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.     

Measuring school engagement for child welfare involved youth: Assessing the dimensionality of the Drug Free School Scale

BackgroundResearch using data from the National Survey of Child and Adolescent Well-Being (NSCAW) have consistently used the scale developed from the Drug Free Schools and Communities Act (DFSCA) to examine school engagement. Although the DFSCA is widely used, no study has examined the factor structure to determine if the scale is best used as a summative score of all items or as a three-factor variable distinguishing behavioral, emotional, and cognitive school engagement.ObjectiveThe primary goal of this study was to evaluate the hypothesized factor structure of the DFSCA scale by testing models previously supported in the literature.MethodsUsing NSCAW-I data, we performed confirmatory factor analysis in a structural equation modeling (SEM) framework.ParticipantThe study sample included 2429 children and adolescents who were between 6 and 15 years of age who had recently been investigated by child protective services due to a maltreatment report.ResultsResults indicated that school engagement is a multidimensional concept measuring behavioral, emotional, and cognitive-behavioral dimensions. This model has not been used in studies using NSCAW data, to date. These findings highlight the importance of exploring and understanding the factor structure of instruments before using an instrument in studies.     

Organizational climate, services, and outcomes in child welfare systems

Objective

This study examines the association of organizational climate, casework services, and youth outcomes in child welfare systems. Building on preliminary findings linking organizational climate to youth outcomes over a 3-year follow-up period, the current study extends the follow-up period to 7 years and tests main, moderating and mediating effects of organizational climate and casework services on outcomes.

Methods

The study applies hierarchical linear models (HLMs) analyses to all 5 waves of the National Survey of Child and Adolescent Well-being (NSCAW) with a US nationwide sample of 1,678 maltreated youth aged 4–16 years and 1,696 caseworkers from 88 child welfare systems. Organizational climate is assessed on 2 dimensions, Engagement and Stress, with scales from the well established measure, Organizational Social Context (OSC); youth outcomes are measured as problems in psychosocial functioning with the Child Behavior Checklist (CBCL); and casework services are assessed with original scales developed for the study and completed by the maltreated youths’ primary caregivers and caseworkers.

Results

Maltreated youth served by child welfare systems with more engaged organizational climates have significantly better outcomes. Moreover, the quantity and quality of casework services neither mediate nor interact with the effects of organizational climate on youth outcomes.

Conclusions

Organizational climate is associated with youth outcomes in child welfare systems, but a better understanding is needed of the mechanisms that link organizational climate to outcomes. In addition, there is a need for evidence-based organizational interventions that can improve the organizational climates and effectiveness of child welfare systems.     

Child welfare characteristics in a sample of youth involved in commercial sex: An exploratory study

BackgroundHomeless, runaway, and youth exiting foster care are vulnerable to sexual exploitation, but little research has parsed the societal, community, and individual factors that contribute to their risk.Objectives(1) To estimate child welfare characteristics in a sample of homeless young people who engaged in commercial sex (CS); and (2) To compare young people who were sex trafficked (ST) to those who engaged in some other form of CS.Participants and settingThis study includes 98 homeless young people in Philadelphia, PA, Phoenix, AZ, and Washington, DC, who were interviewed for a larger study of ST and endorsed engagement in CS.MethodsWe used a non-probability, purposive, maximum variation sampling procedure. Interviews were recorded and responses were simultaneously noted on a standardized interview form. Data were analyzed through means, frequencies, and bivariate tests of association.ResultsAverage age of the full sample of 98 homeless young people was 20.9 years; 48% were female and 50% were Black/African American. Forty-six percent of the full sample was sex trafficked. The full sample and the victims of ST differed significantly in three child welfare characteristics, with the ST group more likely to have been maltreated as children, more likely to have had family involvement with the child welfare system (CWS), and more likely to report higher rates of living someplace other than with their biological parents as children.ConclusionsST victims differ from those who engaged in other forms of CS in histories of maltreatment, involvement with the CWS, and exposure to residential instability while growing up.     

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.     

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.     

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.     

Prevalence of adverse childhood experiences (ACEs) among US children

ObjectiveThe purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.MethodsData were drawn from the nationally representative 2016 National Survey of Children’s Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.ResultsThe study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child’s age, family structure, poverty, type of health insurance, and SHCN status.ConclusionsWe found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.     

The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents

Objectives

Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion – a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process.

Methods

The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire ( [Bernstein et al., 1994] and [Bernstein et al., 2003] ). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16–20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment.

Results

Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gender, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion.

Conclusion

Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services.     

Teacher discourse on lesbian,gay and bisexual pupils in Scottish schools

This paper reports on a study which surveyed and interviewed teachers on their perceptions of the barriers and facilitators to the inclusion of lesbian, gay and bisexual (LGB) pupils in school. The outcomes indicated that there was a silencing of diverse sexualities in schools. In theory, teachers had adopted an individual liberal humanitarian stance of “we treat all pupils alike”. In practice this had resulted in confusion regarding how to respond to the needs of LGB pupils and a silence on (homo) sexuality. This paper further discusses the implications of the outcomes of this study for the implementation of the government equality agenda in schools in relation to sexual orientation.     

Resilience and psychopathology among victimized youth in residential care

This study examines the role of several resilience resources in the relationship between lifetime victimization and mental health problems among adolescents in care. The sample comprised 127 adolescents (53.% females, aged 12–17 years) from residential care facilities in Catalonia, Spain. The Juvenile Victimization Questionnaire, the Youth Self-Report, and the Adolescent Resilience Questionnaire were used to assess victimization, psychological symptoms, and resilience respectively. Results indicated that poly-victimization was associated with fewer resources, and with an increased risk of mental health problems. Self-resources mediated the relationship between victimization and internalizing and externalizing symptoms; community support mediated the relationship between victimization and internalizing symptoms. Self, school and peer support moderated the relationship between victimization and externalizing symptoms. Adolescents with fewer self-resources and less school support reported more externalizing symptoms, as did those with more peer support. However, poly-victimized youths reported symptoms within the clinical range, regardless of their level of resources. The findings stress the importance of preventing poly-victimization and of empowering poly-victimized adolescents, who appear to present low levels of resources. Researchers and clinicians should continue to study the poly-victimization/psychopathology relationship, and also design interventions and prevention programs which incorporate the most relevant resilience resources.     

Maltreatment,family environment,and social risk factors: Determinants of the child welfare to juvenile justice transition among maltreated children and adolescents

This study prospectively examines the transition from the child welfare system into the juvenile justice system among 10,850 maltreated children and adolescents and explores how patterns of risks, including severity and chronicity of maltreatment, adverse family environment, and social risk factors, affect service systems transition. Almost three percent of maltreated children and adolescents had their first juvenile justice adjudication within an average of approximately six years of their initial child protective services investigation (CPS). Social risk factors, including a child’s age at index CPS investigation (older), gender (boys), and race/ethnicity (Black and Hispanic) significantly predicted the risk of transition into the juvenile justice system. Recurrence of maltreatment and experiencing at least one incident of neglect over the course of the study period also increased the risk of transition into the juvenile justice system. However, subtypes of maltreatment, including physical, sexual, and other types of abuse did not significantly predict the risk of juvenile justice system transition. Finally, family environment characterized by poverty also significantly increased the risk of juvenile justice system transition. These findings have important implications for developing and tailoring services for maltreated children, particularly those at-risk for transitioning into the juvenile justice system.     

Risk and protective factors for poor school adjustment in lesbian,gay, and bisexual (LGB) high school youth: Variable and person‐centered analyses

This study examined the relations between school climate and school adjustment among 101 lesbian, gay, and bisexual (LGB) high school students and the moderating influence of social support on those relations. Students completed surveys to assess three aspects of the school climate (the school's exclusion/inclusion of LGB people, personal victimization in school for being LGB, and social support from teachers) as well as social support from family and close friends. Criterion variables were GPA, school belonging, and discipline problems. School climate variables explained significant amounts of variance in all criterion variables, after controlling for prior GPA, and there were no moderating effects of parent or friend support. Cluster analyses revealed one small group (n = 14) of highly vulnerable youth who were the least adjusted, most victimized, and least supported. Implications for teachers, counselors, and future research are discussed. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 159–172, 2005.     

Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing

The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.     

The relationship between child protection contact and mental health outcomes among Canadian adults with a child abuse history

Despite being a primary response to child abuse, it is currently unknown whether contact with child protection services (CPS) does more good than harm. The aim of the current study was to examine whether contact with CPS is associated with improved mental health outcomes among adult respondents who reported experiencing child abuse, after adjusting for sociodemographic factors and abuse severity. The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-2012), which used a multistage stratified cluster design (household-level response rate = 79.8%). Included in this study were individuals aged 18 years and older living in the 10 Canadian provinces (N = 23,395). Child abuse included physical abuse, sexual abuse, and exposure to intimate partner violence (IPV). Mental health outcomes included lifetime mental disorders, lifetime and past year suicidal ideation, plans, and attempts, and current psychological well-being and functioning and distress. All models were adjusted for sociodemographic factors and severity of child abuse. For the majority of outcomes, there were no statistically significant differences between adults with a child abuse history who had CPS contact compared to those without CPS contact. However, those with CPS contact were more likely to report lifetime suicide attempts. These findings suggest that CPS contact is not associated with improved mental health outcomes. Implications are discussed.     

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.     

Neglect,educational success,and young people in out-of-home care: Cross-sectional and longitudinal analyses

Maltreated young persons in out-of-home care often have poor educational outcomes, heightening their risk of long-term psychosocial disadvantage (Forsman, Brännström, Vinnerljung, & Hjern, 2016). In their systematic reviews, Romano, Babchishin, Marquis, and Fréchette (2014) and O’Higgins, Sebba, and Gardner (in press) found evidence that neglect was more often linked with low academic achievement, whereas abuse was more likely to be associated with behavioral difficulties. In large samples of young persons in out-of-home care in Ontario, Canada, who had experienced mainly neglect, we investigated risk and protective factors as predictors of educational success. In a cross-sectional hierarchical regression analysis (N = 3659, aged 11–17 years), female gender, youth educational aspirations, caregiver educational aspirations for youth, time with current caregiver, internal developmental assets, and positive mental health were associated with better educational success. Neglect, grade retention, special educational needs, ethnic minority status, behavioral problems, and soft-drug use were associated with poorer educational outcomes. Gender significantly moderated caregiver educational aspirations and youth placement type. In a longitudinal analysis of a subsample (N = 962, aged 11–15 years at Time 1), covering three years, a large decline in educational success (d = −0.80) was observed. Female gender, internal developmental assets, and positive mental health positively predicted, and soft drug use negatively predicted, greater educational success at Time 2. These results point to factors that help or hinder educational success among young people in care and should inform new interventions or improved versions of existing ones that address educational success in the context of neglect.     

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.     

Emotional maltreatment in Canada: prevalence, reporting and child welfare responses (CIS2)

Objectives

To determine the prevalence and characteristics of reports of emotional maltreatment (EMT) in Canada, as well as changes in these reports between 1998 and 2003.

Methods

This study is based on a secondary analysis of data collected in the first and second Canadian Incidence Study. Emotional maltreatment (excluding exposure to intimate partner violence) investigations were categorized into six groups: emotional abuse, emotional neglect, and other maltreatment as the only investigated form of maltreatment, and these same three groups were examined when they co-occurred with another form of maltreatment.

Results

Both the rate of emotional-abuse-only investigations and emotional-neglect-only investigations increased almost threefold from 1998 to 2003. Substantiated emotional neglect investigations had the highest rate of transfer to ongoing services. Half of the investigations involving single forms of emotional maltreatment occurred for six months or more. Finally, emotional neglect cases (in single form and when it co-occurs with another form of maltreatment) were more likely to be associated with emotional harm and longer duration of maltreatment.

Conclusions

In 2003, EMT represented a significant increasing form of maltreatment and is detected nearly twice as often in situations in which abuse or neglect are also reported. Reports of emotional abuse are two and a half times more frequent than reports of emotional neglect. Nevertheless, lack of emotional engagement may also be difficult to identify, since an omission is more difficult to detect. Reports of EMT often reveal situations of chronic victimization that have been the subject of previous reports and are associated with greater emotional impact.     

Improving outcomes for babies and toddlers in child welfare: A model for infant mental health intervention and collaboration

Children under three comprise a sizable and growing proportion of foster care placements. Very young children who enter the child welfare system experience disruptions of critical attachments that are essential to this formative stage of brain development, as well as other traumatic events, leaving them at great risk for lifelong impairments. To reverse these concerning outcomes, babies who have been removed from their homes require intensive, relationship-based interventions that promote secure attachment to a primary caregiver and holistic attention the child's developmental needs. Child welfare decision-makers must be informed of infant brain development and knowledgeable about the particular needs and circumstances of each child. This article describes a model with these features that has been developed and tested in the Bronx, New York, one of the nation's poorest urban counties with high rates of foster care. The Project utilizes evidence-based Child-Parent Psychotherapy (CPP) as its core intervention, and emphasizes collaboration and information sharing– driven by the CPP clinician– with judges, child welfare workers, attorneys and other social service and mental health providers, thereby encouraging developmentally and relationally informed case planning and permanency decisions. The model is evaluated using pre and post treatment psychosocial measures and program outcome data. Results indicate improvement in parenting interactions, positive child welfare outcomes (including increased rates of reunification, fewer returns to foster care), and improved safety and wellbeing. Results highlight the need for child welfare practices to be more closely aligned with the current science of infant brain development, and to incorporate a specialized approach to address the unique needs of infants.