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.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.     

Factors associated with racial differences in child welfare investigative decision-making in Ontario,Canada

Despite the substantial body of literature on racial disparities in child welfare involvement in the Unites States, there is relatively little research on such differences for Canadian children and families. This study begins to address this gap by examining decision-making among workers investigating Black and White families investigated for child protection concerns in Ontario, Canada. Using provincially representative data, the study assessed whether Black children were more likely than White children to be investigated by child welfare, if there was disparate decision-making by race throughout the investigation, and how the characteristics of Black and White children contribute to the decision to transfer to ongoing services. The results indicate that Black children were more likely to be investigated than White children, but there was little evidence to suggest that workers in Ontario child welfare agencies made the decision to substantiate, transfer to ongoing services, or place the child in out-of-home care based on race alone. Black and White children differed significantly with respect to child characteristics, characteristics of the investigation, caregiver risk factors, and socioeconomic circumstances. When adjusting for these characteristics, Black families had 33% greater odds (OR = 1.33; 95% CI: 1.26, 1.40; p = <0.001) of being transferred to ongoing services compared to White families. Among Black families, the assessed quality of the parent-child relationship and severe economic hardship were the most significant and substantial contributors to the decision to provide child welfare services. Implications for practice, policy, and research are discussed.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

A changing child welfare workforce: What worker characteristics are valued in child welfare?

A child welfare system is responsible for making difficult decisions. Child welfare workers are charged with assessing and determining when a child is in need of protection, including when it is necessary to intervene on behalf of children when their caregivers’ abilities and/or situation is deemed to put them at risk of abuse or neglect. Although the child welfare workforce in Ontario attended to an estimated 125,281 child maltreatment investigations in 2013, little is known about the skills, education, and experiences of these investigating workers. Notwithstanding assumptions about the qualifications and characteristics necessary for effective child welfare practice, few studies explicitly link the specific characteristics of workers to children, youth, and families achieving positive case outcomes. These assumptions have been shaped by a multitude of factors including knowledge of human resources, professional standards, and educational requriements. This study examined data from five cycles over twenty years of Ontario Incidence Studies (-1993, -1998, -2003, -2008, -2013) to provide a profile of child welfare workers. This is the first study to examine the changing profile of child welfare workers in any province in Canada and provides a foundation for developing effective recruitment and professional development strategies, and promoting a positive work environment. Policy and practice implications for the changing needs of these families are discussed.     

Teaching Interprofessional Practice: An Exploratory Course Assignment in Social Work and Speech Language Pathology

The professions of social work (SWK) and speech language pathology (SLP) often involve the provision of services to a diverse group of client populations in a variety of settings; this is particularly true when meeting the complex needs of children and their families. It is widely accepted that collaborative treatment approaches utilizing multidisciplinary teams is an effective method of practice when serving children who are developmentally delayed or challenged, yet there is little information in the literature regarding the quantity, quality, and efficacy of collaboration among professional disciplines serving child populations. This article addresses the identified gap in the pedagogical literature regarding collaborative case management approaches between social workers (SWKs) and speech language pathologists (SLPs) using a case example describing a child in need of early intervention services. Following the case study, sample assessment questions are provided (utilizing the professional standards from both SWK and SLP) as a measure of professional competency and practice behavior. Finally, a discussion of the practical ways SWKs and SLPs can be trained in order to be mutually supportive in meeting the needs of children requiring multidisciplinary services through a collaborative or trans-team approach is provided.     

Professionals' decision-making about out-of-home placements following instances of child abuse

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.     

Indian Child Welfare Act: ideas for implementation

The Indian Child Welfare Act of 1978 was passed to curb the excessive rate of placement of Indian children in non-Indian foster and adoptive homes. Congress concluded that these placements were abusive because of their contribution to the identity confusion of the Indian children who had been placed as well as the disruption of tribal culture. This article includes recommendations about implementation of the Indian Child Welfare Act which are based on a survey of individuals involved in Indian child welfare as well as experiences of the author since completion of the survey in November of 1980. In general, the recommendations are: (1) Tribal and state agencies should make special efforts to coordinate services so that the unique difficulties faced by Indian families will be addressed; (2) Urban social service agencies should assign all Indian child welfare cases to one worker or a group of workers and cooperate with urban Indian associations in the transfer of Indian child welfare cases; (3) Social workers handling cases should be involved in all aspects of transfer and not leave the management strictly to attorneys; (4) Where the act is unclear, particularly in off-reservation emergency placements, the state agency must make the policy clear so that all workers understand how Indian children will be protected in emergencies; (5) In individual cases, as well as when negotiating agreements both tribal and state agencies should avoid compromising the rights of the parties involved or the principles of the act.     

The battered child: A study of the role of services in 25 cases of child abuse in The Netherlands

With the help of a questionnaire and the study of 25 cases of child abuse from 1973 to 1976, the course of assistance given by various services and social workers involved was followed and the extent of the coordination between them was assessed. The starting point was the fact that when child abuse has reached the crisis stage many different bodies give immediate assistance to both the child and his parents. Later on, however, as help continues, it is not clear which of the persons or bodies concerned is really in charge of the case. The following conclusions were drawn: Abused children came from multiproblem families who often already have had contact with care or welfare services though no steps had been taken to intervene before ill-treatment was verified. Many parents confessed to illtreatment of their child and desired help. Abused children were subjected to longer than usual hospital stays due to lack of reception facilities outside the hospital. Most ill-treated children abused enough to be hospitalized, were placed away from home although half of the parents did not agree with that decision. Of those later returned to their parents, over half had to be removed later for renewed ill-treatment and neglect. The need for one body to coordinate and be responsible for execution of plans for treatment was stressed.     

Predictors of placement for children who initially remained in their homes after an investigation for abuse or neglect

Objective

To examine the frequency and predictors of out-of-home placement in a 30-month follow-up for a nationally representative sample of children investigated for a report of maltreatment who remained in their homes following the index child welfare report.

Methods

Data came from the National Survey of Child and Adolescent Well-being (NSCAW), a 3-year longitudinal study of 5,501 youth 0-14 years old referred to child welfare agencies for potential maltreatment between 10/1999 and 12/2000. These analyses focused on the children who had not been placed out-of-home at the baseline interview and examined child, family and case characteristics as predictors of subsequent out-of-home placement. Weighted logistic regression models were used to determine which baseline characteristics were related to out-of-home placement in the follow-up.

Results

For the total study sample, predictors of placement in the 30-month follow-up period included elevated Conflict Tactics Scale scores, prior history of child welfare involvement, high family risk scores and caseworkers’ assessment of likelihood of re-report without receipt of services. Higher family income was protective. For children without any prior child welfare history (incident cases), younger children, low family income and a high family risk score were strongly related to subsequent placement but receipt of services and case workers’ assessments were not.

Conclusions/practice implications

Family risk variables are strongly related to out-of-home placement in a 30-month follow-up, but receipt of child welfare services is not related to further placements. Considering family risk factors and income, 25% of the children who lived in poor families, with high family risk scores, were subsequently placed out-of-home, even among children in families who received child welfare services. Given that relevant evidence-based interventions are available for these families, more widespread tests of their use should be explored to understand whether their use could make a substantial difference in the lives of vulnerable children.     

Helping social workers address the educational needs of foster children

OBJECTIVE: The main aim was to evaluate the effectiveness of the Education Initiative, an intervention program in one of the largest urban counties in the US seeking to increase the responsiveness of social workers to the educational needs of foster children. METHOD: A pre-post test control group design was used. Data from case files and social workers were examined at the start of the project and 18 months later to determine changes in social workers' (a) knowledge and practices regarding school programs and services and (b) maintenance of educational records for children on their caseloads. RESULTS: Data were analyzed from approximately 300 case files and over 200 questionnaires completed by social workers. Findings indicated that social workers who received training and had access to an education liaison (1) increased their knowledge about the school system and (2) were more likely to gather current educational data and comment on schooling needs in the case files. On questionnaires measuring knowledge and practices, supervisory social workers showed no gains while case workers increased their levels of knowledge and involvement. CONCLUSIONS: Evaluative data from both sources support the effectiveness of this collaborative model between the school and child welfare agency for addressing the educational needs of foster youth. Social workers in the pilot offices knew more and focused more on the school experience of youth on their caseloads than workers in the control offices. They reported more educational information in the case files and solicited current progress reports from the schools. Discrepancies between worker and school reported performance data raise questions as to whether social workers by themselves are the most effective advocates for foster children.     

Re-reporting of child maltreatment: does participation in other public sector services moderate the likelihood of a second maltreatment report?

OBJECTIVE: This study uses administrative data to track the first re-reports of maltreatment in a low-income, urban child welfare population (n=4957) while controlling for other public service involvement. Service system involvement is explored across the following sectors: Child Welfare, Income Maintenance, Special Education, Juvenile Court, and various forms of Medicaid-reimbursed medical or mental health care. This study builds knowledge by adding the services dimension to an ecological framework for analyses and by following recurrence for a longer period of time than prior investigations (7.5 years). METHOD: We model the re-reporting of a child for maltreatment as a function of child, caregiver, service, and neighborhood characteristics using data from birth records, child welfare, income maintenance, Medicaid, adult corrections, juvenile court, special education, law enforcement, and census sources. Bivariate and multivariate analyses are presented, the latter using Cox regression with a robust sandwich covariance matrix estimate to account for the intracluster dependence within tracts. RESULTS: Key results across bivariate and multivariate analyses included a lower rate of re-reporting among children with parents who were high school graduates and/or permanently exited from the first spell on AFDC (p<.0001); and for children in families that received less intensive in-home services compared to those not receiving services, receiving intensive in-home, or foster care services (p<.0001). Higher rates of re-reporting were found for children with Medicaid mental health/substance abuse treatment records (p<.0001) and special education eligibility for emotional disturbance (p<.005). CONCLUSIONS: Caretaker characteristics and non-child welfare service use patterns had a strong association with the likelihood of a child being re-reported to the child welfare agency and should be more heavily attended to by child welfare workers. High rates of service sector overlap suggest that interagency ties and cooperation should be strengthened. The lower risk associated with less intensive in-home services compared to un-served cases may indicate under-identification of in-home service eligibility following a first report of maltreatment.     

Social Work Students' Attitudes About Working With Involuntary Clients

Social workers employed in areas such as public child welfare, substance abuse, and corrections often provide services to involuntary clients. These individuals do not seek social work services on their own volition and may be actively opposed to the services they are receiving. This study explores social work students' attitudes about working with involuntary clients. The article is based on a cross-sectional survey of social work students (N = 107) at a large Southeastern university. Participants answered questions regarding their experience, knowledge, and attitudes about involuntary clients. Findings and implications for social work education and practice are discussed.     

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.     

Fatal child maltreatment: Characteristics of deaths from physical abuse versus neglect

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.     

Improving child welfare through a children's ombudsman.

OBJECTIVE: This report examines the changes in a child welfare system created by establishing an ombudsman's office to investigate complaints regarding children in the foster care, adoption, and child protection systems. METHOD: Serving as a complaint office, the Michigan Office of Children's Ombudsman investigated 443 cases involving 820 children during its first 18 months of operation. Information was collected regarding the nature of abuse and system concerns identified in child protective services, foster care, or adoption agencies from across our state. Information was also collected regarding changes in agency practices or procedures or legislation resulting from case investigation. RESULTS: The Children's Ombudsman in Michigan identified 209 cases in which "administrative acts" of child protective services, foster care, or adoption agencies led to real or potential harm to children. Through investigation of these complaints, a number of areas of concern in the child welfare system were identified, resulting in changes in case management, investigation, or service provision. CONCLUSIONS: A children's ombudsman can improve the child welfare system through complaint investigation and identification of system-wide deficiencies on a state-wide level.     

Exposure to domestic violence as abuse and neglect: Constructions of child maltreatment in daily practice

Research finds that exposure to domestic violence can adversely affect the emotional, behavioral, and physical health of children. These effects have led some child advocates and policymakers in the United States to conclude that child exposure to domestic violence (CEDV) is a type of child maltreatment warranting state intervention. However, few states have defined CEDV as a type of maltreatment in statute and little is known about how child welfare agencies respond to allegations of CEDV in the absence of other safety threats. This study considers that CEDV itself might prompt an initial child welfare referral and may be construed by workers as a type of statutory maltreatment. Using a random sample (n = 295) of case records, this study analyzed one large child welfare agency’s response to referrals alleging CEDV between 2011 and 2012. Findings indicate that CEDV itself did trigger investigation. At time of referral, workers used statutory maltreatment typologies to construe alleged CEDV as a type of maltreatment; however, CEDV was not consistently construed as a safety threat and few allegations were substantiated. Instead most families were referred to community-based domestic violence services. Findings indicate that CEDV was not consistently construed as a type of statutory maltreatment and infrequently resulted in ongoing child welfare services. Findings suggest that training is needed to help workers better assess CEDV-related safety threats. Findings also raise questions about what types of interventions are needed to protect children from domestic violence and which types of agencies are best positioned to deliver those interventions.