Interagency collaboration: Strengthening substance abuse resources in child welfare

Supporting child welfare (CW) workers’ ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers’ lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery.     

Perceptions of child protective services among pregnant or recently pregnant,opioid-using women in substance abuse treatment

Pregnant, opioid-using women represent a challenge to healthcare providers attempting to engage them in prenatal and substance abuse services. Limited, primarily international research suggests that child welfare clients have mixed feelings about Child Protective Services (CPS) and that fear of CPS may present a barrier to care. Understanding how pregnant opioid-using women in substance abuse treatment perceive CPS may be useful in encouraging substance abuse treatment initiation. Participants were currently or recently (within past 12 months) pregnant women with current or recent (within past 12 months) abuse/dependence of pharmaceutical opioids at a drug treatment facility. Participants were recruited by treatment staff to participate in a comprehensive study across multiple domains. Data for this analysis were collected using semi-structured qualitative interviews. Transcribed data were thematically analyzed using in vivo and interpretive coding by three coders for purposes of inter-rater reliability. Following 2, two-hour meetings, consensus was reached on primary themes and sub-themes. Two major themes and several sub-themes were identified: 1) Participants’ feelings and attitudes about CPS (positive and negative); 2) Interaction-based perceptions of CPS’ function and performance. Participants’ feelings toward CPS were often conditioned by their experiences with individual caseworkers. While many pregnant, opioid-using women identify legitimate, and even useful features of CPS, fear of CPS can be a barrier to care. Making substance abuse treatment accessible to this population requires recognition of their complex feelings toward CPS, and coordination among CPS case workers and substance abuse treatment providers.     

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.     

Child welfare services involvement among the children of young parents in foster care

Despite the high rate of early parenthood among youth in foster care as well as the increased risk of child maltreatment among children whose adolescent parents have been neglected or abused, very little is known about child welfare services involvement among children whose parents were in foster care when they were born. This study uses administrative data from the Illinois Department of Children and Family Services (DCFS) to examine the occurrence of child abuse and neglect investigations, indicated reports and out of home care placements among the children of youth in foster. Thirty-nine percent of the children were the subject of at least one CPS investigation, 17 percent had at least one indicated report and 11 percent were placed in out of home care at least once before their 5th birthday. Cox proportional hazard models are also estimated to identify characteristics of parenting foster youth and their placement histories associated with the risk of child welfare services involvement. Implications of the findings for policy and practice are discussed.     

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.     

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.     

Predicting the decisions of hospital based child protection teams to report to child protective services,police and community welfare services

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010–2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement.     

How much of a problem is resident mistreatment in child welfare institutions?

The purpose of this article is to provide information developed since 1980 by the Institutional Child Protection Project about the size and significance of the problem of mistreatment in child welfare residential institutions. In the 1.700 facilities surveyed, there are about 69.000 children and youths. Rates of utilization vary among Health and Human Services (H.H.S.) regions from 8 per 10.000 to 19 per 10.000 children and youths in the population. The average rate is 12 per 10.000. In 1961 this rate was estimated at 10 per 10,000. About 2,700 complaints were reported by facilities to the survey for 1979. Complaint rates range by H.H.S. region from 25 per 1.000 to 55 per 1.000 children and youth in care. The average complaint rate per 1.000 residents in care was 39. Observations of site visitors suggest that only one out of five complainable situations may be reported to child protection agencies. A list of complainable occurrences that came to the attention of site visitors is included to document the problem. An additional effort to assess the significance of this issue is made by comparing intrafamilial complaint rates with rates reported by child welfare facilities. The authors believe residential complaint rates may be twice as large as intrafamilial complaint rates.     

The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers,children and young people and young adults

Objectives

To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.

Methods

A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.

Results

2.5% of children aged under 11 years and 6% of young people aged 11–17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11–17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11–17 and 18.6% of females aged 18–24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.

Conclusions

The past year maltreatment rates for children under age 18 were 7–17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.     

The role of co-occurring intimate partner violence,alcohol use,drug use,and depressive symptoms on disciplinary practices of mothers involved with child welfare

BackgroundEvidence suggests intimate partner violence (IPV), substance use, and depression adversely affect the disciplinary practices of caregivers involved with child welfare; however, it remains uncertain whether the combined effects of these conditions are syndemic.ObjectiveThe purpose of this study was to examine the (1) associations between IPV, problematic drug use, problematic alcohol use, and depressive symptoms and self-reported disciplinary practices among a sample of mothers with child welfare contact; and (2) effect of co-occurrence of these conditions on child disciplinary practices.Participants and settingWe used data from the second cohort of the National Survey of Child and Adolescent Well-Being (NSCAW II). The analysis focused on 965 biological mothers with children who were subjects of child abuse/neglect investigations between February 2008 and April 2009 in the United States.MethodWe conducted multiple linear regression analyses.ResultsOur findings showed that IPV (B = .28; 95% CI = [.04, .53]) and depressive symptoms (B = .27; 95% CI = [.03, .52]) were independently associated with psychologically aggressive disciplinary practices. Also, IPV was independently associated with physically aggressive disciplinary practices (B = .64; 95% CI = [.18, 1.11]); and IPV (B = .21; 95% CI = [.06, .35]) and depressive symptoms (B = .22; 95% CI = [.07, .37]) were independently associated with neglectful parenting strategies. A significant effect was found for the interaction between problematic drug use and depressive symptoms with physically aggressive practices as the outcome. As the number of conditions caregivers had increased, so did their propensity for self-reporting each of the disciplinary practices (p < .05).ConclusionsThe findings highlight the need for using a more holistic/multidisciplinary approach to child maltreatment prevention research, policy, and intervention.     

Association between psychosocial stressors with emotional and behavioral problems among children of low-income addicted families living in Brazil

BackgroundChildren exposed to substance use in their families are vulnerable to multiple risk factors in their development and at increased risk for emotional and behavioral problems. The aims of the study were as follows 1) estimate the prevalence of emotional and behavioral problems among children aged 6–11 years old, living with addicted family members in a low-income urban community of São Paulo, Southeastern Brazil; 2) evaluate the children’s exposure to family psychosocial stressors and substance use; and 3) investigate the factors related to the increased risk of emotional and behavioral problems and substance use.MethodsA cross-sectional study was conducted among 101 children aged 6–11 years old (M = 9.16 years, SD = 1.61). The instruments used were a sociodemographic questionnaire, the Child Behavior Checklist (CBCL) and the Psychosocial Stress Factors (PSF).ResultsHigh prevalence of problems was found for this sample: the CBCL showed 26.7% of clinical scores for Internalizing Problems, 40.6% for Externalizing Problems, and 40.6% for Total Problems. Exposure to family psychosocial stressors was also high, including severe disease (33%), physical aggression (28.9%), death (27.8%), psychiatric hospitalization (16.7%), suicide attempts (15.5%), and suicide (9.3%). Exposure to these family stressors was associated with an increase of two to four times in the prevalence of internalizing and externalizing problems.ConclusionsChildren exposed to substance abusers have more mental health problems than general population, even when compared to peers living in similar low-income areas. This is a group that should be target of a selective preventive intervention.     

When love hurts: Assessing the intersectionality of ethnicity,socio-economic status,parental connectedness,child abuse,and gender attitudes in juvenile violent delinquency

Researchers have not yet reached agreement about the validity of several competing explanations that seek to explain ethnic differences in juvenile violent offending. Ethnicity cannot solely explain why boys with an ethnic minority background commit more (violent) crimes. By assessing the intersectionality of structural, cultural and individual considerations, both the independent effects as well as the interplay between different factors can be examined. This study shows that aforementioned factors cumulatively play a role in severe violent offending, with parental connectedness and child abuse having the strongest associations. However, since most variables interact and ethnicity is associated with those specific factors, a conclusion to be drawn is that ethnicity may be relevant as an additional variable predicting severe violent offending although indirectly.     

Identifying families with complex needs after an initial child abuse investigation: A comparison of demographics and needs related to domestic violence,mental health,and substance use

Families with complex needs related to domestic violence, mental health, and substance use have some of the worst child protective services (CPS) outcomes. Although many of these families are identified during a CPS investigation and subsequently referred to home-based postinvestigation services (HBPS), many are re-reported to CPS, so it is important to understand the postinvestigation experiences of this vulnerable group. Therefore, this study compared families with and without complex needs to understand their uniquedemographics, needs, and postinvestigation outcomes.The sample consisted of 2008 caregivers who received HBPS following an initial CPS investigation. The Family Assessment Form (FAF) was used to measure family functioning in eight domains using a 1–5 scale with higher ratings representing worse functioning. Complex needs were indicated by a mean FAF score of 3 or higher for either domestic violence, mental health, or substance use. Using Pearson chi-square analyses and two-sample t-tests, comparisons were made between families with (n = 836) and without (n = 1172) complex needs. Half of caregivers with complex needs had a history of abuse, 25% had three to five needs, and nearly half had six to eight needs; 90% of caregivers without complex needs had zero to two needs. Furthermore, caregivers with complex needs had higher mean scores for concrete, educational, and clinical needs. These findings highlight the importance of recognizing variation among families referred to HBPS and accurate screening to ensure that families with complex needs are offered and receive services matched to their unique characteristics and needs.