Child fatality in Intercountry adoption: What media reports suggest about deaths of Russian children in the U.S.

This article addresses the ultimate risk in child placement, fatality, in the context of international adoption. It first reviews relevant literature, then profiles demographic and policy trends, followed by analysis of risk factors derived from public media reports related to the children, families, and placing agencies in 19 known cases of death of Russian children in U.S. adoptive homes since 1996. The article concludes that many of the child deaths involved recently placed boys, frequently age 3 or younger, most with special needs or challenging behaviors, and often placed along with siblings. Most of the children who died had multiple injuries characteristic of battered child syndrome. Parents were traditional couples under severe parenting stress who usually had other children, often including additional preschoolers and/or homeschoolers. Mothers frequently pled guilty to various charges, typically less serious than murder. In four situations, parents either were not charged or were found not guilty. Most placements involved agencies founded within 15 years before the child fatality, and several subsequently closed, three amid scandals unrelated to the deaths. The remaining agencies include well-regarded organizations, and five directors or representatives contributed their perspectives. This article identifies patterns and makes recommendations for practice, with the goal of reducing risk of harm to children placed internationally.     

Parent perspectives on adoption preparation: Findings from the Modern Adoptive Families project

Preparing prospective adoptive parents for receiving a child into their family is an important task for child and family professionals. This study uses data from the recent Modern Adoptive Families survey to understand parent perspectives on their preparation for adoption. Logistic regression (n = 917) and qualitative thematic analysis of adoptive parents' comments about their adoption preparation were conducted to understand aspects of the preparatory experience that were satisfactory (n = 623) or dissatisfactory (n = 283). Child emotional and behavioral problems significantly predicted parent dissatisfaction with adoption preparation. Major themes for satisfactory aspects of preadoption services included receiving information about adoption in general and, more specifically, about clinical and special populations, and parenting tools and strategies. In addition, parents identified opportunities to connect with others touched by adoption and access to specialized post-adoption services as helpful. Conversely, parents expressed dissatisfaction when information was lacking or withheld, when they had quality concerns with the worker or agency, and when there was a dearth of services and supports following adoption. Implications of these findings include the need for adoption mental health competent training for adoption professionals to better support families preparing for or experiencing adoption.     

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.     

Factors affecting post-permanency adjustment for children in adoption or guardianship placements: An ecological systems analysis

Despite a growing body of research on post-permanency adjustment for children adopted from public child welfare agencies, many studies lack a systematic review using a theoretical framework. To develop promising post-permanency services for adopted children with special needs and their families, the first step is to examine risk and protective factors affecting adoption or guardianship adjustment. This study systematically reviews and synthesizes current empirical studies investigating post-permanency outcomes using an ecological systems analysis, with an integration of family theories. A search of five electronic databases and relevant child welfare books identified 36 empirical studies on post-permanency adjustment. Risk factors include some individual factors such as caring for a child with special needs, raising children with a multiple placement or maltreatment history and involving parents with no parenting experience. Living in a family experiencing boundary ambiguity and lacking social support are also risk factors. Protective factors include having adoption preparation and having a child living with married parents, as well as a high level of adoption openness and the availability of formal and informal social support. Implications for child welfare practice and policy also are discussed.     

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.     

How early is early intervention and who should get it? Contested meanings in determining thresholds for intervention

The latest wave of reforms of the child protection system in Australia have been based on attempts to provide support to all families with vulnerable children, rather than increasing surveillance of ‘at risk’ families and forensic responses to incidents of maltreatment. This includes a drive to widen the remit of child protection from the statutory child protection agency and involve other government agencies such as health and education as well as the non-government sector in child protection. This paper reports on the effects of one such reform, the NSW initiative Keep Them Safe. It focuses on the classification of families as needing either early intervention or intensive support, using thematic analysis of qualitative interview data.MethodInterviews and focus groups were conducted with practitioners and managers from human service agencies (total n = 115), and discussed their perceptions of the initiative and the changes it had introduced to service delivery.FindingsPractitioners discussed family needs in ways which contested the policy meanings of ‘early intervention’: whether families are conceptualised in terms of their needs or risk; whether engagement with services should be voluntary or mandated; and whether the agencies to support them should be the statutory agency or an NGO. The implications for these tensions, in terms of policy and practice, are discussed.     

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.     

Examining rates and risk factors for post-order adoption disruption in England and Wales through survival analyses

PurposeThis paper reports findings from two research studies that set out to calculate the rate and predictors of post-order adoption disruption in England and Wales.MethodsAll available national level administrative data on adopted children in England and Wales were analysed, supplemented by national surveys adoption managers. Complete national datasets were available 12 years in England and for 11 years in Wales.ResultsOf the 36,749 and 2,317 adoptions considered, 565 in England and 35 in Wales had disrupted over the follow up period. Kaplan-Meier analyses indicate that cumulative post-order adoption disruption rates were 3.2% and 2.6% respectively for England and Wales. Cox regression models indicate that being older than four years adoptive placement, adoptive parents taking longer than a year to legalise the adoption, being a teenager and previous multiple placements in care were risk factors for post-order adoption disruption.ConclusionThe post order adoption disruption rate is low. Implications for policy and practice are discussed.     

Finish what you start: A study of Design Team change initiatives' impact on agency climate

This study employs a multi-site longitudinal design to examine the effect of a Design Team intervention on organizational climate. Thirteen private, not-for-profit child welfare agencies from one state participated in a Design Team intervention to address workforce needs. A total of 407 workers from those agencies responded pre and post intervention to a survey that measures worker perceptions of the psychological climate of their organization using the Parker Psychological Climate Survey. Workers in organizations that completed the Design Team intervention had statistically significant increases in three of the four dimensions of the Parker scale. On the role dimension, significant change was noted on all three subscales on the interaction between Time 1 and Time 2 (ambiguity: p = 0.012; conflict: p = 0.04; overload: p = 0.05). On the organization dimension, the justice and support subscales had significant differences in the desired direction (justice: p = 0.05; support: p = 0.03). On the supervisor dimension, significant change was observed in the desired direction for both the goal emphasis and work facilitation subscales (goal emphasis: p = 0.02; work facilitation: p = 0.00). Statistically significant improvements in the organizational climates of child welfare agencies suggest the benefit of future research to test the effectiveness of Design Team interventions in other service areas. These findings build on intervention research with organizations by linking the ability of an organization to fully implement a change initiative to their capacity to improve the workplace climate for employees.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

Placement of children in out-of-home care in Québec,Canada: When and for whom initial out-of-home placement is most likely to occur

This study contributes to the growing child protection placement literature by providing the first Canadian provincial longitudinal study examining when and for whom initial out-of-home placement is most likely to occur. Anonymized clinical-administrative child protection data were merged with the 2006 Canadian Census data for the province of Québec, and the final dataset included 127,181 children investigated for maltreatment for the first time between April 1, 2002 and March 31, 2010. Cox proportional hazard results indicate that the vast majority of investigated children do not experience a placement, but for the others, placement tends to occur immediately following the maltreatment investigation with only a slight increase in risk over time. The increased risk of placement for younger children aged 0 to 9 years was statistically explained by a combination of male gender, behavioral problems, parents' high risk lifestyles, hospital referral, the number of investigations and neighborhood area socioeconomic disadvantages. The increased risk of placement for older children aged 10 to 17 years was statistically explained by a combination of behavioral problems, police reporting, the number of investigations and neighborhood area socioeconomic disadvantages. Neighborhood area socioeconomic disadvantages significantly contributed to the increased risk of out-of-home placement for all children, but this factor is most influential when it comes to younger children.     

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.     

If you build it,will they come? A qualitative investigation into community barriers to accessing paediatric HIV services in Kenya

We present qualitative research investigating demand-side barriers to uptake of paediatric HIV services in Kenya. We explore community perceptions of services in 3 provinces where paediatric treatment is readily available but under-utilised, aiming to focus on demand-side obstacles and derive strategies for increasing uptake. We conducted focus-group discussions with openly HIV-positive parents and caregivers of children aged up to 15 years (n = 7 groups), and clinic- and community-based healthworkers (n = 13 groups); and individual in-depth interviews with managers and Ministry of Health representatives (n = 6 interviews). Results revealed low community awareness of medical indications for paediatric HIV testing, alongside widespread anxieties about potential infection routes. Care-seeking delays reflect strong perceived associations between antiretroviral treatment (ART) and mortality. Despite free drugs available from the Kenyan government, costs for laboratory services, medications for opportunistic infections, transportation and nutritional needs remain major obstacles. Attitudinal barriers include fatalistic beliefs about early death for infected children and reliance on traditional healers. Stigma reduces access, especially as paediatric testing represents a “window” into parental HIV status. Apprehensive caregivers fear the lifelong nature of ART and report adherence struggles. Even when paediatric ART is relatively accessible, demand-side barriers impede uptake and must be addressed at community and facility levels.     

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.     

Is child protective services effective?

A number of studies have concluded that there is little observable connection between CPS involvement and improved outcomes for children and families. Evidence of CPS effectiveness is complicated by the presence of selection bias and difficulty controlling for confounding. To understand outcomes by group and intervention effects, comparable groups are necessary and difficult to ascertain using CPS administrative case record data. This study examines the causal effect of CPS involvement on the likelihood of future maltreatment using administrative case management records from July 1, 2010 and June 30, 2011. The current study accounts for differences in pre-existing condition between groups to establish sound estimates of CPS involvement effects. Logistic regression models were used to examine the difference in subsequent substantiated investigation between families with comparable risk and differing service recommendation (p = 0.83), recurrence among families with comparable risk, the same service recommendation that did or did not receive services (p = 0.83). Hazard models were used to explore risk of substantiated investigation among families with comparable risk and differing service recommendation (p = 0.77). Results indicate receipt of CPS services had no observable effect on recurrence of maltreatment overall and among families with similar levels of risk of recurrence. Further inquiry into worker attributes, decision-making, types of and quality of services offered to families could help explain the effective, or ineffectiveness, or services.     

Differential response in child protection: How much is too much?

Recurring maltreatment can have devastating, lifelong consequences for children who are victims of abuse and neglect. The primary mission of child protection services (CPS) agencies is to prevent the recurrence of child maltreatment by offering families services designed to prevent future maltreatment. In order for these services to be effective, however, families must actually engage in them. This study focuses on how differential response programs impact families' successful engagement in services as indicated by long-term child safety outcomes.Differential response refers to a dual track system that allows public CPS agencies to respond to accepted reports of child abuse or neglect with either a traditional investigative response (TR) or an alternative response (AR). The AR is designed to be a less authoritative and less adversarial approach to families presenting a low- to moderate-risk of maltreatment. The AR involves collaboration with the family in a comprehensive assessment of the family's needs, risks and strengths and a referral to services on a voluntary basis. States implementing DR systems statewide vary greatly in the percentage of accepted reports that are assigned to the AR track. The goal of this study is to determine what rate of AR utilization is most effective in reducing subsequent reports of abuse and neglect for cases assigned to the AR.This study compares child safety outcomes for children assigned to the AR and those assigned to the TR within each of the fourteen states which implemented DR statewide between 2000–2012. The analysis uses Cox proportional hazards regression. Data for this observational study are drawn from the 2000–2012 data in the National Child Abuse and Neglect Data System (NCANDS) child files. Child safety is measured by re-reporting of the child to CPS.The theoretical model underpinning the study is McCurdy and Daro's (2001) Integrated Theory of Participant Involvement (ITPI) which outlines a conceptual model of parental engagement in services. This study hypothesizes that AR utilization rates affect the risk level of cases assigned to the AR. The ITPI model offers a possible explanation as to why higher risk cases may not be as responsive to the AR approach which depends upon the family's voluntary participation in services.The key finding of this study is that, in states assigning > 33% of reports to the AR, children on the AR track are being re-reported at equal or higher rates than those on the TR track. Only in those states utilizing the AR track for < 33% of the cases are AR cases being consistently re-reported at lower rates than those on the TR track. This article explores ways to improve the accuracy of track assignment decisions to prevent the assignment of higher risk families to the alternative response.     

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home.MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18 months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression.ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P < 0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P < 0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18 months.ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.     

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.