The impacts of family treatment drug court on child welfare core outcomes: A meta-analysis

BackgroundSubstance abuse has been prevalent among caregivers involved in child welfare and is a major barrier to their achieving favorable outcomes. Family Treatment Drug Courts (FTDCs) have been viewed as one of the most promising interventions but research has reported mixed effects on child welfare outcomes. No meta-analysis was conducted to synthesize the findings to reach a more generalizable conclusion.ObjectiveThe meta-analysis synthesized findings from existing evaluations to examine whether and to what extent FTDC participants achieved better reunification and safety outcomes than non-participants.Participants and SettingAmong 17 identified studies dated from 2004 to 2018, the pooled sample subjects in the intervention and comparison groups were 3402 and 3683 for the 16 studies on reunification outcomes, and 842 and 632 for the eight studies on child safety outcomes.MethodsWe first estimated the FTDCs’ pooled effects on child reunification and safety outcomes. Furthermore, we conducted a series of subgroup meta-analysis to compare FTDCs’ effects across study and program characteristics.ResultsSubjects participating in FTDCs were substantially more likely to achieve reunification (OR = 1.75, 95% CI = 1.38, 2.22) without increasing the risk of subsequent foster care reentry or maltreatment re-report. Subgroup meta-analysis suggests factors such as research design, FTDC model, observation length, publication type and period may contribute to FTDCs’ disparities on reunification outcomes.ConclusionsThe synthesized findings strengthen evidence for the implementation and expansion of FTDCs for serving substance abusing caregivers in the child welfare system.     

Maltreatment following reunification: Predictors of subsequent Child Protective Services contact after children return home

ObjectivesThis study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment.MethodA longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment.ResultsChildren in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification.ConclusionsSupports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports.Practice implicationsThis study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.     

The profile and progress of neglected and abused children in long-term foster care

ObjectivesThis study compared the profile of neglected and abused children in the Australian foster care system as well as differences between maltreatment types in relation to parental contact, reunification and psychosocial progress in care.MethodThe case files of 235 children entering foster care were examined and their social workers were administered standardised questionnaires at the point of intake. All measures were repeated for those remaining in care 1 year and then again 2 years later.ResultsNeglected children were younger than non-neglected children, more likely to have a physical or mental disability, more likely to experience multiple forms of maltreatment and less likely to pose conduct problems for carers. Neglected children were more likely than non-neglected children to experience a decline in parental contact over time, and were less likely to be reunified with their families of origin. There was minimal difference between neglected and non-neglected in their psychosocial progress while in care. Aboriginal children were more likely to be reunified than non-Aboriginal children when neglect was attributable to transient factors (parental incapacity) but the reverse was true for non-neglected children.ConclusionsThe fact that neglected children more often require a second form of maltreatment before being removed from home suggests that children's services workers are less inclined to remove children for neglect than for other forms of maltreatment. As a consequence, those neglected children who are in care tend to come from more dysfunctional families than non-neglected children do, as evidenced by the relatively poorer parental contact and reunification results of neglected children.Practice implicationsNeglected children differ systematically from non-neglected children and suffer relative disadvantage in relation to multiple forms of maltreatment, parental contact, and reunification. The fact that declines in parental contact among neglected children in care occurred only when indirect contact was provided suggests that, wherever possible, care plans should include face-to-face visits and overnight stays rather than being restricted to less direct forms of contact. The difference in the success of reunification according to type of neglect (chronic or transient) also suggests that parental intervention programs need to focus their efforts on chronic factors rather than transient parental factors.     

Parenting intervention effects on reunification: A randomized trial of PMTO in foster care

Evidence-supported parenting interventions (ESPIs) have expanded into child welfare because a growing research base has demonstrated positive results among children with serious emotional and behavioral problems. Despite a clear federal policy emphasis on reunification, few randomized trials have tested ESPIs with biological families of children in foster care; even fewer studies have investigated the distal outcomes of ESPIs. The aim of the current study was to examine the effects of Parent Management Training, Oregon (PMTO) model on reunification. Children in foster care with emotional and behavioral problems were randomized to in-home PMTO (n = 461) or services as usual (SAU) (n = 457). Cox regression models tested whether children in the PMTO group achieved higher rates of reunification. We applied life tables data for integrals calculations to estimate days saved in foster care. Analyses were conducted as intent-to-treat (ITT), and per protocol analysis (PPA). ITT results showed reunification rates were 6.9% higher for the PMTO group (62.7%) than the SAU group (55.8%) with 151 days saved per typical child. PPA indicated that intervention completion strengthened effects as PMTO completers’ reunification rates (69.5%) were 13.7% higher than the SAU group (55.8%), and were 15.3% higher than non-completers (54.2%). Days saved were also greater for completers as compared to the SAU group (299 days) and non-completers (358 days). Overall, findings suggest that an in-home parenting intervention positively affected reunification as delivered to biological parents of children and youth in foster care with serious emotional and behavioral problems. Implications and future considerations for research are discussed.     

Mothers in methadone treatment and their involvement with the child protection system: A replication and extension study

Objectives

Although a high level of involvement with the child protection system has been identified in families where parental substance use is a feature, not all such parents abuse or neglect their children or have contact with the child protection system. Identifying parents with substance-use histories who are able to care for their children without intervention by the child protection system, and being able to target interventions to the families who need them the most is important. This study interviewed a relatively large sample of mothers about their histories, their children and their involvement with the child protection system. We hypothesized that mothers in opioid pharmacological treatment who are involved with child protection services are different in characteristics to those mothers who are not involved.

Methods

One hundred and seventy-one women, with at least one child aged under 16 years, were interviewed at nine treatment clinics providing pharmacological treatment for opioid dependence across Sydney, Australia.

Results

Just over one-third of the women were involved with child protection services at the time of interview, mostly with children in out-of-home care. Logistic regression analyses revealed that factors which significantly increased the likelihood of the mother being involved with the child protection system were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with her own parents.

Conclusions

This study replicates and extends the work of Grella, Hser, and Huang (2006) and the limited literature published to date examining the factors which contribute to some substance-using mothers becoming involved with the child protection system while others do not. The finding that mental health problems and parental supports (along with the number of children) were significantly associated with child protection system involvement in this study, indicates a need for improved interventions and the provision of treatment and support services if we are to reduce the involvement of the child protection system with these families.     

How does family drug treatment court participation affect child welfare outcomes?

Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectiveness of FDTCs in North Carolina on child welfare outcomes. Data come from North Carolina records from child protection services, court system, and birth records. Three types of parental participation in a FDTC are considered: referral, enrolling, and completing an FDTC. The sample includes 566 children who were placed into foster care and whose parents participated in a FDTC program. Findings indicate that children of parents who were referred but did not enroll or who enrolled but did not complete had longer stays in foster care than children of completers. Reunification rates for children of completers were also higher. Outcomes for children in the referred and enrolled groups did not differ in the multivariate analyses. While effective substance use treatment services for parents may help preserve families, future research should examine factors for improving participation and completion rates as well as factors involved in scaling programs so that more families are served.     

Can the actions of child welfare case managers predict case outcomes?

This study examined the effect of efforts made by child welfare case managers to involve parents in case processes on two divergent case outcomes: reunification and the termination of parental rights (TPR). The sample was comprised of a cohort of children who received child protection services while in out-of-home care during fiscal year 2009–2010 and were randomly selected by the Florida Department of Children and Families (DCF) for their case management quality of practice reviews. Findings revealed that when child welfare case managers made efforts to encourage and support parents in participating in child-related decisions and activities, there were increased chances for timely reunification. However, these same efforts were only associated with a lower risk of TPR for mothers and not for fathers. Implications of these findings are discussed.     

Intergenerational transmission of child maltreatment: Predictors of child emotional maltreatment among 11 to 17 years old children residing in communities of Karachi,Pakistan

ObjectiveFamilies where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11–17 years old children residing in peri-urban and urban communities of Karachi, Pakistan.MethodStructured interviews were conducted with 800 children and parents-pair using validated questionnaire “International Child Abuse Screening Tool for Child (ICAST-C)” comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression.ResultsThe average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P < 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse.ConclusionThe current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings’ rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration.     

Predictors of Parenting: Family-Wide and Child-Specific Factors

Objective. The goal of the study was to identify determinants of child perceptions of parenting. Design. By using two children per family, the current study predicted siblings’ (106 pairs) perceptions of mothering and fathering at ages 9–13 from children’s perceptions of parenting and parent ratings of child difficulty, parental emotionality, and household organization, when the children were 4–8 years old. Multi-level modeling was used to differentiate between- and within-family variation. Results. Stability in child perceptions was moderate, and this stability was due to family-wide parenting shared by siblings. Conversely, the majority of variance in the 9- to 13-year-olds’ perceptions indicated differential, rather than similar, parental treatment. Maternal anger predicted maternal hostility. In contrast, household chaos predicted paternal hostility. Conclusions. Relationships between individuals in the family are part of a larger system, and children are equally as likely as parents to reap the benefits of services or interventions directed toward enhancing maternal well-being.     

Child Care Decision Making: Understanding Priorities and Processes Used by Low-Income Families in Minnesota

Research Findings: Few studies have described parents' child care decision-making process, yet understanding how parents make child care choices is fundamental to developing effective services to promote the selection of high-quality care. This study used latent profile analysis to distinguish subgroups of low-income parents identified as having commonalities in the number of options, duration, and sources of information sought as part of their child care decision-making process. Study participants included 260 parents who participated in the baseline wave of the Minnesota Child Care Choices study, a longitudinal phone survey of welfare applicants. Two subgroups of parents were identified. The majority of parents (82%) made choices within 2 weeks and considered on average 2 arrangements. Fewer than half of these parents considered information from experts, public lists, or family members/friends when making a child care choice. The remaining 18% of the sample took on average 11 weeks to make a child care choice, considered on average 3 options, and relied more heavily on information from experts and family members/friends. Practice or Policy: Findings from this study have implications for the marketing of resource and referral counseling services, Quality Rating and Improvement Systems, and consumer education aimed at facilitating the selection of high-quality care.     

School functioning of children in residential care: The contributions of multilevel correlates

ObjectiveThis study, using an ecological approach, examines the relationships between problems in school functioning (including academic and behavior problems) of children in residential care with a number of variables describing the child and the care setting.MethodsThe study reports on 4,061 children and youth (ages 6–20) in 54 Israeli residential care facilities supervised by the Ministry of Welfare. It is based on data derived from an ongoing system of monitoring care based on annual reports by social workers on children in care settings. Additionally, data on the characteristics of the settings were collected through a structured questionnaire completed by the supervisors at the Ministry of Welfare. Hierarchical Linear Modeling (HLM) was utilized to examine how characteristics of the individual children and the care settings were related to problems in school functioning among the children.ResultsMost of the children (about 62%) had at least one problem in school functioning. The most vulnerable children were boys, children who were taken from parental homes by court decree, children with problems in quality of contact with their biological parents, and children who stayed in the care setting for shorter periods. The settings’ characteristics most associated with poor performance at school are group structure (vs. mixed and family home structures), higher levels of peer violence, fewer after-school activities, and settings in which children tend to stay for shorter periods of times.ConclusionsThe findings demonstrate the need for an ecological perspective in addressing children's problems in school functioning within the care system. The results help to identify the types of placements that should benefit from additional resources in order to promote adaptive performance in school among the children.Practice implicationsSocial workers in residential care should give high priority to children's positive academic involvement. The study demonstrates the need for identifying the intersection of the individual, familial and institutional contexts in which problems in school functioning are more prevalent. Therefore, it is important to allocate sufficient resources to care settings which serve these children. The study suggests some priorities and directions for policy and practice with children in residential care.     

Change trajectories for parent-child interaction sequences during parent-child interaction therapy for child physical abuse

ObjectiveParent-child interaction therapy (PCIT) has been found to reduce future child abuse reports among physically abusive parents. Reductions in observed negative parenting behaviors mediated this benefit. The current study examined session-by-session interaction sequences in order to identify when during treatment these changes occur and how much the trajectory varies from case-to-case.MethodSession-by-session parent-child interaction sequences, using the Dyadic Parent-Child Interaction Coding System-II (DPICS-II) categories, were coded for 22 child welfare involved parent-child dyads undergoing PCIT for child physical abuse. A total 5,436 interactions across PCIT were coded and analyzed using growth curve analysis.ResultsAt pre-treatment baseline, negative and positive parental responses were about equally likely to follow a child positive behavior. This pattern changed rapidly during PCIT, with rapid increases in positive parental responses and decreases in negative parental responses to appropriate child behavior. A quadratic growth pattern accounted for 70% of observed variance and virtually all change occurred during the first three sessions.ConclusionChanges in observed abusive parent-abused child interaction patterns can occur early in PCIT, a parenting intervention that involves direct coaching and practice of skills. These benefits sustained throughout treatment.Practice implicationPrior to receiving behavioral parent training (PCIT), parents who have physically abused their children failed to match their parental response to their children's behavior. This pattern of interaction improved rapidly and substantially during the first three sessions of PCIT. The changes in the patterns of interaction also remained relatively stable for the remainder of treatment while parents continued to practice positive parental responses as well as began practicing effective discipline techniques. This suggests that use of immediate parent feedback through coaching, explicit directions to parents in how to respond to child behavior, and customization of the application of skills to the problems that arise in session are important components to effective parenting programs with physically abusive parents. Targeting these behaviors with PCIT has been found to reduce rates of recidivism, further supporting clinical application of PCIT in these cases.     

Relationship between out-of-home care placement history characteristics and educational achievement: A population level linked data study

Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children’s out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children’s educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N = 235,045 children, including 2160 children with a history of out-of-home care). Children’s educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR = 1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child’s care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification.     

Parental cognitive impairment and child maltreatment in Canada

Objectives

The aim of this study was to determine the prevalence of parental cognitive impairment in cases opened for child maltreatment investigation in Canada, and to examine the relationship between parental cognitive impairment and maltreatment investigation outcomes including substantiation, case disposition and court application.

Methods

The method was secondary analysis of the Canadian Incidence Study of Child Abuse and Neglect (CIS-2003) core-data, which is derived from a multi-stage stratified cluster sample of 11,562 child maltreatment investigations.

Results

Parental cognitive impairment was noted in 10.1% of sampled cases that were opened for child maltreatment investigation in 2003, and in 27.3% of sampled cases that resulted in child welfare court application. Neglect was the most common cause of concern. With child and case characteristics held constant, parental cognitive impairment predicted investigation outcomes. The data further suggest that the relationship between parental cognitive impairment and investigation outcomes was partially mediated by perceived parent non-cooperation, mental health issues and low social support.

Conclusions

The number of children who are living with a parent with cognitive impairment and who are referred for protective services is thought to be increasing. Building systems capacity to support parents with cognitive impairment and promote child wellbeing is therefore essential to containing the human and economic costs of maltreatment and out-of-home care.

Practice implications

A broad-spectrum approach is needed to support parents with cognitive impairment and their children. Equipping services with the knowledge, skills, and mandate they need to deliver evidence-based parent training is vital. However, strategies are also needed to tackle discrimination, alleviate family poverty, strengthen the social ties of parents with cognitive impairment and in turn, improve the life chances of their children.     

Disentangling the effect of out-of-home care on child mental health

BackgroundChildren in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children’s mental health outcomes from the effects of the adverse circumstances that led to their admission to care.ObjectiveThis research investigated the association between care placement and the presence of child mental health problems after controlling for children’s pre-care experiences. It also identified factors associated with mental health problems among children in care.Participants and SettingThe sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).MethodsThe mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.ResultsThe odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).ConclusionsThese findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.     

Parental Expectations of Early Childhood Services for Preschool Children: The case of policy change in Greece

This study aimed to investigate parental expectations of early childhood education and care services for young children. A total of 582 parents participated in the research and answered a range of questions relating to their expectations of the social and educational role of early childhood education services in Greece. The findings of the research confirmed that the administrative division between the types of preschool establishments are related with parental expectations for care provision (p < 0.001) and support for their needs (p < 0.05) during their absence from home to work. Also there was strong evidence that parents had high expectations for their collaboration with teachers of early childhood education about (a) solving their personal problems with their child at home (p < 0.001) (b) ensuring the best care provision for their child (p< 0.001) in the early childhood setting and (c) keeping their child happy at the preschool institution with fun activities when they have to go to work (p <0.001).     

Family,child and location factors and parents’ reasons for multiple concurrent childcare arrangements in the years before school in Australia

Research suggests that multiple non-parental care arrangements may have adverse effects on young children, yet little is known about their prevalence, factors associated with their use, or parents’ reasons for making these care arrangements. This longitudinal study reports on 677 children and their families recruited from government-regulated child care centers and family child care services in urban and rural New South Wales, Australia. Multiple concurrent care arrangements were relatively common, with one third of children attending at least two child care arrangements per week. Multiple child care was found to be more likely for children who were older, with better health, or with employed mothers, and who were living in rural rather than urban areas. Results suggest that parents’ reasons for using multiple care arrangements were based largely based on preferences that were made in the best interests of the child and on convenience. The deliberate choice by parents to use multiple child care arrangements to benefit their child challenges the assumption in previous literature that mixed care is not the parents’ first choice.