Health and Home Environments of Caregivers of Children Investigated by Child Protective Services

Abstract

OBJECTIVE: The goal was to describe the mental and physical health of caregivers and the home environments of children who have been investigated by child protective services (CPS). METHODS: Subjects were 5299 children 0 to 14 years of age, from the National Survey of Child and Adolescent Well-being, a cohort study of children investigated by CPS. The Short-Form Health Survey was used to measure mental and physical health. The Home Observation for Measurement of the Environment-Short Form (HOME-SF) total and cognitive stimulation subscale scores were used to measure developmentally appropriate characteristics of children's home environments. These validated measures were compared across placement types, that is, remaining at home (investigated home), nonrelative foster care (foster care), and relative foster care (kin care). RESULTS: Kin and foster caregivers had better-than-average mental health, but 11% to 13% of kin/foster caregivers and 24% of investigated-home caregivers had scores consistent with untreated mental illness. All caregivers had worse-than-average physical health; 25% of foster and 26% of kin caregivers had scores consistent with serious physical illness. There was no significant difference in mean HOME-SF scores between foster and investigated homes. Kin care homes of 6- to-10-year-old children were superior to investigated and foster homes. All setting types had more homes in the lowest quartile than in the highest quartile for HOME-SF and cognitive stimulation subscale scores. CONCLUSIONS: A sizable minority of children investigated by CPS subsequently live in homes with mentally or physically ill caregivers and with developmentally inadequate nurturing and stimulation. Foster homes are indistinguishable from investigated homes on the HOME-SF. Clinicians should assess the mental and physical health of caregivers and should facilitate access to appropriate resources, including parent/caregiver training programs.