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.     

Caregiver depression and trajectories of behavioral health among child welfare involved youth

Child welfare involvement has been linked to child behavioral health issues, including increased likelihood of internalizing mental health problems such as depression and anxiety, and externalizing behavioral problems such as oppositional behaviors and substance use problems. One predictor of child behavioral health is caregiver mental health. Although, there remains a specific gap associated with identification of factors among caregivers that are associated with longitudinal child behavioral health trajectories. Using LONGSCAN, we explore the effects of caregiver depression on the behavioral health of children over time. Multilevel mixed-effects linear regression models showed that children with a caregiver who reported depression showed significantly higher internalizing behavioral problems over time, and significantly larger decreases in externalizing behavioral problems over time, compared to children with a caregiver who reported no depression. These findings emphasize that early interventions geared towards jointly assessing and treating parent and child mental health issues in the child welfare system may be successful at improving future behavioral health outcomes.     

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.     

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.     

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.     

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.     

Differences in polysubstance use among youth in the child welfare system: Toward a better understanding of the highest-risk teens

The current study extended limited prior work on polysubstance use among youth in the child welfare system (CWS) by addressing their potentially greater risk of engaging in polysubstance use, the causes of interpersonal variation in use, and changes in use over time, particularly at later points of involvement in the CWS. Using longitudinal data from the National Survey of Child and Adolescent Well-Being (n = 1,178), a series of time-invariant and time-varying demographic and contextual factors were explored to assess their role both overall and at unique points of involvement in the CWS. A series of unconditional and conditional curve-of-factor models were estimated and results indicated that time-invariant characteristics of ethnicity and gender were not related to polysubstance use. Time-variant characteristics of age and placement were associated with polysubstance use and highlighted the dynamic nature of age as a risk factor. Out-of-home placement was protective against later substance use for youth who had been removed from contexts with their original caretaker where there were higher levels of reported violence. Our results suggest that in the child welfare population, the modeling of multiple substances rather than a single substance in isolation is more informative because it yields information on the confluence of behaviors that tend to occur and evolve together.     

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.     

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.     

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.     

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.     

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.     

Connectedness and suicidal ideation among adolescents involved with child welfare: A national survey

Using data from the National Survey of Child and Adolescent Well-Being, this study examined the relationship between connectedness in major social domains (i.e., caregiver, peers, deviant peers, and school) and suicidal ideation among adolescents (11–17 years old) investigated by child welfare agencies (N = 995). Weighted logistic regression models were used to evaluate the relationships between connectedness variables and suicidal ideation, after adjusting for covariates. Youths with a stronger connection to caregivers were much less likely to report suicidal ideation, whereas youths with stronger deviant peer relationships were significantly more likely to report suicidal ideation. Significant associations found between primary caregiver and deviant peer connectedness and suicidal ideation highlight the need for attentive consideration of these relationships when working with this highly vulnerable population. Identifying domain-specific connectedness factors related to suicidal ideation presents an opportunity for the development of targeted early intervention for child welfare-involved youths.     

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.     

Reducing maltreatment recurrence through home visitation: A promising intervention for child welfare involved families

Maltreatment of children is a key predictor of a range of problematic health and developmental outcomes. Not only are affected children at high risk for recurrence of maltreatment, but effective interventions with known long term impact are few and limited. While home visiting is one of the most tested secondary prevention models for improving parenting, its primary focus on young primiparous mothers underemphasizes one of the most important risk groups: child welfare involved multiparous mothers. This study's focus is a randomized controlled trial of Healthy Families New York that included a subgroup of mothers (n = 104) who had at least one substantiated child protective services (CPS) report before enrolling in the program. By the child’s seventh birthday, mothers in the home visited group were as half as likely as mothers in the control group to be confirmed subjects for physical abuse or neglect (AOR = .46, p = .08). The number of substantiated reports for mothers in the control group was twice as high as for those in the home visited group (1.59 vs. 79 p = .02, ES = .44). Group differences were only observed after the child's third birthday, suggesting the possible effect of surveillance in early years. Post-hoc analyses indicate that home visited mothers had fewer subsequent births that may have contributed to less parenting stress and improved life course development for mothers. In light of our findings, we suggest considering and further testing home visiting programs as a tertiary prevention strategy for child welfare-involved mothers.     

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.     

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.