Early care and education arrangements and young children's risk of foster placement: Findings from a National Child Welfare Sample

A primary goal of the U.S. child welfare system (CWS) is to maintain children investigated for maltreatment in their parents' homes whenever safely possible. This study explores the possibility that early care and education (ECE) services (e.g., child care, preschool, day care) can help the CWS achieve this goal by using a nationally representative sample of children referred to CWS for suspected maltreatment to measure the relationship between ECE receipt and the likelihood that 0–5 year olds in the CWS will be placed in foster care approximately 18 months later. Specifically, logistic regression analyses explore the relationship between: (1) regular ECE participation (yes/no), and (2) type of ECE arrangement (Head Start, other center- or home-based ECE, family/friend/relative ECE, other ECE, and multiple types of ECE) and foster placement risk. After controlling for multiple socio-demographic characteristics and foster placement risk factors, children who received ECE (yes/no) were no less likely to be placed in foster care than children who received no ECE. However, when exploring type of ECE arrangement, children who received Head Start were 93% less likely to be placed in foster care than children with no ECE. Children who participated in multiple types of ECE were almost seven times more likely to be placed in foster care than children with no ECE. These results suggest that Head Start may help maltreated children avoid foster placement and that experiencing multiple types of ECE is a risk factor for foster placement. It is recommended that caseworkers routinely assess the ECE service history and needs of families with young children who come in contact with the CWS, paying attention to the type and number of ECE services used.     

The importance of matching the evaluation population to the intervention population: Using Medicaid data to reach hard-to-reach intervention populations

Subject recruitment is a challenge for researchers and evaluators, particularly with populations that are traditionally hard to reach and involve in research, such as low-income and minority groups. However, when the evaluation sample does not reflect a program's intended audience, the discrepancy may lead to evaluation results that are not valid for that audience. We conducted evaluation activities for a state Supplemental Nutrition Assistance Program-Education (SNAP-Ed) intervention that promotes consumption of fruits and vegetables (F&V) in low-income areas. Previous program evaluations efforts had failed to obtain a sufficient proportion of individuals identified as low-income based on their participation in SNAP. We used state Medicaid data as a means of identifying low-income families to recruit for a telephone survey (n = 311) and an in-depth qualitative interview (n = 30) that we designed for the program being evaluated. We chose to focus on the dynamics of parent-child communication around F&V because we considered this previously unevaluated component of the intervention vital to understanding program effectiveness. Our results indicated that the Medicaid database provided an appropriate sample and that parents reported frequent F&V requests from their children. Parents also reported that they would positively respond to requests in many different settings, such as grocery stores (92.6%), restaurants (88.1%), and fast food restaurants (80.4%).     

The relationship between parent immigration status and concrete support service use among Latinos in child welfare: Findings using the National Survey of Child and Adolescent Well-being (NSCAWII)

The underutilization of concrete services by immigrants is widely documented across several service sectors, yet evidence is lacking on the use of such services among immigrants reported to child welfare for the purposes of reducing maltreatment. It has been suggested that Latino immigrants involved with the child welfare system may face steep challenges to receiving needed services due to issues surrounding legal status, language and cultural barriers. The purpose of this study was to determine whether referral to and receipt of concrete services by Latino families reported to child welfare agencies, was associated with legal immigration status. The sample included children of Latino parents who participated in the second National Survey of Child and Adolescent Well-being (NSCAWII), who remained in the home following a child welfare investigation (n = 561). Over a third (37%) of Latino families were referred for at least one concrete service, yet only 17% received any. Weighted logistic regression models showed that families in which the primary caregiver was undocumented had significantly lower odds (OR = .24) of receiving services once referred. Families who had trouble paying for basic necessities (OR = 7.52), those with active domestic violence in the home (OR = 4.98), and those receiving ongoing child welfare services (OR = 4.52) had increased odds of referral for services by the caseworker. The odds of receiving services increased when the primary caregiver was unemployed (OR = 5.24), when there was domestic violence in the home (OR = 4.59), and with the receipt of child welfare agency services (OR = 8.83). There appears to be an unmet need for concrete services among Latinos investigated by child welfare, as demonstrated in the gap between overall service referral and receipt. A parent's legal status may be one reason for that unmet need, implying that children of undocumented parents are less likely to have basic needs met to mitigate economic stress and reduce maltreatment risk upon contact with child welfare. Policy recommendations and implications for child welfare practice are discussed.     

Self-report of health problems and health care use among maltreated and comparison adolescents

The study aims were to compare maltreated and comparison adolescents' health problems and to identify how individual, family and home characteristics and maltreatment status affect adolescents' self-report of health status and health care use. The sample was 224 maltreated adolescents (mean age = 18.3 years) and 128 comparison adolescents (mean age = 18.15 years). Comparison adolescents reported more cold and pain symptoms during the previous 30 days but no differences in other physical health problems, self-assessment of their physical and mental health or health care use compared to maltreated adolescents. Girls were more likely to have had a dental checkup, to have seen a psychological counselor, and to self-identify their physical health as poor compared to boys. Older adolescents were less likely to have had a medical checkup or seen a psychological counselor than younger adolescents. A history of maltreatment was not related to health or health care disparities for adolescents growing up in the same low-income environment as adolescents without a maltreatment report. The environmental context and geographical location in which these adolescents grew up may be the primary driver in their health behaviors and health problems and not the experience of maltreatment.     

The subjective well-being of adolescents in residential care compared to that of the general population

The aim of this research is to study the subjective well-being of adolescents in residential care and compare it with that of the general population of the same age in Catalonia. Two samples were used: one from the general population in the first year of secondary education (n = 491; 50% boys; mean age = 12.1 years) and another from the residential care population aged 12–13 years (n = 226; 56% boys; mean age 12.5). The questionnaire of the International Survey of Children's Well-Being (ISCWeB) was used. It includes two psychometric scales: the Personal Well-Being Index—School Children (PWI-SC7) and the Overall Life Satisfaction (OLS); the former being adapted for the in-care population. To test the validity of the factorial structure of data for the two groups, a Confirmatory Factor Analysis (CFA) of the PWI-SC7 and different multi-group structural equation models (SEMs) were conducted. The CFA of the PWI-SC7 showed a good fit with the pooled sample and good comparability of correlations and regressions between the two groups. The SEM with constrained loadings allowed us to compare the contribution of the different items on the PWI-SC7 latent variable which was higher in all cases for adolescents in care. Likewise it showed a high correlation between OLS and PWI-SC7 in both populations, being it more intense among adolescents in care. Scores on the OLS and on the PWI-SC7 are significantly lower among adolescents in care. However, according SEM results mean scores of the PWI-SC7 are not strictly comparable between groups. Results challenge public policy concerning children by increasing efforts to promote equal opportunities for the in-care community and improve satisfaction with particular life domains, such as school and residential homes.     

Aggressive behaviors among Korean children in out-of-home care: The role of placement characteristics

Using data from the Korean Panel Study on Children in Out-of-Home Care, this study examined the impact of placement characteristics on aggressive behaviors among children in out-of-home care by placement type. The sample was divided into three groups based on placement type: institutional care (n = 118), group homes (n = 95), and foster care (n = 212). Results from hierarchical multiple regression analyses indicated that the length of stay in out-of-home care significantly influenced aggressive behaviors amongst children in institutional care, such that increased duration of out-of-home care decreased the level of aggressive behaviors. Perceptions of stigma/discrimination also significantly influenced aggressive behaviors displayed by children in institutional and foster care. Children with a higher perception of stigma/discrimination were more likely to exhibit severe aggressive behaviors than were their counterparts. On the other hand, placement characteristics had no significant influence on aggressive behaviors of children in group homes. The study findings suggest that children's mental health problems and disabilities should be considered during the placement procedure and interventions focusing on decreasing stigmatization should be developed and provided for children in out-of-home care.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family.MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care.ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR = 1.05, CI = 1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR = 1.84, CI = 1.04–3.24). Child's psychosocial care use was more likely among older children (OR = 1.94, CI = 1.20–3.15); greater social support by family and friend (OR = 1.03, CI = 1.00–1.06); more psychosocial problems (OR = 1.75, CI = 1.04–2.97); and when there were more parenting concerns (OR = 1.19, CI = 1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR = 1.27, CI = 1.17–1.38, and OR = 1.39, CI = 1.25–1.55).ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.     

The within poverty differences in the occurrence of physical neglect

This secondary data analysis examined the risk and protective factor(s) associated with physical neglect within a sample of impoverished children. We conducted a multivariate logistic regression analysis to examine the associations among maternal age, child gender, caregiver depression, caregiver history of maltreatment, income-to-needs ratio, number of children in the home, marital status, neighborhood quality, and physical neglect. Social support was explored as a potential moderator. Among this impoverished sample, children whose caregivers had depression were 2.03 times as likely to experience physical neglect as children whose caregivers were not depressed (95% CI 1.25, 3.30; p = 0.004). Children whose caregivers reported experiencing child maltreatment were 1.81 times as likely to experience physical neglect as children whose caregivers did not experience maltreatment as a child (95% CI 1.17, 2.81; p = 0.008). Children who live in higher quality neighborhoods were 0.74 times as likely to experience physical neglect as children who live in lower quality neighborhoods (95% CI 0.57, 0.96; p = 0.03). No other significant relationships were found.     

Factors affecting adoption in Wales: Predictors of variation in time between entry to care and adoptive placement

In the UK, there has been an increasing emphasis in recent years on reducing the delay in making permanent placements for children who cannot remain living with their birth parents. Adoption is one such plan for permanence. This study examined those factors that predicted a lengthier care episode for a national sample of children recently placed for adoption. The data was drawn from the Wales Adoption Study. This is a mixed methods study that analysed information from the adoption reports of all children placed for adoption over a 13 month period during 2014 and 2015 (n = 374). Children were aged between 0 months and 6 1/2 years on entry into care. On average, the time between entering care and moving into an adoptive placement was 528 days. The results of the regression analysis showed that four child-related factors were associated with a longer wait in care before being placed for adoption. These were developmental delay, externalizing behaviour, serious and enduring health problems/disability and exposure to domestic violence. The procedural factors examined showed no association with length of time to placement. The findings from this study make a substantial contribution to further developing what is known about the timeliness of adoption within the current UK context. The implications for policy and practice are discussed.     

Quality improvement learning collaborative to examine foster care guidelines

Learning collaboratives (LC) are an important method of implementing quality improvement by serving as laboratories to translate research into practice and sharing knowledge. We created a Foster Care Learning Collaborative (FCLC) of 11 foster care health sites to share best practices on providing health services for children in foster care. Using a collaborative approach involving monthly conference calls, we invited each health site to present specific health care delivery issues for the purpose of developing collaborative quality improvement projects regarding the delivery of healthcare to children placed into foster care. For health sites providing primary care (n = 8 of 11 sites), we examined adherence to two American Academy of Pediatrics (AAP) guidelines for children entering foster care: a) the initial health screen, and b) the comprehensive medical evaluations. At least four distinct types of health care models that provide either direct primary care or administrative oversight for children in foster care were identified: 1) medical home sites (n = 3); 2) foster care evaluation/intake sites (n = 2); 3) specialized primary care sites (n = 1); and, 4) state administrative programs (n = 2). Data from the six direct primary care sites (n = 586 children) and two state administrative models (n = 3855 children) was collected. The time-frame for the initial health screen was adjusted to 7 days after entry and adherence (31%) was comparable among primary care sites. Adherence to AAP guidelines regarding completion of a comprehensive medical evaluation within 30 days of intake varied among medical homes (30%–86%), intake models (23%–33%), specialized primary care site (43%), and state models (43%–73%). No site was fully compliant with the AAP guideline for universal comprehensive medical evaluation within 30 days, and there is variation within and among care models. A foster care learning collaborative identified significant variability in adherence to a commonly accepted guideline for timely access to healthcare for children placed into foster care. The LC c model offers the opportunity to evaluate best practices, identify barriers to care, and provide objective feedback for improvement.     

Aggressive and stressed? Youth's aggressive behaviors in light of their internet use,sensation seeking,stress and social feelings

Aggressive behavior and its consequences are a serious mental health problem for youth all over the world. In this study we investigated how problematic internet use, sensation seeking and social/dispositional factors are related to three forms of aggression: physical, verbal, and anger in a sample of Hungarian youth. In total 408 (50% females) aged between 14 and 24 years (M = 20.8 years, SD = 2.6) completed an online survey (between January and June 2014; different online social networking sites and online forums, such as university groups on Facebook and Hungarian writing sites) assessing these constructs. Multiple linear regression analyses (stepwise method) revealed a mixed pattern of predictors of each type of aggression, with boredom, age (as negative predictor), stress, lack of shyness and internet-associated neglect accounting for significant variance in verbal aggression. Obsessive internet use, disinhibition, stress and loneliness each accounted for significant variance in anger. Finally, after controlling for gender, internet-associated neglect, disinhibition and loneliness were associated with physical aggression. These findings suggest that interventions targetting aggression need to focus on different behaviors and attributes, depending on the type of aggression exhibited. Learning effective aggression management techniques should be a part of complex health education programs that would help with prevention of social conflicts, substance use, problem behavior, psychological and mental health problems as well as problematic internet use.     

Unmet legal and social advocacy needs of children with sickle cell disease: Implications for health care payer costs

Previous studies of advocacy needs faced by children and families have not differentiated needs that require attorney involvement (“legal advocacy needs”) from needs best addressed by social workers or lay advocates (“social advocacy needs”). Studies have also not examined the relationship between either type of need and health care costs. We developed a novel, replicable process to differentiate between legal advocacy needs and social advocacy needs. We then collected cross-sectional data from a sample of 52 children with sickle cell disease who were at least 1 year of age, a population with high advocacy needs and high health care costs. Mean annual health care costs to payers for children whose families had a least one legal advocacy need were $16,314, compared to $5552 for children in families with no legal advocacy needs (P = 0.007). After adjusting for covariates, the presence of a legal advocacy need was associated with $12,040 more in health care costs to payers (P = 0.02). Whether interventions to prevent and resolve legal advocacy needs can reduce health care costs by addressing the social determinants of health warrants future study.     

Children's executive function in a CPS-involved sample: Effects of cumulative adversity and specific types of adversity

Prior research has identified the presence of executive function (EF) deficits in child protective service (CPS) involved (versus non-involved) children but minimal work has examined predictors that might explain individual differences within these CPS-involved children. Here, we sought to characterize EF in a large sample (N = 694) of CPS-involved children and examine how specific adversities (physical abuse, neglect, caregiver domestic violence, and caregiver substance dependence) and cumulative adversity (at ages 0–3 and 3–6 years) predict EF (at approximately 5–6 years). It was expected that the sample would exhibit low EF overall based on previous research in maltreated children. Specific adversity and cumulative adversity analyses were largely exploratory given the limited previous work in this area. Results indicated poor EF overall, with 43.5% of children performing worse than chance. Among children who performed greater than chance, higher cumulative adversity, physical abuse, and caregiver substance use (at ages 3–6 years) predicted better EF. These findings join literature documenting that, within CPS-involved children, the presence of certain adversities predicts variable cognitive function. Findings highlight the potential relevance of evolutionary psychology to understanding how alterations in behavior linked to harsh and unpredictable early environments may cue accelerated brain development underlying relative cognitive advantages, within at-risk, low performing samples. Longitudinal studies are critical to determine if the relative EF advantages linked to higher adversity persist over time or result in lower EF later on, reflecting a more rapid, but overall limited, trajectory of cognitive development.     

We have rights too: examining the existence of professional prejudice and discrimination against public relations

This study of a large sample of public relations educators (n = 342) found substantial evidence that professional prejudice and discrimination towards public relations and public relations education exists. More than half (56.6%) of the respondents said they have had a dean, director or department chair who was prejudiced against public relations, and many of these administrators evidently have made use of exaggerations and stereotypes about public relations while criticizing it. Results also suggest this prejudice is more pronounced among print journalists and journalism faculty than it is among other groups of communication educators and practitioners.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

Association between social support and child abuse potential among Japanese mothers

Child abuse is a global public health problem and a serious social issue in Japan. Social support is beneficial for parents faced with childrearing challenges. The aim of this study was to clarify the association between social support and child abuse potential. A cross-sectional study was conducted using a structured questionnaire. The target population was mothers of children at nine public nursery schools. Bivariate and multiple linear regression analysis were performed to examine the effects of socio-demographic, social support and psychological distress factors on child abuse potential. Among 309 mothers, 29 (9.4%) had a high child abuse potential score. Bivariate analysis indicated that mothers with a higher child abuse potential score were more likely to be divorced or unmarried (P < 0.001); living in single-female-parent households (P < 0.001); have low perceived economic status (P < 0.001); have a low level of child care support (P = 0.01); have a low Multidimensional Scale of Perceived Social Support (MSPSS) score (P < 0.001); and/or a high General Health Questionnaire-12 score (GHQ-12) (P < 0.001). Important predictors of child abuse potential among the mothers surveyed included living in single-female-parent households, having low perceived economic status, low MSPSS score, and high GHQ-12 score. Improving approaches that help mothers build social support relationships and ease them into child rearing in a psychologically healthy condition is recommended to prevent child abuse.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Looking for sufficient change: Evaluation of counsellor training for STI syndromic management in India

In India, public health care of Sexually Transmitted Infections is delivered through Designated STI/RTI Clinics (DSRCs) using syndromic management. This paper describes efforts, over three years, to improve in-service training for counsellors positioned at DSRCs—using a data approach. The programme managers realised, through rigorous monitoring of initial induction training reports that, while knowledge and attitudes of most trainees had improved as evident from t-tests, at least one-quarter scored worse on post-training assessments (n = 859). Therefore, they undertook a survey using a competency approach to diagnose what critical competencies are influenced through training: counselling skills, risk reduction suggestions, labelling male and female anatomy, record-keeping and STI patient education (n = 132). Survey results demonstrated that trainees failed to pass a two-thirds cutoff score in most competencies. These findings led the programme managers to modify training and implement tighter quality measures. In the second round of training – refresher training – outcomes on competency assessments before and after training showed more acceptable performance (n = 833). The paper describes how programme managers, after an acceptance of such initial short-comings, developed customized assessments when literature provided limited guidance and how they worked to achieve change that was acceptable for programme needs.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.