Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

Broadening Our View

Summary

The growth in child welfare caseloads and the increasing use of kinship foster care has raised new questions about effective permanency planning. The majority of children in kinship foster care are children of color and have been less likely to exit the custody of the child welfare system than children placed in traditional foster care. Permanency planning which ensures the long-term protection and well-being of children from diverse cultural backgrounds requires a broad view of family, ongoing striving for cultural competence, collaboration between the formal child welfare system and the kinship systems of children in state custody, and a long-term view of permanency planning and child-rearing that builds on the case-management capacities of kinship networks to support permanent plans, looks beyond the child's exit from state custody, and helps families and larger kinship systems make long-term plans for the protection, permanence, and well-being of children.     

The legal rights of LGBT youth in state custody: what child welfare and juvenile justice professionals need to know

Youth in state custody, regardless of their sexual orientation or gender identity, have federal and state constitutional and statutory rights. These rights guarantee a young person safety in their placement as well as freedom from deprivation of their liberty interest. Many lesbian, gay, bisexual, and transgender (LGBT) youth have these rights violated on a regular basis. Many cases in both the child welfare and juvenile justice contexts have resulted in extensive and time-consuming consent decrees as well as sizable damages awards. Knowledge of a youth's legal rights can help providers avoid legal liability while creating a safer and healthier environment for LGBT youth. This article provides a general overview of the successful federal legal claims that youth in the child welfare and juvenile justice systems have made, discussion of the rights generated as a result, particle application of these rights to the experiences of LGBT youth with hypothetical scenarios, a focus on specific rights that emanate from certain state laws, and a focus on specific concerns of transgender youth.     

Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

Liability in child welfare

Child welfare workers and agencies are vulnerable to lawsuits. Recent court rulings have more clearly defined the liability of workers. The distinguishing variable is custody. Children injured while in the custody of the state are entitled to sue for damages. Children injured by their parent, even if under the supervision of a child welfare agency, are not entitled to claim a violation of their 14th Amendment rights. These cases are reviewed and strategies designed to minimize vulnerability are offered.     

Parent-child supervised visitation within child welfare and custody dispute contexts: An exploratory comparison of two distinct models of practice

This paper aims to untangle the assumptions and goals of supervised visitation services in the child welfare and custody dispute contexts, through presenting a legal analysis and review of social science literature. There is confusion in the literature on the specific roles, duties and expectations of supervised visitation services in facilitating parent-child contact within child welfare and custody disputes. A framework is outlined for understanding supervised visitation services in general. The overarching tenets of these services are discussed, and the assumptions of safety, protection and parent-child contact are explored. The legal context of supervised visitation in Canada is outlined, specifically examining the ‘best interest of the child’ principle and comparing the legal backdrop of visitation in child welfare and custody disputes. The social science literature is then reviewed with the goal of discerning supervised visitation across child welfare and custody disputes. The limited research on outcomes for children and families after utilizing supervised visitation services is discussed. This paper concludes with cautions and considerations for policy and practice for supervised visitation in child welfare and family law contexts, as well as recommendations for both fields.     

Sharing the Baton,Not Passing It: Collaboration between Public and Private Child Welfare Agencies to Reunify Families

ABSTRACT

Increasingly, public sector child welfare agencies are contracting with private agencies for the provision of specialized services to clients while maintaining oversight and case management responsibilities. At the same time, funders, both private and public, are demanding that service providers partner and collaborate with one another. In this article, we present results from a study of a unique partnership between two state child welfare agencies and a private child welfare agency aimed at reunifying families whose children have been removed and placed in foster care. Data was obtained from 41 key informants using a questionnaire and a structured interview. Findings support earlier studies of collaboration, and indicate the strengths of this partnership and factors that facilitated and hindered it. The results have implications for agencies that both contract for and provide a range of child welfare services as well as other interagency relationships.     

Upping the ante: relative caregivers' perceptions of changes in child welfare policies

Thirty-five caregivers of related children who were in the custody of the child welfare system were interviewed individually or in focus groups as the state child welfare system implemented new federal and state policies encouraging these caregivers to adopt or assume guardianship of the children in their care. Interviews were transcribed and analyzed using qualitative methods. Issues of concern included emergency entrance into caregiving; the simultaneous satisfaction and burden of caregiving; obstacles to caregiving, adoption, or guardianship; complex changes in family dynamics following placement of children; sources of support; and caution regarding adoption or guardianship. The caregivers also offered recommendations for the child welfare system. Policy, practice, and research implications are discussed.     

From Foster Care to Adoption and Guardianship: A Twenty-First Century Challenge

For nearly four decades, child welfare policy and practice have focused on the achievement of legal permanence for children in foster care. Although federal child welfare policy has resulted in the movement of children from state custody to legally permanent adoptive or guardianship families, little is known about the quality and enduring nature of these placements. A significant challenge of the twenty-first century child welfare system is how to ensure the well-being of children currently living with adoptive parents or guardians. This paper discusses child welfare policy and trends related to post-permanency well-being, including the decrease in Title IV-E foster care caseloads nationwide and the simultaneous increase in Title IV-E adoptive and guardianship caseloads. We highlight the needs of a twenty-first century child welfare system, including increased federal efforts to ensure child permanence and well-being after legal adoption or guardianship has been achieved, as well as more rigorous longitudinal and interdisciplinary research focused on the post-permanency adjustment of children and their families.     

The relationship between child welfare financing,screening, and substantiation

This study examines the relationship between state-level child welfare spending and two important decision points in the child welfare system: the decision to screen out a referral and the decision to substantiate. The model is estimated using a pooled fractional probit estimator that controls for year effects and state-level clustering. The findings suggest that decreases in state-level child welfare expenditures predict increases in the proportion of referrals that are screened out and decreases in the proportion of maltreatment claims that are substantiated. The results are robust to the inclusion of caseload and federal spending as control variables, to the exclusion of states known to have changed their screening or funding practices during the sample period, and to the use of combined state and local child welfare expenditures as an explanatory variable in lieu of state-level child welfare expenditures. The findings imply that the amount of money a state spends on child welfare may influence important decisions in the child welfare process.     

Kin and non-kin foster care—findings from a National Survey

This article uses national data to look at the differences between children in kinship and non-kinship care arrangements. Three groups are compared: children in non-kin foster care, children in kinship foster care, and children in “voluntary” kinship care. Children in voluntary kinship care have come to the attention of child welfare services, are placed with kin, but unlike those in kinship foster care, these children are not in state custody. Findings suggest that children in the kin arrangements faced greater hardships than those in non-kin care. They more often lived in poor families and experienced food insecurity. They were more likely to live with a non-married caregiver who was not working and did not have a high school degree. And fewer kin than expected received services to overcome these hardships. In addition, nearly 300,000 children lived in voluntary kinship care arrangements; these children are of particular concern because they are not in state custody and therefore may or may not be monitored by a child welfare agency.     

The emotional encounter with child welfare services: the importance of incorporating the emotional perspective in parents' encounters with child welfare workers

The child welfare service (CWS) in Norway represents a growing field. In 2011 about 52,000 children received help. Families mainly received supportive services in their homes while around 8000 children were taken into the custody of the CWS. Although most actions taken by the CWS are deemed to be supportive and have the consent of the parents, many parents find being assessed by the CWS to be distressing, and there is a widespread feeling that there is a stigma attached to receiving help from the CWS. This article discusses the importance of parents' emotions, and how these emotions can influence their cooperation with the CWS by using the concepts of recognition and trust. The data are based on analyses of 385 interviews with parents in which they describe their emotional encounters with the CWS. The results show that certain emotions can create a barrier between the family's need for assistance and the CWS's actions and initiatives. The article concludes by discussing how the emotional encounter challenges child welfare practice.     

The child welfare service's assessments in custody cases that involve minors

The percentage of breakdowns in marriages, cohabitations and civil partnerships is increasing in the Western world, resulting in questions of child custody. In Norway and other Western countries, there is little knowledge of the support system's work in child custody cases. This article focuses on the assessments Norwegian child welfare service employees conduct in 37 cases about child custody. We explain why they sometimes conduct investigations of reports and at other times do not.

‘Street-level bureaucracy’ is the theoretical reference framework for interpreting the interviews. Assessments and decisions of the child welfare service in custody cases vary from one service to another. It is relatively difficult to predict whether the notifications will be investigated or dropped. Decisions are the result of a jigsaw puzzle of risk assessment, interpretations of legislation, cooperative procedures and an understanding of the county social welfare board. Notifications concerning violence and notifications from family counselling offices stand out since generally they result in investigations.

Child welfare services' handling of notifications regarding custody questions is challenging as these cases are in the grey zone between the Children Act and the Child Welfare Act. Child welfare workers want clearer guidelines for the cases on which they are to work. However, new rules cannot replace the professional and ethical assessments the child welfare service workers have to make in each individual case.     

Testing,One, Two,Three, Testing: An Attorney Perspective

SUMMARY

This article addresses the attorney perspective on the use of psychometric testing in the context of family law child custody evaluations. Although attorneys, judicial officers and child custody evaluators “use” psychometric testing in family law matters, the ways in which each discipline uses the information gleaned from the results of these tests as administered to child custody litigants can differ substantially. This article distinguishes the attorney perspective from the mental health perspective in the use of the results of such tests.     

Evaluating the Probative Value of Child Custody Evaluations

Abstract

The ultimate purpose of a child custody evaluation is to assist children and their families to restructure their family lives after divorce. A competent forensic work product is defined, in part, by the eval-uator'S use of current state of the art forensic methods and procedures applied to child custody evaluations (Gould, 1998). In this paper, a detailed structure for reviewing the reliability and relevance of a child custody advisory report is provided in order to help these professionals produce a work product of greater weight and sufficiency to the court and a work product that is increasingly useful to the families we seek to help.     

On the margin? Residential child care in Scotland and Finland

Situated on the margins of Europe, Scotland and Finland are small countries which share similar demographic and economic profiles. In many European countries, residential child care can also be considered to be ‘on the margin’ of child care provision; there is ambivalence about residential care and a view that it should be used as a last resort. This paper examines systems and practices of residential care in Scotland and Finland, locating these in the context of wider child welfare policy in both countries. The underpinning principles of child welfare provision in both countries are similar—based on children's rights and primarily family-focused. In both countries there are also similar concerns about the fragmentation of child care provision and the cost of residential services. However, there are also important differences relating to child welfare provision and the use of residential care. In Finland, overall numbers of children in residential care are much greater than in Scotland; the age profile of these children and young people is very different; and the two countries vary markedly in the use of secure accommodation and custody. This comparative analysis suggests new ways of understanding the similarities and difference in the use of residential care in the two countries. It highlights the continuing challenge to develop residential care as a positive and integral part of a continuum of care services.     

Securing Children’s Best Interests While Resisting the Lure of Simple Solutions

The best-interest-of-the-child standard for child custody policy and decisions has benefits and hazards, the latter related to the exercise of judicial discretion in custody disputes. This article examines alternatives to the status quo, including the primary parent presumption, the approximation rule, shared parenting, an exact even split of custodial time, sole custody for couples labeled as in high conflict or those with young children, the friendly parent presumption, and decisions that defer to children’s stated preferences. Each alternative promises simpler paths to securing children’s welfare, but some have more support than others in the social science literature.     

Diagnosis and medication overload? A nurse review of the psychiatric histories of older youth in treatment foster care

Prior research has raised concern about the appropriateness of psychotropic medication use and the validity of psychiatric diagnosing for youth in child welfare but has lacked in-depth case information. This study reports results from a psychiatric nurse review conducted with eight youth entering a foster care intervention using case records and multiple key informant interviews. Results revealed extensive histories of unique (nonoverlapping) psychiatric diagnoses (M = 8, range 7-9) and past psychotropic medications (M = 13, range 9-21). The findings highlight the need to improve assessment practices and to create mechanisms that promote greater continuity of psychiatric care.