Profiles and predictors of behavioral resilience among children in child welfare

Children living in out-of-home care have experienced a multitude of adversities, often resulting in compromised functioning. The current study used Ontario Looking After Children (OnLAC) project data to estimate developmental trajectories of behavioral outcomes (i.e., conduct and emotional problems) over a 4-year period (i.e., ages 6–10 to 9–13) in 313 children living in out-of-home care. Predictors measured at baseline (e.g., sex) and across the subsequent 4-year period (e.g., parenting practices) were also investigated. Findings indicated that 64.2% and 58.6% followed resilient trajectories for conduct behaviors and emotional functioning, respectively. Predictors of resilient trajectories included internal developmental assets, number of children in the home, whether the child was receiving treatment, and positive parenting. Findings need to be interpreted with an understanding that children in out-of-home care have varying levels of functioning across various domains (e.g., educational, social) other than the ones measured here. Predictors were static and dynamic and cut across various contexts, emphasizing the importance of considering child functioning within an ecological model.     

Pre-kindergarten child care and behavioral outcomes among children of immigrants

The school transition model suggests that children's transitions into formal schooling can have lasting and profound implications for their educational careers, though this model is rarely used to understand the outcomes of children of immigrants. Using data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative sample of kindergarteners in 1998–1999, we examine the pre-kindergarten child care arrangements of children of immigrants and how these care arrangements are associated with children's behavior. We find that minority and immigrant children are less likely than their native-born white counterparts to be enrolled in center-based care and other care, compared to parental care, prior to kindergarten. We also find that ethnic origin is an important predictor of child care usage. Finally, though center-based care, on average, is not independently associated with children's behavior in kindergarten, the association between center-based care and behaviors varies by race and immigrant status. Broadly, these findings underscore the importance of understanding how native- and foreign-born children experience the transition to schooling, a critical period in the life course.     

Sexual reoffense trajectories with youths in the child welfare system

The present study sought to determine whether the persistence of problematic sexualized behaviors (PSBs) committed by boys in the Massachusetts child welfare system would lend support to previous taxonomies categorizing offenders as early-onset/life course-persistent, adolescence-onset/adolescence-limited, or childhood-limited in their offending behavior. We examined the persistence of PSBs in a male sample (N = 638; age range: two to 17), using a retrospective longitudinal archival design. Procedures involved a comprehensive archival review of records from the Department of Children and Families. Subsamples were established by trifurcating the sample based on age at the time of the boys’ first documented PSB, resulting in age cohorts reflecting early childhood (age two to seven), middle childhood (age eight to 11), and preadolescence/adolescence (age 12–17). Results supported the hypothesis that youths who first exhibited PSBs in early childhood would produce higher sexual reoffense rates during each of three follow-up windows (i.e., three years, five years, and seven years) than youths who first exhibited such behaviors in middle childhood, or preadolescence/adolescence (p < 0.01 for all group contrasts). Findings supported the distinctions of several taxonomies classifying youthful offenders in the juvenile justice system. Abuse reactivity, coping ability, and vulnerability to iatrogenic intervention effects are considered as some of many possible contributing factors.     

Area-socioeconomic disparities in mental health service use among children involved in the child welfare system

Relying on data from a nationally representative sample of youth involved in the child welfare system (CWS) in 1999–2000 (the National Survey of Child and Adolescent Well-Being, Cohort 1) and 2008–2009 (Cohort 2), this study implemented a diverse set of disparity indicators to estimate area-socioeconomic disparities in mental health (MH) services use and changes in area-socioeconomic disparities between the two cohorts. Our study found that there are area-socioeconomic disparities in MH service use, indicating that the rates of MH service use among youth referred to the CWS differ by area-socioeconomic positions defined by county-level poverty rates. We also found that area-socioeconomic disparities increased over time. However, the magnitude of the increase varied widely across disparity measures, suggesting that there are different conclusions about the trend and magnitude of area-socioeconomic disparities, depending upon which disparity measures are implemented. A greater understanding of the methodological differences among disparity measures is warranted, which will in turn impact how interventions are designed to reduce socioeconomic disparities among children in the CWS.     

Religious socialization of youth involved in child welfare

Increased religiosity is associated with a variety of improved outcomes, especially for youth in disadvantaged contexts. Although youth involved in child welfare may experience protective effects of religious participation or values, little is known about the impact of maltreatment on religious development. Using the National Survey of Child and Adolescent Well-Being, a nationally representative study of child welfare involved families, correlates of religious attendance and importance of religion for youth were investigated using weighted logistic regression at two waves 18 months apart. Youth self-reports of religious attendance and their ratings of its importance were associated with religious attendance of their caregivers, whether birth-parents or foster parents. Foster parents were more likely to attend religious services than birth parents. Increases in youth attendance from Wave 1 to Wave 2 were associated with high youth religious importance at Wave 1, whereas decreases in attendance were associated with moving between home and foster placements. Increases in religious importance from Wave 1 to Wave 2 were associated with religious attendance at Wave 1 and with the youth being Black.     

Factors associated with mental health services referrals for children investigated by child welfare

Although child welfare caseworkers are responsible for facilitating mental health services access for maltreated children, little is known about caseworkers’ decisions to refer children to services. We aimed to identify factors associated with caseworker referral of children to mental health services after a maltreatment investigation. We analyzed data from 1956 children 2–17 years old from the Second National Survey of Child and Adolescent Well-being. We examined associations of children’s predisposing, enabling, and need-related factors and caseworkers’ work environment characteristics with referral to mental health services. Caseworkers referred 21.0% of children to mental health services. In multivariable analyses controlling for potential covariates, factors associated with increased odds of caseworker referral included: older child age; child sexual abuse (versus neglect); child out-of-home placement; caregiver mental health problems; prior maltreatment reports; clinically significant child behavioral problems; and child welfare agency collaborative ties with mental health providers (all p < .05). Factors associated with decreased odds of caseworker referral included child Black race (versus White race) and lack of insurance (versus Private insurance) (all p < .05). In summary, children’s need for mental health services was positively associated with caseworker referral to services but certain predisposing and enabling factors and caseworker work environment characteristics also correlated with services referral. Interventions to reduce disparities in services referral by race and insurance type are critically needed. These may include child welfare agency implementation of policies for mental health screening, assessment, and services referral based on clinical need and establishment of child welfare-mental health agency collaborative ties.     

Educational neglect: Understanding 20 years of child welfare trends

Educational neglect is an understudied phenomenon that is difficult to define and also to address. While it is clear that attending to children’s academic needs is important to child development, few studies focus on educational neglect and therefore little is known about its associated risk factors and the outcomes following this form of maltreatment. The purpose of this research was to (a) determine the rate at which child welfare service providers investigate educational neglect in Canada and identify any trends in rates over time, (b) better understand educational neglect and its distinction from other types of neglect and truancy, and (c) understand how child welfare services respond to allegations of educational neglect. Data from five cycles of the Ontario Incidence Studies of Reported Child Abuse and Neglect were examined. A trend analysis was conducted followed by a mixed-method examination of educational neglect investigations. Results indicate that rates of investigated educational neglect in Ontario have been consistently low over time. However, these investigations are significantly more likely to be substantiated and to be transferred to ongoing child welfare services compared to investigations of other subtypes of neglect. Educational neglect investigations involving younger children are more likely to note risk factors for caregivers whereas those involving adolescents are more likely to note functioning issues for youth. The findings are discussed in relation to international trends in educational neglect and policy and practice implications are explored.     

Trauma-symptom profiles of adolescents in child welfare

In the province of Ontario (Canada), over 28,900 adolescents are investigated by child welfare agencies each year because of suspected maltreatment. Exposure to childhood maltreatment represents a major threat to the psychological well-being of young people, particularly in terms of trauma-related stress. The present study investigated trauma symptom profiles among 479 adolescents (13–17 years) involved with the Canadian child welfare system between 2003 and 2010. Latent profile analysis identified three profiles using self-report data from the Trauma Symptom Checklist for Children. Most adolescents (59%, n = 281) were classified into the profile depicting minimal trauma-related symptoms, 30% (n = 144) were characterized by moderate trauma-related symptoms, and 11% (n = 54) were in the profile reflecting severe trauma-related symptoms. Several variables predicted profile membership. Greater severity of sexual abuse and female sex were associated with a greater likelihood of belonging to the severe trauma symptom profile than both the moderate and the minimal trauma symptom profiles. In addition, having society ward status (compared to crown ward) was related to an increased likelihood of belonging to both the severe and moderate symptom profiles relative to the minimal symptom profile. This study provides some insight into the typologies of trauma experienced among child-welfare-involved adolescents and the set of factors which relate to the specific profiles. Findings are important for informing psychological assessment practices, as well as tailored interventions, for adolescents in the child welfare system.     

Child strengths and placement stability among racial/ethnic minority youth in the child welfare system

While all children deserve a stable living environment, national data illustrate that many states struggle to achieve placement stability for youth in the child welfare system as a significant number of children in foster care continue to experience multiple placements while in state custody. Prior research has not considered the impact of youth protective factors or strengths on the frequency of placement changes that youth experience while in the child welfare system. This study examined the association between strengths measured at multiple levels (i.e., individual, family, and community) and placement stability among 4022 minority youth (aged 10–18) using administrative and clinical data from the Illinois child welfare system. Negative binomial regressions at the family level revealed that youth with at least one loving and supportive family member experienced 16% fewer placement changes than youth without family strengths. At the community level, youth attending schools that work to create an environment that meets its students’ needs experienced 13% fewer placement changes than youth without educational supports. These findings can inform the quality of treatment and services provided to minority youth in the child welfare system.     

Pediatric health assessments of young children in child welfare by placement type

Objectives

To describe health-related problems across placement types (unrelated foster, kin foster, in-home with birth parent); to examine the association of placement and demographic/child welfare variables (child gender, age, race/ethnicity; caregiver language; type of maltreatment, and length of time receiving services from child welfare) with health-related problems.

Methods

This study utilized a retrospective medical chart review of children less than 6 years old (n = 449) seen at an outpatient child welfare pediatric clinic. Logistic regression modeling was used to estimate odds of having a weight, medical, or provisional developmental delay problem by placement and demographic/child welfare characteristics.

Results

Almost 13% of children in the sample were obese (≥95% age-gender specific percentile) and more than a quarter were overweight/obese (≥85%) while only 7% were underweight (≤5%). Most children (78%) had a physical health diagnosis and 25% were provisionally identified with a developmental delay. No differences between weight diagnoses, type of medical diagnoses, and provisional developmental delay by placement type were found, although children with 3 or more medical diagnoses were more likely to be with kin (p < .05). Children 2 years old or older were more likely to be overweight/obese than children under 2 years old (p < .05) and Hispanic children were more likely to be overweight/obese than non-Hispanic children (p < .01). Length of stay in child welfare was positively related with a medical diagnosis or provisional developmental delay (p < .01).

Conclusions

Results argue for careful assessment of weight, medical, and developmental problems in children active to child welfare, whether residing in their home of origin, with kin, or with unrelated foster parents. The increasing problem of obesity among young children in child welfare warrants further investigation and intervention.

Practice implications

The comprehensive health examination and enhanced health maintenance schedule for children in foster care should be extended to children who remain at home with child welfare services as child welfare involvement rather than placement is related to health-related problems.     

Social disorganization and the profile of child welfare: Explaining child welfare activity by the community-level factors

This article addresses the question of the structure of local child welfare activities in light of community-level factors. It poses the following research questions: how are different community-level factors related to child welfare client structures in communities and what is the extent to which these factors explain structural differences? The applied theoretical framework is based on social disorganization and strain theories as well as human developmental approach. The data has been collected from two Finnish national databases and it consists of variables containing 257 Finnish municipalities. The method of analysis is multinomial logistic regression. The results suggest that the local child welfare structures are tied to social disorganization, policing and culture as well as to the intensity of control in the communities. In general, the more fragile the communal structures, the more last-resort child welfare there is in the community. Combining fragile communal structures with weak dependency ratio and high proportion of social workers, the more intense the level of child welfare statistics indicated. The results indicate that the theoretical framework for the application of child welfare activity analysis is justified, but they also suggest that it requires further development through both context-bound reflection and application.     

Effect of worker contacts on risk of child maltreatment recurrence among CPS-involved children and families

The mission and responsibility of child protective services (CPS) is to investigate maltreatment; intervene to protect children from harm; and promote safety, permanency, and well-being (DePanfilis & Salus, 2003; Goldman, Salus, Wolcott, & Kennedy, 2003). In 2015, approximately 7.2 million children in the United States were referred to CPS agencies, and 3.4 million children had an investigation or received an alternative response (US Department of Health & Human Services, 2017). Fluke, Shusterman, Hollinshead, and Yuan (2005) found that about one third of children with an allegation of maltreatment would have at least one re-report within a five-year period. Research indicates that the rates of child maltreatment or changes in indicators of child maltreatment have remained unchanged over time (Gilbert et al., 2012). Despite policies aimed at reducing or preventing maltreatment, the development of CPS systems across the United States, and a CPS workforce, the aggregate effects of the CPS system, services, and worker efforts are not well understood.     

Examining the association between suicidal behaviors and referral for mental health services among children involved in the child welfare system in Ontario,Canada

Although various studies have investigated factors associated with mental health service utilization, few studies have examined factors associated with referral for mental health services among maltreated children. The objective of this study was to examine the association between suicidal thoughts and self-harming behavior and referral for mental health services among children involved in the Child Welfare System in Ontario, Canada. Data for this study were obtained from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013. An estimate 57,798 child maltreatment investigations was analyzed using binary logistic regression with referral for mental health service as the outcome variable. Of the 57,798 cases, 4709 (8.1%), were referred for mental health services. More than seven out of ten maltreated children who engaged in self-harming behavior and two out of three maltreated children who expressed suicidal thoughts were not referred for mental health services. In the multivariate logistic regression model, children who expressed suicidal thoughts had 2.39 times higher odds of being referred for mental health services compared to children with no suicidal thoughts (AOR = 2.39, 99% C.I. 2.05–2.77) and children who engaged in self-harming behavior had 1.44 times higher odds of being referred for mental health services compared to children who did not engage in self-harming behavior (AOR = 1.44, 99% C.I. 1.24–1.67), both after controlling for child demographic characteristics, maltreatment characteristics, and child functioning concerns. Given that referral is the initial step towards mental health service utilization, it is important that child welfare workers receive the necessary training so as to carefully assess and refer children in care who expressed suicidal thoughts or engaged in self-harming behavior for appropriate mental health services. The paper discusses the results and their implications for child welfare policy and practice.     

Investigating geographic variation in use of psychotropic medications among youth in child welfare

Objectives

Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.

Methods

Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.

Results

Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.

Conclusions

Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.

Practice implications

These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.     

A scoping review of evidence-based interventions available to parents of maltreated children ages 0-5 involved with child welfare services

Parents referred to child welfare services for child maltreatment often struggle against chronic risk factors including violence, substance abuse, mental health concerns, and poverty, which impinge upon their ability to be sensitive caregivers. The first line of intervention within the child welfare context is to modify parenting behavior. This scoping review comprehensively surveyed all available literature to map the extent and range of research activity around the types of interventions available within a child welfare context to parents of infants and toddlers (0–5 years of age), to identify the facilitators and/or barriers to the uptake of interventions, and to check that interventions match the risk factors faced by parents. This scoping review engaged in stringent screening of studies based upon inclusion/exclusion criteria. Sixty-five articles involving forty-two interventions met inclusion criteria. Interventions generally aimed to improve parenting practices, the relationship between parent and child, and/or attachment security, along with reducing child abuse and/or neglect. A notable finding of this scoping review is that at present, interventions for parents of children ages 0–5 involved with the child welfare system are most frequently measured via case study and quasi-experimental designs, with randomized control trials making up 26.2% of included study designs.     

Assessing risk of commercial sexual exploitation among children involved in the child welfare system

The objective of this study was to assess item characteristics indicative of the severity of risk for commercial sexual exploitation among a high-risk population of child welfare system involved youth to inform the construction of a screening tool. Existing studies have discerned factors that differentiate Commercial Sexual Exploitation of Children (CSEC) victims from sexual abuse victims, yet no research has been conducted to discriminate which items in a high risk population of youth are most predictive of CSEC. Using the National Survey of Child and Adolescent Well-Being (NSCAW) cohorts I and II, we examined responses from 1063 males and 1355 females ages 11 and older, over three interview periods.A 2-parameter logistic Item Response Theory (2 PL IRT) model was employed in order to examine item performance as potential indicators for the severity of risk for CSEC. Differential Item Functioning (DIF) analysis was conducted in order to examine potential differences in item responses based on gender. Modeling strategies to assess item difficulty and discrimination were outlined and Item Characteristic Curves for the final retained items were presented. Evidence for uniform DIF were present within items that asked about runaway, any drug use, suicidality, and experiencing severe violence. Results from this study can inform the construction of a screening instrument to assess the severity of risk for experiencing CSEC.     

Trajectories of child protective services contact among Alaska Native/American Indian and non-Native children

BackgroundContact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups.ObjectiveWe aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes.Participants and settingWe used data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) births with administrative data including CPS records.MethodsWe conducted growth mixture modeling to identify trajectory classes of CPS contact from birth to age five years. We used Vermunt’s three-step approach to examine associations with preconception and prenatal risk factors.ResultsAmong AN/AI children, we identified three classes: 1) no/low CPS contact (75.4%); 2) continuous CPS contact (19.6%), and 3) early, decreasing CPS contact (5.0%). Among non-Native children, we identified four classes: 1) no CPS contact (81.3%); 2) low, increasing CPS contact (9.5%); 3) early, rapid decline CPS contact (5.8%); and 4) high, decreasing CPS contact (3.3%). Maternal substance use had the largest impact on probabilities of class membership, increasing the probability of membership in classes characterized by CPS contact, among both AN/AI and non-Native children.ConclusionsResults reveal heterogeneity in longitudinal patterns CPS contact across early childhood among Alaska children and identify maternal substance use as an important target for primary prevention.     

Predicting re-involvement for children adopted out of a public child welfare system

Some of the approximately 400,000 children currently placed out-of-home in a public child welfare system will not reunify with their family of origin. They may instead be adopted into a new family. Adoption placements can be characterized by poor adjustment for children; some such placements even result in disruption or dissolution. We conducted a stratified Cox regression of 4,016 children from the Colorado public child welfare system. All of the children had a finalized adoption during the years 2002 through 2006. The two outcomes analyzed were new child protection and youth-in-conflict referrals and assessments for these previously adopted children. New child welfare referrals and assessments may be early indicators of poor adjustment for adopted children within the adoptive family. Study results indicate that older children and Hispanic children had higher rates of referral and assessment. Children with a pre-adoption history including longer time out-of-home or a larger number of out-of-home placements also experienced higher referral and assessment rates. Additional factors which predicted subsequent system re-involvement included presence of paid adoption assistance, adoption by a non-relative foster parent and younger adoptive parent age. Several study results were moderated by the presence or absence of an ethnic match between the child and the adoptive parents. We provide an overview of the statistical model used for analysis and we discuss implications of the study results for child welfare practice.     

Complex health concerns among child welfare populations and the benefit of pediatric medical homes

Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare-involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare.