Administrative case reviews: Improving outcomes for children in out-of-home care

For nearly three decades foster care review has been required and practiced in the United States. It is well established that foster care review was designed with the intent to reduce the time children spend in foster care and increase permanent placements for children. This article presents that foster care review, as practiced in Colorado, is a social work intervention and quantitative results of this study demonstrate that as an intervention, timely administrative case review is an effective social work intervention related to improving child welfare outcomes for the children and families served in Colorado. The major findings show that timely administrative case review and increased levels of review attendance (mother, father, Guardian ad litem's, and foster parents) are predictors of the child welfare outcomes of permanency and length of time in out-of-home care. Bivariate results indicate a median length of stay approximately 10.76 months longer for children who do not consistently receive timely case reviews. Additionally, the results show that timely care review moderates the underlying casework process related to caseworker contacts, demonstrating that a child's length of stay differs depending on the level of timely case review. In essence, the administrative case review process in Colorado is effectively achieving its goal and is an effective intervention for improving the lives of children in foster care.     

Profile of children placed in out-of-home care: Association with permanency outcomes

The goals of this study were to explore characteristics and profiles of children who received out-of-home care services and to examine the relationship between their profiles and permanency outcomes. Results of latent class analysis suggest that there are three distinct subgroups of children served in out-of-home care (N = 33,092): Children with Complex Needs (6%), Children in Families with Complex Needs (64%), and Older Abused Children (30%). Of the three identified subgroups Children with Complex Needs consisted of youth who were at greater risk for adverse outcomes. These children were less likely to experience timely adoption, had the longest length of stay in out-of-home care, and were least likely to experience timely reunification. Although permanency outcomes for Older Abused Children are somewhat better than for Children with Complex Needs, they represent a vulnerable population of youth in out-of-home care who have a very low chance of being adopted. Overall, this study suggests that service provision by itself may not improve permanency outcomes for children unless both prevention and intervention efforts address co-occurring family needs and are tailored to specific characteristics of the children being served.     

Child resilience in out-of-home care: Child welfare worker perspectives

The study of resilience and its associated factors is highly applicable to the child welfare population as children living in out-of-home care have often experienced much adversity and are particularly vulnerable to the development of problems in numerous domains of functioning. The use of qualitative research in this area is scarce, and the majority of such studies have been based on the U.K. or U.S. child welfare systems. Therefore, the goal of the current study was to gain child welfare workers' perspectives on resilience and to explore the factors that they believe might influence resilience. Semi-structured interviews were conducted with 11 child welfare workers from Ontario (Canada) to accomplish this goal. The interview was developed using an ecological perspective that inquired about possible sources of resilience from within children themselves, their family, their community, and the child welfare worker and agency. The workers identified a number of factors associated with resilience (e.g., child intelligence, worker communication skills); however, the critical importance of a child's relationships and social support from others underpinned all factors discussed. The findings highlight the importance of including the perspectives of all those involved in the child welfare system in assessing the well-being of children in out-of-home care. In addition, the dynamic interrelationships between the various levels of the ecological model and how these can impact on how a child is doing in out-of-home care were highlighted.     

Exploring patterns of employee psychosocial outcomes among child welfare workers

Child welfare workers continue to suffer from increased levels of job stress and burnout, often resulting in an intention to leave. Although the literature on these psychosocial employee outcomes is extensive, much of it is limited in that it has failed to determine if variability exists across these constructs in a way that can be systematically categorized. This cross sectional exploratory study utilized a statewide purposive sample of respondents (N = 209) from a public child welfare organization in a Northeastern state. Two complementary cluster methods and discriminant function analysis were used to determine if subtypes of job stress, burnout, well-being, job satisfaction and intent to leave exist among public child welfare workers. Since the results yielded three different clusters of workers, an Analysis of Variance was used to identify significant group differences, while Scheffé post hoc tests were examined to determine which groups differed. Findings show that the all three clusters significantly vary from one another in terms of the adverse employee psychosocial outcomes. Our findings suggest that child welfare workers represent a heterogeneous group with dissimilar psychosocial needs. To meet those employee needs and maximize their work output, child welfare administrators should make a concerted effort to better understand the unique needs of this strained workforce.     

Caregiver substance abuse among maltreated children placed in out-of-home care.

Child protective services (CPS) case records of 639 children placed in out-of-home care due to maltreatment were reviewed, and substance abuse by the child's caregiver prior to the child's placement was evaluated systematically. Based on several different sources of information, 79% of the caregivers were found to meet the criteria for caregiver substance abuse (CSA). Children with and without evidence of CSA differed on age, ethnicity, family composition, and type of maltreatment. The importance of operational specificity in defining CSA and implications for policy and service delivery are discussed.     

Folk-healing among Mexican-American families as a consideration in the delivery of child welfare and child health care services

If practitioners in cross-cultural services do not understand traditional health beliefs and practices and find ways to incorporate a compatible approach to them in their work, their clients and patients will go their own ways, sometimes with dire results. Practices among Mexican-American families are described.     

Developmental outcomes among Korean adolescents in out-of-home care: A longitudinal study comparing kinship foster care and institutional care

Kinship foster care has recently become the new main form of Korean out-of-home care, and has reached similar usage proportions as the more traditional form, institutional care. To compare the effectiveness of the two care types, we focused on adolescents' developmental outcomes. We also examined changes over time in the outcomes and group differences in the changes. We analyzed five-year longitudinal data from 244 adolescents who participated in the Panel Study on Korean Children in Out-of-Home Care. A repeated measures Analysis of Variance (ANOVA) was used as the major analytic method. The study results revealed that the kinship group was better off at the baseline for covariates than was the institution group for almost every development measure. However, the group differences observed at baseline disappeared or reversed in direction, which indicated better longitudinal outcomes for the institution group. In terms of changes over time, self-esteem and delinquency of all adolescents, no matter to which group they belong, changed in a positive way. However, there were no group differences in the patterns of changes. Based on these results, we discuss the limitations of the Korean out-of-home care system, such as the lack of assessment and monitoring, and support for kin caregivers.Ethical approvalWe obtained informed consent from the participating adolescents and Sookmyung Women's University IRB (the first through the third wave panel research) and Ewha Womans University IRB (the fourth and the fifth wave) approval before we began this research.     

Wellbeing of children and adolescents with special health care needs in the child welfare system

Children and adolescents in child welfare have the highest rates of chronic conditions and disabilities of any studied child population. The purpose of this study is to determine the wellbeing of children and adolescents with special health care needs (SHCN) in child welfare compared to their peers without SHCN. Wellbeing was measured using the Child and Adolescent Needs and Strengths (CANS) assessment; children and adolescents were assessed on the domains of Life Domain Functioning, Traumatic Stress Symptoms, Behavioral/Emotional Needs, Risk Behaviors, and Child Strengths. Scores on the CANS were compared between initial entry into the child welfare system and 18 months later. This is the first study to assess wellbeing over time of children and adolescents with SHCN in the child welfare system. This study found that children and adolescents with SHCN had increased wellbeing over an 18-month period. By the 18-month assessment, children and adolescents with SHCN presented similarly to their healthy peers, indicating that wellbeing improved more for children and adolescents with SHCN than those without SHCN across several domains of wellbeing. Children and adolescents with SHCN still had significant needs compared to children and adolescents without SHCN in the area of Life Domain Functioning. Adolescents (ages 12–18), with and without SHCN, had greater needs and fewer strengths compared to children (ages 6–11) both initially and 18 months later. Children and adolescents without SHCN also improved over the 18-month period. While this study specifically measured needs and strengths, the findings show that the wellbeing of children and adolescents, as measured across a variety of domains, improved while in child welfare.     

Substance-abusing child welfare parents: treatment and child placement outcomes

The authors present findings from their study of 167 child welfare parents referred for substance abuse assessments. Relationships between gender, prior treatment, court-ordered intervention, significant others' support, and treatment and placement outcomes are examined. Findings indicate significant others' support positively influences all outcomes while court-ordered intervention is not predictive. Prior treatment is associated with continued substance abuse. Gender differences exist for assessment completion and several client characteristics. Implications for practice are drawn.     

Risk factors for mental health diagnoses among children adopted from the public child welfare system

Children awaiting adoption through the child welfare system often have “special needs,” or characteristics that make securing an adoptive home for them challenging. A subset of these youth experiences significant psychiatric symptomatology, which may pose a problem for the stability of the adoptive placement. Clinicians and policymakers require information about precursors to mental health difficulties in order to plan effectively for the placement of these children.This study examines potential child and biological family risk factors for the presence of a DSM-IV mental health diagnosis among 368 children placed for adoption by a special needs adoption program between February 1997 and April 2005 using logistic regression within the Generalized Estimating Equations (GEE) framework. A significant proportion of the children and biological parents in our study experienced serious adversity prior to adoptive placement. Older age at adoptive placement, white race, male gender, having more than one placement, and a history of sexual abuse are significant predictors of the presence of a mental health diagnosis in the logistic regression model. Biological parent incarceration is significantly associated with the absence of a mental health diagnosis.Adoptive placement is a key transition for youth who have often experienced significant loss and trauma prior to placement. Support of the adoptive family and youth can be critical to ensuring placement stability and may be especially salient for youth with documented mental health diagnoses and corresponding behavioral problems, which put children at increased risk for placement disruption. More work is needed to understand the interplay of risk and protective factors for mental health difficulties among youth adopted from the child welfare system, including how these are affected by child welfare policies, informal procedures, and resources to produce varying outcomes for children in peril.     

Health care policies for children in out-of-home care

Placement in out-of-home care is one intervention used to protect children from abuse and neglect. While children are in such care, it is the child welfare agency's responsibility to ensure that their health needs are met. The study reported here examined health care policies and services for children in 46 state child welfare agencies. Virtually all states had some sort of written policies regarding health care for children in out-of-home care. Half, however, reported having no information management system to record health care data, and only six of the 23 had computerized systems. Most states fell short of meeting the standards set by the Child Welfare League of America for the health care of children in out-of-home care.     

Reunification outcomes among Mexican immigrant families in the child welfare system

This study examined reunification outcomes among Mexican immigrant families involved in the child welfare system, and compared characteristics of Mexican-origin and non-immigrant children involved in the child welfare system. An exploratory retrospective longitudinal design using administrative data from two counties in Northern California was utilized. The quantitative sample (N = 2152) included children entering the foster care system for 8 or more days between January 1, 2001 and December 31, 2007 in the two participating counties. Child welfare administrative data (CWS/CMS) were merged with eligibility data (CalWIN) in order to obtain parent and child place of birth and citizenship status. Quantitative measures drawn from the merged CWS/CMS and CalWIN dataset included the following: demographic characteristics, immigrant characteristics, case characteristics and reunification outcomes. Results indicated that a significantly higher proportion of Mexican immigrant families (70.7%) were reunified than non-immigrant families (43.1%). Significant correlates of reunification among Mexican immigrant families included the following: mothers with authorized citizenship status (vs. unauthorized citizenship status), mothers whose primary language was Spanish (vs. English), and children with two or fewer placements (vs. three or more placements). Differences between Mexican-origin and non-immigrant children were that Mexican-origin children were older on average than non-immigrant children, and they were more likely to experience physical abuse, sexual abuse or emotional abuse; they were also more likely to be placed in foster care or a group home (vs. relative care). Implications for social work practice and policy are discussed.     

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

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

Assessing child welfare outcomes: the American perspective

This paper examines US research on child welfare outcomes, focusing on family preservation, out-of-home care, and family reunification services. The review highlights the range of mixed findings in each of these areas, along with methodological issues and constraints. In light of the complexity of child welfare services, future outcome research should complement the rigorous use of quantitative methods with the careful application of qualitative methods.     

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.     

Behaviorally impaired children in out-of-home care.

This study was undertaken to determine the nature of the out-of-home care placement experience for 131 behaviorally impaired children entering care over the course of a year in Nebraska. Variables analyzed included behavioral impairment, age at entry, age at termination, gender, race/ethnicity, family violence, geographical area before and at termination, closeness to home of most recent placement, and length of time in care. Multiple regression analysis showed that behavioral impairment was the strongest predictor of length of time in care, accounting for 2.4% of the variability.     

Perceptual difference of child neglect among Korean parents and children: Implications for child welfare policy

This study examined the perceptual differences in child neglect among Korean parents and children. The data were collected from a convenient sampling of 321 Korean parents and 294 children using the case statements developed by Giovannoni and Becerra (1979). The statements consisted of examples of child neglect in the following seven domains: (1) emotional neglect; (2) lack of supervision; (3) medical neglect; (4) educational neglect; (5) neglect of personal hygiene; (6) nutritional neglect; and, (7) drug/alcohol use. Findings showed that both Korean parents and children consider child neglect moderately serious while Korean children consider child neglect situations significantly more serious. Korean parents perceive emotional neglect as the most serious child neglect domain whereas Korean children perceive drug/alcohol use as the most serious domain of child neglect. Gender variation among Korean children indicates that girls are more likely to perceive the emotional neglect and lack of supervision domains more seriously than boys. The implications of the study offer valuable insights into policy development and program planning efforts in reducing the child neglect among Korean parents and children. Additionally, the findings of the study will likely contribute to the existing body of knowledge in the area of child neglect among Korean children and parents.     

Functional outcomes among sexual minority youth emancipating from the child welfare system

The heterogeneity of youth emancipating from the foster care system makes it difficult to establish the extent to which their functional outcomes are equivalent across different subgroups. In the present study, we use secondary data from the Multi Site Evaluation of Foster Youth Programs (MSEYP) to explore the challenges faced by sexual minority youths in comparison to their heterosexual peers. We focus on measurements of key independent living outcomes at age 19 to obtain a broad picture of how sexual minority youth fare during the period of transition to adulthood. Bivariate results indicate that the deficits for sexual minority youth are noteworthy across all categories of functional outcomes (i.e. education, employment, homelessness and financial stability). Furthermore, results from binary logistic regression models indicate that sexual orientation was associated with each category of functional outcomes, even when controlling for demographics and child welfare history factors. Findings suggest that sexual minority youth leaving foster care are particularly vulnerable to negative outcomes and may require more intensive supports during the period of transition to adulthood. Implications for practice and future research are discussed.     

The impact of income on reunification among families with children in out-of-home care

Income appears to be associated with faster time to family reunification. The observed connection between income and reunification, however, may be causal in nature or the relationship may be an issue of selection, in that other underlying factors explain both income and family safety and stability. We examine the causal role that the source of income plays in reunification. We use administrative data on primary caregivers of children placed in out-of-home care in Washington State from 2000 through 2007 (N = 15,159) matched with public economic support and employment data linked by the Washington State Department of Social and Health Services (DSHS) Integrated Client Database (ICDB). Using instrumental variable analysis, we estimated the effect of the amount of earnings and the amount of cash benefits on reunification. We used county unemployment rates and county food stamp participation rates as instruments. We find modest and inconsistent results that suggest higher earnings are associated with lower likelihood of reunification. We find no consistent evidence linking cash assistance to reunification.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.