Providing context to the implementation of health promoting schools: A case study

PurposeIssues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada).MethodsUsing a case-study approach, data was collected using interviews (n = 14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools.ResultsCase study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3).ConclusionsThe study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS.     

The crucial role played by social outrage in efforts to reform child protective services

In this paper, we question the widely, if tacitly, held perspective that exceptional and immensely publicized instances of child abuse and neglect offer little guidance or understanding in improving the efficacy of child protective services (CPS). Using insights from Carl Jung, Max Weber and Henry Mintzberg, we argue that not only do such archetypical cases and the attendant moral outrage serve as catalysts for legislative and judicial actions; they also motivate structural and procedural changes in CPS operations. We propose extending to CPS a risk model commonly considered in the fields of environmental science, food safety and chemical engineering, where risk is conceptualized as a function of both technical hazard and moral outrage. We point out, however, that unlike in these non-CPS fields where the typical response is to ‘manage’ outrage via public education or public relations campaigns and to allow outrage to influence only the more immediate and exceptional decisions following an outrageous event, in the CPS field where children are the focal point, exceptional decision processes also seep into routine decision making by necessity. We term our proposed enhanced risk model the Socially Outraged Risk Expression (SORE). We conclude with recommendations for an empirical test of SORE.     

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.     

Getting with the (evidence-based) program: An evaluation of the Incredible Years Parenting Training Program in child welfare

This study evaluates four group sessions of the Incredible Years (IY) Parenting Training Program used for the first-time in two child welfare agencies in New York State. Few studies have examined process and evaluation outcomes of evidence-based parenting programs in child welfare. Qualitative staff interviews and surveys on parenting behaviors were used to examine program processes, improvements in parenting behaviors, and participant satisfaction. Program participation was associated with less parental distress, defensive responding, dysfunctional parent-child interactions, child difficulty, total stress, and greater empathy and social support. The effectiveness of this evidence-based, parent education program in the context of a child welfare population, as well as implementation challenges and recommendations, are discussed.     

Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare

Objective

High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures.

Methods

The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2346 youth aged 1.5- to 18-years-old and 1544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18-month follow-up.

Results

The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency.

Conclusions

To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.     

Organizational culture influence on service delivery: A mixed methods design in a child welfare setting

Despite the growing acknowledgement that mixed methods can be useful to better understand complex organizational cultures, there are few examples of studies, which demonstrate how organizational culture studies combine quantitative and qualitative methods in a single study within the child welfare setting. The purpose of the article is to illustrate how a concurrent triangulation was accomplished in a single organizational culture study in a child welfare agency. A sample of 92 employees was selected from a Midwestern private, non-profit, faith-based child welfare agency. Four distinct methods were used to measure organizational culture and its influence on service delivery which allowed for greater validity by collecting different data bearing on the same organizational culture phenomena. Strengths and implications are discussed.     

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities.This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.     

The influence of father involvement on child welfare permanency outcomes: A secondary data analysis

Children have a higher risk for poor psychosocial outcomes when their fathers are absent or uninvolved. These children are more likely to live in poverty, drop out of school, and engage in risky behaviors like using alcohol, tobacco, and illicit drugs. Only 54% of nearly a half million children in foster care had contact with their fathers in the past year compared to 72% of children from the general population. Data on the involvement of fathers whose children are in out-of-home placements are scarce and child welfare agency efforts to involve fathers and children's permanency outcomes also are not well documented.     

Similarities and differences in program registers: A case study

Researchers, clinicians, and other professionals are increasingly in need of cost-effective, evidence-based programs and practices. However, these individuals may lack the time and, for some, the required expertise to search for and identify such interventions. To address this concern, several online registers that list or categorize programs according to their empirical evidence of effectiveness have been established. Although these registers are designed to simplify the task of selecting evidence-based interventions, the use of distinct review processes and standards by each register creates discrepancies in final program classifications, which can pose a challenge for users. The present case study highlights three programs that have been evaluated by more than one register and have received similar or different classifications. Reasons for inconsistencies are discussed, and several recommendations for evaluating organizations and register users are provided to enhance the functionality and ease of use of online program registers.     

Washington State's adoption of a child welfare practice model: An illustration of the Getting To Outcomes implementation framework

Despite a great need for evidence-informed practices in child welfare, very few child welfare systems have implemented evidence-based case management models state-wide. While the literature on implementation from the perspective of model developers and researchers is steadily increasing, there has been little attention to the process of implementation originating from the reverse direction, by community organizations themselves, or with regard to going-to-scale implementation in child welfare. The Getting to Outcomes (GTO) model, which was originally created to help organizations choose and implement prevention programs, is a promising guide for child welfare systems seeking to initiate system-wide implementation of evidence-based practices. The GTO framework provides a step-by-step guide for surveying a system, building motivation, training, and evaluation. This article will illustrate the state-wide implementation of Solution-Based Casework (SBC), an evidence-based model of case management, by Washington State's Children's Administration, following the GTO framework. Despite some barriers and obstacles, the GTO model proved to be feasible and to aide in the implementation of SBC. Implications for the GTO model as a framework for empowering community organizations to choose and implement relevant evidence-based practices will be discussed.     

Engaging substance-affected families in child welfare: parent perspectives of a parenting intervention at program initiation and completion

Families affected by substance abuse are at an increased risk of child welfare involvement and poor child welfare outcomes. One strategy to improve outcomes among these families is evidence-based parenting interventions. While these interventions show the potential for advancing the child welfare field, they have not been widely and rigorously evaluated with birth parents, especially those affected by substance abuse, who face marked vulnerability and marginalization. We sought to draw on parents’ expertise and to understand their first and changing impressions throughout involvement in a parenting intervention, as well as overall impressions at program completion. Semi-structured interviews were conducted with a purposive sample of 10 parents who were involved in child welfare and a family drug treatment court. All parents were affected by parental substance use and had recently completed the Strengthening Families Program. Interviews were transcribed verbatim and analyzed for prominent themes. The study’s findings showed that parents described four key themes that influenced their perspectives of the parenting intervention: program reputation as communicated by peers, relevance and applicability of the program, children’s involvement and enjoyment of the program, and program structure issues that pointed to the need for high-quality group facilitation. Implications for practice and research are discussed.     

Validity in an evaluation of Healthy Families Florida—A program to prevent child abuse and neglect

Evidence-based continuums have become a guide for identifying the level of evidence in evaluations of home visiting programs conducted to determine their effectiveness in preventing child abuse and neglect. While randomized controlled trials are required for the highest levels of evidence, quasi-experimental designs have also been specified as an appropriate alternative. Using a quasi-experimental evaluation of a home visiting program to prevent child abuse and neglect that adheres to the Healthy Families America model, this paper describes and illustrates how types of validity can be improved. More specifically, we address how threats to internal validity can be identified and reduced through statistical techniques; how construct validity may be strengthened using state records to measure the outcomes; and how external validity is affected by including or excluding study participants. After applying a variety of statistical adjustments to reduce selection bias, we found that the outcomes favored the home visiting program and increased after accounting for covariates that contributed to child abuse and neglect. This was true across the statistical techniques (traditional covariate and propensity score adjustment) used. For evaluations using quasi-experimental designs, recommendations relevant to the illustrations in the paper are also presented.     

The impacts of welfare reform on federal assistance to persistently poor children

During the late twentieth century, the US social safety net was transformed to incentivize work by providing generous wage subsidies for low-income workers and reducing federal assistance to able-bodied unemployed adults. Following the transformation and during the economic boom of the 1990s, welfare rolls and annual poverty rates plummeted, especially for children. Despite the economic boom, there were still many persistently poor children living with parents who did not work, and little is known about how the reforms impacted these children's finances. In this paper we compare rates of persistent child poverty before and after the welfare reforms and examine how federal assistance received by persistently poor children changed as a result of the reforms. We find that federal assistance to persistently poor children declined following the reforms, but with divergent results depending on parental employment. While persistently poor children with employed parents benefited from increased income via the Earned Income Tax Credit, those with chronically unemployed parents did not and also experienced substantial reductions in cash welfare and food stamps. These findings demonstrate how persistently poor children fared financially in the years following the reforms and suggest possible implications for the current period of high unemployment.     

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

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

Adult well-being of foster care alumni: Comparisons to other child welfare recipients and a non-child welfare sample in a high-risk,urban setting

Research has shown that children placed in foster care fall below population norms on many indicators of well-being. Yet few studies have been designed to distill the effects of foster care from conditions that precede foster care. Based on the available evidence, it is also uncertain whether the purported effects of foster care are lasting. This study used data gathered prospectively from an economically disadvantaged, urban cohort to examine whether foster care is associated with decreased educational and economic attainments as well as increased criminality in adulthood. Individuals who were placed in foster care after an indicated allegation of maltreatment were compared to three naturally occurring groups: (a) maltreatment victims who did not reside in foster care, (b) individuals without an indicated maltreatment allegation who were raised in a household with a Child Protective Services (CPS) record, and (c) individuals without an individual or household record of CPS involvement. Using multiple estimation procedures, we found that all participants with a CPS record fared worse in adulthood than their peers without a CPS record. Despite their poor outcomes, foster children functioned as well as other CPS recipients who did not reside in foster care. Our findings indicate that caution is warranted when attributing dysfunction observed in foster children to the effects of foster care. Implications for prevention and intervention within the context of child welfare are discussed.     

Reflections on citizen-state child welfare partnerships: Listening to citizen review panel volunteers and agency liaisons

Objective

Previous research pertaining to the citizen review panel (CRP) initiative indicates that discrepancies exist between panel member and state agency liaison perceptions of CRP effectiveness in fulfilling the CAPTA CRP mandate. This study explores the impressions of both CRP members and liaisons involving barriers to effective CRP-state child welfare partnerships and recommendations to improve the relationship, provided through narrative survey responses from CRP liaisons from 30 states and D.C. and panel members from 32 states and D.C. Thematic categories which emerged from analyses of these responses are discussed, and a conceptual model and substantive-level theory of the CRP-child protective services (CPS) relationship developed from the results are presented.

Results

The complex nature of CRP-CPS relationships emerged as the central theme among CRP members' and liaisons' responses. Liaisons and CRP members identified a need for CRP members to become more educated globally on child welfare despite the relatively high level of education and experience of much of the sample. Difficulties encountered by panel members in the effort to partner surfaced in themes of mistrust and skepticism about the worth of citizen participation in child protection. Negative agency attitudes, lack of role clarity, and lack of commitment to authentic partnership were cited as negative influences upon the relationship by both liaisons and CRP members. The most important preferred outcome of the partnership was that citizen volunteers would become more knowledgeable partners who could meaningfully contribute to child welfare efforts. A second desired outcome important to CRP members was to form a shared vision with CPS.

Conclusions

Findings imply that when key components of mutual respect, legitimacy, CPS knowledge, shared vision, authenticity, citizen engagement, honest communication, and a serious, deliberative process are in any way impeded, the partnership is vulnerable to breakdown, and intended outcomes may be compromised.

Implications

Important relational difficulties that have formed barriers between volunteers and CPS agencies have been identified, and results suggest specific issues to target for improvement. These findings can prompt a more informed discourse about the challenges and opportunities presented when attempting to engage citizens in child welfare practice and policy-making, and can lead to new research paths. Suggestions for such efforts are offered.     

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

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

Dosage matters: The relationship between participation in the Nurturing Parenting Program for infants, toddlers, and preschoolers and subsequent child maltreatment

This article uses statewide data on caregivers of young children referred to the Nurturing Parenting Program (NPP) for allegations of abuse and neglect to examine the relationship between program dosage and subsequent maltreatment. At six months after participating in the program, caregivers who attended more sessions were significantly less likely to be reported for child maltreatment, holding other factors constant. At two years after participating, caregivers attending more sessions were significantly less likely to have a substantiated maltreatment incidence, controlling for other characteristics of families associated with maltreatment. These findings demonstrate the program is associated with preventing short-term allegations and longer-term substantiated incidences of maltreatment for a child welfare population. By demonstrating the importance of participation in the NPP, we increase the evidence about effective parent education programs for this population.     

The policy context of leaving care services: A case study of Northern Ireland

The transition of foster youth from state care to independent living has received increased research, practice, and policy attention in the United States and in many other countries. Most contributions to this literature have focused on documenting poor outcomes across various dimensions of need in the young people's lives whereas little attention has been given to the policy context in which the responses to those needs are being developed. In this article, we argue that there is a pressing need for better understanding of how the policy context can both promote and impede the development of appropriate services. To illustrate our argument, we use Northern Ireland as a policy case study both because of recent initiatives underway there in regard to youth transitions from state care and because of the heightened political sensibilities associated with it as a society. We draw attention to the socio-political historical context, a number of intersecting social policies, and the place of social work as a key occupation involved in delivering service improvements. We conclude by suggesting that this case study not only highlights the need to address similar aspects of the policy on youth transition from state care in the United States but also demonstrates the benefits of reflecting on policy development and implementation elsewhere in the world.