Abstract
Introduction
There is a large, international literature demonstrating that children who live in out-of-home care are at greater risk for developing mental health problems and experiencing disadvantage across multiple domains, including education, employment, and health (Bakketeig et al., 2020; Courtney et al., 2010; Tarren-Sweeney, 2008). These children often come from high-risk backgrounds characterized by exposure to a cluster of risk factors and stressors. These risks include factors related to life with their birth family, but also aspects of their care experience including age entering care, time spent in care, and placement instability (Asif et al., 2024; Engler et al., 2022; Longshaw et al., 2024; Wade, 2023; Winokur et al., 2018). Both the structure of child welfare services and the challenges faced while in care are similar in the US and many European countries. Placement instability concerns the changes in household or caregivers that do not result in a permanent placement. Placement instability is argued to be an important feature of a young person’s care experience (Fisher et al., 2013) and has been linked to poor outcomes for physical, mental, and sexual health, risk-taking behaviour, employment, academic achievement, and criminal behaviour (Engler et al., 2022; Fisher et al., 2013; Jones et al., 2011). Fisher did, however, recognise that care-experienced children’s outcomes are diverse, with many children and young people thriving and adapting despite these experiences.
Identifying the contextually sensitive and modifiable protective factors for these children has informed the development of interventions; child welfare agencies are particularly interested in interventions that can decrease disruptions and increase placement stability. For example, an evaluation of the KEEP training course on positive reinforcement and non-harsh discipline (Price et al., 2008a) found that prior placement instability increased the potential for negative disruptions in the current placements, but the intervention mitigated these effects. Additionally, a skills group and mentoring intervention was successful in increasing non-relative fostering and kinship placement stability and permanence for an intervention group compared to controls (Taussig et al., 2012). Given that problematic behaviour has been identified as both a cause and a consequence of placement disruption (Konjin et al., 2019; Newton et al., 2000), interventions targeting both placement stability and behavioural improvement among care-experienced children have shown effectiveness (Fisher et al., 2009).
Despite a wealth of research investigating the associations between aspects of care experience and a range of outcomes in late adolescence and early adulthood, comparatively few studies have investigated their perceived opportunities for their future lives as a potential protective factor (Somers et al., 2020; Van Audenhove & Vander Laenen, 2017). In this study, we investigated the relationship between care experienced children’s placement instability and their perceived opportunities for the future. We also investigated the potential moderating role of caregivers’ positive expectations on this relationship.
Perceived Opportunities
Expectations, hopes, and dreams for the future are of great importance to children and adolescents (Seginer et al., 2004). Sometimes termed ‘future orientations’, studies of perceived opportunities have investigated the content of these expectations. Seginer reported a consensus that individuals consider their future in relation to domains for work and career, relationships, family, and education. While research has considered the extent to which individuals value these respective domains, how far they ‘look ahead’ and their ability to plan accordingly (Nurmi, 1991; Seginer et al., 2004; Steinberg et al., 2009), recent studies have focused predominantly on positive expectations and the likelihood of future events. Cui et al. (2020) found that children’s positive expectations of future career and employment, education, and family at age 14 was associated with higher levels of social competence, and that these expectations attenuated the effects of adversity on late adolescent levels of delinquency and substance use. Longitudinal research has also investigated the developmental course of maltreated children’s future orientation, based on expectations of employment, education, and life span (Oshri et al., 2018). Oshri identified three trajectories, with the first group starting and remaining positive about their future, and the second group having increasing expectations, while the third had decreasing expectations. Children in the first two groups were more likely to reach young adulthood milestones for employment and income. Overall, the findings suggested that expectations are not fixed and this may relate to experiences of adversity.
Despite limited research with care experienced people, there is evidence that they are optimistic about the future but that this optimism can be affected by increasing school moves (Somers et al., 2020). Courtney et al. (2010) also found that care-experienced young adults were also generally optimistic about the future, though their expectations for life expectancy, marriage, divorce, and income were low compared to a nationally representative sample of young adults. Courtney attributed these low expectations about the future to low self-sufficiency, potentially limited further by many leaving care without a support network in place.
The Role of Positive Caregiver Expectations
Parents play an important role in supporting children’s perceived opportunities, and Seginer et al. (2004) has argued that the parent-child relationship is associated with how children think about their future. Positive parenting - parenting that is child-centred, authoritative, and enabling - is particularly important to perception of the future. This has been extended to foster families, with studies demonstrating the importance of foster caregiver emotional responsiveness (Cashmore & Taylor, 2020), their ability to recognise and react to signals from the child (West et al., 2020), and their warmth and positive communication (Fuentes et al., 2015). Children who perceive positive parent support are more likely to be optimistic, trusting, and to have a positive attitude towards the future (Trommsdorff, 1983), while children in out-of-home care who perceived high levels of caregiver support were more engaged in school (Tilbury et al., 2014).
Parents have expectations of what their child should or will achieve. Evidence suggests that this is positively associated with their child’s motivation and achievement, for a review, see Wigfield et al. (2015), particularly in relation to education (Pinquart & Ebeling, 2020). Eccles' model of parental influences on children’s motivation and achievement (Eccles, 1993; Wigfield et al., 2015) emphasises the ways in which parent expectations may translate into how they socialise their children. For example, parents with positive expectations may be more likely to participate in and monitor achievement-related activities and structure the home environment in such a way to stimulate children’s learning. There is a paucity of research considering foster caregiver expectations and children’s perceived opportunities, though one study found that caregivers had lower expectations for their child than their child’s teacher (Eiberg & Olsen, 2022). However, the children of caregivers with positive expectations had better outcomes for maths and reading, potentially due to caregivers investing more resources (e.g., time, material resources) if they felt the child likely to succeed. Studies of different placement types have also found greater access to financial support and resources for those in non-relative foster care than kinship care (Cole, 2006; Winokur et al., 2018). Despite this difference in support, children in kinship care had better behavioural (Longshaw et al., 2024), mental health, and wellbeing outcomes (Delfabbro, 2020; Winokur et al., 2018). Studies have not previously focused on differences in expectations between settings, but it is conceivable that non-relative foster and kinship caregivers have different expectations for the children in their care.
While these studies suggest that positive parenting, and particularly the expectations of parents and caregivers, are important to the development of perceived opportunities, there is also evidence that the child’s own expectations are associated with their outcomes, including their educational attainment (Ou & Reynolds, 2008). Nurmi (2004) highlighted the importance of positive emotions and cognition in helping children frame their future selves, with this influencing their behaviour and positive development. Schmid et al. (2011) used a longitudinal approach to test the importance of hopeful expectations on the development of children, again finding relationships with youth development. Research on children in out-of-home care has also highlighted the importance of both the child’s optimism and parents’ social support in enabling engagement in school (Tilbury et al., 2014) and educational success (Sulimani-Aidan, 2015). Sulimani-Aidan (2017) also argued that these constructs aid the child’s resilience and motivation. Research has also theorised an interaction between children’s expectations and parental expectations for them, particularly in relation to educational achievement. Although the precise nature of this interaction remains unclear, evidence indicates that it is reciprocal and varies by the gender of both parent and child. For example. Niu, Fang and Qi (2025) found that fathers’ expectations exerted an increasingly strong influence on children’s expectations over time, while mothers’ expectations were associated with increased father expectations.
The Present Study
We investigated the relationship between placement instability in new episodes of out-of-home care and children’s perceived educational and employment opportunities. We also considered the attenuating role that caregiver expectations might play in buffering children from the effects of instability. We hypothesised that instability would be associated with lower perceived opportunities. We also hypothesised that positive caregiver expectations would attenuate the negative effects of placement instability on perceived opportunities. Due to the lack of research into how carer expectations vary for different placement types, we also planned to explore whether the moderation effect would vary for children in kinship versus non-relative fostering placements.
Method
Participants
Preadolescent children (ages 9–11 years old) and their caregivers were recruited for a randomized controlled trial of a preventive intervention, the Fostering Healthy Futures program, between 2007 and 2011 in a large metropolitan area of the Western U.S (Taussig et al., 2007). Data used in the current study were collected from baseline interviews that took place prior to randomization. The children were recruited if (1) they had experienced a new episode of out-of-home care due to maltreatment by court order within the preceding year (i.e., a first or new removal from their homes), and (2) they still resided in out-of-home care at the time of the baseline interview.
Of the eligible children, 89.5% (N = 270) were recruited for the study. When participants were part of a sibling group (n = 22) or shared the same caregiver (n = 9), one participant of the group was randomly selected for analysis. In addition, children who were living in congregate care (n = 9), or who had missing data (n = 3) were excluded from this study, resulting in a final sample of N = 227. The participants’ mean age was 10.25 years (SD = 0.91). Half (52.0%) were male, and 48.0% female. The participants’ self-reported racial/ethnic identities were non-exclusive, as follows: 53.3% Hispanic, 53.3% White, 37.4% American Indian, and 25.1% Black. Almost two-thirds (n = 143, 63%) were living in kinship care; the remainder (n = 84, 37%) were in non-relative foster care.
Procedure
This study was approved by the University of Denver's Institutional Review Board, and informed consent and assent were obtained from all participants. Children and their current caregivers were interviewed by separate interviewers, typically in their homes and at the same time. All interviewers received substantial training, and interviews were regularly observed for quality and consistency. All questions were read aloud by interviewers. Children and caregivers received an incentive of $40.00 for their participation.
Measures
Placement Instability
Placement instability was measured by a single item that asked interviewers to calculate and report the number of homes the child had lived in during the current episode of out-of-home care. This was calculated by creating a chronological log with the participants of their official living placements during that episode, excluding reunification. This variable was operationalized as the number of moves between placements. This ranged from zero (children who stayed in their first placement) to four placement moves.
Child-Reported Perceived Opportunities
Children completed a ten-item scale of perceived opportunities that asked about the likelihood of achieving various accomplishments. The items included (1) graduating high school; (2) going to college; (3) job that pays well; (4) job they enjoy doing; (5) happy family life; (6) good health; (7) good friends to count on; (8) success if work hard; (9) getting what want out of life and 10) things working out the way you want them to. Each item had three response options (0 = low chance; 1 = medium chance; 2 = high chance). The questions were obtained from the Adolescent Risk Behaviour Survey that combined three separate valid and reliable scales of risk behaviours (for more information, see Taussig, 2002).
Caregiver Perceived Expectations
Interviews with the caregivers included the question: ‘What will your child’s life be like in 10 years?’. Responses were transcribed verbatim and coded for the presence of positive, negative and uncertain expectations about the child. Carer expectations were largely positive and concerned language relating to the child (for example, “Going to be okay”), comments about success in school, further study or work (“Very stable and strong individual. Successful”) or mention of hopes or a positive future (“I hope she follows her dreams and succeeds - I’m there to help her”). This informed the decision to code responses that were evidence of exclusively positive expectations (1). Responses that were negative or uncertain, or that included mixed comments were coded as not exclusively positive (0). Inter-rater reliability was established on 20% of the sample (k = .85).
Data Analysis
Collinearity between each variable pair of the ten perceived opportunities items was assessed to enable the latent factor development, where each included indicator was representative of a different facet of perceived opportunities. Persistent multi-collinearity or poor linearity among variable pairs informed decisions to remove individual variables. A Principal Component Analysis (PCA) was then conducted to assess the optimal number of factors.
Moderation studies enable investigation of interactions between various risk factors and protective factors. This study used an approach highlighted by Cui et al. (2020) for analysing adversity and the different aspects of caregiving for children who are care-experienced. Mplus (Muthén & Muthén, 2017) was used for the development of structural equation models (SEM) due to its strength in analysing categorical data. There was a high level of positivity for all ten of the perceived opportunities items but the lack of variation in the data resulted in the decision to dichotomise each item by merging the low and medium chance responses. Identification was aided by constraining the first indicator of the perceived opportunities latent factor (graduating high school) to 1, ensuring that other factor loadings were calculated relative to this.
Three models were developed. The first model tested for an association between placement instability and perceived opportunities in the absence of caregiver expectations as a moderator. The second model tested whether the interaction between placement instability and positive caregiver expectations was associated with perceived opportunities. The aim of the third model was to explore whether the interaction was different for children in non-relative foster and kinship care placements. However, the modest sample size combined with uniformly high levels of placement stability, positive caregiver expectations and perceived opportunities in the kinship group, resulted in the model not converging for that group. As a result, only the non-relative fostering subgroup was included. The interactions in the second and third models were probed using the simple slopes method.
Results
Descriptive Statistics
Sociodemographic Characteristics of Sample, and Subsamples by Placement Type
***p < .001.
Latent Factor Development
Linearity Results for Indicator Pairs. The First Four Indicators Were Included in the Perceived Opportunities Later Factor
Placement Instability and Perceived Opportunities
The first model tested the association between placement instability and perceived education and employment opportunities, without the inclusion of caregiver expectations as a moderator. Although the effect was not statistically significant (β = −0.128, p = .082), the negative coefficient suggests that perceived opportunities tended to decrease as placement moves increased (Figure 1). Table 3 contains the full results, including the confidence intervals, latent factor loadings and model fit statistics. Structural equation model diagram of the association between placement instability and perceived opportunities. Standard errors in brackets. (N = 227). Model fit ranged from very good for indices with sensitivity to modest sample sizes: CFI = 0.975; TLI = 0.951) to good (SRMR = 0.039; RMSEA = 0.094 (CI: 0.051–0.150; p. = 0.078) Standardised Results of the Base Structural Equation Model Assessing the Association Between Placement Instability and Perceived Opportunities *p < .05; **p < .01; ***p < .001. Model fit ranged from good to acceptable: CFI = 0.975; TLI = 0.951; SRMR = 0.039; RMSEA = 0.094 (CI: 0.051-0.150; p = 0.078).
Parent Expectations as a Moderator
The second model tested the interaction between placement instability and caregiver expectations and found that it was associated with perceived education and employment opportunities in the whole sample (Figure 2). The simple slope test (Figure 3) again indicated that perceived opportunities decreased as placement instability increased (β = −0.363, p = .005). However, while this effect was not statistically significant in the first model, positive caregiver expectations significantly moderated this relationship in the revised model (β = 0.338, p = .018). This suggests not only that caregiver expectations buffer the negative effects of instability, but that the relationship between placement instability and perceived opportunities is dependent on the presence of the moderator. Furthermore, the effect of instability on perceived opportunities was greater when caregiver expectations were low, with this effect reduced for children whose carers had positive expectations. Table 4 presents the full results for the moderated model including the latent factor loadings. Structural equation modelling diagram of how caregiver expectations attenuate the interaction between placement instability and caregiver expectations for the whole sample. Standard errors in brackets. (N = 227). Model fit range from very good for indices with sensitivity to modest sample sizes: CFI = 0.963; TLI = 0.939) to acceptable (SRMR = 0.052; RMSEA = 0.074 (CI: 0.035–0.114; p. = 0.137) Standardised simple slopes of how caregiver expectation attenuates the effect of placement instability on perceived opportunities Standardised Results for the Moderated Structural Equation Model of How Caregiver Positive Expectations Attenuate the Association Between Placement Instability and Perceived Opportunities *p < .05; **p < .01; ***p < .001. Moderated model fit ranged from good to acceptable: CFI = 0.963; TLI = 0.939; SRMR = 0.052; RMSEA = 0.074 (CI: 0.035-0.114; p = 0.137).

Moderated Model for the Non-Relative Fostering Subsample
Exploratory analysis was used to consider variation in the interaction between placement instability and caregiver expectation for the fostering and kinship groups, though the model did not converge for the kinship group. The results for the foster group only are therefore included in the Online Supplement, with this including the table of results (S2), SEM diagram (S3) and simple slopes test (S4). The results indicate that the interaction between placement instability and positive carer expectations was again associated with perceived employment and education opportunities in the non-relative fostering group.
Discussion
We considered the association between placement instability and perceived opportunities of care experienced children, with caregiver expectations about the child’s future included as a moderator in later models. A latent factor was developed for perceived opportunities with four employment and education-related items that represented graduating school, attending college, having an enjoyable job, and having a job that is well paid. The initial model indicated an association between increasing placement instability and lower levels of perceived opportunities within a large sample of care-experienced children, though this association was not statistically significant. This finding aligns with studies that have demonstrated associations between placement instability and outcomes of care experienced children (Engler et al., 2022; Fisher et al., 2013; Jones et al., 2011).
We also tested whether the association between placement instability and perceived education and employment opportunities was moderated by positive caregiver expectations of the child’s future. Although research has demonstrated the importance of positive parenting including emotional responsiveness, parental warmth, and communication (Cashmore & Taylor, 2020; Fuentes et al., 2015), there has been little consideration of how caregiver factors relate to how care experienced children think about the future. Our study found that positive caregiver expectations attenuated the relationship between placement instability and perceived opportunities. This suggests that caregiver expectations could be a protective factor, though this finding is interpreted with caution given the use of an interview question coded as a single-item bivariate variable. One possible explanation relates to caregiver expectations but also differences in the family environment. As parents with high expectations are also known to be more interested and engaged in their child’s education and future career (Eccles, 1993; Wigfield et al., 2015), foster caregivers with similar expectations may exhibit a caregiving style characterised by these behaviours. This may help explain foster children’s increased sense of perceived opportunities when they are removed from a challenging environment likely characterised by immediate and wider family challenges. However, putative protective factors are unlikely to fully mitigate the effects of early adversity, as the adjustment of children to caregivers who have positive expectations can depend on their experiences while in care and characteristics of the placement itself, including type (Cole, 2006; Delfabbro, 2020; Winokur et al., 2018).
As such, we also explored whether the interaction between placement instability and caregiver expectation varied for children in non-relative foster and kinship care. The descriptive statistics for this study indicated greater placement stability for those in kinship care, while children in foster care placements were more likely to experience multiple placement moves. Furthermore, kinship caregivers were more likely to have positive expectations about their children’s futures than non-relative foster caregivers. Past studies (Delfabbro, 2020; Winokur et al., 2018) have also demonstrated differences between kinship and non-relative foster care, including non-relative foster caregivers having greater access to services, and children in kinship foster care placements having fewer behavioural issues, better health and wellbeing, and greater stability. While this could be due to the kinship foster caregiver feeling a sense of duty and connection to the child as a member of their family, this greater positivity could also reflect their genuine view of the child, particularly if their living in a stable home results in an increased sense of permanency and a better relationship with the caregiver (Cole, 2006; Delfabbro, 2020; Winokur et al., 2018). However, the final moderation analysis comparing the two placement types did not converge for the kinship group, preventing formal tests of whether differences between non-relative foster care and kinship care were statistically significant. The descriptive findings should therefore be interpreted with caution.
While the current study focused on perceived education and employment opportunities and the role of caregiver expectations in attenuating the effect of placement instability, the provision of actual opportunities remains key in supporting the transition of foster care children to adulthood and independent living. Gypen et al. (2017) has highlighted the importance of job schemes, mental health services and mentoring in reducing the education, employment, health and housing gap between foster care children and their peers. Furthermore, Holten and Valset (2025) demonstrated how the provision of these ‘aftercare’ services can act as a moderator for the challenges of transitioning from school to work. Scannapieco et al. (2007) also indicated a need for youth-driven opportunities for foster-care leavers to lead and develop skills, and for services to collaborate more in the production of an array of services suitable to children leaving foster care. Supervised Independent Living Programs (SILPs) have been designed in the U.S. to support the transition from foster care to independent living through services including financial assistance, education support, housing assistance and the development of practical skills (Tuyishime et al., 2024), and an evaluation of programs has highlighted the particular value of post-secondary education support, financial support and extending the age that people can remain in foster care (Liu, 2020).
Limitations
We acknowledge limitations. First, the study was successful in recruiting 89.5% of children who were living in the geographical area, in a new episode of out-of-home-care and still in care at the time of the baseline interview. While this compares favourably to other studies, there is a risk of selection bias due to systematic differences between those who did and did not participate. The use of incentives is expected research practice in the United States, but it could also contribute to this bias. Additionally, the voices of care-experienced children are vital to understanding their lives and improving policy and practice, but there may be a reluctance to disclose personal information in research contexts. This could affect responses to questions pertaining to number of moves and reasons for placement instability, creating a risk of social desirability bias. While training, observations and supervisions were used to ensure consistency between interviewers, it is possible that the administration of the survey by different interviewers affected responses.
We focused on perceived opportunities, specifically whether children expected to succeed in future education and employment. This decision was made because indicators for health, family, and relationships were removed due to low coherence within the perceived opportunities latent factor. Future work on measurement approaches could incorporate these domains. Research on perceived opportunities has also expanded to include how much children and young people think about the future, the extent to which they value these domains, whether they feel able to influence them, and the degree to which they take action to achieve their goals (Nurmi, 1991; Seginer et al., 2004; Steinberg et al., 2009). These dimensions represent important avenues for further investigation among care-experienced children.
The final aim of the study was to develop multi-group models to assess the difference between kinship and non-relative fostering settings. This was challenging, in part due to the modest sample sizes when seeking to compare the subgroups. There was also a lack of variation in the kinship fostering group data, with uniformly high levels of placement stability, positive caregiver expectations and children’s optimistic reports of perceived opportunities. This resulted in the kinship model not converging, and the model being developed for the non-relative fostering group alone. It was therefore not possible to consider whether the differences between the groups were statistically significant; this could be an area for further research.
The interviews with the children included detailed discussion on where the children had lived while in the new episode of out-of-home care. While there is a possibility that the children forgot certain moves, the maximum one-year timespan and structured approach to understanding the number of moves reduces this risk. In considering opportunities for further work, there is the potential to develop a more complex measure of placement instability for detecting variation within the group. We defined instability as the number of placement moves (Fisher et al., 2013), but other studies have framed placement stability as continuity in the caregiver that the child lives with. These studies have incorporated multiple aspects of the in-care experience including changes in placement but also total time in care, time in each placement and type of placement (Asif et al., 2024). Similarly, caregiver positive expectations for their child’s future were assessed by analysing open responses to a survey question. A more in-depth qualitative question, or potentially a five-minute speech sample of the caregiver talking about the child, would provide the data for a more detailed analysis (Sher-Censor, 2015). Alternatively, quantitative measures with multiple items have also been developed to assess the parental expectations in the context of educational achievement (Neuenschwander et al., 2007; Pinquart & Ebeling, 2020) and career development (Zhou et al., 2024). The use of these measures, and the possible development of equivalents for relationships, marriage and family would enable more nuanced analysis of parental expectations.
Implications and Future Directions
Research into the factors that influence outcomes for care-experienced children has informed the development of interventions with the aim of improving behaviour (Fisher et al., 2009) and increasing placement stability (Price et al., 2008b; Taussig et al., 2012). There is the potential for further research into additional factors that contribute towards placement instability, for example including caregiver affluence or birth family circumstances, but also for research that evaluates interventions focused on the child’s relationship with the caregiver. Most intervention studies with care-experienced children have focused on training or raising caregivers’ awareness of the benefits of warmth, positive communication, and rules-based caring (Fuentes et al., 2015), behavioural and attachment problems (Gabler et al., 2014) and the child’s needs (Cole, 2006; West et al., 2020). Such interventions may positively impact caregiver expectations, but more research on this outcome is needed. No interventions specifically targeting caregivers’ expectations for their children were found, so there is good potential to develop interventions. These interventions could emphasise the importance of communicating positive expectations for children’s futures, as well as strengthening caregiver behaviours that may aid educational achievements or career development. In-depth consideration of how gender or education factors affect future prospects is outside of the scope of this study. However, future research could also look at differences between gender, and the role that teacher expectations and education more generally has in improving the perceived opportunities of care-experienced children.
Conclusion
We considered the relationship between placement instability and the perceived education and employment opportunities of children in care, and the potential for caregiver expectations to attenuate this relationship. The findings suggest that placement instability can have a detrimental effect on how children in out-of-home care perceive their future education and career opportunities, though this finding was only statistically significant with the inclusion of positive caregiver expectations as a moderator. Caregiver positivity, particularly in relation to their expectation for the child, appears important to reducing these effects. Future interventions could be developed to boost these caregiver attributes.
Supplemental Material
Supplemental Material - The Moderating Role of Positive Caregiver Expectations on the Relationship Between Placement Instability and the Perceived Education and Employment Opportunities of Care Experienced Children
Supplemental Material for The Moderating Role of Positive Caregiver Expectations on the Relationship Between Placement Instability and the Perceived Education and Employment Opportunities of Care Experienced Children by Edward Janes, Katherine Shelton, Amy Paine, Heather Taussig in Developmental Child Welfare
Footnotes
Acknowledgements
We wish to express our appreciation to the young people who made this work possible and to the participating county departments of social services for their ongoing partnership in the Fostering Healthy Futures project. We also thank the program staff, especially the project managers, research assistants and project interviewers.
Ethical Considerations
The Colorado Multiple Institutional Review Board approved the study (#02-516) and respondents gave informed consent and assent before starting interviews.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was primarily supported by the National Institute of Mental Health (K01 MH01972, R21 MH067618, and R01 MH076919, H. Taussig, PI) as well as by the Kempe Foundation, Pioneer Fund, Daniels Fund, and Children’s Hospital Research Institute. Dr. Taussig’s time and effort were also supported by a U.S. Fulbright Scholar Award.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
Data available on request due to privacy/ethical restrictions.
Supplemental Material
Supplemental material for this article is available online.
References
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