Cumulative adverse childhood experiences among children in foster care and the association with reunification: A survival analysis.

Background: Research shows children in foster care are at amplified risk of experiencing cumulative adverse childhood experiences (ACEs). Though separate bodies of literature exist for ACEs and foster care, ample research demonstrates overlap in negative outcomes between ACEs and foster care involvement, such as substance use, early pregnancy, and poorer educational outcomes, among others. Rare are studies that have explored ACEs influence on targeted foster care outcomes.

Objective: To address this gap in the literature, this study's objective was to investigate the association between cumulative ACEs and reunification.

Participants And Setting: 2,998 American children between 6-18 years old in foster care between October 2015 and July 2019 in a Midwestern state.

Methods: Cox proportional hazard regression was utilized to examine likelihood of and time to reunification, comparing children with 1-5 ACEs, 6-9 ACEs, and 10+ ACEs.

Results: Increased cumulative ACE exposure among children in foster care significantly impeded likelihood of reunification, and slowed time to reunification. Children with 6-9 ACEs and 10+ ACEs were 28 % (HR = .72, p = .024) and 42 % (HR = .58, p = .000) less likely to reunify, respectively, when compared to their counterparts with 1-5 ACEs. Other significant predictors of reunification included: race, age at foster care entry, siblings in foster care, and placement setting type.

Conclusion: Results support the notion that among an already vulnerable population, subgroups of children may disproportionally experience negative foster care outcomes. Continued research is necessary to further examine intersections and implications of cumulative ACEs among children in foster care.