Esposito et al (2017 - PREPRINT) The placement trajectories of CSA youth

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Running head: PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD
PROTECTION 1
The Placement Trajectories of Youth Served by Child Protection for Sexual Abuse
Tonino Esposito
University of Montreal
Ashleigh Delay
McGill University
Martin Chabot
McGill University
Nico Trocmé
McGill University
Delphine Colli-Vézina
McGill University
Megan Simpson
McGill University
Author Note
Tonino Esposito, School of Social Work, University of Montreal, Quebec, Canada;
Ashleigh Delaye, School of Social Work, McGill University, Quebec, Canada; Martin Chabot,
Center for Research on Children and Families, McGill University, Quebec, Canada; Nico
Trocmé, School of Social Work, McGill University, Quebec, Canada; Delphine Collin-Vézina,
School of Social Work, McGill University, Quebec, Canada; Megan Simpson, School of Social
Work, McGill University, Quebec, Canada.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 2
This study was supported by a grant from the Social Sciences and Humanities Research
Council of Canada (430-2014-00299) and the Canada Research Chair in Social Services for
Vulnerable Children (950-230680) to Tonino Esposito, Principal Investigator.
Correspondence concerning this article should be addressed to Tonino Esposito, Ph.D., School of
Social Work, University of Montreal, 3150, Jean-Brillant, Montreal, Quebec H3T1J7. Phone:
(514) 343-7735. E-mail: tonino.esposito@umontreal.ca
Tonino Esposito, Ph.D. is Assistant Professor at University of Montreal in Quebec and
Canada Research Chair in Social Services for Vulnerable Children (950-230680).
RECEIVED: March 21, 2016
REVISION DATE: November 28, 2016
ACCEPTANCE DATE: December 5, 2016

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 3
Abstract
This paper examines the long-term placement trajectories of youth aged 10 to 17 years at initial
child protection investigation, with special attention given to the comparative trajectories of
youth served for sexual abuse gender differences, and the mediating effects of behavioral
difficulties experienced post investigation. This analysis draws administrative data on all youth
served (N = 77,579) by child protection agencies in Quebec for the first time in the last 12 years.
Hazard results suggest that youth served for CSA do not enter out-of-home care as quickly as
other youth and once in out-of-home care, it takes longer for these youths to reunify with their
families. Behavioral problems drive the increased risk of placement for all served youth but play
a much more influential role for youth served for CSA. Understanding the effects of CSA on
youth placed in out-of-home care can help practitioners and program implementers offer more
comprehensive and targeted services to improve reunification timelines, or possibly avoid out-of-
home placement and placement instability due to behavioural problems associated with CSA
experiences.
Keywords: Child sexual abuse, out-of-home placement, placement instability, family
reunification, clinical administrative data, longitudinal analysis

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 4
The Placement Trajectories of Youth Served by Child Protection for Sexual Abuse
For the most part, focus on childhood sexual abuse (CSA) research has centred on
prevalence, adult memories of CSA, and the short and long-term outcomes and
psychotherapeutic approaches to treatment. Child protection research on CSA has focused
primarily on investigation, prosecution, and treatment, but there is surprisingly little information
about out-of-home placement. Where longitudinal studies have sought to understand the
relationship between maltreatment and child protection services, sexual abuse is often
categorized under the general rubric of abuse, failing to provide specific information on the long-
term service trajectories for these youths. This study attempts to address this gap by following
the placement trajectories of all youth aged 10 to 17 years served by child protection authorities
in the last 12 years, with special attention given to the comparative placement trajectories of
youth served
1
for CSA. Specifically, this study focuses on when and for whom: 1) placement
occurs; 2) changes in placement take place; and, 3) family reunification is most likely to occur.
Background
Finkelhor (1994) laid the groundwork on international epidemiology for CSA and
found prevalence rates from 7 – 36% for women and 3 – 29% for men over 19 countries. A
follow up epidemiology scale study by Pereda, Guilera, Forns, and Gómez-Benito (2009) found
a similarity in CSA prevalence distribution with averages of 18-20% for females and of 8-10%
for males. The lowest rates for both girls (11.3%) and boys (4.1%) were found in Asia, and
1
Youth served by child protection agencies refers to youth 10-17 years receiving child protection services for
reasons of suspected or confirmed abuse, neglect, or severe behavioral difficulties. Child protection services
refer to actions that are least disruptive for youth, and may include: 1) offering support services to the youth and
family; 2) protecting the youth through placement with relatives, a foster family or specialized residential
resources, and; 3) clinical monitoring of the youth’s care.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 5
highest rates were found for girls in Australia (21.5%) and for boys in Africa (19.3%)
(Stoltenborgh et al., 2011).
The prevalence rate of sexual abuse in the Canadian population was found to be 8-10%
for males and 22% for females (Hébert et al., 2009; MacMillian et al.,2013). In sharp contrast,
the Canadian Incidence Study of Reported Child Abuse and Neglect (Public Health Agency of
Canada, 2008) indicates that 3% - gender aggregated - of all substantiated primary maltreatment
investigations are sexual abuse cases (.43 per 1000 investigations). This finding clearly
demonstrates a major lack of convergence between the official reports of CSA to authorities, and
the rates of CSA that youth and adults self-report retrospectively, a trend confirmed in a recent
comprehensive meta-analysis that combined estimations of CSA in 217 studies (Stoltenborgh et
al., 2011).
In addition to prevalence studies, a thorough review of the possible negative emotional
impacts was done by Kendall-Tackett, Williams, and Finkelhor (1993). While not all youth with
CSA backgrounds will experience the following negative outcomes, CSA has been closely
linked to a range of short and long term negative health, psychological and behavioral outcomes
for both males and females such as; post-traumatic stress disorder (Dubner & Motter, 1999; Mc
Leer, Deblinger, Henry, & Orvaschel, 1992; Ullman, Najdowski, & Filipas, H. H. 2009); drug
and alcohol abuse (Simpson & Miller, 2002; Ullman, Najdowski, & Filipas, H. H. 2009);
suicidality/ideation (Dube et al., 2005; Molnar, Burkman, & Buka, 2001); obesity and disordered
eating (Gustafson & Sarwar, 2004; Neumark-Sztainer, Story, Hannan, Beuhring, & Resnick,
2000); transactional sex work (Ahrens, Katon, McCarty, Richardson, & Mark, 2012);
revictimization (Loh & Gidycz, 2006; Widom, Cjaza, & Dutton, 2008); incarceration (Gover,

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 6
2004; Raj et al, 2008); and psychiatric, psychological, mood and conduct disorders (Green et al.,
2010; Maniglio. 2015; Molnar, Buka, & Kessler, 2001).
In examining issues such as gender and CSA, there has been greater focus on female
sexual abuse survivors with regards to short and long term outcomes, while male CSA survivors
have been less likely to receive dedicated studies (Banyard, Williams, & Siegel, 2004; Dube, et
al., 2005; Maikovich-Fong & Jaffee, 2010; Lewis, McElroy, Harlaar, & Runyan, 2015). It has
been hypothesized that males are socially conditioned to hide CSA experiences and emotional
reactions due to the stigma of victimization, and the reducing effect that stigma has on
heterosexual masculinities (Cermak & Molidor, 1996, Romano and Deluca, 2001). Some reports
have found that males were more likely to mask negative emotions stemming from CSA with
externalizing behavioral problems, substance abuse, and clinically defined disorders (Lewis,
McElroy, Harlaar, & Runyan, 2015). These male externalizing behaviours have been juxtaposed
with findings that describe females as more likely to internalize emotions leading to depressive
symptomologies (Cermak & Moildor, 1996; Cutler & Nolen-Hoeksema, 1991; Romano and
Deluca, 2001). However, studies have been inconsistent on this gender specific finding.
Moving away from the gendered expression of CSA affected behaviours; Dube et al.
(2005) concluded that males and females with histories of CSA experienced similar health and
social consequences leading to substance abuse and mental health issues. Specifically, Dube et
al. (2005) indicated that females and males with CSA backgrounds were at similar risk levels for
suicide attempts when compared to populations without CSA backgrounds.
The particularities of sexual abuse as it tends to be experienced by females and males
(such as: penetration, substantiation, relationship to perpetrator, and multi-maltreatment) was not
found to be a significant predictor of the service needs of CSA survivors, or predicted

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 7
externalizing or internalizing negative emotions or behavioral problems (Maikovich-Fong &
Jaffee, 2010). Maikovich-Fong and Jaffe (2010) concluded that both genders are similarly
vulnerable to the effects and that there may be complexities of circumstances that may explain
why some CSA survivors encounter emotional, health, and social difficulties, while others do
not. These complexities of circumstances may contribute to the disagreement among findings on
this topic (Maikovich-Fong & Jaffee, 2010). An example of these complexities are evident in
recent findings reported by Lewis, McElroy, Harlaar, & Runyan (2015), that suggest that aging
and gender were moderating how negative emotions were impacting the internalization or
externalization of children with CSA associated behaviours. Lewis, McElroy, Harlaar, and
Runyan (2015) found that both females and males experienced greater amounts of internalizing
and externalizing behaviour problems when compared to maltreated youth without CSA
histories. However, overtime, as the youth aged, overall male victims of sexual abuse
internalized problems to a greater extent; however internalizing problems increased with time
and age for girls only. On the other hand, externalizing problems was not found to be
significantly impacted by age and gender of CSA survivors (Lewis, McElroy, Harlaar, &
Runyan, 2015), which is an interesting finding given the preponderance of literature that
attributes externalized behavioral problems primarily to males.
The types of behavioral problems that manifest in some victims of CSA can lead to
contact with child welfare agencies, and in some cases, difficult out-of-home care trajectories
(Farmer et al., 2008; Leathers, 2006). Behavioral related problems have been associated with
increased risk of placement and instability throughout their out-of-home care trajectories,
particularly for older males (Farmer et al., 2008; Leathers, 2006; Esposito, 2013; 2014a; 2014b).
Given that behavioral problems are the primary factor leading to placement and placement

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 8
instability for older male youth, it may be that efforts to understand the specific links between
CSA and child welfare out-of-home care trajectories have been confounded, or difficult to
disaggregate from the independent and gender related effects of severe behavioral problems.
Quebec is particularly interesting in this context where youth, under the age of 18, may receive
child protection services for severe behavioral related difficulties as a main concern, but these
youths will likely fall under broad categories of maltreatment (i.e. abuse and neglect) in other
jurisdictions (Trocmé, 2008).
In a series of three longitudinal studies identifying age-specific factors associated to when
and for whom placement, placement changes, and family reunification are most likely to occur,
Esposito and colleagues (2013; 2014a; 2014b) reported that older youth manifesting high risk
behaviours were the most likely to be placed and males were the most likely to experience
placement instability. However, these youths were also most likely to reunify as the probability
of reunification decreased primarily as a result of parent’s high risk behaviours and a lack of
appropriate and adequate parental care. Although useful, the findings do not specifically isolate
the placement trajectories of youth served for CSA or account for the behavioral difficulties that
may manifest in youth served for CSA.
Though difficult to find studies that make connections between CSA, out-of-home care
trajectories, and criminality, there are many studies on the relationship between CSA and
criminality, particularly when it concerns incarceration later in life. In one study of 100 male
inmates (Johnson et al. 2005), 59 inmates self-reported sexual abuse on before their thirteenth
year. Although the authors found this prevalence to be higher than other studies done among
similar populations, it supports findings elsewhere that those with a history of criminal or deviant
behaviour have a history of CSA greater than the general population (Holmes & Slap, 1998;

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 9
McGrath, Abbott, Kerley, 2011; Murrell, Christoff, & Henning, 2007; Siegel and Williams,
2003; Widom & Ames, 1994; Widom, 1995; Widom, 1996). Sex offences were found to be the
primary reason for incarceration among those with CSA backgrounds, but CSA was also
prevalent for those who were in prison for other crimes, such as burglary, theft, and non-drug
related felonies (22 – 33%) (Johnson et al. 2005). Especially for females aging out of care, the
odds of participating in transactional sex (sex for money or drugs) and associated risky
behaviours (unsafe sex practices, intravenous drug use) following CSA has been found to be
significant (Ahrens, et. al, 2012).
In general poverty has been found to be a risk factor for CSA experiences in youth, as it
is for other forms of maltreatment (Chui et al., 2013; Greely et al., 2016; Macmillan et al. 2013).
While Matta Oshima, Jonson-Reid, and Seay (2014) found no difference in prevalence in CSA
between poor and non-poor families, they found a greater re-reporting rate for maltreatment
more generally among youth served for CSA in poverty (see also: Maikovich-Fong & Jaffee,
2010; Jonson-Reid et al., 2003).
In Canada, CSA is reported to be roughly similar across ethno-racial background groups;
ranging from 3.1% for Asian groups to 5.8% for Aboriginal groups, while Caucasian, Black, and
Other fall somewhere between (Lavergne et al., 2008). Conversely, an American meta-analysis
(Kenny & MacEeahran, 2000) found inconsistencies among reports of CSA and ethnicity, as
well as a lack of comparative analysis. However, Kenny and MacEeachran (2000) note that
Caucasian families have the largest number of CSA incidents, with rising incident rates among
visible minorities. Whether incidents of CSA are similar across ethno-racial backgrounds in
Canada, the overrepresentation of Aboriginal children, and in the United States, Black and
Hispanic children in youth protection is well documented (Canada: Sinha et al., 2011;

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 10
Blackstock, C., 2009; Blackstock, Trocmé, & Bennett, 2004; Lavergne et al., 2008; Wray &
Sinha, 2011. US: Barth & Miller, 2001; Drake et al., 2011; Shaw, et al., 2008; McCrae, & Fusco,
2010). Overrepresentation of a population minority within the child welfare system is alarming
for reasons outside the scope of this paper; however, it is important for social work and mental
health professionals to understand the overrepresented minority youth – irrespective of
maltreatment type - to prepare culturally safe interventions (Kenney & MacEachran, 2000;
Lavergne et al., 2008; Mennen, 1995).
The isolated placement trajectories of youth served for CSA and the extent to which
behavioral difficulties manifesting in youth served for CSA, and their associated placement
trajectories remain elusive. Studies focusing on CSA have primarily focused on prevalence, and
the symptomatology and psychopathology of victims of CSA in the short and long term, but less
is known about the ensuing child welfare interventions (e.g. out-of-home placement). Also,
studies have not examined the extent to which behavioral problems associated with CSA explain
gender differences in placement risk. The present study therefore contributes to the child
maltreatment literature by examining the long-term placement trajectories of youth aged 10 to 17
years at initial investigation, with special attention given to the comparative placement
trajectories of youth served for CSA, gender differences, and the mediating effects of behavioral
difficulties experienced post-investigation.
Method
This study uses a longitudinal research design that draws data from two sources: (1)
administrative data from Quebec’s child protection agencies (Esposito et al., 2013; Esposito et
al., 2014a; Esposito et al., 2014b); and, (2) Canadian Census data for the province of Quebec.
The first data source consists of anonymized longitudinal clinical administrative child protection

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 11
data from all mandated jurisdictions across the province of Quebec. These data were drawn from
a common provincial information system used by every mandated child protection agency in
Quebec and contain data on approximately 450,000 children dating back to 1989. All covariates
used in this study—except for neighborhood socioeconomic disadvantage—were constructed
using these clinical administrative data. A neighborhood area socioeconomic disadvantage
composite index was also developed using provincial data extracted from the 2006 Canadian
Census and merged with the clinical-administrative child protection data. The cohort used for
this study consists of 77,579 youth aged 10 to 17 years served for the first time within a child
protection jurisdiction between April 1, 2002 and March 31, 2014, of which 6,466 youth were
served for sexual abuse.
Three Cox proportional hazard models were used to examine when initial placement,
placement changes, and family reunification are most likely to occur, with special attention given
to the placement trajectories of youth served for CSA. Initial out-of-home placement was defined
as a youth’s entry into out-of-home care following their initial maltreatment investigation.
Placement changes are only considered if they last longer than 72 hours, to account for respite
placements and/or emergency placements that are not part of a child’s long-term plan. Findings
from an earlier study by Esposito and colleagues (2014a) suggests that the cumulative risk of
changing placements starts at third placement change and continues to increase over time,
representing a subgroup of youth who are the most vulnerable to placement instability. Based on
these findings, the reported placement change model in this study is divided into two discrete
groups: (1) youth who do not change placements; and, (2) youth who change placements at least
three times.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 12
Family reunification consists of a return to one or both birth parents as well as the
extended natural family (i.e. relatives). The follow-up period for the three models starts from the
date of initial maltreatment investigation to the date of: (1) initial out-of-home placement and
from the date of initial placement to (2) fourth placement for youth who move three or more
times and (3) initial reunification. For youth who do not experience a placement, placement
change or reunification, the follow-up period starts from the date of initial maltreatment
investigation (for the placement model) and from the date of initial placement (for the placement
change and reunification model) to the end of the follow-up period — March 31, 2014 or the
youth’s 18th birthday, whichever comes first.
Covariates
We estimated Cox proportional hazard models for two distinct groups: (1) youth served
for sexual abuse by child protection for the first time; and (2) youth served for the first time for
other reasons. Sexual abuse investigation consists of a situation in which youth are subject to
gestures of a sexual nature by their parents or others, with or without physical contact, and the
youth’s guardian fail to take the necessary steps to put an end to the situation (Youth Protection
Act, 2016). Other reasons for investigation consist of: (1) psychological & emotional
maltreatment, which includes rejection, denigration, exposure to intimate partner violence and
exploitation; (2) physical, material, health neglect and parent high-risk lifestyle, which includes
physical neglect, medical neglect, and material deprivation and parents’ lifestyle resulting in a
failure to supervise or protect the child; (3) abandonment due to parental absence and refusal to
assure child care; (4) school truancy & school neglect, which includes failure to attend school or
failure to ensure that the child attends school; (5) physical abuse; and, (6) behavioral problems

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 13
such as harming behavior, violence towards self and others, child substance abuse, school
behavioral problems, runaway behavior, and destruction of property.
The models include covariates reflecting the ecological influences that impact the risk of
out-of-home placement, instability, and reunification for placed youth. Age at entry is measured
as a continuous variable. Gender is a nominal variable with female as the reference group for
male. Visible minority youth consists of a nominal variable with White as a reference group for
Aboriginal, Black, Arab, and Asian minority youth. Youth criminal justice service request
measures, as a nominal variable, whether youth received a request for services under the Quebec
Youth Criminal Justice Act (LSJPA—Loi sur la justice pénale des adolescents) prior to
placement for the placement model, 3rd placement change for the instability model and prior to
reunification. Severe behavioral problems measures, as a nominal variable, whether youth were
also served for harming behavior, violence towards self and others, substance abuse, school
behavioral difficulties, runaway behavior, and destruction of property prior to placement for the
placement model, 3rd placement change for the instability model and prior to reunification for the
reunification model. Source of referral includes the following nominal values: (1) community
health and social services clinics (CLSC); (2) child protection agency; (3) extended family and
neighbors; (4) school staff; (5) police; (6) hospital staff; (7) other professional institutions; and,
(8) unknown. Initial placement type is a nominal variable measured at initial placement with
foster family care acting as the reference group for residential or group care. The clinical
population specific measure of neighborhood socioeconomic disadvantages includes six
socioeconomic indicators (for details, see Esposito et al. 2013). For each of the census
dissemination areas, we coded the (1) total population 15 years and over who are unemployed or
not in the labor force; (2) median income in 2005 for population 15 years and over; (3) total

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 14
persons in a private household living alone; (4) total population 15 years and over who were
separated, divorced or widowed; (5) family median income in 2005; and, (6) median household
income in 2005. The socioeconomic disadvantage composite index was normalized and linked
with the child protection clinical administrative data based on the children’s postal codes at
initial maltreatment investigation, reflecting the socioeconomic disadvantage estimates relative
to the neighborhood - ranging from 400 to 700 persons - of the clinical population of children
served by child protection. The index has a minimum score for children served by child
protection of −3.37 representing the lowest socioeconomic risk and a maximum score of 3.51
representing the highest socioeconomic risk. The index has a mean score of 0.2898 (Std.
0.92037) and median of 0.2931.
Analytic Method
Cox proportional hazard regression analysis was used to examine the chances of
placement, placement changes, and family reunification from the point of youth’s initial
maltreatment investigation. The Cox proportional hazard regression model is specified as:
ln[H(t) / H0(t)] = b1X1 + b2X2 + b3X3 + ……..+ bkXk
H(t) / H0(t) represents the risk of placement, 3rd placement change or reunification within
an interval of time when all covariates are zero. The coefficients b1…..bk are estimated by Cox
proportional hazard regression function and the expb1 represents the likelihood of placement, 3rd
placement change or reunification for the independent variable X1, at any time, holding all other
covariates constant. Statistical tests were conducted at 95% level of confidence. The dataset has
been built and transformed using SPSS version 22 and analyzed using both SPSS 22 and STATA
11.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 15
Analytic Process
The analysis is composed of several steps. First, the observed cumulative hazard
function was used to examine the hazard rate and time to placement, 3rd placement change and
family reunification by gender, and between youth served for CSA and youth served for other
reasons (see figures 1 to 6). For these estimates, we calculated Z-scores to compare whether
gender specific coefficients between youth served for CSA and all other youth differ
significantly, specified as: Z = ((b1 – b2) / (SQRT (SEb12 + SEb22)))
To ensure that there is no linearity among covariates, an ordinary least squares regression
was conducted with all the covariates used in the final Cox proportional hazard models,
indicating no issues of linearity between covariates in either of the youth cohorts. Tables 3 to 5
report the results of the Cox proportional hazard models for both youth cohorts. The models
present hazard estimates, and the Wald statistic, which allows us to quickly consider whether the
null hypothesis that the true coefficients equals zero.
Results
The overall population studied includes 77,579 youth served for the first time between
April 1, 2002 and March 31, 2014 by the Quebec child protection system, of which 31.8% (N =
24,704) were admitted to out-of-home care at some point during the follow-up period. Of the
overall cohort of youth admitted to out-of-home care, 30.5% (N = 7,554) change placements
three or more times and 75.1% (N = 18,559) reunified with their families.
The population studied was divided into two groups: (1) youth served for the first time
for reasons of CSA (N = 6,466); and, (2) youth served for the first time for reasons other than
sexual abuse (N = 71,113). Youth served for CSA represent 8.3% of all first time served youth
aged 10 to 17 years in the last 12 years. There is relatively even distribution of male and female
served youth, except for youth served for CSA, where only 14.1% (N = 912) were male, and

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 16
85.9% (N = 5,554) were female. Slightly over seventeen percent of youth served for CSA (N =
1,115) were admitted to out-of-home care compared to 33.1% (N = 23,589) for remaining youth.
Close to twenty six percent of placed youth served for CSA and 30.7% on other placed youth
changed placements three times or more. Of the placed youth served for CSA 65.5% (N= 731)
were reunified compared to 75.6% (N= 17,838) for other youth.
Regarding the mediating effects of severe behavioral difficulties, table 1 shows that of the
overall population of youth served by child protection, 24.3% (N= 18,880) also committed a
youth crime and 12.9% (10,055) were also receiving child protection services for severe
behavioral problems. Specifically, slightly over a third (34.7%) of youth were served for reasons
of severe behavioral problems of which 42.4% (N = 11,425) also committed a crime and 20.7%
(N = 5,585) were reported multiple times for severe behavioral problems. In comparison, 8.3%
(N = 6,466) of youth were served for sexual abuse, of which 9.9% (N = 638) committed a crime,
and 8.2% (N = 531) were also reported to have severe behavioral problems.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 17
Table 1.
Reasons for Initial Investigation, Youth Criminality and Subsequent Behavioral Problems
(a) Percentages are column percentages for each category and may not add to 100% because of
rounding
(b) Percentages are row percentages for initial investigation category
Youth 10 to 17
years old
investigated for
the first time by
child protection
Youth 10 to 17
years old
investigated for
the first time
with a request
for youth
criminal justice
services
(N = 18,880)
Youth
10 to 17 years
old investigated
for the first time
with an
additional
request for
services
because of
behavioral
problems
(N = 10,055)
Reason for initial investigation
(N = 77 579)
Neglect
27.9%(a)
18.2%(b)
10.3% (b)
Physical Abuse
20.6% (a)
13.5% (b)
8.3% (b)
Sexual Abuse
8.3% (a)
9.9% (b)
8.2% (b)
Severe behavioral problems
34.7% (a)
42.4% (b)
20.7% (b)
Abandonment
1.3% (a)
23.2% (b)
8.6% (b)
Psychological maltreatment
7.2% (a)
8.8% (b)
5.1% (b)

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 18
We next compared gender and CSA differences by illustrating the hazard rate to out-of-
home placement, 3rd placement change, and reunification. Figure 1 and 2 illustrates the hazard
rate, by gender, of out-of-home placement from the moment when youth are initially served for
maltreatment. Half of all served youth who are placed in out-of-home care, irrespective of
reasons for investigation, will experience an out-of-home placement within 53 days of initial
investigation, and risk of changing placements continues to increase over time for all youth.
When comparing youth served for CSA to all other youth, we found noted differences in time to
placement - half of all placed youth served for CSA did so within 137 days of initial
investigation compared to 50 days for other youth. Female CSA are also significantly at higher
risk of experiencing a placement compared to male youth served for CSA – a pattern which is
reversed for other youth. Bivariate gender coefficients significantly differ between groups. Male
youth served for CSA were significantly less at risk of experiencing a placement compared to
female youth served for CSA (b = -.184; SE = .090, P = .040). On the other hand, for all other
served youth, males were significantly at higher risk (b = .060; SE = .013; P = .000) – regression
coefficients that significantly differ between both youth cohorts (Z = -2.68, p = .004).

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 19
Figure 1 and 2. Time to Out-of-Home Placement by Gender for Youth Served for CSA and
Youth Served for Other Reasons
Figure 3 and 4 illustrates the hazard rate, by gender, of third placement change from the
moment when youth are initially placed in out-of-home care. Half of all placed youth who
change placements at least three times, irrespective of reasons for investigation, will do so within
175 days of initial placement. For these youth, the risk of changing placements continues to
increase over time. When comparing youth served for CSA to all other youth, we do not find
significant differences in time to third placement change. Half of all placed youth served for
CSA experienced their third placement change within 168 days of initial placement compared to
176 days for other youth. When comparing the risk of third placement change by gender for CSA
and other served youth, we find in both groups that male youth are significantly at higher risk of
experiencing a third placement – risk which continues to increase over time for both groups but
significantly more rapidly for CSA male youth. At the bivariate level, male youth served for
CSA were significantly more likely to experience a third placement change compared to female
Youth 10 to 17 years old investigated for CSA
(N = 6 466)
Youth 10 to 17 years old investigated for other reasons
(N = 71 113)
Cumulative Hazard
Days to initial placement
Days to initial placement

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 20
youth served for CSA (b = .502; SE = .152, P = .001). For all other placed youth, males were
also significantly at higher risk (b = .233; SE = .024; P = .000) – regression coefficients that
significantly differ between both youth cohorts with male victims of CSA at higher risk than
male youth served for other reasons (Z = 1.76, p < .05).
Figure 3 and 4. Time to 3rd Placement Change by Gender for Youth Served for CSA and Youth
Served for Other Reasons
Figure 5 and 6 illustrates the hazard rate, by gender, of family reunification from the
moment when youth are initially placed in out-of-home care. The observed hazard rate illustrates
an early peak, indicating that youth, irrespective of reasons for investigation, usually reunify with
their families immediately following the initial out-of-home placement. Half of all youth placed
in out-of-home care returned to live with their natural families within the first 187 days of initial
out-of-home placement. When comparing youth served for CSA to all other youth, we find
significant differences in time to reunification. Half of all placed youth served for CSA reunified
Youth 10 to 17 years old investigated for CSA
(N = 678)
Youth 10 to 17 years old investigated for other reasons
(N = 14 534)
Cumulative Hazard
Days to 3rd placement change
Days to 3rd placement change

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 21
within 246 days of initial placement compared to 184 days for other youth. When comparing the
likelihood of reunification by gender for CSA and other served youth, we found that female
victims of CSA are more likely to reunify compared to male youth served for CSA – a pattern
which is reversed for other youth. However, these bivariate gender-based differences were not
statistically significant for either group; females were statistically no more likely than males to
reunify.
Together then, female youth served for CSA are more likely to be placed but less likely
to experience instability compared to male youth served for CSA. On the other hand, female
youth served for other reasons are less likely to be placed and experience instability. There is no
significant gender effect between CSA and other youth regarding the likelihood of reunification.
Regarding time-to-event, it takes significantly longer for youth served for CSA to enter out-of-
home care but if placed in out-of-home care, it takes significantly longer for youth served for
CSA to reunify with their natural families compared to youth served for other reasons.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 22
Figure 5 and 6. Time to Family Reunification by Gender for Youth Served for CSA and Youth
Served for Other Reasons
Hazard Analysis for Out-of-Home Placement
Table 2 presents final estimates of the effect of case level factors, subsequent criminality,
behavioral problems, and neighborhood area socioeconomic disadvantages on the risk of
experiencing an initial placement for youth aged 10 to 17 years at investigation. Youth served for
CSA enter out-of-home care proportionately less than youth served for other reasons. Of the
6,466 youth served for CSA, 17.2% (N = 1,115) were placed in out-of-home care.
Comparatively, 33.1% (N = 23,589) of youth served for other reasons were placed in out-of-
home care.
Factors that increase the risk of placement for both youth served for CSA and youth
served for other reasons include: older age at the time of the initial investigation; visible minority
youth, manifesting behavioral problems; and socioeconomic disadvantages. All else held
Youth 10 to 17 years old investigated for CSA
(N = 1 115)
)
Youth 10 to 17 years old investigated for other reasons
(N = 23 589)
Cumulative Hazard
Days to family reunification
Days to family reunification

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 23
constant, there is no significant gender effect on the risk of placement for youth served for CSA;
however, male youth served for other reasons are at significant increased risk of placement.
Youth served for other reasons, referred for investigation by a family member, the police,
community health and social services clinic, hospital staff, or other professional institutions are
at increased risk of placement compared to those referred by a school official or unidentified
source. Interestingly, for both youth served for CSA and youth served for other reasons, a request
for youth criminal justice services significantly reduces the risk of placement.
For youth served for CSA, the most influential factors enabling us to predict an increased
risk of initial placement were the following: being older (Wald = 64.9), being visible minority
(Wald = 42.7), manifesting severe behavioral problems (Wald = 270.7) and coming from
neighborhoods with higher levels of socioeconomic disadvantages (Wald=27.1). Of these
factors, severe behavioral problems are the most influential in magnitude for youth served for
CSA and the second most influential for all other served youth.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 24
Table 2.
Cox Proportional Hazard Models of Initial Out-of-Home Placement for Youth Aged 10 to17
Years
Number of Events and Censored Values
Total
Events
Censored
% Censored
CSA
6,466
1,115
5,351
82.8%
Total
Events
Censored
% Censored
Not CSA
71,113
23,589
47,524
68.8%
Final model (CSA)
Final model (Not CSA)
Beta
S.E.
Wald
Adj. HR
Beta
Wald
Adj. HR
Age at initial
investigation
.131
.016
64.9
1.140***
.216
3581
1.241***
Male gender (female ref)
-.053
0.92
.330
.949
.107
62.6
1.112***
Visible minority
(Caucasian ref)
.615
.094
42.7
1.850***
.211
89.3
1.235***
Source of referral:
CLSC
.065
.187
.120
1.067
.385
52.0
1.470***
Police
.073
.180
.165
1.076
.456
76.0
1.577***
School
.192
.177
1.18
1.212
-.117
5.04
.889***
Hospital staff
-.098
.229
.183
.907
.393
44.1
1.481***
Other professional
institutions
.098
.180
.294
1.103
.163
9.38
1.177**
Family
.077
.184
.177
1.081
.442
73.2
1.555***

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 25
Unidentified (ref)
Request for youth
criminal justice services
-.265
.120
4.86
.767**
-.121
49.3
.886***
Severe behavioral
problems
1.26
.077
270.7
3.530***
.556
986
1.744***
Socioeconomic
disadvantages
.178
.034
27.1
1.194***
.060
72.3
1.061***
*P<0.05; **P<0.01; ***P<0.001

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 26
Hazard Analysis of Placement Disruption
Table 3 presents hazard estimates of changing placements at least three times for placed
youth served for CSA and youth served for other reasons. Youth served for CSA placed in out-
of-home care experience proportionately less disruption than youth served for other reasons. Of
youth served for CSA placed in out-of-home care (N = 1,115), 34.8% experience no disruption,
25.5 % move once, 13.6% move twice and 25.9% move three times or more. Comparatively for
youth served for other reasons placed in out-of-home care (N = 23,589), 31.1% experience no
disruption, 23.4 % move once, 14.6% move twice and 30.7% move three times or more.
For youth served for CSA, the increased risk of changing placements three times or more
was statistically explained by a combination of the following variables: older youth, request for
youth criminal justice services and neighborhood area socioeconomic disadvantages. While older
youth served for CSA were statistically more at risk of experiencing at least three placement
changes compared to younger youth served for CSA, older age decreased the likelihood of
experiencing three or more placement changes for youth served for other reasons. Although for
youth served for CSA manifesting behavioral problems was not a significant predictor of
placement changes, for all other youth, severe behavioral problems were the second most
influential factor predicting three or more placement changes. However, a sensitivity analysis
removing youth criminality from the youth served for CSA model shows that behavioral
problems (exp (B) = 1.343, Wald = 5.26; P < .05) and male gender (exp (B) = 1.632; Wald =
9.47; P < .05) significantly predict instability, but becomes statistically insignificant once we
account for youth criminality. For youth served for reasons other than CSA, being admitted to
residential care as an initial placement is also significantly associated with a higher hazard rate
for instability.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 27
Table 3.
Cox Proportional Hazard Models of 3 or More Placement Changes for Placed Youth Aged 10
to17 Years
Number of Events and Censored Values
Total
Events
Censored
% Censored
CSA
678
289
389
57.3%
Total
Events
Censored
% Censored
Not CSA
14,534
7,265
7,269
50.0%
Final model (CSA)
Final model (Not CSA)
Beta
S.E.
Wald
Adj. HR
Beta
Wald
Adj. HR
Age at initial
investigation
.008
.035
.046
1.008***
-.015
4.45
.985*
Male gender (female ref)
.255
.165
2.38
1.290
-.017
.427
.984
Visible minority
(Caucasian ref)
.085
.187
.209
1.089
.019
.233
1.020
Source of referral:
CLSC
-.860
.333
6.66
.423*
-.039
.174
.962
Police
-.506
.298
2.88
.603
.017
.034
1.017
School
-.600
.293
4.20
.549*
-.113
1.53
.893
Hospital staff
-.637
.465
1.87
.529
-.244
5.07
.784*
Other professional
institutions
-.586
.302
3.76
.557
-.040
.180
.961
Family
-.492
.312
2.48
.611
-.022
.059
.978

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 28
Unidentified (ref)
Initial placement in
residential care
(family foster care ref)
-.041
.123
.109
.960
.124
22.8
1.132***
Request for youth
criminal justice services
.689
.132
27.3
1.992***
.617
548
1.854***
Severe behavioral
problems
.205
.129
2.51
1.227
.324
162
1.383***
Socioeconomic
disadvantages
.129
.065
3.92
1.138***
.071
30.6
1.073***
*P<0.05; **P<0.01; ***P<0.001
Hazard Analysis for Family Reunification
Table 4 presents hazard estimates of family reunification for CSA and all other youth.
Only 65.5% of placed youth served for CSA (N = 1,115), were reunified, compared to 75.6% of
youth served for other reasons (N= 23,589). For both cohorts, the most influential factors
predicting the decreased probability of reunification was a combination of youth referred by an
unidentified or anonymous source, foster family placement, a request for youth criminal justice
services, and youth who were living in more socioeconomically disadvantaged neighborhoods
prior to placement. While older age, gender and severe behavioral problems did not significantly
explain the chances of reunification for youth served for CSA, the combination of these factors
did so for youth served for other reasons. A possible explanation is that these reasons overlap to
represent an indicator of the severity of the challenges and complex needs faced by non-youth
served for CSA which cannot be met by the current Quebec out-of-home care system without
needed additional therapeutic supports, therefore leading to quick returns home. Another
possible explanation is that youth with behavioral problems are more likely to return to live with

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 29
their families because their therapeutic needs are met in residential or group out-of-home care;
reflecting positive practice residential care and group home standards in Quebec — both
contending explanations need to be further explored. A sensitivity analysis for youth served for
CSA, however, shows that behavioral problems (exp (B) = .806; Wald = 5.62; P < .05)
significantly reduces the likelihood of reunification but becomes statistically insignificant once
we control for youth criminality. This implies that, all else being equal, youth served for CSA are
less likely to reunify with their families if they lived in more socioeconomically disadvantaged
environments prior to placement, were reported by an unidentified source and committed a youth
crime.
Taken together then and in an integrated manner, this study suggests that youth served for
CSA are at high risk of placement if they are older minority male who come from
socioeconomically disadvantaged environments, and who manifest severe behavioral problems.
If in out-of-home care, however, the increased risk of placement instability and decreased
likelihood of reunification for youth served for CSA is primarily explained by youth criminality
and socioeconomic disadvantages.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 30
Table 4.
Cox Proportional Hazard Models of Family Reunification for Placed Youth Aged 10 to17 Years
Number of Events and Censored Values
Total
Events
Censored
% Censored
CSA
1,115
731
384
34.4%
Total
Events
Censored
% Censored
Not CSA
23,589
17,838
5,751
24.3%
Final model (CSA)
Final model (Not CSA)
Beta
S.E.
Wald
Adj. HR
Beta
Wald
Adj. HR
Age at initial
investigation
-.021
.021
.966
.979
.052
125
1.053***
Male gender (female ref)
-.075
.118
.408
.928
.084
28.2
1.087***
Visible minority
(Caucasian ref)
-.033
.121
.076
.967
-.043
2.66
.958
Source of referral:
CLSC
1.39
.297
22.1
4.052***
.538
59.5
1.712***
Police
1.31
.297
20.4
3.722***
.644
88.6
1.905***
School
1.28
.287
20.0
3.623***
.629
84.4
1.875***
Hospital staff
1.10
.339
10.6
3.020**
.460
37.1
1.584***
Other professional
institutions
.811
.294
7.60
2.251**
.364
27.1
1.439***
Family
1.04
.296
12.3
2.830***
.541
63.6
1.718***
Unidentified (ref)
Initial placement in
.517
.079
43.1
1.677***
.490
866
1.633***

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 31
residential care
(family foster care ref)
Request for youth
criminal justice services
-.652
.128
26.0
.521***
-.472
647
.624***
Severe behavioral
problems
-.162
.092
3.12
.850
-.087
20.2
.916***
Socioeconomic
disadvantages
-.095
.040
5.80
.909*
-.041
25.2
.960***
*P<0.05; **P<0.01; ***P<0.001
Discussion
The results of this study contribute to the growing CSA literature by examining the long-
term placement trajectories of youth aged 10 to 17 years, and reflects movements in child
protection policy focusing on family preservation and reunification. The results are also coherent
with the aforementioned series of three longitudinal studies identifying factors associated to
when and for whom placement, placement changes, and family reunification are most likely to
occur in Quebec (Esposito et al. 2013; 2014a; 2014b). The majority of youth served by the
Quebec child protection system are not placed in out-of-home care and of those who are placed,
few change placements frequently and most return to live with their families within less than six
months of initial out-of-home placement.
At the bivariate level, female youth served for CSA are more likely to be placed but less
likely to experience instability compared to male youth served for CSA. However, there is no
significant gender effect for youth served for CSA once we account for youth criminality and
severe behavioral problems. This is in part consistent with the literature, which overall indicates
that the effects of gender for youth served for CSA are moderated by the manifestation of
behavioral problems leading to placement (Lewis et al. 2015). With regards to gendered

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 32
differences in placement stability, males are often found to exhibit externalizing behavioral
problems, such as criminality, which are positively related to placement instability (Esposito,
2014b; Farmer, et al. 2008, Leathers, 2006; Park & Ryan, 2009). However, it is interesting that
once youth criminality is accounted for, the effect that gender has on placement instability is no
longer significant. Youth criminality may account for one of the many complexities that
influence the higher male association to externalizing behaviours, those same behaviours leading
to negative placement outcomes, and yet may in reality be related to other case characteristics,
such as socioeconomic disadvantage and living in high risk family environments that are not
specific to CSA.
Also adding to existing CSA literature, large differences (Z = 8.91; P = < .05) are noted
between youth served for CSA and other served youth regarding the effects of severe behavioral
problems on out-of-home care, with youth served for CSA 3.5 times (b = 1.26; SE = .077; P <
.05) more likely to enter care if they manifest severe behavioral problems compared to 1.7 times
(b = .556; SE = .018; P < .05) more likely for youth served for other reasons. While severe
behavioral problems drive the increased risk of placement for these youth, criminal justice
services were not a factor that increased the risk of placement. These results corroborate the
evidence from the placement literature, suggesting that the primary factor that put older youth at
increased risk of placement is behavioral problems (Farmer, et al. 2008, Leathers, 2006; Park &
Ryan, 2009). However, behavioral problems did not significantly influence the risk of placement
instability or likelihood of reunification for youth served for CSA. The primary factor driving the
risk of placement instability, and one of the primary factors reducing the likelihood of
reunification for youth served for CSA was youth criminality. However, criminality is not unique

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 33
to youth served for CSA and this same factor also increases the risk of instability and decreases
the likelihood of reunification for all other youth.
This study also confirms the association between socioeconomic disadvantages and the
cumulative increased risk of experiencing problematic placement trajectories. Together, for both
youth served for CSA and youth served for other reasons, an increase in neighbourhood area
socioeconomic disadvantages significantly increases their chances of placement and placement
changes, and decreases their chances of returning to live with their families.
Implications
Our findings have several implications for child protection policy and practice.
Comparisons of the placement trajectories of youth served for CSA and youth served for other
reasons provide reasons for concern. On one hand, youth, irrespective of reasons for child
protection services or maltreatment type, are not generally placed in out-home-care, and if
placed, experience stability and reunify quickly. On the other hand, it takes longer for youth
served for CSA who enter out-of-home care compared to their peers to reunify. Also, youth
criminality plays a significant and influential role in the problematic placement trajectories
experienced by youth served for CSA. It has been established elsewhere (Esposito, 2013; 2014a;
2014b, Farmer et al., 2008; Leathers, 2006), that older youth, particularly males engaging in
criminal or other high risk behaviours experience more problematic placements. So, while our
findings are in line with these earlier studies that indicate that criminality itself is not unique to
youth served for CSA, this study reveals that criminality is one of the most influential factors in
the placement trajectories of youth served for CSA, and reduces the effect of gender and other
behavioral difficulties on negative placement outcomes.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 34
While these findings call for further research that is better designed to understand why
behavioral difficulties and criminality play such a differential role for youth served for CSA, our
findings point to a possible opportunity for child protection to act on these specific cases to
prevent criminality and the development of behavioral problems and to encourage reunification
for youth served for CSA. Considering extra and renewed efforts to prevent criminality and
address behavioral difficulties for youth in out-of-home care can minimize the instability
experienced by these youth, irrespective of maltreatment type. It should be noted here, however,
that crime and behavioral difficulties may be associated to a history of having lived in unsafe
environments (Jonson-Reid, 2002). Strengths-focused interventions may also be an effective tool
to engage high risk youth with behavioral problems and increase participation in support services
aimed at reducing the risk associated with problematic placement trajectories (Bass, Shields, &
Behrman, 2004; Sousa, Ribeiro, Rodrigues, 2006). This perspective works from the assumption
that youth have the capacity to make significant progress facing their difficulties when
empowered and offered the right supports (Maluccio, Abramczyk & Thomlison, 1996; Early &
GlenMaye, 2000; Saleebey, 1996; 2006a; 2006b). Also given the increased likelihood of
criminality in youth from socioeconomically disadvantaged neighbourhoods, efforts to empower
communities to address sexual abuse may be helpful (Itzhaky & York, 2001).
At a program level, every effort should be made to provide adequate mental health and
family supports needed to work toward improving family circumstances in order to encourage
the reunification of youth served for CSA in out-of-home care. Preventative or stabilizing
interventions embedded in the community network, for example, school resource officers,
community youth justice, mental health, and social service provision may increase youth’s
resilience, and protective factors; particularly as they age (Maikovich-Fong & Jaffee, 2010).

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 35
Doing so would mean a reduction in the proportion of youth who experience problematic
placements and increase in stable reunifications, and ultimately a reduction in the disruption in
the lives of these youth.
Limitations
Although this represents the largest study to date specifically describing the child
protection placement trajectories of youth served for CSA, it has several limitations. First,
including youth’s ethno-racial background as a predictive characteristic in the final hazard
models posed a methodological challenge given that in close to 40% of served youth, and close
to 15% of placed youth, the ethno-racial background was not identified. Because many of the
youth’s ethno-racial information was absent, this study might significantly underestimate the
problematic placement trajectories of visible minority youth. Second, the clinical administrative
data used for this study does not have a measure of family-level poverty. If we had household
income information of the clinical population served, it might reduce the relationship between
neighbourhood socioeconomic disadvantages and placement events examined. We attempted to
address this bias by creating a composite index based on the immediate socioeconomic
surrounding (400 to 700 residents) of served youth, reflecting a proxy measure of family-level
poverty. Last, the administrative data used for these analyses provides limited information about
the specific contexts of these youth: file reviews and interviews with a sample of youth could
provide important information to better understand the factors impacting their service
trajectories.
Together, this study contributes to the CSA and child protection placement research by
providing insight into the rate of placement, instability and reunification, and the ecological
factors associated with youth served for CSA’s placement trajectories. This information can be

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 36
beneficial in assisting child protection authorities when making program and policy decisions
regarding both existing child protection and community level support efforts aimed at targeting a
vulnerable and understudied child protection population.
Disclosure of Interest
The authors of this article declare no conflict of interest.
Ethical Standards and Informed Consent
This article contains secondary analysis of data approved (CÉR CJM-IU: 11/06/003 and
CJQ-IU-2011-07) for the purposes of understanding the placement trajectories of children served
by child protection in the province of Quebec. This article does not contain any studies with
human participants performed by any of the authors.
Acknowledgments
This study was supported by a grant from the Social Sciences and Humanities Research
Council of Canada (430-2014-00299) and the Canada Research Chair in Social Services for
Vulnerable Children (950-230680) to Tonino Esposito, Principal Investigator.

PLACEMENT TRAJECTORIES OF YOUTH SERVED BY CHILD PROTECTION 37
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