Risk and Resilience in the Internalizing Outcomes of Children in Out-of-Home Care

Abstract

Internalizing problems are prevalent in childhood and adolescence in both community and out-of-home populations. Internalizing symptoms are frequently associated with problems in other areas of functioning as well. For children in out-of-home care, who face additional adversities such as maltreatment and witnessing traumatic events, internalizing problems have shown increased prevalence while less frequently addressed in research. The current studies used longitudinal data collected across 7 years from a sample of 1,765 children, 5 to 14 years old, in out-of-home care in Maryland, USA. Data consisted mainly of Child and Adolescent Needs and Strengths (CANS) assessments, as well as demographic information (age, sex, and race/ethnicity) and out-of-home placement type. In Study 1 we examined the trajectories of anxiety and depression across age and time in care separately and evaluated a comprehensive model of resilience for each outcome using hierarchical linear modeling. This exploratory model included both indicators of internal resilience (i.e. cognitive, emotional, spiritual, physical, behavioural) and environmental risk and resilience factors (i.e. family, acculturation, community, placement, school functioning, social functioning) related to internalizing problems in children and adolescents. Results showed anxiety was fairly stable over time in care and age, with few significant predictors aside from already well-known risk factors. Depression results showed a slight increase across age and decrease across time in care with several more significant predictors than the anxiety model. While both models showed overlap in predictors, they also included predictors unique to each outcome. In Study 2 we examined the reciprocal relationships across time between anxiety, depression, and significant risk and protective factors from Study 1. Using time lagged hierarchical linear models we found few significant relationships related to anxiety, and largely unidirectional relationships between depression and relevant factors over time. Two factors, traumatic stress and placement in residential treatment care, displayed reciprocal relationships with depression over time. However, our results largely did not support the direct resilience feedback mechanisms proposed between variables for either outcome, but revealed other possible mechanisms at work (i.e. dual cascades developmental model) to explain maladaptation towards depression in particular, but also anxiety. Findings are discussed in terms of theoretical implications, future research directions, and applied implications for prevention/intervention programs for internalizing problems for children in out-of-home care.