The Children’s Stability and Well-Being Study (CSAW): Responding to the Many Needs of Youth in Foster Care

Statement of Problem

According to national estimates, two-thirds of children who are in foster care for more than a year experience three or more placements. Placement instability is a risk factor for negative health and educational and social-emotional outcomes, yet we have little knowledge of the factors that impact a child’s stability in foster homes.

Additionally, many children in foster care have significant mental health issues for which they do not receive adequate behavioral health services. The training foster parents receive often does not do enough to help caregivers feel prepared for managing children with significant challenging behaviors or complex trauma histories. Left without evidence-based ways to address these challenges, caregivers can experience considerable stress and youth behavioral problems can increase, which can also lead to children in foster care frequently changing placement.

In order to address the behavioral health needs of children in foster care and mitigate the effects of placement instability, the child welfare system needs to provide more promising evidence-based therapeutic interventions and promote positive educational outcomes for youth.  


“The Children’s Stability and Well-being Study” (CSAW) is one of many research projects we have undertaken at PolicyLab to try and improve the health and well-being of children in foster care. Part of this research captured how the child welfare system influenced placement stability and child well-being for 400 young children who entered out-of-home care in Philadelphia between 2006 and 2008. Partnering with the Philadelphia Department of Human Services, the project examined: 1) the relationship of placement stability to school outcomes for children; 2) the challenges for relatives who were raising children in kinship care; and 3) the system barriers that influenced placement stability for children. Rates of chronic school absenteeism (truancy) among young students in placement are alarmingly high—on average, children in the CSAW study missed 25 days of school per year. There have been many federal, state, and local efforts to improve the educational stability and experience for youth in placement. These findings emphasize the value of these efforts.

To help address the behavioral needs of children in foster care that we observed in the longitudinal study of youth placement changes, we piloted a multi-level behavioral health intervention co-located in two Philadelphia foster care agencies. We based our model on the evidence-based therapeutic intervention Parent Child Interaction Therapy (PCIT)—a 12 to 20 session intensive mental health program demonstrated to reduce behavioral concerns and improve parent-child attachment. We provided PCIT to caregiver-child pairs at risk for placement disruption because of reported child behavior problems and/or associated caregiver stress.

Additionally, we implemented Child Adult Relationship Enhancement (CARE), a trauma-informed six-hour training, for foster and kinship caregivers and staff at two foster care agencies. Over 200 foster caregivers participated in the CARE training, and they reported high levels of satisfaction with the program.

We then conducted a pilot study to obtain preliminary data on the effectiveness of CARE to decrease behavioral problems in children entering foster care. We compared 19 children, ages 3 to 8 years, who had newly entered foster care and whose caregivers were exposed to CARE with 28 historical comparison children from the same foster care agencies. We assessed child behavioral problems at baseline and follow-up using the Child Behavior Checklist, which ultimately revealed greater improvements in externalizing and internalizing behaviors among children in the CARE group than the historical comparison group. The effect was concentrated in younger children. Thus, CARE showed promise in improving parent-reported child behavior problems. The effectiveness of CARE needs to be further evaluated as it is replicated within child welfare systems.

Next Steps

The CSAW program has had both regional and national influence in guiding reforms within the child welfare system. Locally, the team worked with the performance management unit of Philadelphia’s child welfare system to more systematically measure placement disruptions on children, increase the availability of behavioral services earlier in care, strengthen coordination of services with the School District of Philadelphia and improve the use of kinship care as a resource to improve outcomes for children.

This project also led to additional portfolios of work examining concerns around over-prescribing of psychotropic medications to foster care youth and developing more integrated models of behavioral health services embedded into the child welfare care system.

This project page was last updated in October 2020.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. The Children’s Stability and Well-Being Study (CSAW): Responding to the Many Needs of Youth in Foster Care [Online]. Available at: [Accessed: plug in date access here]. 

More projects from Child Welfare and Foster Care View More Projects