Most out-of-home placed children have experienced early adversities, including maltreatment and neglect. A challenge for caregivers is to adequately interpret their foster child’s internal mental states and behavior. We examined caregivers’ mind-mindedness in out-of-home care, and the association among caregivers’ mind-mindedness (and its positive, neutral, and negative valence), recognition of the child’s trauma symptoms, and behavior problems. Participants (N = 138) were foster parents, family-home parents, and residential care workers. Caregivers’ mind-mindedness was assessed with the describe-your-child measure. Caregivers’ recognition of the child’s trauma symptoms, their child’s emotional symptoms, conduct problems, prosocial behavior, and quality of the caregiver-child relationship were assessed using caregivers’ reports. Foster parents produced more mental-state descriptors than did residential care workers. General mind-mindedness, as well as neutral and positive mind-mindedness, related negatively to conduct problems. Besides, positive mind-mindedness was associated with prosocial behavior and neutral mind-mindedness with a better quality of the caregiver-child relationship and fewer child conduct problems. Negative mind-mindedness related positively to the caregiver’s recognition of the child’s trauma symptoms, and indirectly, to emotional symptoms. In conclusion, mind-mindedness seems to be an essential characteristic of out-of-home caregivers, connected to the understanding of their child’s behavior problems and trauma symptoms, as well as to the relationship with the child. The findings suggest a possible use of mind-mindedness in out-of-home care evaluation and intervention.