Reducing out-of-home placements of abused children: two controlled field studies

This study presents the outcome data on the effectiveness of social learning treatments in reducing out-of-home placements of abused children. Noteworthy are that true experimental designs used in both studies and their being conducted in a natural field setting, child protection services agencies. The results indicate that this model of family intervention is an effective alternative to out-of-home placements with this population for approximately 50% of typical child protection services caseloads. The cost benefits of social learning treatments are discussed along with potentially useful clinical and research directions.     

The ups and downs of child care: Variations in child care quality and exposure across the early years

There is considerable policy interest in understanding the role of child care in children’s development. Yet little research has examined whether individual children experience changes in child care quality across their early years, and less has included children’s varying levels of exposure to care in analyses of child care trajectories. Using data from the NICHD Study of Early Child Care, this study seeks to fill these gaps by studying the non-maternal care experiences of children whose mothers work at some point during their early years. We find that few of these children experience continuously high-quality care or continuously low-quality care. Instead, many children experience changes in child care quality. Children from low socioeconomic status families are more likely to experience low-quality care than children who are never poor, but children who are never poor are more likely to have child care histories that include both low- and high-quality care arrangements. We discuss the implications of our findings for studies of selection into low-quality child care arrangements and the effects of child care quality on children’s development.     

Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey

Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011–2012 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0–17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children’s health and wellbeing throughout the life course.     

Testing a theory of organizational culture,climate and youth outcomes in child welfare systems: A United States national study

Theories of organizational culture and climate (OCC) applied to child welfare systems hypothesize that strategic dimensions of organizational culture influence organizational climate and that OCC explains system variance in youth outcomes. This study provides the first structural test of the direct and indirect effects of culture and climate on youth outcomes in a national sample of child welfare systems and isolates specific culture and climate dimensions most associated with youth outcomes. The study applies multilevel path analysis (ML-PA) to a U.S. nationwide sample of 2,380 youth in 73 child welfare systems participating in the second National Survey of Child and Adolescent Well-being. Youths were selected in a national, two-stage, stratified random sample design. Youths’ psychosocial functioning was assessed by caregivers’ responses to the Child Behavior Checklist at intake and at 18-month follow-up. OCC was assessed by front-line caseworkers’ (N = 1,740) aggregated responses to the Organizational Social Context measure. Comparison of the a priori and subsequent trimmed models confirmed a reduced model that excluded rigid organizational culture and explained 70% of the system variance in youth outcomes. Controlling for youth- and system-level covariates, systems with more proficient and less resistant organizational cultures exhibited more functional, more engaged, and less stressful climates. Systems with more proficient cultures and more engaged, more functional, and more stressful climates exhibited superior youth outcomes. Findings suggest child welfare administrators can support service effectiveness with interventions that improve specific dimensions of culture and climate.     

Mothers’ search for infant child care: The dynamic relationship between availability and desirability in a continental European welfare state

The availability, affordability, and desirability of quality child care are matters of concern, especially for children raised in poverty, given the literature showing that young children raised in poverty can benefit from early access to quality care. The unique features of the Brussels context enable us to look at the connection between availability and parental preferences, while ‘controlling’ environmental constraints on costs and quality. We looked at access policies in 83 funded providers, and examined 100 mothers’ search for child care. The results show that quality child care was distributed unequally, favoring higher-income groups. Moreover, the access policies of individual providers furthered the exclusion of lower educated and ethnic minority parents. All parents took into account both quality and pragmatic criteria when looking for early child care, although the value of these criteria may vary according to ethnic background and education. The study also shows that access to and use of good quality care is an interactional process in which the mothers’ preferences and decisions are affected by the availability of care which, in turn, is determined by external conditions.     

Functional outcomes of maltreated children and adolescents in a community-based rehabilitation program in Brazil: Six-month improvement and baseline predictors

This study sought to implement outcomes monitoring and to review outcome data from a community-based rehabilitation program for maltreated children and adolescents in São Paulo, Brazil. Maltreated children and adolescents (N = 452) were enrolled in The Equilibrium Program (TEP), a multidisciplinary community-based rehabilitation program. About half (n = 230) of the participants were successfully evaluated using the Children's Global Assessment Scale (C-GAS) at entry, 3, and/or 6 months later. Analysis of outcomes used hierarchical linear modeling of functional change from baseline. With a baseline C-GAS score of 51.7 (SD = 14.22), average improvement was 2.8 and 5.5 points at 3 and 6 months, respectively (reflecting small to moderate effect sizes = 0.20 and 0.39). Improvement was associated with Problems related to upbringing (p < .02) at entry and absence of Physical abuse (p < .05) and Negative life events in childhood (p < .05) but was not associated with sociodemographics or any specific psychiatric diagnosis. This study showed that outcomes monitoring is feasible in a community-based program in a developing country. Although there was no untreated control group for comparison and specific evidence-based treatments were not used, it is notable that significant improvement, with small to moderate effect size, was observed.     

Economic evaluation research in the context of Child Welfare policy: a structured literature review and recommendations

Objectives

With over 1 million children served by the US Child Welfare system at a cost of $20 billion annually, this study examines the economic evaluation literature on interventions to improve outcomes for children at risk for and currently involved with the system, identifies areas where additional research is needed, and discusses the use of decision-analytic modeling to advance Child Welfare policy and practice.

Methods

The review included 19 repositories of peer-reviewed and non-peer-reviewed “gray” literatures, including items in English published before November, 2009. Original research articles were included if they evaluated interventions based on costs and outcomes. Review articles were included to assess the relevance of these techniques over time and to highlight the increasing discussion of methods needed to undertake such research. Items were categorized by their focus on: interventions for the US Child Welfare system; primary prevention of entry into the system; and use of models to make long-term projections of costs and outcomes.

Results

Searches identified 2,640 articles, with 49 ultimately included (19 reviews and 30 original research articles). Between 1988 and 2009, reviews consistently advocated economic evaluation and increasingly provided methodological guidance. 21 of the original research articles focused on Child Welfare, while 9 focused on child mental health. Of the 21 Child Welfare articles, 81% (17) focused on the US system. 47% (8/17) focused exclusively on primary prevention, though 83% of the US system, peer-reviewed articles focused exclusively on prevention (5/6). 9 of the 17 articles included empirical follow-up (mean sample size: 264 individuals; mean follow-up: 3.8 years). 10 of the 17 articles used modeling to project longer-term outcomes, but 80% of the articles using modeling were not peer-reviewed. Although 60% of modeling studies included interventions for children in the system, all peer-reviewed modeling articles focused on prevention.

Conclusions

Methodological guidance for economic evaluations in Child Welfare is increasingly available. Such analyses are feasible given the availability of nationally representative data on children involved with Child Welfare and evidence-based interventions.

Practice implications

Policy analyses considering the long-term costs and effects of interventions to improve Child Welfare outcomes are scarce, feasible, and urgently needed.     

Cumulative teen birth rates among girls in foster care at age 17: An analysis of linked birth and child protection records from California

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports.     

Resilience: a study of risk and protective factors from the perspective of young people with experience of local authority care

As part of a review of services in one local authority, young people aged 13–19 with experience of local authority care were asked to provide their views of what makes a difference to them. As Jackie Dearden makes clear in this article, young people consistently reported on themes collated from previous research into resilience and identified factors which were most and least helpful. The compelling personal accounts draw attention to what services could do to increase protective factors which include interest of carers, access to facilities, taking bullying seriously, a clear sense of a positive future and adults who listen. Additionally, positive change occurred most often after significant changes in circumstances, especially transition phases, providing turning points for some young people. Such personal stories present a powerful perspective that would be hard for service providers to ignore. This raises the question of how local authorities are routinely consulting with vulnerable young people.