Receipt of independent living services among older youth in foster care: An analysis of national data from the U.S.

Fifteen years has passed since the Chafee Foster Care Independence Program was created under the Social Security Act, which marked an increased role of the U.S. federal government in supporting foster care youth to independence. It was not until the National Youth in Transition Database (NYTD) was launched in 2010 that all 50 states reported standard data on receipt of the 13 types of Chafee independent living services. This paper, which draws on the first two years of NYTD data, analyzes Chafee service receipt across the U.S. among youth in foster care (ages 16–21). About half of the 131,204 youth included in this analysis received at least one type of Chafee service, and considerable variation existed in the proportion of youth that received each of the 13 specific types of services. Females were more likely than males to receive all but one type of service, and African Americans were less likely to receive most of the services. An interaction effect indicated that Black youth were significantly less likely to receive services in large urban areas than other racial/ethnic groups. Young people with disabilities or medical/psychological conditions were generally more likely to receive services than youth without disabilities. Youth in large urban regions receive fewer services than youth residing in other areas, and substantial variation exists between states in proportions of service recipients. Recommendations are made for targeting services, future data collection, and research, including suggestions on ways to improve measurement of Chafee services.     

The effect of race/ethnicity on the relation between substance use disorder diagnosis and substance use treatment receipt among male serious adolescent offenders

The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N = 638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.     

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.     

Racial/Ethnic Differences in Court Referred Pathways to Mental Health Services for Children in Foster Care

Racial/Ethnic disparity in placement patterns and service utilization among children in foster care has been documented in a variety of studies. This study examined the role of the court process in referring children in foster care to mental health services and tested for racial/ethnic differences in the patterns of referral and service use. Court records for 142 children ages 2–16, representing Caucasian, African American, and Hispanic racial/ethnic groups were reviewed. Results indicate that the court process does play a significant role in referring children to services. Significant differences by race and ethnicity in mental health service utilization prior to the child's protective placement, as well as service orders, and post-placement service use were identified. Caucasian youth were more likely to receive orders for psychotherapy and to have documented use of psychotherapy than were African American and Hispanic youth, even when the possible confounding effects of age and type of maltreatment were controlled. Implications for the effective delivery of supportive services to those children most in need are discussed.     

Exploring Adoptive Motherhood: Adoption-Seeking Among Hispanic and Non-Hispanic White Women

Predictors of ever having sought adoption are evaluated for Hispanic and non-Hispanic White women. Analysis of the 2002 National Survey of Family Growth, a nationally representative study of reproductive health of 7,643 women aged 15 to 44 years, is employed. These include Hispanic and non-Hispanic White women aged 18 to 44 who are currently married and cohabiting (n = 3,118) and Hispanic and non-Hispanic White women aged 18 to 44 of all marital statuses (n = 5,236). Being married, older, and attending religious services are significantly associated with having sought adoption among non-Hispanic White women. Nativity status, language spoken, and resources are significantly associated with having sought adoption among Hispanic women.     

Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY

This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.     

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19 year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N = 181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.     

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.     

A national probability study of problematic substance use and treatment receipt among Latino caregivers involved with child welfare: The influence of nativity and legal status

The goal of this study was to determine whether differences exist in problematic substance use and receipt of services by nativity (U.S. born, foreign born) and legal status (U.S. citizen, legal resident, undocumented) among Latino parents reported for child abuse and neglect. We used data from the National Survey of Child and Adolescent Well-Being II and weighted bivariate chi-square tests to compare rates of problematic substance use and services receipt by nativity and legal status. Weighted logistic regression models estimated the effect of immigrant status on the odds of service receipt. Rates of problematic substance use were not significantly different by nativity or legal status. Service receipt was significantly lower for foreign-born (2.1%) versus U.S.-born (9.4%) parents. Compared to U.S. citizens (8.1%) and legal residents (4.3%), services receipt was least likely for undocumented parents (0.3%). Adjusting for covariates, nativity did not affect services receipt but undocumented legal status reduced the odds of receiving services by 95%. Data indicate that disparities do exist in receipt of substance use services among immigrant parents, especially undocumented parents, compared to U.S. born parents. Findings also suggest that the protective effect of immigrant status on problematic substance use, i.e., the immigrant paradox, may not apply to child-welfare-involved families.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

Safety segregation: The importance of gender, race, and ethnicity on workplace risk

Using micro data of the Bureau of Labor Statistics we examine the extent and the causes of workplace risk inequality in the United States. Far more men than women and far more blacks and Hispanics than whites are killed or injured at work. Occupational differences between men and women and among the races explain most, but not all, of the workplace risk inequality in the United States. After controlling for occupation, men experience twice as many workplace fatalities as women but fewer nonfatal injuries, while black and Hispanic males experience slightly more workplace fatalities than white males but fewer nonfatal workplace injuries. We find little evidence men choose higher risk jobs and women lower risk jobs because of differences in economic circumstances or risk preferences. But economic and taste factors explain large fractions of the fatal and the nonfatal injury rate differences by race/ethnicity. Workplace risk inequality among the races primarily reflects differences in educational attainment.     

The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse

This study examined the impact of the Affordable Care Act (ACA) on gender and racial and ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy or binge alcohol use (n = 52,496) and those with alcohol use disorder (AUD; n = 22,966). Difference-in-differences models estimated service-related disparities before (2008–2009) and after (2011–2014) health care reform. A subanalysis was conducted before (2011–2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy or binge drinking were excluded from substance use disorder (SUD) treatment and unmet need outcome models due to insufficient cell size. Among heavy or binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. Mental health (MH) treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. Although there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.     

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.     

Educational risk,recidivism, and service access among youth involved in both the child welfare and juvenile justice systems

Dually-involved youth represent a population of youth who receive some level of supervision from both the child welfare and juvenile justice systems concurrently. The current study examined education-related risk factors, recidivism, referrals for services, and service access among dually-involved youth in Los Angeles County. Specifically, whether increased educational risk was associated with referrals to, and access of, educational services and supports and whether higher receipt of educational services reduced recidivism approximately six months post-disposition. Data for this study consisted of a sample of dually-involved youth (N = 131) who were adjudicated delinquent and also had a child welfare case open. An Educational Risk Index (ERI) was developed and included school attendance, credit deficiency, problem school behavior, and current grades. Results indicate that educational risk was negatively associated with mental health services accessed, demonstrating that those with higher educational risk accessed less mental health services. Educational risk, however, was not associated with increased educational service referrals or access, suggesting a possible mismatch in educational need and service referrals. Lastly, there were no significant differences between those that recidivated and those that did not recidivate in service access and educational risk.     

THE IMPLICATIONS OF CHOOSING "NO RACE" ON THE SALIENCE OF HISPANIC IDENTITY: How Racial and Ethnic Backgrounds Intersect among Hispanic Adolescents

Using data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of youth from 7th to 12th grades, we examined how racial and ethnic identification overlap among Hispanic adolescents. We evaluated the relative proximity between race and ethnic identifiers among Hispanics. Empirical analyses suggest that the racial identification of other students at school has a significant impact on the odds of choosing particular racial identifiers. Both Hispanic and non-Hispanic schoolmates' racial identification is related to the racial identification of Hispanic adolescents. We also find evidence that both ethnicity and race are distinct stratifiers among Hispanics. Overall, our findings support the notion that Hispanic may be a more meaningful "racial" identity than black, white, or other, but we also find that racial identification and ethnic background are still important and meaningful dividers among Hispanic youth.     

Same‐Race Friendships and School Attachment: Demonstrating the Interaction Between Personal Network and School Composition1

Previous research has demonstrated that students are strongly attached to school when many same‐race peers are present. This study extends the literature by considering students’ immediate social environment at school—egocentric friendship networks. I hypothesized that same‐race friendships contribute to school attachment by increasing the amount of support that students receive for their racial backgrounds in direct interactions. Further, the association between same‐race friendships and school attachment should be stronger when the school includes many same‐race peers because the organizational condition increases the ability of same‐race friendships to connect students to the major components of school‐wide networks and reduces perceived racial contrast between friends and nonfriend peers. Statistical analysis of the National Longitudinal Study of Adolescent Health (Add Health) provided some support for these hypotheses, but white, black, Hispanic, and Asian students showed somewhat different patterns, suggesting group differences in how students develop and view same‐race friendships. The study highlights the importance of individual agency in navigating the multileveled social environment as well as the ability of organizational contexts to shift emotional consequences of personal relationships.     

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.     

EMPLOYER SPONSORED MEDICAL BENEFITS: The Influence of Occupational Characteristics and Gender

This research investigates gender differences in employer-sponsored medical fringe benefits: health insurance, dental insurance, sick leave, life insurance, and eye care coverage. Using data from a nationally representative sample of workers in the United States, human capital and structural theoretical approaches are drawn upon to explain the receipt of these benefits. The data suggest (a) men were more likely than women to receive each medical benefits from their employer; (b) occupational conditions largely account for the gender differences in coverage; (c) structural conditions of the occupation were more likely to predict the receipt of employer-sponsored medical benefits than were human capital attributes; (d) hazardous working conditions were not compensated for with medical benefits, with the exception of eye care coverage; and (e) gender did influence the relationship between several occupational conditions and benefit coverage.     

Impacts of agency coordination on nonprofit domestic violence and sexual assault programs in communities with STOP formula grant funding

The goals of the current study are (a) to understand the community and state context in which STOP(Services* Training* Officers* Prosecutors)-funded victim service (VS) programs operate, (b) to assess the degree to which receipt of STOP funding for VS programs and the degree of state-level STOP agency support for collaboration among community agencies have led to improved program services and community interaction, and (c) to assess the degree to which improved interaction between community agencies leads to improvements for VS programs. The results show that community interaction between VS programs and other community agencies can improve VS program services as reported by service providers. In addition, the higher the pre-STOP levels of activity around violence against women issues in communities, the more agencies can enhance their service system with STOP funding. Also, STOP funding has facilitated greater levels of change for communities whose pre-STOP attention to violence against women was lower.