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.     

Treatment Approaches for Child Welfare Mothers with Addiction Problems

Abstract

This paper argues that child welfare mothers with addiction problems may require specialized treatment approaches based on their gender. The prevalence of women's problems with addiction and the unique ways addictions manifest themselves in women are discussed. The literature is then used to guide a discussion on the limitations of traditional treatment approaches that have been designed for men and may be of ill service to child welfare mothers. Alternative treatments are reviewed, and suggestions for improving treatment services to child welfare mothers with addiction problems are provided.     

Psychotropic medication management for youth in state care: consent, oversight, and policy considerations

The use of psychotropic medications in youth with emotional disturbances in state custody is increasing and presents unique challenges concerning consent and oversight. We examine various means that state child welfare agencies use to provide consent for and oversight of psychotropic medications for children in state custody and describe benefits of a consent process that provides for expert consultation to the child welfare agency and prescribing clinicians, case-specific and systemic oversight of psychotropic medication use, and education for stakeholders.     

Absent Fathers as Providers: Race/Ethnic Differences in Support for Adolescent Mothers

Race/ethnic differences in the prevalence of and characteristics associated with low support provided by fathers of babies born to pregnant adolescents were examined among 719 adolescent mothers who were interviewed postpartum. Low support was reported by 41.9% of African-American, 26.2% of Mexican-American, and 19.4% of Caucasian adolescent mothers. Across race/ethnic subgroups, fathers who provided limited support were characterized by chronic substance use, gang or police involvement, or partner-directed violence. Policies advocating universal father involvement without concomitant programs designed to address their many needs may ultimately be detrimental to the welfare of mother and child.     

Shredding the Safety Net

Abstract

Recent federal legislation bans receipt of cash and food assistance to individuals convicted of a drug felony. This study examines the different definitions and methodologies used in estimating substance abuse among welfare recipients. It then analyzes a stratified sample of predominantly low-income young mothers on the basis of welfare receipt and consequences associated with alcohol and drug use. Results indicate that young mothers who received welfare for more than two years had lower reported drug use consequences than mothers who never used welfare or relied on it for a period of less than two years. Variables measuring consequences of drug use were not found to mediate length of time on welfare.     

Welfare Status and Child Care as Obstacles to Full-Time Work for Low-Income Mothers

SUMMARY

In this study, we use new data from the Philadelphia Survey of Child Care and Work to expand on previous analyses: we include child care problems as a work obstacle, and we analyze both current welfare recipients and non-welfare “working poor” mothers. Results show that two main obstacles have a large impact on full-time work: poor mental health and child care problems. Net of other factors, mothers with severe child care problems are 22 percent less likely to work full time. Dividing the sample by welfare status, we find a child care problems effect for both groups. Among welfare recipients, the gap in full-time work between those with severe child care problems and those without is 30 percent. Among the working poor, child care problems reduce the chance of full-time work by about 18 percent. Our findings show that improving mothers' child care situation can significantly improve their ability to support their families.     

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse

Considering the importance of mother’s support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother–child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3–18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.     

Post-permanency discontinuity: A longitudinal examination of outcomes for foster youth after adoption or guardianship

For over two decades, federal policies and case practices in child welfare have shifted to prioritize legal permanence for children in foster care, and increasing numbers of children have been placed in permanent adoptive or guardianship homes. Despite this change, little research has examined the long-term stability of legally permanent adoptive and guardianship homes for former foster youth. This study used child welfare administrative records to track a population of 51,576 children in Illinois who exited foster care through adoption or guardianship for ten years or until the age of majority. Univariate and bivariate analyses were conducted to describe the population, and a multivariable Cox proportional hazards model was estimated to examine the relationship between child age and discontinuity, controlling for several pre-placement characteristics. Results indicated that the vast majority (87%) of children did not experience post-permanency discontinuity. In addition, African American children and children who had more moves in foster care had a higher hazard of discontinuity, while children placed with siblings and children who spent three or more years in foster care had a lower hazard of discontinuity. Study findings also indicated that prevention efforts should be targeted at families with adolescents. This study contributes significantly to the scant literature on long-term outcomes for adoptive and guardianship families, and suggests several areas for future research.     

Trends in infants reported to child welfare with neonatal abstinence syndrome (NAS)

BackgroundSubstance abuse among caregivers is a known risk factor for child maltreatment, and some of these children subsequently come to the attention of the child welfare system. The recent opioid epidemic has led to rising numbers of women who use opioids during pregnancy and infants born with neonatal abstinence syndrome (NAS), raising the question of whether there has been a consequent rise in the numbers of these infants reported to the child welfare system. The purpose of this study is to examine the trend in the number and percentage of infants reported to the child welfare system with neonatal abstinence syndrome (NAS) from 2004 to 2014, and determine whether the trend is distinct from the trend in the percentage of infants reported with fetal alcohol spectrum disorder (FASD).MethodsWe analyzed National Child Abuse & Neglect Data System (NCANDS) data on reports of infants (aged <1 year) with NAS between 2004 and 2014. Due to state differences in data collection and data quality across the study period, the sample included reports from 10 states. We utilized a Generalized Estimating Equations (GEE) model approach to examine the trend over time in the percentage of NAS and FASD cases reported to child welfare in our 10 state sample. Year was used as an identifying variable and Substance Type was repeated over time and clustered by State.ResultsThe number of reports of infants with NAS for the 10 states was the lowest at 3073 in 2009 and highest at 4806 in 2014. The average percentage of cases of NAS reported rose from 4.72% in 2004 to 9.19% in 2014. The results of the GEE revealed a significant main effect of Substance Type (p = 0.015) and Year (p = 0.009), indicating that overall, averaged across time, the percentage of NAS reports was greater than the percentage of FASD reports and averaged across substance type, the percentage of substance-related reports increased over time.DiscussionNAS reports increased significantly over time, most pronounced between 2010 and 2014, while the trend for FASD reports did not show significant change over the study period. Moreover, the child welfare reports data obtained from the 10 state sample aligned with national NAS incidence data. Although recent efforts to curb prescribing and other means of supply have been implemented, it remains to be seen whether the large rise seen will continue or be ameliorated by these public health initiatives. However, overall these findings suggest that immediate efforts are needed to prepare the child welfare system for this trend, as well as to treat opioid addiction among women of child bearing age.     

Reunifying Families Affected by Maternal Substance Abuse: Consumer and Service Provider Perspectives on the Obstacles and the Need for Change

ABSTRACT

This paper presents the findings of a qualitative study which examined the views of chemically dependent mothers, child welfare service providers and substance abuse service providers regarding the obstacles to family reunification and recommendations for change. Implications for practice, policy and research are discussed, with special reference to the mandates of the Adoption and Safe Families Act.     

Child protection pathways for newborn infants: A multi-disciplinary retrospective chart review of an Irish maternity hospital’s records

In Ireland, little is known about mothers and infants where child welfare and protection concerns arise during the perinatal period. This study explores, for the first time, perinatal child protection. A retrospective audit was carried out of a large maternity hospital's medical social work, neonatal and psychiatric files for a five-year period from 2016 to 2020. The study identified 99 children, born to 86 mothers, who were either subject to a child protection conference; placed for adoption; discharged to someone other than the mother; or discharged home under supervision. The study found that two-thirds of the children were discharged to their mother's care. When compared to national data, the health indicators for this cohort of mothers and children painted a grim picture. The maternal profiles identified high prevalence of mental health and addiction difficulties and domestic violence. The study found evidence of supports provided to the mothers to enable them to care for their infants while they remained in the hospital and during an initial discharge from hospital. However, a significant number of the mothers were not caring for their children when viewed across a longer time frame. Dedicated multi-disciplinary clinics and improved data systems were identified as of importance.     

The California Collaboration

Summary

This article documents the Title IV-E child welfare social work project of the California Social Work Education Center (CalS WEC): The establishment and ongoing support of collaborative arrangements among 58 California counties, the California State Department of Social Services, and all of the California graduate social work schools. The primary goal of this collaboration is to produce MS Ws who will commit to helping disadvantaged children and families in publicly supported child welfare services. The project model contains five interdependent components: a competency-based curriculum, financial support for students, development of instructional materials, active participation among public child welfare agencies and the universities, and evaluation.

This paper focuses on the collaborative curriculum development process. Evolving arrangements among stakeholders are described here in terms of the reciprocal adjustment of curriculum development and field and classroom instruction to prepare MSWs for public child welfare careers.     

Partner Abuse Among Women Whose Children Have Been Sexually Abused: An Exploratory Study

ABSTRACT

To explore partner abuse among women in families in which a child has disclosed sexual abuse, 102 mothers completed a measure of partner abuse and the Coping Responses Inventory. Results suggest that, like women in the general population, mothers of children who have been sexually abused have often experienced partner abuse. As expected, physical abuse in a current relationship was found to be related to the use of avoidance strategies in dealing with the sexual abuse disclosure. The implications for practitioners and for future research are discussed.     

Mothers matter: A feminist perspective on child welfare-involved women

ABSTRACT

Mothers involved in child welfare services are often marginalized and misunderstood while the system focuses on protecting their children. These women are mothering within a context of poverty, violence, addictions, and racism, leaving them with minimal resources and supports. Using a feminist perspective, this article seeks to shift the common perception that children must always be regarded as needing to be protected from these mothers. Rather, a richer understanding of these women and more focus on attending to their needs may provide an added measure of safety and security for their children. An appreciation for the relationships central to these women’s experiences can provide child welfare workers with the ability to create strong working alliances and move families toward safe reunification.     

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.     

Falling Through The Cracks: Gaps In Child Support Among Welfare Recipients

This article examines gaps in child support among welfare recipients in Wisconsin. Documented is the extent to which breakdowns at various stages—including paternity establishment, support orders, and payments—contribute to the low rate of child support receipt. Children were tracked over a 2‐year period to assess their progress through the child support system over time. Few welfare recipients are able to successfully negotiate the child support system, and mothers frequently achieve different degrees of success with different children. The characteristics of children who drop out prior to obtaining a support order suggest that, with an order in place, they would be as likely to receive support as are those children who already have orders.     

Best Practices in the Treatment of Substance-Abusing Women in the Child Welfare System

ABSTRACT

This paper reviews the literature on women's chemical dependency and its effects on their children. Many risk factors (e.g., a history of traumatic exposure) and consequences (interference with parenting) of substance abuse are unique for women, giving rise to special treatment needs of substance-abusing women with children. Substance-abusing mothers also experience unique barriers to receiving the services they need to recover, such as absence of child care and lack of gender-specific treatment in their communities. Model programs are described and recommendations are offered for best treatment practices for women with chemical dependency who present in the child welfare system.     

Representation of children's views in court hearings about custody and parental visitations — A comparison between what children wanted and what the courts ruled

PurposeFollowing the UN convention on the rights of children, a shift in policy towards greater emphasis on child participation in child protection case processing has occurred. A growing body of research has emerged concerning participation processes in child protection cases and the experiences of children in child protection cases. Very few studies have looked into if and when children get what they want, however. The aim of this study is to assess children's views about living arrangements and visitations in dependency court hearings and to compare these views with the rulings of courts.MethodThe study uses a retrospective cohort design. Cases where child welfare board rulings are in line with the wishes of children are compared to cases where rulings differ from the wishes of children. Data were collected from regional social welfare board archives. The study included 151 cases that were randomly drawn from a total population of 2481 cases. Simple and multivariate logistic regression was used to identify factors associated with the rulings being in accord with the child's wishes in each sample case.ResultsA child advocate was appointed in almost 95% of the cases (n = 142). Fifty-nine percent of the children did not want a change in care. Rulings about care were in line with the wishes of the child in 39% of the cases. Rulings about care were most likely to be what the child wanted, if the child was presently living in public care and did not want to move. Children wanted more visitations with their mothers in 60.5% of the cases and with their fathers in 39.8% of the cases. Whether children wanted more visitations with their mothers was associated with more visitations being granted. What a child wanted was not associated with the ruling on visitations with the child's father.ConclusionThe impact of children's views on visitations on dependency court rulings depends on what a child wants and how these desires coincide with what is proposed by child protection services. Children's views can be quite effective in blocking certain decisions but are less effective if the child requested a specific change. If a child does not want to stay with his or her birth parents, then the odds that the birth parents will be granted custody is minimal.     

The challenges of child welfare involvement for Afro-Caribbean families in Toronto

There is a growing and robust child welfare literature on service users' perspectives. However, little attention is paid to the experiences of Afro-Caribbean mothers and youth as service users. The author argues that this lack of attention is problematic given that the literature consistently shows an overrepresentation of Black children in the child welfare system. This article reports on some of the findings of a study that was conducted in Toronto with Afro-Caribbean service users about their experiences in the child welfare system. Findings reveal themes that are common to both groups of service users: mothers and youth, though some themes are unique to each group. Themes generated from interviews with service users show the challenges of structural inequalities and the complexities of racism, classism, sexism and cultural differences on child welfare involvement for Afro-Caribbean families in Toronto. Interviews with child welfare workers also revealed themes that supported service users' perspectives. The article concludes by arguing that research is needed to explicate the relationship between structural inequalities, including culturally different parenting practices on the experiences of Afro-Caribbean services users in the child welfare system in Toronto. Such exploration has the potential to reduce the number of Afro-Caribbean children entering the child welfare system.     

“Welfare Mother” Activism,Mainstream Feminism,and the Cunning of History in Ontario’s 1970s Welfare Debate

ABSTRACT

This article examines the voice of mobilized welfare mothers and the mainstream women’s movement in the welfare debate of the 1970s in Ontario. A question debated was whether welfare mothers had a right to “stay home” while receiving welfare. The article shows that a radical strain of welfare mother activists at this time demanded recognition of women’s unpaid work. While mainstream women’s groups were generally sympathetic to welfare mothers, their overriding focus on employability as the solution to their poverty served to derail the radical possibilities of welfare mother politics and solidify a policy agenda that undermined the deserving status of welfare mothers.