 per 1000) in 2008 in these 14 states. In 2008, 22% of children placed out of the home for the first time in Archive states were 0-1 when they entered care.

Research studies have consistently found that infants in out- of- home care have lower rates of reunification, higher rates of adoption and longer median lengths of stay than older children. In the recent Chapin Hall study, infants, 0-3 months at entry- into- care had longer lengths of stay and much higher rates of adoption than infants who entered care from 3-12 months of age. About a third of infants placed in Archive states in 2008 spent at least 50% of their days in care in kinship placements, a large increase in use of kinship care for babies since 2000.

Given the developmental need of infants to form strong attachments to one or more primary caregivers, and the sudden unplanned nature of most emergency placements, there have always been concerns among child welfare practitioners, child advocates and child development specialists about the possibility of doing serious emotional harm to infants through separation from parents and placement in temporary foster homes or with unlicensed relatives. Nevertheless, the physical vulnerability of infants, their complete dependence on caregivers and urgent need for consistent nurturing care has made it difficult to develop sound approaches to in– home safety planning for neglecting or abusing parents with substance abuse and/ or chronic mental health problems, often combined with family violence, severe parental cognitive impairments and deep poverty.

When I was a CPS caseworker, I often worried that lengthy placements of infants in foster care would interfere with babies‟ capacities to form attachments with a birth parent, or perhaps with any other caregiver and, in doing so, cause irreparable damage to these children's development. Fortunately, I found that babies usually thrived when placed with stable nurturing foster parents or relatives, and were able to form strong positive attachments to new caregivers even after early neglect (usually) or abuse, a conclusion Mary Dozier's research has confirmed. Dozier's studies have found that the quality of foster parenting, rather than the characteristics of early maltreatment, is the major influence on infants‟ capacity to form secure attachments with alternative caregivers.

A recently published study (Jones –Harden, et al, 2010) of developmental outcomes for infants included in the National Study of Adolescent and Child Well Being (NSCAW) strongly suggests the importance of the quality of the early caregiving environment. NSCAW is a large comprehensive longitudinal study of a nationally representative sample of children and families served by public child welfare agencies, both in- home and in out- of- home care. Jones – Harden and her co- authors examined a wide range of developmental indicators during the pre- school years for 1720 infants in NSCAW, over three quarters of whom had lived at home during their family's child welfare involvement; 12.2% of the infants had lived with relatives and 9.2% had been placed with non – kin foster parents. Contrary to their hypothesis, “Young children who remained at home or who were in kinship foster care tended to have more compromised functioning than children in non-kinship foster care.” The authors comment that “The current findings on the home environment are compelling. They underscore the importance to children's well being – regardless of placement type – of cognitive stimulation and emotional support.” The authors emphasize “the pivotal role of child welfare agencies in promoting the well being of children living with their biological families … The priority in serving these children must be not only safety and permanency but also long-term well-being.”

These findings are encouraging regarding the potential of foster care to serve infants‟ needs, but they should be balanced with recognition of how foster care can harm infants. Jones – Harden's, et al, analysis of NSCAW data found that child welfare agencies are doing a good job of stabilizing placements for babies; the infants in the NSCAW averaged less than two placements over a period of years. However, 2009 AFCARS data for adopted children who entered care as infants (0-12 months of age) indicates that approximately 30% of these infants had 3 or more placements and 14% had 4 or more placements. Only 6% of reunified children who entered care as infants had 4 or more placements, however, one third of reunified children in the Archive states re-entered care to additional placements.
In addition, AFCARS data indicates that 12% of youth aging out of care in 2009 entered out- of- home care from 0-3; 39% of this were 0-1 when they entered out- of- home care. These youth who entered foster care or kinship care from 0-3 years of age and exited out- of- home care without a permanent family averaged 7.2 placements. These statistics are a cause for concern to say the least. Most infants in out- of- home care have 1-2 placements, but there are a significant percentage of very young children in foster care systems with unstable placement histories.

Jones – Harden, et al, did not find a relationship between number of placements and young children's developmental outcomes when comparing children with 0 and 1 placements to children with 2 or more placements, possibly because they included children remaining in the parents‟ homes in the analysis (and these children had poorer developmental outcomes on average than children in foster care) or because (they suggest) the adverse effects of placement moves may not appear until later in childhood or only be present for the small fraction of infants with extremely unstable placement histories.

However, Bada, et al (2008), in an important and fascinating longitudinal study of 1092 children with prenatal exposure to cocaine and/ or opiates found that “For every (placement) move per year, the associated increases for total, externalizing, and internalizing problem scores was 2.3, 2.0 and 2.4 points, respectively” on the Child Behavior Checklist (CBCL). CPS involvement was associated with poorer developmental outcomes, possibly because neglected and abused children were more likely to receive sustained CPS attention. This study also found that children living with kin caregivers had better developmental outcomes than children living with either parents or in non – kin foster homes. Children living with parents and children living in non- kin foster homes at age 3 had similar development outcomes on the CBCL and Vineland Adaptive Behavior Scales (VABS).

In addition to the number of moves babies and other young children experience, how children are moved from home to home and the reasons for these moves is often a cause for concern. The Chapin Hall study referenced above found that most of the moves that infants experienced occurred in the first 6 months of out- of- home care. In many child welfare agencies, children in emergency placements enter receiving homes or shelters and then are moved within a few days into a foster home or relative's home. Some of these children are moved again into a pre- adopt home if caseworkers believe parents are unlikely to do what is required of them to reunify with their child.
In recent years, it has become more common to move infants and toddlers from non- kin foster care to relatives‟ homes after placements of months or years in foster parents‟ homes. It is of the utmost importance that these types of moves be done gradually, after careful planning, and with sensitivity to the emotional reactions of very young children. Vera Fahlberg's outstanding book, A Child's Journey Through Placement continues to be the best practice guide for planning and carrying out moves from temporary homes to potentially permanent homes. Every caseworker who is responsible for moving foster children from home to home should review Fahlberg's guidelines for transition planning at least once a year.

Jones – Harden, et al, found that number of children in the homes where infants were placed effected their cognitive development. Surprisingly, at baseline, having more children in the home was associated with better cognitive development of infants, but at the 36 month follow up higher numbers of children in the home was associated with poorer cognitive development and weaker social skills. Barth's, et al's study, “Kinship and Nonkinship Foster Care: Informing the New Debate (2007),” also uses NSCAW data. Barth, et al, comment that “The sizeable proportion of children living in foster care with three or more other children is striking and not previously reported.” Even though these scholars failed to find a relationship between larger families and poorer developmental outcomes, they assert that “When a young child with a variety of developmental vulnerabilities lives with three or more older children, each of whom may also have special problems, one is entitled to raise questions about the level of individual attention the child will receive.” As a rule, it seems a poor idea to place more than one baby in a foster home at a time, and yet in some agencies with chronic shortages of foster homes this is a common practice.

Dozier has found that foster parents need to be trained to initiate nurturing interactions with babies who have developed insecure avoidant or ambivalent attachment styles before being placed in foster care. Babies who have learned avoidant attachment behavior, perhaps due to erratic or neglectful parenting, may appear to be surprisingly self reliant when hurt or frightened and may not reach out to caregivers for comfort and reassurance in these situations. Non - kin foster parents and relative caregivers need to be trained to “lead the interaction” with babies who exhibit unusual degrees of independence at an early age. Similarly, young children with ambivalent attachments may be exceptionally clingy (and suddenly hostile) in ways that irritates foster parents and occasionally elicits harsh discipline or emotional reactions that frighten children. Foster parents need to be prepared to cope with the insecure and disorganized attachment styles of young children.

In addition, both foster parents and adoptive parents need training on trauma influenced practice and to develop skills for helping children who have difficulty controlling their emotions calm down and self soothe. “Screaming and tantrums are bad are bad for kids‟ brains,” Deborah Gray asserts in Nurturing Adoptions (2007), one of the best practice guides I have found to helping traumatized children of all ages control their emotions. Every child welfare caseworker, foster parent and adoptive parent should be thoroughly familiar with the importance of structure and routine in helping traumatized children feel safe, with the disciplinary use of use of "time in‟ rather than "time out‟ for these children, and with a wide range of therapeutic skills useful in helping abused and neglected children with emotional regulation.

Gray's most important theme is that babies who experience early trauma due to neglect and or abuse have difficulties with emotional regulation because they have not been able to depend on parents or other caregivers to buffer stress and help them calm down. Gray maintains that “The key to determining who recovers from trauma, then lies in the ability to control levels of emotional arousal,” and “The key determinant behind this capacity is early attachment experiences.” She adds that “Caseworkers will have the obligation to place children into homes that are prepared for and competent to help in these emotional processes.” Babies and toddlers must learn to depend on caregivers to buffer stress and calm down rather than avoiding or suddenly attacking them.

Infants and other young children in the child welfare system are likely to have a wide range of developmental challenges and needs. Expert assessments of babies and toddlers who enter foster care by teams of professionals or by professionals with specialized training in early childhood development should be a standard feature of child welfare practice. Nothing is more important to infant development than the quality of day in day out caregiving, but often parents, foster parents and relatives need help in understanding infants‟ needs and reactions. Substitute caregivers should not be left to figure out on their own how to care for infants with special needs.

Birth parents, especially low income single parent mothers, need help in providing emotionally responsive parenting to infants and toddlers. This country's high rate of infant placements is the result of high child poverty rates combined with high rates of single parent families struggling to cope with the challenges of parenting without much support. The Washington State Institute of Public Policy (WSIPP) study of racial disproportionality (2008) in found that over 80% of children in out- of- home care in Washington were from single parent families. Until there is a bigger investment in prevention and early intervention programs for low income families (with an emphasis on single parents), infant placement rates are not likely to decline. Prevention/ early intervention programs that offer a combination of poverty related services, emotional support, child care and respite care and screening for depression, substance abuse and family violence have the potential to reduce infant placement rates.


Adoption and Foster Care Analysis and Reporting System (AFCARS), Children's Bureau, Administration on Children, Youth and Families, U.S. Department of Health and Human Services.

Bada, Henrietta S., Langer, John, Twomey, Jean, Bursi, Charlotte, Lagasse, Linda, Bauer, Charles R., Shankaran, Seetha, Lester, Barry M., Higgins, Rosemary and Maza, Penelope L., “Importance of Stability of Early Living Arrangements on Behavior Outcomes of Children With and Without Prenatal Drug Exposure,” Journal of Developmental and Behavioral Pediatrics , Vol. 29, No. 3, June 2008.

Barth, Richard P., Guo, Shenyang, Green, Rebecca L. and McCrae, Julie S., “Kinship Care and Nonkinship Foster Care: Informing the New Debate,” Chapter 11 in Child Protection: Using Research to Improve Policy and Practice , edited by Ron Haskins, Fred Wulczyn and Mary Bruce Webb, Brookings Institution Press, 2007.

Dozier, Mary, Bick, Johanna and Bernard, Kristin, “Intervening With Foster Parents to Enhance Biobehavioral Outcomes Among Infants and Toddlers,” Zero To Three , Vol. 31, No. 3, January 2011.

Dozier, M., Stovall, K.C., Albus, K.E. and Bates, B. “Attachment for infants in foster care: The role of parent state of mind,” Child Development , 72, 2001.

Fahlberg, Vera I., A Child's Journey Through Placement, Perspectives Press, Inc., 1991

Gray, Deborah D., Nurturing Adoptions: Creating Resilience after Neglect and Trauma, Perspectives Press, Inc., 2007.

Jones-Harden, Brenda, Whittaker, Jessica V., Hancock, Gregory and Wang, Kevin, “Quality of the Early Caregiving Environment and Pre-School Well –Being,” Chapter 2 in Child Welfare and Child Well – Being , edited by Mary Bruce Webb, Kathryn Dowd, Brenda Jones-Harden, John Landsverk and Mark Testa, Oxford University Press, 2010.

Washington State Institute for Public Policy, “Racial Disproportionality in Washington State's Child Welfare System,” Olympia, Washington, 2008.

Wulczyn, Fred, Chen, Lijun, Collins, Linda and Ernst, Michelle, “The Foster Care Baby Boom Revisited: What do the Numbers Tell Us?”, Zero To Three , Vol. 31, No. 3, January 2011.


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