Caregiver Physical and Mental Health As Correlates of Internalizing and Externalizing Problems Among Young Children In the Child Welfare System

Background and Purpose: Children involved with the child welfare system experience high rates of internalizing and externalizing problems, and these difficulties often persist over time following investigation for maltreatment. Prior research has documented behavioral continuity and the influence of maltreatment, placement, and socioeconomic conditions, yet caregiver physical and mental health remain largely absent from longitudinal models of child behavioral functioning in child welfare populations. Grounded in bioecological theory, which positions caregiver health as a microsystem influence shaping the proximal processes that drive child development, this study tested whether caregiver physical and mental health were concurrently associated with child internalizing and externalizing problems above and beyond prior behavioral functioning and demographic characteristics.

Methods: Data were drawn from the National Survey of Child and Adolescent Well-Being II (NSCAW-II), a nationally representative longitudinal study of children investigated for maltreatment. Analyses focused on children ages 4–6 at baseline (N = 708; 54% male; 43% non-Hispanic White, 32% non-Hispanic Black, 25% Hispanic). Two three-block hierarchical regressions predicted Wave 3 (36 months) Child Behavior Checklist internalizing and externalizing T-scores. Block 1 entered covariates (community environment, child age, poverty level, race/ethnicity, child sex). Block 2 added the corresponding Wave 1 behavioral baseline. Block 3 entered Wave 3 caregiver health via the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS). Missing data, including 26.7% missingness on Wave 3 caregiver health, were addressed using fully conditional specification multiple imputation (40 datasets) pooled with Rubin’s rules. Formal comparison of PCS and MCS coefficients used the Paternoster test.

Results: For internalizing behavior, the full model explained 25.7% of the variance. Wave 1 internalizing was the strongest predictor (β = .380, p < .001). Caregiver health explained significant incremental variance beyond behavioral stability (ΔR² = .055, p < .001); both PCS (β = −.079, p = .042) and MCS (β = −.218, p < .001) were significant, with MCS significantly stronger than PCS (t = 2.54, p = .011). For externalizing behavior, the full model explained 29.0% of the variance. Wave 1 externalizing was the strongest predictor (β = .455, p < .001). Caregiver health again explained significant incremental variance (ΔR² = .034, p < .001); both PCS (β = −.088, p = .025) and MCS (β = −.158, p < .001) were significant, though their magnitudes did not differ significantly (t = 1.25, p = .212).

Conclusions and Implications: Caregiver mental health emerged as a particularly salient concurrent correlate of child internalizing problems, whereas physical and mental health contributed comparably to externalizing outcomes. Findings suggest that caregiver well-being is an important family-level context for child behavioral functioning in child welfare settings. Practitioners conducting family assessments should attend to caregiver health alongside traditional child-level risk indicators, and integrated services addressing caregiver mental health may yield meaningful benefits for children’s emotional and behavioral functioning. The domain-specific pattern also supports assessing caregiver physical and mental health as distinct dimensions rather than as a unitary construct.