Disparities in high school completion among Latinos: The role of the age-at-arrival and immigration status

In comparing educational outcomes among Latino immigrants and their native-born peers, prior research has largely overlooked the potential roles of age-at-arrival to the United States and immigration status. To address these oversights, this study considers the relationships between age-at-arrival and immigration status (citizen, authorized, and unauthorized) on high school completion among a sample of Latino adults (N = 932) from the 2001 Los Angeles Family and Neighborhood Survey (LA FANS). Results from weighted logistic regression models suggest that, irrespective of age-at-arrival to the United States, having an authorized or unauthorized immigration status is significantly associated with a lower likelihood of high school completion. Moreover, no significant differences were found in high school completion between early and later childhood arrivals once accounting for immigration status and other covariates. This study suggests that immigration status plays an important role in high school completion and should be considered in efforts to improve educational outcomes among Latino immigrants.     

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.     

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.     

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.     

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.     

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.     

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.     

Drivers of change: Examining the effects of gender equality on child nutrition

India has the world's highest burden of child undernutrition. Lack of income is considered as one of its primary causes. However, evidence suggests that despite steady economic growth and investments in social services directed towards child welfare, undernutrition rates continue to rise. Thus indicating, that there are other societal factors impacting child undernutrition. Previous studies indicate that countries with higher gender inequality have worse health outcomes for women and children. India, particularly in the northern states, has deep-rooted gender biases, leading to disproportionately worse outcomes for women and children. This study uses cross sectional data from the India National Family Health Survey Round-3 (NFHS-3) to examine the immediate and underlying effect of gender inequality on child nutritional status. The sample includes urban married women between 15 and 49 years (N = 9092) who have at least one living child between 0 and 5 years. Findings highlight the significant effect of autonomy and health related awareness on child nutritional status, when the relationship is mediated by maternal health. Implications for policy and practice are provided.     

The reasons why children work on the streets: A sample from Turkey

The phenomenon of children working on the streets is a societal issue in all underdeveloped or developing countries just as it is in Turkey. The purpose of this research was to examine the reasons that children work on the street by conducting individual in-depth interviews with working children and their mothers, choosing individuals from similar socioeconomic demographic backgrounds and making a comparison of their acceptance or rejection of working, the perception of social support received by the mothers, and their problem-solving skills. The research was a mixed study that used both qualitative and quantitative techniques. The research was conducted in two stages. In the first stage, quantitative comparisons were made of the problem-solving skills of and social support received by the mothers of children working on the streets (n = 37) and non-working children (n = 35) and of the parental acceptance or rejection/control status of working children (n = 41) and non-working children (n = 41). In the second stage, the reasons children were working on the streets were evaluated qualitatively with seven children who were working on the streets and nine mothers. The Child/Adolescent Parental Acceptance–Rejection/Control Questionnaire, the Multidimensional Scale of Perceived Social Support, the Problem-Solving Inventory, and individual interview questionnaires were used as data collection tools. The social support and problem solving skills of the mothers with children working on the streets were lower than those of the mothers whose children were not working. The main themes and sub-themes that stood out at the end of the research were socioeconomic and political factors, environmental factors, cultural factors and family factors.     

Wait until your father gets home? Mother's and fathers’ spanking and development of child aggression

This study examined whether fathers’ and mothers’ spanking contributed to development of child aggression in the first 5 years of life. We selected parents (N = 1,298) who were married or cohabiting across all waves of data collection. Cross-lagged path models examined fathers’, mothers’, and both parents’ within-time and longitudinal associations between spanking and child aggression when the child was 1, 3, and 5 years of age. Results indicated that mothers spanked more than fathers. When examining fathers only, fathers’ spanking was not associated with subsequent child aggression. When examining both parents concurrently, only mothers’ spanking was predictive of subsequent child aggression. We found no evidence of multiplicative effects when testing interactions examining whether frequent spanking by either fathers or mothers was predictive of increases in children’s aggression. This study suggests that the processes linking spanking to child aggression differ for mothers and fathers.     

Child development in HIV-positive and HIV-affected children in South Africa and Malawi—What role for community organisations?

There is evidence that children who are HIV positive (HIV +) are at risk for poor developmental outcomes. The aims of this study were to use developmental screening tools to measure outcomes of children affected by HIV/AIDS attending community-based organisations (CBO) and to determine what types of CBO provision these children were receiving. In a cross-sectional study, we interviewed 979 children and their carers (4 to 13 years) at 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Developmental outcomes were assessed using the Ten Questions childhood disability screening tool and the Strengths and Difficulties Questionnaire. Health-related quality of life was measured using the Paediatric Quality of Life Scale. Overall, 13.8% (n = 135) were HIV +. HIV + children were more likely to have developmental difficulties and lower health and educational quality of life, controlling for a range of factors. Developmental difficulties and poorer quality of life were predicted by being HIV +, living in South Africa, not attending school regularly, poor housing conditions and living with a sick family member. HIV + children tended to have been enrolled in CBO programmes for a longer period compared to other children but reported lower rates of contact. A greater proportion of HIV + children received medical services, psychosocial interventions and emotional support, compared to HIV − children. However, fewer HIV + children were enrolled in play groups, early childhood intervention programmes and educational programmes. Screening for developmental problems using short tools is possible in community settings in order to identify children with developmental difficulties and plan services for children infected with and affected by HIV. This study highlights the important role of CBOs to intervene to improve child development outcomes. The delivery of evidence-based services that target child development outcomes will enable HIV-infected children to meet their developmental potential and promote their participation in their communities.     

Psychotherapeutic care for sexually-victimized children – Do service providers meet the need? Multilevel analysis

ObjectivesSurprisingly little is known on the decision to refer sexually-victimized children to psychotherapy. Previous research on service provisions for victims of child maltreatment has analyzed the impact of case characteristics, like child or caregiver functional levels, lack of social support, and socioeconomic status. Findings, however, show that the decision to provide services is not only needs-driven, but also affected by external factors like provincial legislation, institutional policies, and the availability and accessibility of services. By analyzing characteristics behind the decision to refer sexually-victimized children to psychotherapy at the case and institutional level, we aimed to disentangle the complex interplay of factors driving this decision.MethodsThe data for this analysis were drawn from the first nationally-representative agency survey on reported child sexual victimization (CSV) in Switzerland. Over a 6-month data-collection period, 165 child protective services, 87 penal authorities and 98 agencies in the health and social sector documented a total of 911 incidents of CSV. Multilevel logistic regression was applied to analyze factors at both the case and contextual level.ResultsThe main finding was that the severity of consequences was strongly associated with the probability of psychotherapeutic service referrals (OR = 10.4; p < 0.001). However, one bias was identified at the individual level: sexually-victimized children born in Switzerland were more likely to be referred to psychotherapy than immigrant children. Institutional disparities in the decision to refer a sexually-victimized child to psychotherapy were large (median OR = 3.83), with penal authorities referring significantly fewer cases to psychotherapy than specialized agencies in the health and social sector. What exactly was driving the difference between psychotherapy referral in different types of agency remains largely unexplained.ConclusionsFuture research should invest in scrutinizing contextual factors of child protective service decisions. As we operationalize the need for psychotherapy as proxy-rated consequences of victimization, routine screening for mental health needs using standardized measures for children in contact with child protection agencies should be implemented, to help frontline workers to identify the psychotherapeutic needs of victimized children.     

Contact with birth family in intercountry adoptions: Comparing families headed by sexual minority and heterosexual parents

Contact between adoptive families and birth families in the context of intercountry adoption, as well as adoption by sexual minorities (e.g., lesbians and gay men), represent understudied topics. In the current study, we examine the extent and type of contact with birth family in intercountry adoptive families headed by heterosexual and sexual minority parents. Data were drawn from the Modern Adoptive Families project, a nationwide, non-random survey of adoptive parents' beliefs and experiences that was conducted from 2012 to 2013. The current sample consisted of 479 families headed by heterosexual parents (H) and 38 families headed by sexual minority women (SM) whose oldest adopted child was younger than 18 years of age and who had been placed from another country. Although no family type difference was found in contact with birth family prior to or at the time of placement (H = 9.6%; SM = 13.2%), sexual minority respondents reported a higher level of contact with one or more members of their children”s birth families following adoptive placement than did heterosexual respondents (SM = 28.9%; H = 14.4%), as well as currently (SM = 21.1%; H 9.8%). They also reported more contact with their children”s birth mothers than did heterosexual parents, although no family type differences were found for contact with other birth family members. Policy and practice implications are discussed.     

Ethnic disproportionality in the child welfare system: A Norwegian national cohort study

This study of Norwegian child welfare clients examined the extent to which ethnic disparities in involvement with the child welfare system can be attributed to ethnic differences in sociodemographic background. Using logistic regression models and a unique dataset constructed by linking child welfare records to national administrative registers for the 1993–1994 birth cohorts, we computed ethnic disparities in the odds of child welfare involvement at age 6–12 (N = 122,894), both before and after adjustments for sociodemographic background. Compared with ethnic Norwegian cohort peers, non-Western children had twice the unadjusted odds of entering the child welfare system (odds ratio = 2.13). However, the data also indicated pronounced ethnic disparities in eight sociodemographic correlates of child welfare involvement. When adjustments for these background factors were modeled, we found no ethnic differences in the odds of child welfare involvement. Our findings suggest that the association between ethnicity and child welfare involvement is confounded by differences in socioeconomic status, maternal social assistance, family size and family structure.     

Medical complexity and placement outcomes for children in foster care

ObjectiveMedical complexity threatens placement stability and permanency outcomes for children in foster care (FC). This study aimed to characterize for US children in FC: 1) medical complexity, using number of diagnosed types of disability as a proxy; 2) demographic and removal characteristics based on level of complexity; and 3) whether increasing levels of complexity were associated with foster care placement outcomes.MethodsThe analysis included children in FC, ages 0–21 whose disability status was clinically assessed and documented (n = 538,695). Using data from the FY 2014 Adoption and Foster Care Analysis and Reporting System, medical complexity was categorized (0–4 +) based on 5 disability types: emotional, hearing/vision, intellectual, physical, and other. Bivariate analyses (χ² tests, Kruskall-Wallis) compared the distribution of demographic and removal characteristics among complexity groups. Multiple logistic regression evaluated relationships between medical complexity and placement outcomes, including length of stay in FC, placement stability, and permanency.ResultsTwenty-three percent of the sample had 1 disability type, 7% had 2, 3% had 3, 1% had 4 +, and 67% had no disability. Children with increasing complexity were more likely to be older, older on FC entry, male, Black, non-Hispanic, placed in a group home or institution, have abuse, neglect, and/or child disability/behavior as reason for removal, and have poor placement outcomes.ConclusionChildren in FC with greater medical complexity are at risk for undesirable placement outcomes. By recognizing and addressing the unique needs of this vulnerable population, pediatric providers and child welfare staff may identify strategies to improve placement outcomes.     

Perspectives on disclosure among children living with HIV in India

BackgroundFollowing the widespread uptake of anti-retroviral therapy (ART), young children living with HIV are entering adolescence and beyond, necessitating disclosure of HIV status. However, few studies have described children's experiences following disclosure.MethodsWe assessed disclosure status among children attending HIV clinics at two tertiary-care centers in southern India. Children who had disclosure were administered a pre-tested questionnaire assessing their knowledge about HIV, ART, experiences following disclosure, perceived stigma and ideas about their future. The association of the children's responses with social desirability bias was examined using a modified social desirability scale.ResultsTwenty-four caregiver-child dyads participated in this study. They constituted a subset of children who had been told of their HIV diagnosis from a larger study of 247 dyads. Mean age at disclosure was 10.9 ± 2.5 years. Medical personnel were responsible for disclosure to 14 children, parents/caregivers to 3 children, both medical and care personnel together to 4 children and other relatives to remaining 3 children. Disclosure was met with acceptance by one-third of the children. Despite disclosure, five children did not know how HIV spreads, and three were unaware about how infection could be prevented. Notwithstanding their positive status, 20 children felt that they were treated well at school and by their immediate relatives, although 11 children mentioned that they needed to hide while taking ART. Social desirability bias did not play a role in the responses given by these children.ConclusionsThe rate of disclosure of HIV status among children living with HIV in India was low, even among older children. Most children accepted their status, but knowledge about HIV and ART was inadequate. Disclosure was predominantly performed by medical personnel, rather than the primary caregiver. Incorporating disclosure into the care process for older children is likely to be beneficial, and should be recognized as an iterative process with a need for incorporating cultural sensitivities and a comprehensive approach to health education.     

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.     

The impact of para-professional social workers and community health care workers in Côte d'Ivoire: Contributions to the protection and social support of vulnerable children in a resource poor country

BackgroundResearch indicates a disproportionate impact of HIV and AIDS in sub-Saharan African countries, leading to many vulnerable families and children. Many of these communities have limited resources to support these vulnerable families, especially orphans and vulnerable children (OVC).Study aims and objectiveThis study set out to investigate how para-professional social workers and community health workers (PSWCHW) impact the provision of services and the psychosocial wellbeing and protection of vulnerable children in the community.MethodsThis quasi-experimental research study used data from an independent Save the Children program evaluation study in Côte d'Ivoire. We compared the health and psychosocial wellbeing of identified vulnerable children supported by para-professionals (n = 334) and children not receiving para-professional support (n = 213).FindingsSupport services and activities provided by PSWCHW included encouraging the children to be part of psychosocial support groups. Many of the children reported legal issues that ranged from getting a birth certificate issued to fighting or quarrelling with adults, disputes, public insults, beatings, and refusing to go to school. We found that the engagement of PSWCHW helped three out of four children go to school (compared to only one in four of the children without PSWCHW). PSWCHW also helped the children improve access to health care services.ConclusionsCommunities in sub-Saharan Africa should continue to consider the integrated utilization of para-professional social workers and community health care workers to support and improve psychosocial wellbeing of orphaned and vulnerable children which, in turn, enhances child protection services and access to healthcare.     

Expanding the conceptualization of re-entry: The inter-play between child welfare and juvenile services

Re-entry in child welfare is traditionally viewed as a child exiting to permanency and then reentering the child welfare system. Using this approach is effective for understanding child welfare practice from a single-system lens, but gives an incomplete picture of how children may move between related child serving systems. The present study expands the definition of re-entry by examining re-entry for 2259 children who either return to the child welfare system or move into the juvenile justice system after reunification from foster care. When measuring a broader concept of re-entry (into either system) the rate of re-entry went from 18% to 25% - a 33% increase. Regression analyses further suggested that many of the risk and protective factors associated with standard child welfare reentry were also predictive of multisystem re-entry such as having previous child welfare experience (OR = 1.79, p < 0.000), and child behavior as a factor at removal (OR = 1.75, p < 0.000). Findings of this study support the need to continue increasing the conceptualization of re-entry to be more inclusive of related systems as well as continuing to focus research efforts on understanding effective practices within child serving systems so that re-entry into either system is mitigated.