Abstract Objective To examine the frequency and predictors of out-of-home placement in a 30-month follow-up for a nationally representative sample of children investigated for a report of ...maltreatment who remained in their homes following the index child welfare report. Methods Data came from the National Survey of Child and Adolescent Well-being (NSCAW), a 3-year longitudinal study of 5,501 youth 0–14 years old referred to child welfare agencies for potential maltreatment between 10/1999 and 12/2000. These analyses focused on the children who had not been placed out-of-home at the baseline interview and examined child, family and case characteristics as predictors of subsequent out-of-home placement. Weighted logistic regression models were used to determine which baseline characteristics were related to out-of-home placement in the follow-up. Results For the total study sample, predictors of placement in the 30-month follow-up period included elevated Conflict Tactics Scale scores, prior history of child welfare involvement, high family risk scores and caseworkers’ assessment of likelihood of re-report without receipt of services. Higher family income was protective. For children without any prior child welfare history (incident cases), younger children, low family income and a high family risk score were strongly related to subsequent placement but receipt of services and case workers’ assessments were not. Conclusions/practice implications Family risk variables are strongly related to out-of-home placement in a 30-month follow-up, but receipt of child welfare services is not related to further placements. Considering family risk factors and income, 25% of the children who lived in poor families, with high family risk scores, were subsequently placed out-of-home, even among children in families who received child welfare services. Given that relevant evidence-based interventions are available for these families, more widespread tests of their use should be explored to understand whether their use could make a substantial difference in the lives of vulnerable children.
Abstract Background Children, particularly minority children, referred to child welfare because of suspected maltreatment are vulnerable and need many services. We sought to assess whether service ...use has improved over the past decade and whether racial-ethnic disparities in service use have decreased. Methods We used 2 national data sets (the National Survey of Child and Adolescent Well-Being NSCAW I and II) collected a decade apart to assess changes over time in health, education, mental health (MH), and dental services and overall service use. Results In NSCAW II more children were young, had lower Child Behavior Checklist (CBCL) scores, and were Hispanic. We found significant increases in dental services, a decrease in special education services, and a decrease in MH services on the bivariate level (all P < .01). A large proportion of the change in MH services occurred in school settings, but the pattern continued when examining only those services delivered outside of school. The greatest decrease occurred for children with CBCL scores <64. However, in multivariate analyses, older children, white non-Hispanic children, and children placed out of the home were significantly more likely to receive MH services. Rates of MH services controlling for CBCL scores showed no improvement over the decade, nor was there a decrease in racial and ethnic disparities. Conclusions These data showed no change in MH services over time for children referred for child welfare evaluation, but improvement in dental services was noted. Racial and ethnic disparities persist. Decrease in MH services occurred predominantly among children whose MH symptoms were below the clinical range.
To assess the presence of chronic health conditions (CHCs) among a nationally representative sample of children investigated by child welfare agencies.
The study included 5872 children, aged 0 to ...17.5 years, whose families were investigated for maltreatment between February 2008 and April 2009. Using data from the second National Survey of Child and Adolescent Well-Being, we examined the proportion of children who had CHC. We developed 2 categorical and 2 noncategorical measures of CHC from the available data and analyzed them by using bivariate and multivariable analyses.
Depending on the measure used, 30.6% to 49.0% of all children investigated were reported by their caregivers to have a CHC. Furthermore, the children identified by using diverse methods were not entirely overlapping. In the multivariable analyses, children with poorer health were more likely to be male, older, and receiving special educational services but not more likely to be in out-of-home placements.
The finding that a much higher proportion of these children have CHC than in the general population underscores the substantial health problems of children investigated by child welfare agencies and the need to monitor their health carefully, regardless of their placement postinvestigation.
Abstract Purpose The aim of this study was to examine prevalence and correlates of health-risk behaviors in 12- to 17.5-year-olds investigated by child welfare and compare risk-taking over time and ...with a national school-based sample. Methods Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were analyzed to examine substance use, sexual activity, conduct behaviors, and suicidality. In a weighted sample of 815 adolescents aged 12–17.5 years, prevalence and correlates for each health-risk behavior were calculated using bivariate analyses. Comparisons to data from NSCAW I and the Youth Risk Behavior Survey were made for each health-risk behavior. Results Overall, 65.6% of teens reported at least one health-risk behavior with significantly more teens in the 15- to 17.5-year age group reporting such behaviors (81.2% vs. 54.4%; p ≤ .001). Almost 75% of teens with a prior out-of-home placement and 77% of teens with child behavior checklist scores ≥64 reported at least one health-risk behavior. The prevalence of smoking was lower than in NSCAW I (10.5% vs. 23.2%; p ≤ .05) as was that of sexual activity (18.0% vs. 28.8%; p ≤ .05). Prevalence of health-risk behaviors was lower among older teens in the NSCAW II sample (n = 358) compared with those of the 2011 Youth Risk Behavior Surveillance System high school-based sample with the exception of suicidality, which was approximately 1.5 times higher (11.3% 95% confidence interval, 6.5–19.0 vs. 7.8% 95% confidence interval, 7.1–8.5). Conclusions Health-risk behaviors in this population of vulnerable teens are highly prevalent. Early efforts for screening and interventions should be part of routine child welfare services monitoring.
Abstract Objective To assess the sociodemographic, health, and mental health of children in different types of out-of-home placements after investigation by child welfare agencies; to determine ...whether there are systematic differences in the children and their caregivers by type of out-of-home placements; and to provide the first description of these characteristics in a nationally representative sample for children in informal kinship care after child welfare involvement. Methods Using data from the National Survey of Child and Adolescent Well-being (NSCAW II), we compared children (0–17.5 years) in formal nonkinship foster care, formal kinship foster care, and informal kinship care shortly after a child welfare investigation. All analyses were weighted to reflect the sampling design. Results Children in informal kinship care are at comparable risk of having chronic health conditions and poorer health but are less likely to receive school-based services. All children in kinship care (formal and informal) are less likely to be reported to have mental health problems and are more likely to live with older caregivers whose educational level is low and whose health is reportedly poorer. Conclusions Although children in kinship care have health problems similar to children in nonkinship foster care, they are likely to live in families with fewer economic and educational resources. This mismatch between need and access has implications for the long-term well-being of the children who are living in informal kinship arrangements without system-level support of formal foster care.
To examine the extent to which child welfare agencies adopt new practices and to determine the barriers to and facilitators of adoption of new practices.
Data came from telephone interviews with the ...directors of the 92 public child welfare agencies that constituted the probability sample for the first National Survey of Child and Adolescent Well-being (NSCAWI). In a semi-structured 40min interview administered by a trained Research Associate, agency directors were asked about agency demographics, knowledge of evidence-based practices, use of technical assistance and actual use of evidence-based practices. Of the 92 agencies, 83 or 90% agreed to be interviewed.
Agencies reported that the majority of staff had a BA degree (53.45%) and that they either paid for (52.6%) or provided (80.7%) continuing education. Although agencies routinely collect standardized child outcomes (90%) they much less frequently collect measures of child functioning (30.9%). Almost all agencies (94%) had started a new program or practice but only 24.8% were evidence-based and strategies used to explore new programs or practices usually involved local or state contracts. Factors that were associated with program success included internal support for the innovation (27.3%), and an existing evidence base (23.5%).
Directors of child welfare agencies frequently institute new programs or practices but they are not often evidence-based. Because virtually all agencies provide some continuing education adding discussions of evidence-based programs/practices may spur. Reliance on local and state colleagues to explore new programs and practices suggests that developing well informed social networks may be a way to increase the spread of evidence-based practices.
•Child welfare agencies commonly initiate new programs or practices but these are not usually evidence-based.•Agencies rely on other community agencies or state contracts to explore possible new programs/practices.•Well informed social networks may be a way to spread evidence-based practices.
This study examines the prevalence and correlates of heightened posttraumatic stress (PTS) symptoms in a nationally representative sample of 1,848 children and adolescents (ages 8-14) who were ...referred to child welfare for investigation of abuse or neglect based on the National Survey of Child and Adolescent Well-Being. The severity of current PTS symptoms was assessed using the PTS subscale of the Trauma Symptom Checklist for Children, a standardized child-report scale evaluating common symptoms associated with trauma. The overall prevalence of clinically significant PTS symptoms was 11.7% (overall mean T score = 49.5). The prevalence was higher for cases that were placed in out-of-home care (19.2%) than those maintained at home (10.7%). Multivariate hierarchical regression identified four contributors to heightened PTS symptoms: younger child age, abuse by a nonbiological parent, violence in the home, and child depression. The authors discuss the modest but still lower than expected prevalence of self-reported, clinically significant PTS symptoms and the variables associated with greater risk for heightened PTS symptoms found among cases referred to child welfare services.
Objective: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample ...in the United States.
Method: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2–15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale
T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use.
Results: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children.
Conclusions: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services.
French-language abstract not available at time of publication.
Objetivo: Determinar los factores influyentes en el uso de servicios externos de salud mental de profesionales de salud mental (OMHS) para niños en acogimiento, haciendo uso de una muestra nacional de probabilidad en los Estados Unidos.
Método: Como parte del National Survey of Child and Adolescent Well-being, se recogieron cuestionarios detallados de datos de 462 niños, de edades 2–15 años, que habı́an estado fuera del cuidado familiar durante aproximadamente 12 meses en el momento del muestreo. Un modelo de regresión logı́stica multivariado se utilizó para determinar la necesidad clı́nica, según fue medida de las puntuaciones T de 64 o mayor en las escalas de Problemas Total, Externalizando, o Internalizando del Achenbach Child Behavior Checklist (CBCL) y factores no clı́nicos que afectaban el uso de OMHS.
Resultados: Más de la mitad de los niños/as de la muestra recibieron OMHS al menos en una ocasión. La necesidad, la edad mayor y la historia de abuso sexual predijeron positivamente OMHS. Una historia de negligencia fı́sica predijo negativamente OSMHS. Los afro-americanos utilizaron menos servicios que los niños/as de antecedentes caucásicos en todas los valores del CBCL. Este hallazgo es particularmente saliente en los niveles bajos de las puntuaciones del CBCL; a niveles mayores, la discrepancia en el uso de servicios disminuye pero la proporción de niños/as que reciben servicios se mantiene menor para los niños afro-americanos.
Conclusiones: Este estudio nacional confirma los hallazgos previos referentes al uso de servicios de salud mental en datos a nivel regional. Las limitaciones en el uso de servicios impuestos por factores no clı́nicos, especı́ficamente: edad, raza/etnia y tipo de abuso necesita ser examinada con el objetivo de identificar las polı́ticas y prácticas implı́citas y explı́citas que puedan resultar en una distribución no equitativa de los servicios.
Despite the field's understanding of individual and family level predictors of child maltreatment, research on neighborhood indicators of child abuse and neglect, especially in immigrant communities, ...is limited. This study employed a qualitative approach using semi-structured interviews to elicit perceptions of 28 key community informants to further understand the social dynamics of highly concentrated immigrant communities and their influence on child maltreatment. Thematic content analysis used coding consensus, co-occurrence, and comparison to analyze results. Findings suggest maltreatment reporting and behaviors may be related to three themes concerning the socio-cultural context of immigrant communities. Themes are cultural norms and values, fear and mistrust, and lack of knowledge and misinformation. Suggestions for neighborhood-level interventions in immigrant communities are presented.
With increased workforce diversity, human service organizations are recognizing the need to create inclusive workplaces; yet little is known about how leaders can enhance workplace inclusion. We ...collected data at three time points in 6-month intervals from a public child welfare organization (n = 363). Using latent change score models, we analyzed whether leader-member exchange influenced how inclusion changed over time. Results indicate that favorable perceptions of leader-member exchange are associated with increased feelings of inclusion 6 and 12 months later. Findings highlight the importance of improving leadership interactions with their employees to increase workplace inclusion.
PDF
