Home placement decisions. Unlike prior research (Barth, Guo, McCrae, 2008b; Hegar Rosenthal, 2009; Keller et al., 2001), this study found no mental health differences between youth placed with kin versus other placement types among African American youth after accounting for developmental and contextual factors. Instead, youth mental health problems at the time of child protective services investigation, as well as problems in the neighborhoods in which youth are placed predict increased problems over time. Furthermore, change in behavior problems function through a combination of structural characteristics of the placement settings. Caregiver physical health and age combine to predict changes in youth behavior problems, and this effect functions differently for youth placed with kin versus other out-of-home placement settings. Youth placed with kin exhibit increases in externalizing problems when placed with older and sicker caregivers. This finding is consistent with previous research suggesting AZD4547 site kinship caregivers are often older and in poorer health (Iglehart, 1994; Raphel, 2008; Zinn, 2012), as well as qualitative research indicating the age disparity between kinship foster caregivers and youth is a barrier to successful fostering (Coakley et al., 2007). The reverse is found in nonkinship placements; youth placed with older caregivers in poorer health exhibit fewer behavioral issues over time. While these factors do not separately predict increases in externalizing scores over time, their presence together with the placement type distresses youth. Many potential influences may explain this pattern of effects. Research suggests that children placed with kin exhibit better mental health outcomes compared to youth placed in other PD325901 dose settings (Barth et al., 2008b; Hegar Rosenthal, 2009; Keller et al., 2001). However, youth may only benefit from a kinship placement when contextual stressors are limited, asJ Soc Serv Res. Author manuscript; available in PMC 2016 February 25.Rufa and FowlerPagedemonstrated in prior research (Barth et al., 2008a). In particular, it seems more difficult to manage living with a sick caregiver if that caregiver is a loved one, such as an aunt or grandmother, as opposed to a previously unknown foster caregiver. It may seem more intuitive these youth would show increased internalizing behaviors if distressed by caregivers ailing health; however, it is also common for youth to exhibit feelings of sadness through irritability and reactive aggression (White, Jarrett, Ollendick, 2013). Additionally, previous research on youth placed in kinship foster care indicates significant levels of externalizing behaviors including aggression and delinquency (Dubowitz et al., 1994), with both African American and white males in kinship care at the greatest risk for juvenile delinquency (Ryan et al., 2010). Increased behavior problems in youth placed in kinship care with older caregivers in poorer health may also be related to use of services by these families. Research suggests that service provision for families in kinship care is not utilized to its full extent, in that a greater number of these families do not receive the same level of monitoring and caseworker supervision as compared to nonkinship foster homes (Bartholet, 2009; Berrick Barth, 1994). Less contact with kinship foster families may cause child welfare services to miss opportunities to identify and engage youth in need of preventive interventions that add.Home placement decisions. Unlike prior research (Barth, Guo, McCrae, 2008b; Hegar Rosenthal, 2009; Keller et al., 2001), this study found no mental health differences between youth placed with kin versus other placement types among African American youth after accounting for developmental and contextual factors. Instead, youth mental health problems at the time of child protective services investigation, as well as problems in the neighborhoods in which youth are placed predict increased problems over time. Furthermore, change in behavior problems function through a combination of structural characteristics of the placement settings. Caregiver physical health and age combine to predict changes in youth behavior problems, and this effect functions differently for youth placed with kin versus other out-of-home placement settings. Youth placed with kin exhibit increases in externalizing problems when placed with older and sicker caregivers. This finding is consistent with previous research suggesting kinship caregivers are often older and in poorer health (Iglehart, 1994; Raphel, 2008; Zinn, 2012), as well as qualitative research indicating the age disparity between kinship foster caregivers and youth is a barrier to successful fostering (Coakley et al., 2007). The reverse is found in nonkinship placements; youth placed with older caregivers in poorer health exhibit fewer behavioral issues over time. While these factors do not separately predict increases in externalizing scores over time, their presence together with the placement type distresses youth. Many potential influences may explain this pattern of effects. Research suggests that children placed with kin exhibit better mental health outcomes compared to youth placed in other settings (Barth et al., 2008b; Hegar Rosenthal, 2009; Keller et al., 2001). However, youth may only benefit from a kinship placement when contextual stressors are limited, asJ Soc Serv Res. Author manuscript; available in PMC 2016 February 25.Rufa and FowlerPagedemonstrated in prior research (Barth et al., 2008a). In particular, it seems more difficult to manage living with a sick caregiver if that caregiver is a loved one, such as an aunt or grandmother, as opposed to a previously unknown foster caregiver. It may seem more intuitive these youth would show increased internalizing behaviors if distressed by caregivers ailing health; however, it is also common for youth to exhibit feelings of sadness through irritability and reactive aggression (White, Jarrett, Ollendick, 2013). Additionally, previous research on youth placed in kinship foster care indicates significant levels of externalizing behaviors including aggression and delinquency (Dubowitz et al., 1994), with both African American and white males in kinship care at the greatest risk for juvenile delinquency (Ryan et al., 2010). Increased behavior problems in youth placed in kinship care with older caregivers in poorer health may also be related to use of services by these families. Research suggests that service provision for families in kinship care is not utilized to its full extent, in that a greater number of these families do not receive the same level of monitoring and caseworker supervision as compared to nonkinship foster homes (Bartholet, 2009; Berrick Barth, 1994). Less contact with kinship foster families may cause child welfare services to miss opportunities to identify and engage youth in need of preventive interventions that add.