This study explored perceptions of community informants on socioenvironmental factors that explain why rates of child maltreatment reporting are different in neighborhoods with similar population ...characteristics. This study used data from the SoCal Neighborhoods and Child Welfare study, a multiphase, mixed-methods study of neighborhoods in Los Angeles and San Diego counties. Semistructured qualitative interviews with key informants (
N
= 28) in 22 census tracts explored factors that account for differences in maltreatment rates among sociodemographically similar neighborhoods. Thematic content analysis revealed three themes regarding neighborhood contributors to maltreatment behaviors and reporting: (a) community norms and values, (b) community resources and providers, and (c) housing dynamics and built environment. Findings indicate complexity in forces that affect maltreatment behavior and reporting. Adding to research on neighborhood social dynamics and child maltreatment, findings suggest that composite indicators of maltreatment within neighborhoods are affected by maltreatment behaviors and the definition, recognition, and reporting of maltreatment.
Abstract Objective Behavioral difficulties increase the risk that children will experience negative placement disruptions while in foster care. Chamberlain et al. (2006) found that the Parent Daily ...Report (PDR), a brief measure of parent-reported child behaviors, was a strong predictor of negative placement changes over 1 year among children receiving “usual case work” services. This paper sought to replicate and extend original findings regarding the PDR among 359 foster parents participating in a group parent-training intervention. Methods Foster parents of children experiencing a recent foster placement, and taking part in the KEEP parenting program, were included in analyses. Foster parents completed 16 weekly PDR calls about the behavior of a foster child in their care during the KEEP intervention and about their stress related to the child's behaviors. Multiple strategies, including latent class analysis of weekly PDR counts and continuous moving averages of PDR counts over shorter time frames, were used to test improvements in prediction of negative placement changes. Results Consistent with prior findings, children with elevated PDR ratings and children living with non-relative foster parents had significantly higher levels of negative placement disruptions. Prediction improved with decision rules relying upon increased amounts of weekly PDR information, although good prediction was achieved with 3–5 weeks of PDR information. Parent-reported stress associated with behavior did not improve prediction. Conclusions This study confirmed the potential utility of the PDR as a predictor of negative placement changes and illustrates how longitudinal PDR information may aid in improving such prediction. Potential applications of the PDR for improving the timing, type, and quantity of services offered to help foster parents prevent placement disruptions are discussed.
Objective:
We examine how frontline workers and supervisors delivering a research-supported intervention (RSI) to reduce child neglect negotiated system-related challenges, the pragmatics of RSI ...implementation, and their professional identities and relationships with clients.
Methods:
We conducted semi-structured interviews, small group discussions, and focus groups with frontline workers and supervisors in one large county over two time periods. We used iterative coding to analyze qualitative data.
Results:
Frontline workers navigated several aspects of RSI implementation and sustainment: (1) contract requirements and information dissemination, (2) fidelity, (3) competing demands and crises, (4) structure versus creativity, and (5) relationships with clients.
Conclusions:
Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system or organizational processes and to address the “committed work” supporting RSI delivery.
OBJECTIVE: This study examined the relationship between initiation of outpatient mental health service use and level of child welfare involvement. METHODS: Three levels of child welfare involvement ...were examined: in-home care and no child welfare services beyond an initial investigation, in-home care and additional child welfare services, and placement in out-of-home care (foster care). Longitudinal data were collected for a subsample of children (N=3,592) aged two through 14 years who were enrolled in the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children undergoing investigation for abuse or neglect. Event history analysis was used to model relative risk of initiation of mental health service use over time. RESULTS: Hazard functions revealed a large increase in onset of mental health services immediately after the time of the initial contact with child welfare, varying by level of child welfare involvement and leveling off by three months after the initial contact. The multivariate Cox proportional-hazards model indicated that compared with children who were placed in out-of-home care, those in in-home care who did not receive any further child welfare services were about one-third as likely to use mental health services and those in in-home care who received additional child welfare services were one-half as likely to use mental health services. Other covariates in the model predicted mental health service use, including being older, being Caucasian, having a history of maltreatment (specifically, physical abuse, physical neglect, or abandonment), being uninsured, and need for mental health services, as measured by the Child Behavior Checklist. CONCLUSIONS: Contact with child welfare functions as a gateway into mental health services for children in child welfare, even when need for such services is controlled for.
Abstract Objective To document the persistence and predictors of mental health problems in children aged 12 to 18 months investigated for alleged maltreatment. Methods Data came from the second ...National Survey of Child and Adolescent Well-being (NSCAW II), a longitudinal study of youth 0 to 17.5 years referred to US child welfare agencies. These analyses involved children 12 to 18 months. Baseline sociodemographic, social services, developmental data, and health data were collected on children and caregivers. Potential social-emotional problems at baseline were assessed with the Brief Infant–Toddler Social and Emotional (BITSEA) scales. Outcomes were scores over the clinical cutoff on the Child Behavior Checklist (CBCL) 1.5–5 assessed at 18 months after study entry. Results The multivariable analyses showed that an elevated BITSEA score at baseline (odds ratio 9.18, 95% confidence interval 1.49, 56.64; P = .018) and living with a depressed caregiver (odds ratio 13.54, 95% confidence interval 2.50, 73.46; P = .003) were associated with CBCL scores in the clinical range at the 18-month follow-up. For children who scored both positive on the BITSEA and lived with a depressed caregiver, 62.5% scored positive on the CBCL compared to 10.7% of the children with one risk factor and 3.8% of the children with neither risk factor. Only 23.9% of children and/or their caregivers received any service. Conclusions Data show considerable persistence of mental health problems in very young children that 2 factors could identify. Lack of services to these children is a tremendous missed opportunity for identification and treatment that could potentially prevent more serious mental health problems.
Child welfare service agencies provide parent training as part of their legally mandated responsibility to provide services to assist families to keep their children at home or to achieve ...reunification. The use of parent-training programs for families in the child welfare system has undergone relatively little examination. Mental health, special education, and juvenile justice have been identifying evidence-based approaches that have demonstrated effectiveness with children and families with conduct disorders and other behavioral problems, although few of these interventions have been tested with child welfare services clientele. This article brings together evidence about the most promising programs from other child service sectors with information about the current parent training approaches in child welfare and generates a range of proposals about next steps to enhance the capacity of parent training and fulfill the high expectations set in law and practice.
Purpose
– The purpose of this paper is to examine the experiences of Latino clients following a naturalistic cultural adaptation made to SafeCare, an evidence-based home visiting intervention ...designed to address specific linguistic and cultural issues affecting the Latino community during implementation in San Diego County, California.
Design/methodology/approach
– Hierarchical linear models examined whether Latino clients experienced differences in perceptions of SafeCare delivery, working relationship with the home visitor and satisfaction with services when compared with non-Latino clients and whether language of service delivery and provider-client ethnic match were related to Latino clients’ experiences of the intervention.
Findings
– Overall, across several different dimensions, there was no decrement in experience with SafeCare for Latino clients compared to non-Latino ones, implying that adaptations made locally adequately engaged Latino and Spanish-speaking clients in services without compromising perceived adherence to the programme model.
Research limitations/implications
– Because this was a non-experimental study, conclusions could not be drawn as to whether the locally adapted SafeCare would fare better in Latino client ratings than SafeCare unadapted. However, the findings are important because they contradict concerns that EBPs may not be relevant to diverse client groups, and support the idea that when adaptations are made, it is possible to maintain adherence at the same level of adherence as when the programme is delivered in its non-adapted form.
Originality/value
– The study explicitly documents and generates knowledge around an organic adaptation made in a community to an evidence-based intervention for a client group about whom there has been documented concern regarding the relevance of and engagement in services.
Objective: To describe the documented adherence to quality indicators for the outpatient care of attention-deficit/hyperactivity disorder, conduct disorder, and major depression for children in ...public mental health clinics and to explore how adherence varies by child and clinic characteristics. Method: A statewide, longitudinal cohort study of 813 children ages 6.0-16.9 years with at least 3 months of outpatient care, drawn from 4,958 patients in 62 mental health clinics in California from August 1, 1998, through May 31, 1999. The main outcome was documented adherence to quality indicators based on scientific evidence and clinical judgment, assessed by explicit medical record review. Results: Relatively high adherence was recorded for clinical assessment (78%-95%), but documented adherence to quality indicators related to service linkage, parental involvement, use of evidence-based psychosocial treatment, and patient protection were moderate to poor (74.1%-8.0%). For children prescribed psychotropic medication, 28.3% of the records documented monitoring of at least one clinically indicated vital sign or laboratory study. Documented adherence to quality indicators varied little by child demographics or clinic factors. Conclusion: Efforts to improve care should be directed broadly across clinics, with documentation of safe practices, particularly for children prescribed psychotropic medication, being of highest priority. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(2):130-144. Key Words: quality of care, child mental health attention-deficit/hyperactivity disorder, psychotropic medication, safety.
To 1) investigate the status of policies for comprehensive health assessments of children entering out-of-home care, 2) develop a profile for each primary sampling unit (PSU) regarding the ...comprehensiveness of its assessment policies with respect to physical, mental, and developmental health, and 3) examine the relationship between inclusiveness and the estimated percentage of children assessed, primary assessment location, and principal assessment provider type.
In collaboration with the National Survey of Child and Adolescent Well-Being, a national probability sample of 92 PSUs was identified. Detailed telephone survey data, addressing policies for the assessment of physical, mental, and developmental needs of children on entry into out-of-home care, were collected from child welfare key informants. Descriptive statistics were used for analyses, and were weighted to account for the sampling strategy.
Over 94% of PSUs surveyed assessed all children for physical health problems. The percentage of PSUs with inclusive policies regarding mental health and developmental assessment was much lower (47.8% and 57.8%, respectively). Only 42.6% of PSUs provided comprehensive physical, mental health, and developmental examinations inclusive of all children entering out-of-home care. Community locations and primary care providers were most often used to conduct assessments for physical and developmental problems.
Despite the publication of national guidelines regarding assessment, many PSUs do not have comprehensive policies or routine practices that address all children entering out-of-home care. Given the high use of primary care providers, these providers must be educated regarding the prevalence and types of problems experienced by children entering foster care.
Interdisciplinary research efforts integrating services and interventions research methodologies are needed to improve the “real‐world” clinical utility and impact of youth mental health research. ...“Hybrid” services and interventions research efforts can capitalize on the methodologic strengths of each research tradition in order to more rigorously examine and affect therapy processes in usual care youth mental health service settings. The goals of this article are to (a) identify the need for hybrid practice research on youth mental health care; (b) present a “case example” of a hybrid study, where child and family therapy processes are being examined in a usual care, practice‐based context by a team of services researchers; (c) address the potential advantages and challenges of hybrid research; and (d) suggest promising areas for future hybrid research in youth mental health care.
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