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.     

Family decision making in child welfare: challenges in developing a knowledge base for practice

Over the past two decades, engaging families in decision‐making has grown in popularity across child welfare systems internationally. The family group conference in particular has generated interest as a practice model that facilitates broader family engagement in care and protection. As the practice has flourished, research has been undertaken to strengthen the knowledge base and to support the introduction of family engagement strategies across jurisdictions. This paper examines the recent research relating to family engagement strategies in child welfare and explores the ways in which family involvement in decision‐making can be incorporated into emerging protective practices. Copyright © 2010 John Wiley & Sons, Ltd.     

A multi-level analysis of individual and agency effects on implementation of family-centered practice in child welfare

This study describes factors associated with the implementation of family centered practice (FCP) across a state child welfare system. Using Multi-Level Model (MLM) analysis of self-report data from the child welfare workers and supervisors in one multi-jurisdiction state, individual and organizational factors that may influence successful implementation of innovative practice models are identified. Individual worker's characteristics such as social work degree, training, and age were all associated with higher levels of individual adoption of FCP principles. Organizational culture including innovation and flexibility and outward focus were associated with organization level implementation of FCP principles. Implications for child welfare practice and implementation of FCP are discussed.     

Upping the ante: relative caregivers' perceptions of changes in child welfare policies

Thirty-five caregivers of related children who were in the custody of the child welfare system were interviewed individually or in focus groups as the state child welfare system implemented new federal and state policies encouraging these caregivers to adopt or assume guardianship of the children in their care. Interviews were transcribed and analyzed using qualitative methods. Issues of concern included emergency entrance into caregiving; the simultaneous satisfaction and burden of caregiving; obstacles to caregiving, adoption, or guardianship; complex changes in family dynamics following placement of children; sources of support; and caution regarding adoption or guardianship. The caregivers also offered recommendations for the child welfare system. Policy, practice, and research implications are discussed.     

Child Welfare Social Workers and Open Adoption Myths

Open adoption can have positive effects on the psychological well-being of adopted children. This study's purpose was to explore child welfare social workers' open adoption attitudes and their agreement with open adoption myths in predicting the relationship with their levels of openness toward open adoption. This study showed that open adoption attitudes, open adoption myths, and area of practice have an association with the levels of openness toward open adoption in a group of child welfare social workers. This information could be beneficial to policy makers and professionals who may be interested in increasing the facilitation of open adoption.     

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.     

Re-thinking accountability in child welfare

This paper observes that PL 96-272 has largely focused on the development of external mechanisms, such as citizen's boards and court reviews, to strengthen accountability in the child welfare system. The paper suggests that we might be reaching the limits of what these mechanisms can accomplish, and that further external regulation might have the unanticipated effects of blurring the lines of accountability and of discouraging skilled workers from entering or staying in the field. Instead, the paper argues for renewed attention to structuring child welfare systems in ways that support skilled casework practice. Only then will real accountability be achieved.     

Computerizing protective services intake expertise: Preliminary research

Decision making at child welfare intake has been the subject of considerable investigation for the last thirty years. Previous reserach on the dynamics of abuse and neglect resulted in complexity and inconsistency to the extent that research moved away from determining the relevant information for creating a more structured decision making process. Recent developments in knowledge engineering and computerized expert systems provide new tools for examining protective services intake decision making. These tools are appropriate for organizing the vast amount of information workers use during decision making, extracting decisions from that information, and presenting the decisions and their supporting logic. This research examines existing expertise with a small sample of child welfare experts to determine the feasibility of developing an expert system for supporting intake decisions.     

The relationship between child welfare financing,screening, and substantiation

This study examines the relationship between state-level child welfare spending and two important decision points in the child welfare system: the decision to screen out a referral and the decision to substantiate. The model is estimated using a pooled fractional probit estimator that controls for year effects and state-level clustering. The findings suggest that decreases in state-level child welfare expenditures predict increases in the proportion of referrals that are screened out and decreases in the proportion of maltreatment claims that are substantiated. The results are robust to the inclusion of caseload and federal spending as control variables, to the exclusion of states known to have changed their screening or funding practices during the sample period, and to the use of combined state and local child welfare expenditures as an explanatory variable in lieu of state-level child welfare expenditures. The findings imply that the amount of money a state spends on child welfare may influence important decisions in the child welfare process.     

Emerging strategies for reducing racial disproportionality and disparate outcomes in child welfare: the results of a national breakthrough series collaborative

Racial disproportionality in child welfare has been discussed as a seemingly intractable challenge with complex contributing factors. Some argue that these dynamics are far too difficult to be significantly impacted by public child welfare systems alone. The Breakthrough Series Collaborative (BSC) methodology, incorporating an analysis of structural racism and potential system bias, was proffered as a tool for engaging public child welfare agencies in a rapid, action-oriented process for identifying innovative strategies and practices to reduce racial disproportionality and disparate outcomes. This article describes the Disproportionality BSC process, as well as the work of participating jurisdictions with respect to transforming organizational culture and testing/implementing child welfare practice improvements. A theory of change is presented and critical lessons learned are shared in the form of collaborative reflections.     

Child welfare workers and social justice: Mending the disconnect

While professional social workers are clearly obligated to pursue social justice, controversies abound surrounding what that means in theory and practice. Perhaps nowhere are the paradoxes inherent in practice for social justice seen in sharper contrast than in the field of child welfare. Intended to protect the rights of children, child welfare systems themselves have been characterized as instruments of oppression. This article hopes to enrich that discourse through an examination of how these issues are conceptualized and acted upon by front-line child welfare social workers. Through in-depth interviews with 25 child welfare workers, and 3 focus groups, in two Canadian provinces, and employing grounded theory strategies for data collection and analysis, we have explored understandings of the social justice mandate and how it is expressed in practice. Participants in this study conceptualized social justice in terms of both wider societal goals of fairness and equality, and of the quality of interactions and relationships between social workers and those with whom they work; conceptual emphasis on one or the other of these we found to be associated with differences in practice. We reflect on the implications of each of these emphases for effectiveness in advancing social justice aims in the child welfare context, and make recommendations regarding a grounding for educators and practitioners in theoretical orientations that includes attention to the linkages between macro and micro opportunities to advance social justice.     

Initial Validation of the Open Adoption Scale: Measuring the Influence of Adoption Myths on Attitudes Toward Open Adoption

All adoptions, including those facilitated by public agencies, should be evaluated for openness. Although there are no national figures related to openness in public welfare, there are indications that it is not considered in all cases. Adoption myths may be one of the reasons that adoption workers do not always assess a family's ability to maintain a more open adoption arrangement. The following study is the initial validation of a multidimensional psychometric instrument developed to measure myths as they relate to open adoption. Based on a sample of 547 university students, the results indicate very good reliability and acceptable factorial and construct validity. The instrument was designed as a training and research tool to inform child welfare personnel and policy makers of the influence of adoption-related myths on child welfare adoption practice.     

Transferring training to child welfare practice: Individual and collective efforts

The transfer of training to practice constitutes an ongoing challenge in child welfare services. Many efforts to understand and promote training transfer address the concept as an individual-level behavior. This study suggests that training transfer is both an individual and collective process. The study involves a survey at two time points of 214 workers from child welfare agencies who attended a training program. Principle components analysis identified two meaningful sub-components within the concept of the training transfer. Hierarchical linear regression was used to assess the influence of individual-level and contextual factors on both components. Findings suggest that to promote collective training transfer and enhance both individual and group performance, child welfare administrators may need to strengthen supervisory support and to promote positive work climates in which trainees can discuss training concepts and work together to apply them.     

Systemic differences in views on risk: A comparative case vignette study of risk assessment in England,Norway and the United States (California)

This article examines how child welfare workers from three countries assess risk to a child in the context of different risk assessment tools, child welfare systems and welfare regimes. Previous research suggests that there are distinct differences between child protection-oriented child welfare systems such as England and the U.S., and family service-oriented child welfare systems such as Norway (Gilbert et al., 2011). We use a case vignette method to analyze how 299 child welfare workers from England, Norway and California (U.S.) assess risk. The case vignette describes the case of ‘Beatrice’, a nine year-old girl of Black African descent who was born with an organic heart disease and a cleft palate. We found that respondents from California assessed the risk to be the lowest, followed by respondents from England and Norway. The risk factors that respondents highlighted as important for their assessment also varied significantly between countries, displaying different perceptions of elements in a case constituting risk. Respondents from Norway, who, comparatively, practice within the context of the least regulated assessment platform, identified the most homogenous assessments and types of reasoning, whereas both the assessment of risk levels and identifications of risk factors were more heterogeneous among workers in England and California. We argue that the different risk assessment tools only partly influence what workers identify as risk factors in a case, and that type of welfare states and child welfare systems is also an influence. This study thus supports existing scholarship on the distinctions between child welfare systems. However, we also found significant differences in perceptions of risk factors between England and the United States.     

Lessons from the courtroom: Perspectives from child welfare attorneys and supervisors

Despite a history of child welfare worker performance difficulty in the courtroom, there has been little documentation regarding specific training needs for worker courtroom practice skills. This study expands the literature on child welfare courtroom practice skills by documenting child welfare worker conduct via perspectives from courtroom attorneys and child welfare supervisors. Separate focus groups with child welfare attorneys and supervisors were held to ascertain best and concerning practices for child welfare workers in the courtroom. Focus group participants identified themes related to preparation, adversarial nature of court proceedings, testimony, reasonable efforts, appearance and mannerisms, esteem of workers, duality of worker roles, and support. Study results have implications for focusing and improving training and supervision.     

‘What can I do’? Child welfare workers’ perceptions of what they can do to address poverty

Within the field of child welfare, critical questions have been posed about the intersecting issues of child maltreatment and poverty. The study of the quality and nature of this intersection has continued relevance in light of evidence showing the increased likelihood of maltreatment of children living in poverty. Although child welfare workers interact directly with families involved with the child welfare system, the study of workers’ perceptions of whether or not they address families’ poverty and, if so, how they go about it has not yet been conducted. The study presented begins to address this gap. Analysis from individual interviews with 30 child welfare workers revealed that they differed in their perception of whether or not poverty should be addressed by child welfare and how. Findings suggest workers do what they can despite various barriers, including families’ limitations and the fragile US social welfare safety net. Based on the findings, current practice models and policies that impact poverty and child maltreatment reduction are discussed.     

Improving mental health assessments in child protection through audit

Existing agency records, together with questionnaires completed by social services referrers and mental health providers, were used to identify problems in current arrangements for obtaining specialist mental health assessments in child protection cases. Standards were set and implemented through a multi‐agency steering group. The practice of referrers and providers was then reaudited. Sixty‐nine social workers, six mental health specialists and 27 child protection initial case conferences (involving 31 children) were involved in the reaudit over a 4‐month period. Initially, main problems concerned communications, unclear referral and access arrangements, waiting times and disagreements over prioritization. Standards concerned consultation and decision‐making arrangements within the child mental health service, the format of referral and reply letters, the sharing of information and the attendance of mental health professionals at child protection case conferences. There appeared to be improvements in all these areas at reaudit. In conclusion, some shared views of problems, additional support funding and the audit process appear to have helped to improve inter‐agency collaboration and develop more efficient referral and care arrangements. There is a need to maintain and further develop this work, and audit would again be a useful means. Copyright © 1999 John Wiley & Sons, Ltd.     

Child abuse and the bureaucratisation of social work

Child abuse became a public issue in the early 1970s. The alleged failure of social workers and welfare agencies to prevent children being killed by their parents and caretakers led to changes in the practice and organisation in child abuse work. The way public inquiries and government departments framed the problem of child abuse produced solutions which were essentially legalistic and bureaucratic. No longer was the aim to rehabilitate poorly functioning families, but to protect children from dangerous parents. But in order to achieve this aim, it was first necessary to identify the factors that would allow child protection agencies to recognise which families were dangerous and which were not. Once these factors were identified, it was possible to develop administrative systems that would facilitate the collection and analysis of information obtained during the investigation of suspected families. These systems allowed welfare agencies to identify ‘high risk’ cases. During the translation of the problem of child abuse into a set of judicial and bureaucratic procedures, therapeutically orientated professional practices found themselves out-manoeuvered. The translation witnessed the production of social workers as ‘passive agents’, a new cognitive perspective on the problem of child abuse, and a contribution to the bureaucratisation of child care practice.     

A confirmatory factor analysis of the evidence-based practice attitudes scale in child welfare

Despite the emphasis on evidence-based practice (EBP) in child welfare services (CWS) as an emerging and inevitable trend, implementation factors such as child welfare worker attitudes towards implementing EBP have received little attention in CWS. Aaron's (2004) Evidence Based Practice Attitudes Scale (EBPAS) has been used in multiple studies across mental health and healthcare settings. However, it has rarely been used in CWS. A-Mid Atlantic State implemented the EBPAS in all child welfare jurisdictions to measure workers' performance. The purpose of this study is to examine the EBPAS applied in a large urban child welfare services setting using a confirmatory factor analysis. Based on prior literature, three models were tested: a four factor model, a five factor model, and a second order four factor model. The second order model provided the best fit to the data, suggesting the EBPAS can measure workers' global attitudes, as well as four attitude types, towards EBP in a CWS setting. This study validates the use of the EBPAS with child welfare workers. Implications for effective evidence based practice in child welfare are discussed.