Predictors of placement instability for sexually abused children served by child protection services

For children placed in out-of-home care, experiencing placement instability is associated with deleterious mental health effects. As children in out-of-home care due to sexual abuse are generally found to experience more placement instability than those who never experienced sexual abuse, the main objective was to determine risk factors for their heightened risk of placement instability. A secondary objective was to determine whether prior mental health problems are associated with their risk of placement instability. This study combined data from public health services and a child protective agency. Two hundred and two sexually abused children who experienced out-of-home care at least once between 2001 and 2021 were included. A Cox proportional hazard regression analysis was performed to determine whether sex, age, socioeconomic status, type of first out-of-home care setting, and mental health disorder diagnoses before subjects' placement were associated with subsequent out-of-home placement instability. Analyses suggest that sexually abused children placed in out-of-home care face a greater risk of placement instability when they received a prior diagnosis of an internalizing disorder and when they were first placed in foster rather than kinship care. Understanding which factors may predispose sexually abused children in out-of-home care to experience greater placement instability can help practitioners and program implementers identify which placed children may need increased support. Attachment-based in-terventions could prevent placement disruptions and their associated mental health consequences.