Peer mentoring services,opportunities, and outcomes for child welfare families with substance use disorders

Peer recovery support services (PRSS) in child welfare are being provided by peer mentors in sustained recovery from substance use disorders (SUD) to parents with acute SUD. Previous retrospective interviews demonstrate that peer mentors engage parents in family-centered systems of care through relationships and empowerment. However, the specific profile of services provided is unknown. Personnel challenges and opportunities for persons in recovery serving as peer mentors are described in the literature without understanding the frequency of both. As enthusiasm for hiring peer mentors grows, it is important to understand the specific services provided, the risks and opportunities associated with hiring individuals in recovery, and the impact of mentor services on outcomes. This knowledge can assist in developing training, implementation guides, policies, job expectations, and program evaluation strategies. This is a prospective study of 28 family mentors providing PRSS services to 783 families with child maltreatment and parental SUD over 8 years in a family-centered integrated program with SUD treatment providers. We describe mentor services overall, during the early engagement period, in rural and urban settings, and test the association between services and child/parent unification status at case closure; we identify the proportion of peer mentors that experienced employment challenges and career advancement opportunities. Results demonstrate the complexity of service provision overall and in differing contexts. Face to face visits with children were associated with greater likelihood of parent/child unification at case closure and 64.3% of peer mentors experienced career advancement opportunities. The implications of these findings are discussed.     

Child abuse prevention: Blending research and practice

For over two decades, child abuse interventions have been plagued by poor definitions of what (or who) exactly is being treated, what constitutes ‘success’, and how services can be delivered in such a way as to minimize the harm to the child and to his/her family. Most recently, intervention/prevention programmes reflect the growing recognition that child maltreatment is the product of the interaction between the parent's abilities and resources and the child's emerging behavioural and emotional characteristics (i.e. the parent–child relationship), and place less emphasis on individual psychopathology. Accordingly, ways to strengthen this relationship offer considerably more promise than those aimed at correcting only one component (i.e. the parent) or treating only the visible symptoms of conflict. In an attempt to focus greater effort on prevention and early intervention, this paper reviews prominent risk factors that have been linked to physical abuse and neglect of children and their consequences. Major intervention targets are identified from this literature and discussed in reference to: (a) problems related to the family context; (b) child treatment needs; and (c) parent/caregiver treatment needs. The paper concludes with a discussion of promising developments in early intervention that are beginning to address problems in the early formation of the parent–child relationship (i.e. the pre-natal and infancy periods of development) and problems associated with parental competency and family support. Most notably, preventive efforts have been associated with more positive parenting knowledge, attitudes, skills, and behaviour, as well as fewer child injuries, emergency room visits, and reports to protective agencies among at-risk parents and children. Further evaluation and expansion of these programmes appears to be warranted by these data.     

Integrated Substance Abuse and Child Welfare Services for Women: A Progress Review

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.     

Judgments regarding parental alienation when parental hostility or child sexual abuse is alleged

Abstract

Allegations of Parental Alienation (PA), the systematic disparaging of one parent by the other parent aimed at alienating their child’s affections, as a basis for child custody decisions are highly controversial. Claims of parental hostility or allegations of child sexual abuse in custody cases may trigger concerns about PA. Family court professionals (N?=?280) rated young children’s accuracy of report (e.g., suggestibility, honesty) in general and also read three custody scenarios varying as to whether or not they included allegations of parental hostility or child sexual abuse, or no such allegations. For each scenario, the alleged alienating parent’s gender was experimentally varied between subjects. Participants rated the likelihood that each case involved PA. For the scenario that included allegations of child sexual abuse, professionals who viewed young children as more inaccurate reporters or who read about the mother (rather than a father) as the alleged alienator were more likely to rate the scenario as involving PA. For the scenario that described parental hostility but no child sexual abuse allegations, professionals who were older or female were more likely to judge the scenario as involving parental alienation when a mother (rather than a father) was the alleged alienator, whereas there were no significant predictors of responses to the no-allegation scenarios. Findings are discussed in relation to the difficult task of evaluating custody cases for PA when parental hostility or child sexual abuse is alleged.     

The best and worst of 2018, and hopes and fears for 2019

With public understanding growing every day about the need to address substance use disorders (SUDs) with the full array of health responses our nation deploys for other major illnesses, we hope to see great progress in the coming year. Progress should include dramatic expansion of all quality prevention, treatment services and medications, and recovery supports, with financial investment increased sufficiently to meet the need; full coverage of all SUD treatment services and medications by every state's Medicaid program and by Medicare; much stronger enforcement of federal and state requirements for parity in commercial insurance and Medicaid, including prohibitions on prior authorization, fail‐first, overly burdensome utilization review and inadequate reimbursement for care; availability of all effective and quality SUD treatment and medications at every level of the criminal justice system and throughout the child welfare system; and elimination of discriminatory barriers facing people still suffering or in recovery from SUD, including those with criminal histories, as they seek employment, housing, government benefits, the right to vote and other necessities of life.     

Engaging families in child welfare services: an evidence-based approach to best practice

Successfully engaging clients in the helping process is a critical task for child welfare practitioners. Drop-out and noncompliance rates in child welfare services are high and lead to high rates of removal of children from their families and to eventual termination of parental rights. Although no known interventions guarantee treatment compliance, this review of the empirical literature delineates critical components of engagement in child welfare services. Effective engagement strategies, including service components and caseworker qualities and behaviors, are identified as contributing to the positive case outcomes of treatment compliance, family preservation, and placement prevention. The unique needs of neglectful parents are also examined, with recommendations for practice.     

Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands

Parent management training programs for the treatment of childhood conduct problems are increasingly being transported from their country of origin to international settings. Family interactions, however, may be influenced by different cultural expectations and children's mental health problems may be addressed within different systems. Demonstrating reductions in symptoms within the new population is insufficient to support the wide-scale transport of a treatment model. Implementation outcomes such as the rates of treatment retention and factors related to treatment attrition must also be considered. We explored predictors of attrition in families from the Netherlands referred to the evidence-based parenting program Parent–Child Interaction Therapy (PCIT). Participants included 40 children with conduct problems (2–7 years; 68% boys) and their caregivers. Attrition (40%) was somewhat lower than findings with similar community samples in the US. Significant predictors of attrition were child age and maternal levels of internalizing symptoms. Low parental demandingness and high child compliance before start of treatment were related to early attrition within twelve treatment sessions. Meeting the needs of families at risk for attrition is an important goal for parent management training programs within and outside the US if families in need of services are to benefit from them.     

The influence of concrete support on child welfare program engagement,progress, and recurrence

Families living in poverty are significantly more likely to become involved with child welfare services, and consequently, referred to interventions that target abusive and neglectful parenting practices. Program engagement and retention are difficult to achieve, possibly because of the concrete resource insufficiencies that may have contributed to a family's involvement with services in the first place. Various strategies have been used to enhance program completion, such as motivational interventions, monetary incentives, and financial assistance with concrete needs. This study examines the influence of adjunctive concrete support provided by home visitors on families' (N = 1754) engagement, retention, and satisfaction with services as well as parenting outcomes. Using propensity stratification, mixed modeling procedures revealed that increasing concrete support predicted greater engagement, satisfaction, goal attainment, and lower short-term recidivism. Results suggest that adjunctive concrete support is a potentially beneficial strategy for promoting service engagement and satisfaction and increasing short-term child safety.     

Are At-Risk Parents Getting What They Need? Perspectives of Parents Involved with Child Protective Services

This qualitative study explores the perspective of 24 parents who were at risk for having their children placed in foster care but ultimately retained custody of their children. We asked participants to reflect on their parenting needs prior to Child and Protective Services involvement and if and/or how they implemented parent education skills post-intervention. Parents most frequently cited stressors such as financial strain and single parenthood as contributing factors associated with their involvement with the child welfare system. Many parents stated that they wanted help with their parenting practices and provided their thoughts about time-out and physical punishment. Implications include assessing parental stress at the onset of services, seeking to understand the unique needs of families, evaluating the impact of length of time services are offered, and helping parents utilize age-appropriate discipline strategies.     

An Evaluation of a Parent-Developed,Parent-Run Parent Education Program

This article reports on a new approach to parent education in which a group of parents developed a parent education curriculum and facilitated the program. The approach is based upon a model of empowerment that asserts that parents, working collectively, can affect meaningful change in their lives. After describing the HOPE (Helping Our Parents to be Educators) Project, the article explores whether the program successfully influenced parents' abilities to parent well. Using a repeated-measures model, the study found that participation resulted in improved communication within the family, enhanced social support, better attitudes toward the child, and increased parental empowerment.     

Using administrative data to evaluate the effectiveness of the Healthy Families Oregon home visiting program: 2-year impacts on child maltreatment & service utilization

The present study used state administrative databases to examine the 2-year outcomes of a large-scale randomized study of the impact of the Healthy Families Oregon (HFO) home visiting program. 2727 eligible first-time mothers were randomly assigned to either the HFO program or to a community services-as-usual control group. Outcomes for the current study were tracked for 2 years post-random assignment for all study participants through administrative data linkages to Oregon's statewide child welfare system, self-sufficiency services, and substance abuse treatment programs. Results indicated that families assigned to HFO program were no more or less likely to have a substantiated child abuse report than were controls (6.3% vs. 6.0%), but were significantly more likely to have an unsubstantiated report (9.7% vs. 7.9%). Among HFO families who were reported to the child welfare system, 86.2% (94 children) were reported after they had exited the program, while 13.8% (15 children) had a report while enrolled. However, 50.5% of children with unsubstantiated reports were reported while families were receiving HFO services, suggesting a surveillance effect for unsubstantiated reports. HFO families, compared to controls, were also significantly more likely to have been enrolled in Temporary Assistance for Needy Families (TANF) services for the first time, to have received more days of Supplemental Nutrition Assistance Program (SNAP), and to be enrolled in publically-funded substance abuse treatment services. Results suggest that early effects of home visitation on outcomes that can be measured through administrative data are small to modest, and that findings related to documented child welfare systems involvement may require more nuanced data than are typically used and/or available from state agency systems.     

An innovative child welfare pilot initiative: Results and outcomes

Successful family reunification is achieved only about 50% of the time when children are in foster care. Parents' ability to access and complete court ordered services are paramount in determining whether the family can achieve reunification. However, the research on how to best facilitate service access and utilization are sparse. A matched sample of 100 families with no prior child welfare involvement and at least one child in out of home care were selected from Department of Children and Family closed administrative case files. This study compared 48 families who received traditional child welfare services to 48 families who received a Family First model intervention (PFFP) from a large urban public child welfare agency. The independent variables were the elements that distinguished the Family First model from traditional child welfare services and included the number of caseworkers for the life of the case, caseload size, and service needs met through community partnerships. The dependent variables were the stability of the children's out of home placement, the time to reunification, the length of agency involvement, the stability of reunification at one year follow up, subsequent substantiated child maltreatment reports one year after the cases were closed, the distance a placement location was from the home of the family at intake, the match between identified needs and the timely access of services. Hierarchal regression and survival models were constructed to examine elements of the intervention for their impact on family outcomes. The results suggested that a community partnership model that incorporated family engagement, enhanced service provider accessibility, reduced caseloads, one caseworker for each family, are associated with successful reunification outcomes. Moreover, the intervention families were more likely to have their needs met with clinical or economic services, experienced fewer days in out-of-home placement, shorter involvement with the agency, reduced placement moves and were more likely to be reunified sooner compared to the group who received standard child welfare services. At one year follow up, the intervention families also had fewer substantiated child maltreatment reports and children were more likely to be living in the parental home. Implications for policy, research and practice are presented.     

Parental substance misuse and compliance as factors determining child removal: A sample from the Victorian Children's Court in Australia

Purpose

The current study explores the role of parental substance misuse in child protection cases and examines its impact as a factor in decisions on child removal in court orders.

Methods

A cohort of 273 child protection cases from the Victorian Children's Court was reviewed. This sample consisted of cases where children have been removed (Custody to Secretary Order, n = 142 cases) or remained with parents (Supervision Order, n = 131 cases). Data was extracted on parental substance misuse in single and two parent households as well as compliance with court-based and child protection directives.

Principle results

Parental substance misuse (PSM) was present in 51% of child protection cases sampled and among those, poly-substance abuse was common (67%). PSM was associated with Indigenous status; younger age of child at court appearance; having a court-proven case of emotional abuse, less compliance with child protection services and a longer time between notification to authorities and final court decision. In one parent households, only parental compliance is the primary factor underlying decisions of child removal. In two parent households, the decision to remove a child from the family home was ultimately driven by parental compliance, and to a lesser extent by PSM of illicit drugs and the number of parents misusing drugs.

Conclusion

PSM and non-compliance appear to be significant factors in delaying stability for the child through the granting of court orders which may involve child removal. There is a need, by child protection professionals, for prompt recognition of PSM and associated compliance/engagement issues in order to refer appropriate cases for further assessment and treatment in specialist drug treatment services. Early involvement with specialist drug treatment services provides the Court with an indication of compliance which is an important factor for making decisions that assist with achieving stability for the child.     

How Can the Process of Parental Alienation and the Alienator Be Effectively Treated?

This article discusses primarily approaches or methods in dealing with a parent who alienates a child against another parent due to the hostility developed following divorce and separation. The basic vision or aims for combating parents in conflict are delineated. This is followed by the importance of being aware of the problems resulting in parental alienation (PA). To overcome PA an orderly set of stages from soft options to severe strategies are presented, with reasons for the use of the more severe method being provided. Finally, there is an appeal to the family courts and its judges to consider seriously the conclusions reached by one expert witness in how to combat PA by considering first and foremost the short- and long-term needs of the child and secondarily the alienated parent.     

Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders’ Views of Policy Implementation

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

Facing Time Limits

Abstract

With reauthorization of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) on the horizon, policy makers need to have a sound understanding of the act's consequences for children and families. In contrast to earlier studies, the present study quantifies the impact of a 24-month state imposed welfare time limit on foster care placements. It also examines the impact of a “hardship” provision that temporarily excuses select families from meeting a two-year time limit on foster care placements in Nevada. In order to determine how these factors, in conjunction with other relevant welfare experiences and personal factors, affect parent-child separation, a multivariate logit model was tested. Key findings reveal that families who have more months counted toward their time limits also are more likely to have at least one child removed and placed in foster care. On the other hand, hardship families are not more likely to have their children placed in foster care than non-hardship families. The findings lend support to the notion of providing family-centered casework services to those identified to be at risk of approaching their welfare time limits. The findings also lend support to inter-agency collaboration between TANF and child welfare systems.     

Parents' Definition of Effective Child Disability Support Services: Implications for Implementing Family-Centered Practice

The current study examined parents' perspectives of services within a community-based childhood disability program in the process of enhancing the family centeredness of its services. Qualitative interviews were conducted with 39 mothers and 22 fathers approximately 18 months after entering the service delivery system. Parents reported that effective service delivery requires service coordinators with interpersonal and practice skills working within an adequately resourced service system that has policies and procedures that are responsive to family needs. Parent feedback was congruent with the principles of family-centered practice and has important implications for the implementation of family-centered services.     

Behaviors and Strategies Employed in Parental Alienation

Abstract

A survey study was conducted of adults who self reported being targets of parental alienation. Three research questions were addressed: (1) What alienating strategies were identified by the targeted parents and to what extent were these behaviors consistent with those identified by adult children of PAS? (2) Was gender of the targeted parent associated with number and/or type of strategy identified? And (3) What child and parent characteristics were associated with level of PAS (mild, moderate, severe) as described by the targeted parents? Ninety-seven individuals completed a written survey. One section of the survey asked participants to list every type of behavior that they believed the alienating parent used to effectuate the alienation. From prior research and review of the responses, a list of possible strategies was developed. The 1,300 actions described by the 97 participants were independently coded. Results revealed 66 types of strategies, 11 mentioned by at least 20% of the sample. There was considerable but not complete overlap in the strategies identified by the targeted parents with those described by adult children (from another study). There were no statistical differences in the number or type of strategy mentioned based on the gender of the targeted parent or the gender of the target child. Level of severity of PAS (mild, moderate, severe) as perceived by the targeted parent was associated with age and gender of the target child, with girls and older children being more likely to be reported as more severely alienated. These results provide a systematic examination of the different types of alienation strategies known to targeted parents and as such they offer several avenues for clinical interventions and future research.     

An international classification system for child welfare programs

A major challenge in child welfare is whether a program (or service) developed and successfully implemented in one jurisdiction, especially another country, will attain the same outcomes for children and families in another jurisdiction? This paper presents the “DCE Classification System” (Defining, Classifying, and Evaluating), a classification system that facilitates cross-jurisdiction comparisons of child and family services. The paper reviews the cross-national research literature in child and family services as well as literature on classification schemes and typologies. As an example of the issues that arise when importing a promising program, we briefly highlight the exporting and importing of family group conferencing. After tracing the history and development of the DCE Classification System, the paper describes the proposed classification scheme, and provides a brief example of how researchers and practitioners can use the classification system for cross-national comparisons of client outcomes and program costs. Finally, we discuss the strengths and weaknesses of this approach, as well as possible benefits for child and family practices.     

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.