Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care

Existing research indicates that children who are involved with the child welfare system and placed in various forms of out-of-home care experience emotional and behavioral problems. It is also suggested that children placed in kinship care are less likely to receive mental health services than children placed in non-kinship foster homes. This study sought to compare children in non-kinship foster homes to children in kinship care to determine their receipt of mental health services and the time it took for children in kinship care to receive mental health services compared to children in non-kinship foster homes. Using a Cox regression, researchers determined that children in kinship care had a 14% lower likelihood of receipt of mental health services compared to their counterparts in non-kinship foster placements.     

Is implementation fidelity associated with improved access to care in a School-based Child and Family Team model?

Effective child and family centered service planning is crucial to addressing vulnerable children's needs. However, there is limited evidence about what facets of these processes improve service use and outcomes. The current study used a Poisson random effects hazard model to test correlations between fidelity to NC's Child and Family Support Team model and time to service receipt, using case management data for 3396 children served by that program during the 2008–2009 school year. Students were more likely to receive recommended services more quickly when caregivers and the students attended planning meetings, when their plans included services for caregivers, and when child and family team leaders followed up after meetings to verify service receipt. Contrary to the Child and Family Support Team theory of change, match between student needs and the lead agency of the meeting was not associated with the odds of quicker service receipt, nor was attendance by natural supports. Findings from this study demonstrate the potential effectiveness of using case management systems to measure service planning process fidelity, as well as how results thereof can both inform process improvement and potential refinements to models’ theories of change.     

The independent effects of socio-demographic and programmatic factors on economic strain among parents in a Child Savings Accounts program

This study examines the independent effects of socio-demographic variables and program social services on the degree of economic strain among lower income parents who had an opportunity to open child savings in a subsidized savings accounts program known as Saving for Education, Entrepreneurship, and Downpayment (SEED). SEED is a policy, practice and research initiative designed to test the efficacy of and inform policy for a national system of asset-building accounts for children and youth. Findings suggest that overall, the degree of economic strain was not significantly different at baseline and at the second wave between parents who opened accounts and those who did not open accounts for their children. However, household income, having a household savings account, and receipt of means-tested welfare programs affected the degrees of economic strain. Implications are directed toward helping lower income families effectively participate in child savings programs.     

Comparing Service Use of Early Head Start Families of Children With and Without Disabilities

The current study compared patterns of service utilization reported by Early Head Start (EHS) families of children with and without disabilities by secondary analysis of data from the longitudinal investigation of the effectiveness of EHS. Findings reveal comparable positive trends for both groups of families for receipt of services corresponding to EHS performance standards promoting child and family development, family support, and health care. Service challenges remain in the low use of dental services overall and the higher use of acute health care services for children with disabilities. Future research should examine causes and outcomes of service use.     

Race and Gender Differences in the Distribution of Home and Community-Based Services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and commnunity characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services– whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black womcn to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homcs are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Race and gender differences in the distribution of home and community-based services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Patterns of child care subsidy use and stability of subsidized care arrangements: Evidence from Illinois and New York

Given the prevalence of short child care subsidy spells and program churning documented in prior studies, researchers and policymakers have been concerned about the implications of discontinuity in subsidy receipt for the stability of children's care arrangements. Yet little research has studied the stability of subsidized arrangements or how subsidy discontinuity relates to changes in subsidized providers. Using child care subsidy program administrative records from a cohort of children in four diverse sites across Illinois and New York states, this study examines patterns of subsidy use and stability of subsidized care arrangements, as well as the relationship between the two. Results suggest that the length of states' eligibility periods is related to the duration of subsidy spells; however, significant variation in patterns of subsidy use within states suggests that local level factors are also important. Results show that subsidy discontinuity is related to children experiencing more total changes in subsidized providers. Focusing on provider changes across spells, we also find that the timing of subsidy exits, the length of gaps in subsidy receipt, and within spell provider instability are each related to whether or not children re-enter the program with a different subsidized provider after a break in subsidy receipt. We discuss these findings' implications for understanding how new program requirements established in the 2014 reauthorization of the Child Care and Development Block Grant may matter for subsidy continuity and care stability.     

Faith-Based Programs and the Role of Empirical Research

Abstract

After some decades of being subject to neglect or contempt, faith-based social care programs are receiving increased attention and resources enabling them to undertake a greater role in the national network of human services. Faith-based programs receiving public support can expect to be rightly scrutinized by the public, in terms of their ability to attain professed program goals. The tools of conventional empirically-oriented program evaluation research have tremendous potential to help demonstrate the effectiveness of faith-based programs, which will justify their receipt of ongoing support from public funds. Negative research findings can be properly scrutinized by the faith-based community of service providers to help make tough, data-based, decisions on funding priorities. Several examples are described, illustrating how various types of faith-based programs have profitably participated in program evaluation studies.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

Fostering homeless children and their parents too: the emergence of whole-family foster care.

Children should not be placed in out-of-home care simply because their families lack the means to provide for their basic needs, yet this practice continues nationwide. A new program based in St. Paul, MN, gives county social service departments the placement option of whole-family foster care. The target population is adult parents and minor children without stable residences, where the children are at risk of placement in out-of-home care. Although the parents and children may have special needs, there are no safety risks that would necessitate separating children and parents. The program's design is described and policy questions discussed.     

An evaluation of the Kids are Kids disability awareness program: increasing social inclusion among children with physical disabilities

Despite the intent of integration to promote positive social interactions between children with and without disabilities, there is growing concern that many children with special needs who are in inclusive settings feel socially isolated. The evaluation of interventions designed to promote disability awareness is critical if we are to increase opportunities for social success for these children. This research study was designed to determine whether the Kids Are Kids (KAK) program can positively impact the attitudes of children toward their peers with physical disabilities, as well as increase the social inclusion of these children. Results suggest that the KAK program had a positive impact on the attitudes of children toward their peers with disabilities, immediately following the program. Where social skill building was provided to 1 target child, attitude scores for that class remained elevated 1 month after the program. Two of the 3 target children reported increased social inclusion 1 month after the program.     

Children with serious emotional disturbance: the impact of poverty and receipt of public assistance on behavior, functioning, and service use

The present study examines the associations between poverty status, receipt of public assistance, service use, and children's mental health. Using a sample of children with serious emotional disturbances, findings from logistic regressions indicated that although no significant associations were found between poverty status and emotional or behavioral problems, families living below the poverty threshold were more likely to receive fewer services, even after controlling for receipt of Medicaid or SSI. Significant associations were also found for child's age, race/ethnicity, caregiver education, Medicaid and TANF receipt, child and family mental-health-risk factors. Poor families were more likely to have older children, be non-white, have fewer years of education, receive public assistance, and have more family mental-health-risk factors, but less child mental-health-risk factors. While a higher percentage of nonpoor families received medication management and residential treatment services, more poor families received support services such as transportation and flexible funds. Implications for the findings are discussed.     

The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Do working mothers have healthy children?

This paper examines the effects of maternal employment on children's physical and mental health. The data used are from the Health Interview Survey 1981, Child Health Supplement. A health production model is developed on the basis of Becker's household production theory. The results reveal that a mother's employment is a significant factor affecting her child's physical health. Use of physician services, prices (i.e., CPI used as a proxy variable), sex of the child, receipt of Medicaid, the number of relocations, the mother's education, the mother's health status, breast-feeding practices, and the birth weight of the child are other important variables explaining the health status of children. The role of each of these factors varies according to the marital status of the mother.The authors wish to thank anonymous reviewers for their helpful comments resulting in a much improved product.She received her Ph.D. from Cornell University in 1990. Her current research interests include health care of children and elderly, teen pregnancy and welfare use, children and divorce, and immigrant consumers.She received her Ph.D. from Northwestern University in 1983. Her research includes long-term health care for frail and ethnic elderly, health insurance purchases for the elderly, and health services utilization by the employed and working poor.     

Family history and pensions: The relationships between marriage,divorce, children,and private pension coverage

This article examines how family history affects the odds of private pension receipt and how these effects vary by sex. Analyses indicated that family history had opposite effects for men and women. Compared to continuously married men, men who were single or divorced had lower odds of pension receipt; having children was associated with higher odds. For women, being single or divorced was associated with higher odds of pension receipt, and having children decreased their odds. After reanalyzing the effects of family history in the context of couples' joint pension receipt, the negative association between pension receipt and children becomes insignificant for women, and being single, divorced, or widowed has negative effects for both men and women. These results suggest that if individuals stay together as a couple, they increase their chances of access to a pension and financial well-being during retirement.     

Diffusion of the Property Tax Work-Off Program for Senior Homeowners in Massachusetts

Property tax work-off programs (TWOPs) provide senior homeowners with relief from some of their property tax obligations in exchange for services provided to local governments. These programs are offered by some county and municipal governments at their own discretion in a number of states. Through a qualitative study comparing municipalities in Massachusetts that participate in the program with similar communities that do not participate, the authors sought to learn the reasons for both participation and nonparticipation. They interviewed local officials in eight participating and six nonparticipating communities. Mohr's theory for adoption and Roger's theory for diffusion are used for the conceptual framework of the study. Local leaderships' motivation, financial or political resources and obstacles, senior homeowners' awareness, communication between communities, and perceived benefits of the program were the major factors in adoption and diffusion of TWOPs in Massachusetts.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

Context matters: The state of racial disparities in mental health services among youth reported to child welfare in 1999 and 2009

Upwards of 50% of youth reported to the child welfare system (CWS) do not receive mental health services, despite need. While children of color are less likely to receive services than Caucasians, the mechanisms through which disparities are sustained remain largely unknown. Data come from two nationally representative cohorts of youth who were referred to the CWS in 1999 and 2009. Results showed that while need for mental health services decreased, significant differences in the number of children who received services was not detected between cohorts. African American youth were less likely to receive services compared to their Caucasian counterparts, even after controlling for age, gender, type of maltreatment, and placement instability. However, after taking into account urbanicity, poverty, and the organizational-social context, the disparity between African American and Caucasian youth dissipated. Service disparities between Latino and Caucasian youth were not detected. The odds of service receipt were lower among youth nested within stressful organizational climates and urban (versus rural) counties, and the organizational-social context did not moderate the relationship between race and service receipt. Findings underscore the need to develop and implement strategies to increase access to services in urban counties and to promote an organizational climate conducive to reducing racial disparities.