title: Why good placements matter: Pre-placement and placement risk factors associated with mental health disorders in pre-school children in foster care.
abstract: Pre-school children placed in local authority care show elevated rates of mental health disorders when compared to the general population. This study investigated risk factors for mental health disorders relating to the period prior to entering care and while in care. A representative sample of 43 children in care aged 0-72 months in an inner London borough underwent comprehensive multidimensional assessments. Presence of emotional, behavioural, attachment and adaptive disorders was ascertained. Exposure to two pre-placement risk factors and six placement risk factors was compared between children with and without a disorder. A total of 26 children (60.5%) had at least one mental health disorder. The two pre-placement risk factors, multiple types of maltreatment and entry into care after the age of 6 months, were both significantly associated with mental health disorders. The three placement risk factors of sudden placement moves, multiple placement moves and child-carer alienation showed a significant association with mental health disorders. There was a strong correlation between the number of risk factors and the number of co-morbid mental health disorders per child (r = .67, p < .001). In conclusion, this study identified five modifiable risk factors related to the quality of safeguarding and fostering services which showed a significant association with pre-school mental health.
authors.affiliation: Child and Family Department, The Tavistock and Portman NHS Foundation Trust, Tavistock Centre, UK thillen2@tavi-port.nhs.uk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hillen
authors.affiliation: Child and Family Department, The Tavistock and Portman NHS Foundation Trust, Tavistock Centre, UK.
authors.forename: Leonie
authors.initials: L
authors.lastname: Gafson
mesh_terms: D000342:Affective Symptoms / Q000453:epidemiology; D000367:Age Factors; D017028:Caregivers; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002653:Child Behavior Disorders / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019960:Elimination Disorders / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000453:epidemiology; D005260:Female; D005581:Foster Home Care; D006184:Habits; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D019962:Reactive Attachment Disorder / Q000453:epidemiology; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012918:Social Alienation
keywords: Adversity; behavioural disorder; emotional disorder; fostering; pre-school children; risk factors