Racial and Ethnic Differences in Family Caregiving in California

Abstract

Family caregivers are the main source of long-term care for older persons in the United States. At the same time, cultural values and beliefs shape decisions surrounding who provides care and whether families use formal support interventions to assist the caregiver. The current article examines how the family caregiving experience differs among racial and ethnic groups in terms of caregiver characteristics, service utilization, caregiver strain, and coping mechanisms. Telephone interviews were conducted in English and Spanish with a random sample of 1,643 respondents in California who provide care to someone age 50 or over. Bivariate analyses showed evidence of ethnic differences in the demographic characteristics of caregivers, intensity of care provided, caregiver health, level of financial strain, religious service attendance, formal service utilization and barriers to formal services. Odds ratios showed that White and African American caregivers were about two times as likely to use formal caregiver services as were Asian/Native Hawaiian/Pacific Islander and Latina American caregivers. Implied by these findings is the need for further understanding of caregiver service needs among diverse racial and ethnic groups.     

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

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

Who am I? Who do you think I am? Stability of racial/ethnic self-identification among youth in foster care and concordance with agency categorization

While it has been well documented that racial and ethnic disparities exist for children of color in child welfare, the accuracy of the race and ethnicity information collected by agencies has not been examined, nor has the concordance of this information with youth self-report. This article addresses a major gap in the literature by examining 1) the racial and ethnic self-identification of youth in foster care, and the rate of agreement with child welfare and school categorizations; 2) the level of concordance between different agencies (school and child welfare); and 3) the stability of racial and ethnic self-identification among youth in foster care over time. Results reveal that almost 1 in 5 youth change their racial identification over a one-year period, high rates of discordance exist between the youth self-report of Native American, Hispanic and multiracial youth and how agencies categorize them, and a greater tendency for the child welfare system to classify a youth as White, as compared to school and youth themselves. Information from the study could be used to guide agencies towards a more youth-centered and flexible approach in regard to identifying, reporting and affirming youth's evolving racial and ethnic identity.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Multiple family groups: an engaging intervention for child welfare-involved families

Differences between child welfare- and non-child welfare-involved families regarding barriers to child mental health care, attendance, program satisfaction, and relationship with facilitators are examined for a multiple family group service delivery model aimed at reducing childhood disruptive behaviors. Although child welfare-involved caregivers reported more treatment barriers and less program satisfaction than non-child-welfare-involved families, no significant differences exist between groups on average total sessions attended and attendance rates over time.     

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.     

Looking beneath and in-between the hidden surfaces: a critical review of defining,measuring and contextualizing mental health service disparities in the child welfare system

Efforts to understand and respond to racial and ethnic disparities in referrals to and use of mental health services among children involved in the child welfare system are constrained by the lack of consistency in defining and measuring disparities and the lack of clarity as to what causal mechanisms sustain patterns of disparate treatment. Recent developments in the field of public health offer some insight as to how our understanding of similar disparities in child welfare may be advanced. Despite advancements, there is still an insufficient knowledge base from which to offer an alternative definition of disparities that illuminates conceptual and methodological innovation in child welfare research. Based on a critical review of the literature, more exploratory and etiological research grounded in implementation of advanced metrics and multivariate methods is warranted to generate a clear definition. Recommendations are offered to address conceptual ambiguity.     

Intergenerational families in child welfare: Assessing needs and estimating permanency

Much of the empirical literature on intergenerational child maltreatment focuses on the mechanisms that explain how maltreatment is transmitted across generations. Few studies have examined child protective service outcomes associated with intergenerational families. The current study addresses this gap in the literature. This study compares 1196 caregivers, most of whom are single African American females, and 2143 children from first and second generation child welfare-involved families. All families have a history of substance abuse. We sought to understand how first and second generation families differ with regard to social and economic status indicators, as well as whether intergenerational child welfare involvement is associated with permanency outcomes. Our findings indicate that second generation families experience significantly more risk factors at the time of case opening, and are two-thirds as likely to be reunified as compared with first generation families. The singular effects of generation status disappeared, however, once the interaction between mental health diagnosis and second generation status was entered into the model, suggesting that it is not just being intergenerationally involved in the child welfare system that reduces the chance of reunification, but rather second generation caregivers have more mental health problems that are associated with a lower likelihood of reunification.     

Parental Influence on Adolescent Cigarette,Alcohol and Marijuana Use: A Focus on Race/Ethnicity and Age

This study examined the racial/ethnic differences in the influence of perceived parental attitudes on adolescent cigarette, alcohol, and marijuana use. The 2014 National Survey on Drug Use and Health (NSDUH) was used and included African American, Hispanic, non-Hispanic White, and other race youth (N?=?13,600), aged 12–17. We tested the direct and moderating effects of perceived parental attitudes by race/ethnicity and age on adolescent substance use. Results show that perceived parental disapproval decreased cigarette and alcohol use among older adolescents. Perceived parental disapproval also varied by race/ethnicity and the type of substance used in that non-Hispanic White adolescents were more influenced by perceived parental disapproval for cigarette use, and perceived parental disapproval influenced Hispanic adolescents’ use for all three substances. African American adolescents were less influenced by perceived parental disapproval for all three substances. We also examined perceived harm in substance use and found that only 22.5% of the sample perceived the use of marijuana as harmful compared to cigarette and alcohol use (66 and 62.1%, respectively). Implications for preventive and intervention measures are discussed.     

Juvenile justice sentencing: Do gender and child welfare involvement matter?

For young people who come into contact with the juvenile justice system, how they are sentenced following an arrest may profoundly influence the course of their development and adjustment as adults. Much of the research to date has focused on racial and ethnic disparities in juvenile justice sentencing policies and practices, and less is known about sentencing disparities based on other youth characteristics. Using Los Angeles County administrative data, this study investigates the effects of gender and child welfare statuses on sentencing for young people who are arrested for the first time (N = 5061). Results indicate that both young men and women are sentenced more harshly dependent upon the disposition, such that girls were more likely to be sentenced to group homes compared to boys, but boys were more likely to be sentenced to correctional facilities compared to girls. Child welfare-involved youth with a recent placement history are prone to more punitive sentences compared to their non-child welfare counterparts. Further, child welfare young women were not more likely to be sentenced to a harsher disposition compared to child welfare young men or non-child welfare young women. Implications for practice and future research are discussed.     

Need-service matching in substance abuse treatment: Racial/ethnic differences

This study examines the impact of ancillary health and social services matched to client needs in substance abuse treatment for African Americans, Latinos and Whites. The study uses data collected from 1992 to 1997 for the National Treatment Improvement Evaluation Study, a prospective cohort study of substance abuse treatment programs and their clients. The analytic sample consists of 3142 clients (1812 African Americans, 486 Latinos, 844 Whites) from 59 treatment facilities. Results show that racial/ethnic minorities are underserved compared to Whites in the substance abuse service system. Different racial/ethnic groups come into treatment with distinct needs and receive distinct services. Although groups respond differentially to service types, substance abuse counseling and matching services to needs is an effective strategy both for retaining clients in treatment and for reducing post-treatment substance use for African Americans and Whites. Receipt of access services was related to reduced post-treatment substance use for Latinos. Study findings are relevant to planning special services for African Americans and Latinos.     

Neighborhood racial & ethnic diversity as a predictor of child welfare system involvement

Using U.S. Census and child maltreatment report data for 2052 Census tracts in Los Angeles County, California, this study uses spatial regression techniques to explore the relationship between neighborhood social disorganization and maltreatment referral rates for Black, Hispanic and White children. Particular attention is paid to the racial–ethnic diversity (or ‘heterogeneity’) of neighborhood residents as a risk factor for child welfare system involvement, as social disorganization theory suggests that cultural differences and racism may decrease neighbors' social cohesion and capacity to enforce norms regarding acceptable parenting and this may, in turn, increase neighborhood rates of child maltreatment. Results from this study indicate that racial–ethnic diversity is a risk factor for child welfare involvement for all three groups of children studied, even after controlling for other indicators of social disorganization. Black, Hispanic and White children living in diverse neighborhoods are significantly more likely to be reported to Child Protective Services than children of the same race/ethnicity living in more homogeneous neighborhoods. However, the relationships between child welfare system involvement and the other indicators of social disorganization measured, specifically impoverishment, immigrant concentration child care burden, residential instability, and housing stress, varied considerably between Black, Hispanic and White children. For Black children, only housing stress predicted child maltreatment referral rates; whereas, neighborhood impoverishment, residential instability, and child care burden also predicted higher child maltreatment referral rates for Hispanic and White children. Immigrant concentration was unrelated to maltreatment referral rates for Black and Hispanic children, and predicted lower maltreatment referral rates for White children. Taken together, these findings suggest that racial–ethnic diversity may be one of the more reliable neighborhood-level demographic indicators of child welfare risk across different racial/ethnic groups of children. However, many of the other neighborhood characteristics that influence child maltreatment referrals differ for Black, Hispanic and White children. Consequently, neighborhood-based family support initiatives should avoid a one-size-fits-all approach to child abuse prevention and strategically consider the racial/ethnic make-up of targeted communities.     

Caregivers' Endorsement of Barriers to Mental Health Services for Children and Youth in Child Welfare

The purpose of this study was to examine the three most common types of caregivers in the child welfare system (birth parents, relative caregivers, and foster parents), an active child welfare case, caregivers' endorsement of barriers to mental health services and mental health service use by caregivers for the children under their care. The sample consisted of 430 dyads (caregivers and their children). Results indicate that an active child welfare case, provider characteristics, and accessibility of services predicted mental health service use for children. Implications for the child welfare and mental health systems are discussed.     

Racial/ethnic disparity in child welfare systems: A longitudinal study utilizing the Disparity Index (DI)

The purpose of the study is to examine racial/ethnic disparity among children and families that are involved with the child welfare system. Specifically, the authors explore whether or not disparity levels and long-term changes in disparity in California child welfare systems are significant. In addition, the study investigates how county characteristics such as child poverty rates, unemployment rates, and rurality are associated with levels of disparity and changes in racial/ethnic disparity over time. Using a Latent Growth Curve (LGC) modeling approach, the study estimated the trajectories of county-level Disparity Index (DI) scores (Shaw, Putnam-Hornstein, Magruder, & Needell, 2008). African American and Hispanic/Latino children were compared to Caucasian children for two phases of the child welfare process: substantiated allegations and entries, between 2005 and 2008. The results demonstrate that racial/ethnic disparity between African American and Caucasian children was significant at both phases of the child welfare process in 2008. However, disparity between Hispanic/Latino and White children was not significant. Levels of disparity between African American and Caucasian children remained constant over time. Regarding the effects of county characteristics, higher child poverty rates, higher unemployment rates and rurality were related to lower levels of disparity. In addition, unemployment rates were associated with increasing rates of change in entries disparity between African American and Caucasian children. And urbanicity was associated with increasing rates of change in substantiated allegations disparity between Hispanic/Latino and Caucasian children. The study's implications for future research are discussed.     

Latino caregiver psychosocial factors and health care services for children involved in the child welfare system

Children in the child welfare system have a high prevalence of health problems, making pediatric health service use critical. Latino children represent a growing proportion of the child welfare system, and are at increased risk for health problems. Many have argued that Latino caregivers can provide Latino children with the least disruptive out-of-home placement, but little is known about how caregiver factors might relate to health services utilization or child health status within this population. This study assessed relationships between caregiver psychosocial factors, health care service utilization, and health status for children in the child welfare system. This sample featured 48 Latino caregivers involved in child welfare. Logistic regression models were used to test for relationships between caregiver psychosocial factors and appointment adherence and child health status. Problem-focused coping was positively related to well-child status. No psychosocial factors were related to medical appointment adherence. Case workers may help improve child health outcomes by promoting problem-focused coping skills among Latino caregivers.     

Conducting culturally competent evaluations of child welfare programs and practices

As the population of the United States has changed over the last two decades, so has the population of children who come to the attention of the child welfare system, resulting in increasing calls for cultural competence in all aspects of child welfare programming and practice. Given the changing demographics among children involved in the child weltare system and the increasing need to address the racial and ethnic disparities observed in this system, the need for culturally competent approaches to evaluate the outcomes of services for children and families is essential. This article discusses the challenges in conducting culturally competent evaluations and provides strategies to address those challenges within a child welfare context.     

The role of marriage in explaining racial and ethnic disparities in access to health care for men in the US

Reducing disparities in access to health care is a long-standing objective of the federal government. Building on research showing that marriage can provide important resources for obtaining needed health care, we suggest that racial and ethnic differences in marriage could explain persistent disparities in access. Using data from MEPS and NLSY we investigate the association between marriage and access to health care among men, and estimate the extent to which racial and ethnic differences in both the returns to marriage and marital rates explain differences in access and preventive service use. We find that marriage accounts for up to 24 % of racial and ethnic differences in access and preventive use. The returns to marriage for whites and blacks, however, are greater than that for Hispanics. We suggest that differences in spousal characteristics such as education and income could explain why whites and blacks benefit from marriage more than Hispanics. We find support for this hypothesis: differences in spousal characteristics account for up to 37 % of the gap in access and preventive use among married adults.     

Child Welfare and Juvenile Justice: Examining the Unique Mental Health Needs of Girls

This study investigated the prevalence of mental health problems among girls who are involved in child welfare or juvenile justice systems. The sample consisted of 1,193 girls ranging in age from 4 to 18, the majority (82.3%, n = 982) of which were older than age 12. Differences based on race/ethnicity and developmental age groups were examined. Consistent with other research, this study found that the mental health needs of girls involved in the child welfare or juvenile justice systems are several times higher than in the general population. Intervention approaches must be developed that take into consideration differences in gender, age, and racial and ethnic group.     

Maybe ignorance is not always bliss: The disparate treatment of Hispanics within the child welfare system

Previous studies indicate that the proportion of culturally diverse children to White children is increasing in public social service agencies. In addition, culturally diverse children are more likely to receive more intensive and punitive services, are more likely to stay within the system for longer periods of time and are reported more often to Child Protective Services. The purpose of the study was to explore how child welfare practices with Hispanic children are different from those applied with White non-Hispanic children. This study was a retrospective, two year, longitudinal, survival analysis of differential child welfare placement outcomes of White non-Hispanic and Hispanic children/families which had substantiated cases of abuse/neglect (n=1001).Findings demonstrate that although cases reported for abuse/neglect are relatively proportionate between Hispanic and White non-Hispanic children, substantiated cases are more likely to occur with Hispanic children. These children are more likely to be placed out of the home more quickly and for longer periods of time than their White non-Hispanic counterparts. The current study demonstrates the need for increased cultural awareness among Child Welfare professionals, especially in terms of assessment and case decision making, and the need for the development of culturally sensitive training modules for CPS and case management personnel.