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.     

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.     

Integrated Substance Abuse and Child Welfare Services for Women: A Progress Review

A review of empirical literature reveals improvements in service utilization and outcomes for women when substance abuse and child welfare services are integrated. The increased use of substances by women involved in the child welfare system has resulted in a call for integrated, coordinated, evidence-based practices. Since the late 1990s, specific system- and service-level strategies have been developed to coordinate and integrate the provision of substance abuse and child welfare services such that women are remaining in treatment longer and are more likely to reduce substance use and be reunited with their children. The strategies reviewed provide useful guidelines for developing components of effective, evidence-based programs for substance-involved women in the child welfare system.     

The invisibility of adolescent sexual development in foster care: Seriously addressing sexually transmitted infections and access to services

Adolescents residing in foster care are at higher risk for acquiring sexually transmitted infections (STIs) and human immune deficiency virus (HIV) compared to their non-foster care peers. A literature review was conducted to determine whether youth residing in foster care face different barriers to sexual health care compared to their peers in the general population and, if so, what those barriers are. The review revealed barriers common to adolescents in general as well as additional barriers specific to the ecosystem of adolescents in foster care. Systemic issues that decreased access to sexual health services included child welfare policies that were either missing or implemented without fidelity; complicated financial factors; barriers to service utilization; lack of collaboration between child welfare and medical professionals; and limited information provided to foster youth on their sexual health and development. Consent and confidentiality issues that foster youth face in seeking sensitive health services also need to be resolved. More research is needed on how to facilitate development of coherent policies and effective practices that promote sexual health care access for adolescents in foster care.     

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.     

Toward a Competent Child Welfare Service Delivery System for Gay and Lesbian Adolescents and Their Families

SUMMARY

Analogous to the child welfare delivery system deficits that have been documented for people of color communities, the problems encountered by gay and lesbian adolescents and their families are frequently ignored and largely unrecognized by the majority of child welfare professionals. An understanding of the impact of societal stigmatization of gay and lesbian individuals and their families is crucial to the recognition of, and response to, the needs of this population. This paper posits that the development of competence in this area holds promise for preserving and supporting families and for the establishment of appropriate gay/lesbian-affirming child welfare services for these young people and their families.     

Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents

The present study represents the first large-scale, prospective comparison to test whether aging out of foster care contributes to homelessness risk in emerging adulthood. A nationally representative sample of adolescents investigated by the child welfare system in 2008 to 2009 from the second cohort of the National Survey of Child and Adolescent Well-being Study (NSCAW II) reported experiences of housing problems at 18- and 36-month follow-ups. Latent class analyses identified subtypes of housing problems, including literal homelessness, housing instability, and stable housing. Regressions predicted subgroup membership based on aging out experiences, receipt of foster care services, and youth and county characteristics. Youth who reunified after out-of-home placement in adolescence exhibited the lowest probability of literal homelessness, while youth who aged out experienced similar rates of literal homelessness as youth investigated by child welfare but never placed out of home. No differences existed between groups on prevalence of unstable housing. Exposure to independent living services and extended foster care did not relate with homelessness prevention. Findings emphasize the developmental importance of families in promoting housing stability in the transition to adulthood, while questioning child welfare current focus on preparing foster youth to live.     

Longitudinal trends in substance use and mental health service needs in child welfare

Caregiver substance use and mental health problems have long been discussed as concerns in promoting positive child welfare outcomes. Yet the absence of longitudinal data focused on racial/ethnic differences in service needs and substance use has limited child welfare systems in their ability to address potential disparities. This study examines racial/ethnic trends in service needs and patterns of substances used among child welfare-involved caregivers over a 15-year period (2000–2015) from a large, urban county located in the Midwestern United States. Substance use service needs showed an increase over time among White non-Hispanic individuals, and declined over time for all racial/ethnic minority groups. Mental health service needs increased over time, with White non-Hispanic individuals experiencing the largest increase. Co-occurring service needs showed a moderate increase for all groups. Trends associated with service needs across the lifespan were relatively similar across racial and ethnic groups, with needs peaking between ages 30 and 35. When examining specific substances used, cocaine use decreased over time for all individuals. However, marijuana use increased substantially for Black/African American individuals, while opioid use increased substantially for White non-Hispanic individuals. These results highlight key areas where trends among child welfare-involved caregivers differ from population-based trends and suggest that improved coordination between child welfare agencies, mental health and substance use treatment providers may be a key step in reducing the disparities observed.     

Parental views of in-home services: what predicts satisfaction with child welfare workers?

Evidence on client satisfaction deserves consideration in the design of child welfare policies, programs, and practices. Data in this study come from the National Survey of Child and Adolescent Well-Being. Clients receiving in-home services reported moderate levels of satisfaction with their child welfare workers. Caregiver reports of having less than two child welfare workers, having more recent contact, and receiving timely, responsive services were associated with higher perceived quality of relationships with child welfare workers. The child welfare workers' reports of cooperativeness by the caregiver were also associated with higher caregiver-reported relationship quality.     

Connective complexity: African American adolescents and the relational context of kinship foster care

Attempts to address racial disproportionality in child welfare must include a focus on the benefits and challenges facing children in kinship care. African American children not only are overrepresented in the child welfare system, but also are placed disproportionately in kinship foster care. Using a sample of 18 African American adolescents ages 11 to 14, this article explores how the relational context of care experienced by adolescents in kinship foster care differs from that of adolescents in nonkinship foster family placements. Findings are presented regarding the stability of relationships as well as complex role dilemmas experienced by kinship youth as they relate to caregivers and birthparents in the child welfare context. Implications are given for practice with kinship families.     

INTERGENERATIONAL EFFECTS OF WELFARE REFORM: ADOLESCENT DELINQUENT AND RISKY BEHAVIORS

This study investigates effects of welfare reform in the United States on the next generation. Most previous studies of effects of welfare reform on adolescents focused on high‐school dropout of girls or fertility; little is known about how welfare reform has affected other teenage behaviors or boys. We use a difference‐in‐difference‐in‐differences framework to identify gender‐specific effects of welfare reform on skipping school, fighting, damaging property, stealing, hurting others, smoking, alcohol, marijuana, and other illicit drugs. Welfare reform led to increases in delinquent behaviors of boys as well as increases in substance use of boys and girls, with substantially larger effects for boys. (JEL K42, I12, I31, I38)     

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.     

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.     

Child welfare involvement among children in homeless families

An analysis of 8251 homeless children in New York City found that 18% of them received child welfare services over the five-year period following their first shelter admission, and an additional 6% had a history of having received such services before their first shelter admission. Recurrent use of public shelters, exposure to domestic violence, older age at first episode of homelessness, and larger number of children in a household were associated with an increased risk of child welfare involvement. The high rate of crossover between homelessness and the child welfare system suggests the need for service coordination for children in homeless families.     

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.     

Evidence-based practice for youth in supervised out-of-home care: a framework for development, definition, and evaluation

Adolescents comprise more than half of the children in child welfare supervised out-of-home care. This article considers the evidence-base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.     

African American Men,Child Welfare,and Permanency Planning

Summary

Like social services generally, child welfare and permanency planning services have failed to incorporate African American men as significant and serious participants in the service delivery process. Child welfare and permanency planning services have marginalized African American men such that children fail to benefit from the inclusion of these men in the service delivery process. This incomplete and inappropriate approach to permanency planning specifically, and to child welfare services more generally, is a disservice to African American children. Corrective measures are proffered to promote greater inclusion of African American men in child welfare and permanency planning services.