Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts.

BACKGROUND: Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed. OBJECTIVE: To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts. PARTICIPANTS AND SETTING: Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America. METHOD: Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison. RESULTS: Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones. CONCLUSIONS: Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Arab mothers' viewpoints: Why their children are removed from home.

BACKGROUND: Many studies have explored the impact of child removal on both children and professionals, but there is limited research on the experiences of mothers whose children social services had removed from their homes, particularly within Arab society. OBJECTIVE: This study focused on Arab mothers from East Jerusalem-an ethnic minority in Israel's society, that faces unique challenges-whose children removed from home. The study examines, from the mothers' perspectives (1) reasons for the removal, and (2) relationships with welfare services. METHODS: 15 Arab mothers from East Jerusalem, aged 25 to 49 who had at least one child removed through a court order participated in the study. Nine of the mothers were divorced, separated, or widowed. RESULTS: The mothers described several reasons for their children's removal, including domestic violence and lack of support from their own families after leaving abusive husbands, poverty leading to what social services interpreted as neglect, the child's challenging behavior, and false accusations. The second theme reveals a lack of cooperation between social workers and the mothers, and social workers' negative perceptions of the mothers hindering reunification. CONCLUSIONS: The study sheds light, for the first time as far as we know, on the perspectives of Arab mothers concerning their children's removal. Early support could avert removal, and social workers should make greater efforts to promote child reunification. It is paramount that professionals build trust with these mothers, through culturally sensitive and empowering engagement.

Training health professionals to reduce overreporting of birthing people who use drugs to child welfare.

BACKGROUND: Health care providers are a key source of reports of infants to child welfare related to birthing people's substance use. Many of these reports are overreports, or reports that exceed what is legally mandated, and reflect racial bias. We developed and evaluated a webinar for health professionals to address overreporting related to birthing people's substance use. METHODS: This evaluation study collected data from health professionals registering to participate in a professional education webinar about pregnancy, substance use, and child welfare reporting. It collected baseline data upon webinar registration, immediate post-webinar data, and 6 month follow-up data. Differences in both pre-post-and 6 month follow-up data were used to examine changes from before to after the webinars in beliefs, attitudes, and practices related to pregnant and birthing people who use drugs and child welfare reporting. RESULTS: 592 nurses, social workers, physicians, public health professionals, and other health professionals completed the baseline survey. More than half of those completing the baseline survey (n = 307, 52%) completed one or both follow-up surveys. We observed statistically significant changes in five of the eleven opioid attitudes/beliefs and in four of the nine child welfare attitudes/beliefs from baseline to follow-ups, and few changes in "control statements," i.e. beliefs we did not expect to change based on webinar participation. All of the changes were in the direction of less support for child welfare reporting. In particular, the proportion agreeing with the main evaluation outcome of "I would rather err on the side of overreporting to child welfare than underreporting to child welfare" decreased from 41% at baseline to 28% and 31% post-webinar and at 6-month follow up (p = 0.001). In addition, fewer participants endorsed reporting everyone at the 6 month follow-up than at baseline (12% to 22%) and more participants endorsed reporting no one at the 6-month follow-up than at baseline (28% to 18%), p = 0.013. CONCLUSIONS: Webinars on the legal, scientific, and ethical aspects of reporting that are co-developed with people with lived experience may be a path to reducing health professional overreporting to child welfare related to birthing people's substance use.

Association of child abuse and neglect training with filing reports of concern to child welfare services: a cross-sectional study.

BACKGROUND: The aptitude, knowledge, and competence of dental health personnel on child abuse and neglect (CAN) is not optimal for deciding when to file a report of concern to child welfare services (CWS). OBJECTIVES: The aim of this study was, firstly, to assess the association of the public dental health personnel 's (PDHP) training on CAN received in the last three work years, i.e., in 2016 through 2018 with filing reports to the CWS in the same period and secondly to assess the association of expressed need of training on CAN with filing reports to the CWS. METHODS: This cross-sectional study uses data from an electronic survey census of PDHP from Norway (n = 1791) conducted in 2019. The Pearson chi-square test, non-parametric tests, logistic, and negative binomial regression were used for unadjusted and adjusted analysis. Data was reported with proportions, odds ratios (OR), incidence rate ratios and 95% confidence intervals (CIs). RESULTS: From 2016 to 2018, the prevalence estimate of filing reports to CWS was 50%, with a mean (standard deviation) of 1.39 (2.11) reports sent. The logistic regression analysis showed an association between filing reports of concern and CAN training in the last three years. Compared to those that had not received CAN training during the three previous years, the ORs (95% CI) for filing reports to the CWS during the same period was 2.5 (1.6-4.0) for one day CAN work training, 3.2 (2.0-5.1) for 2-4 days CAN training and 4.9 (2.6-9.4) for five or more days CAN training. Compared to workers who did not need training in reporting (routines of CAN), those who expressed the need for a little more and more training were less likely to file a report. The corresponding OR were 0.6 (0.4-0.9) and 0.6 (0.3-0.9), respectively. CONCLUSION: CAN training during the last three years is associated with filing reports of concern to CWS in the same period among PDHP in Norway. The likelihood of filing CAN reports increased with the number of days of CAN training received. Secondly, the PDHP with an expressed need for training on CAN routines were less likely to report suspicions to CWS.

Disrupted family reunification: Mental health, race, and state-level factors.

The children's mental health landscape is rapidly changing, and youth with mental health conditions (MHCs) are overrepresented in the child welfare system. Mental health is the largest unmet health need in child welfare, so MHCs may affect the likelihood of system reentry. Concerns regarding mental health contribute to calls for expanded supports, yet systems contact can also generate risk of continued child welfare involvement via surveillance. Still, we know little about how expanded supports at the state-level shape child welfare outcomes. Using the Adoption and Foster Care Analysis Reporting System (AFCARS), we examine the association between MHCs and system reentry within 36 months among youth who reunified with their families in 2016 (N = 41,860). We further examine whether this association varies across states and White, Black, and Latinx racial and ethnic groups via two- and three-way interactions. Results from multilevel models show that, net of individual and state-level factors, MHCs are associated with higher odds of reentry. This relationship is stronger for youth in states that expanded Medicaid by 2016 and with higher Medicaid/CHIP child participation rates. The results also show evidence of the moderating role of state-level factors, specifically student-to-school counselor ratio, diverging across racial and ethnic groups. Our results suggest a need for systems of care to better support youth mental health and counteract potential surveillance.

Typologies of Family Dependency Treatment Court Participants: Parental Characteristics and Differential Child Placement Outcomes.

Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p < .05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed.

A prospective study of sexual risk patterns associated with delinquency and justice involvement among child welfare system-involved male adolescents in the United States.

INTRODUCTION: Early sexual activity and teen pregnancy are known risk factors for delinquency and justice involvement among male adolescents. However, less is known about these patterns among child welfare system (CWS)-involved boys who face significant social barriers and past/current traumatic experiences. METHODS: We prospectively examined these associations among male adolescents who identified as low and high risk for child-maltreatment via a secondary data analysis of the Longitudinal Studies of Child Abuse and Neglect dataset-a large scale assessment of children, their parents, and their teachers in the United States to understand issues of child abuse and neglect. We extracted and examined data from 657 boys who were identified as at-risk for maltreatment or with histories of substantiated maltreatment at ages 6, 8, 12, 14, and 16. We used structural equation modeling to examine the relationship between sexual activity (i.e., age of sexual debut, actively having sex, and sex resulting in a child) and changes in delinquency and justice involvement. RESULTS: Male adolescents who have engaged in sex and/or have fathered a child had greater increases in delinquency over time compared to those who have not had sex. Further, fathering a child was significantly associated with justice involvement, especially for the high-risk group. CONCLUSION: Results indicate that greater efforts should be taken to ascertain CWS-involved male adolescents' sexual health practices and parenting status. Male adolescents in the CWS require support with accessing developmentally appropriate sexual health education and family services.

Parent Perspectives on Documentation and Sharing of Health-Related Social Needs Data.

OBJECTIVE: Parents of pediatric patients are key stakeholders in the design and implementation of health-related social needs (HRSN) screening programs. Yet, there is little research exploring their perspectives on the documentation and sharing of HRSN data. We aimed to examine parents' preferences regarding how HRSN data are documented and shared. METHODS: We conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were coded using an inductive and deductive approach to identify emergent themes. RESULTS: The 20 interviewed parents were uniformly female with 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of International Classification of Diseases, 10th Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as the most appropriate recipients of HRSN data. Few parents felt comfortable with HRSN data being shared with payors. Parents desired transparency around HRSN data sharing. Many expressed concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals. CONCLUSIONS: Parents expressed comfort with HRSN documentation and sharing with health care providers, but requested that providers be transparent and respect parental preferences regarding data sharing to mitigate potential harms. When implementing HRSN support programs, health systems and payors should prioritize transparency around documentation and data sharing with families.

Child torture victimization: Review of criminal statutes and medico-legal issues.

A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.

Leveraging machine learning for effective child maltreatment prevention: A case study of home visiting service assessments.

BACKGROUND: Early identification of children and families who may benefit from support is crucial for implementing strategies that can prevent the onset of child maltreatment. Predictive risk modeling (PRM) may offer valuable and efficient enhancements to existing risk assessment techniques. OBJECTIVE: To evaluate the PRM's effectiveness against the existing assessment tool in identifying children and families needing home visiting services. PARTICIPANTS AND SETTING: Children born in hospitals affiliated with the Bridges Maternal Child Health Network in Orange County, California, from 2011 to 2016 (N = 132,216). METHODS: We developed a PRM tool by integrating a machine learning algorithm with a linked dataset of birth records and child protection system (CPS) records. To align with the existing assessment tool (baseline model), we limited the predicting features to the information used by the existing tool. The need for home visiting services was measured by substantiated maltreatment allegation reported during the first three years of the child's life. RESULTS: Of the children born in Bridges Network hospitals between 2011 and 2016, 2.7 % experienced substantiated maltreatment allegations by the age of three. Within the top 30 % of children with high-risk scores, the PRM tool outperformed the baseline model, accurately identifying 75.3 %-84.1 % of all children who would experience maltreatment substantiation, surpassing the baseline model's performance of 46.2 %. CONCLUSIONS: Our study underscores the potential of PRM in enhancing the risk assessment tool used by a prevention program in a child welfare center in California. The findings provide valuable insights to practitioners interested in utilizing data for PRM development, highlighting the potential of machine learning algorithms to generate accurate predictions and inform targeted preventive services.

National training and development curriculum training program impact on placement, permanency, and stability.

BACKGROUND: Resource parent trainings are an important factor in caregiver readiness and retention, which can improve placement stability and permanency achievement for children and youth, especially those who are marginalized. OBJECTIVE: Resource parents need access to evidence-based training programs attentive to caring for children and youth from a variety of diverse backgrounds. This study evaluates placement, permanency, and stability outcomes of children whose resource parents were trained in one such program: the National Training and Development Curriculum (NTDC). PARTICIPANTS AND SETTING: Participants include adults who completed a resource parent training program (N = 3822) and children in their care (N = 2565) in the U.S. states of Florida, Georgia, Illinois, and Missouri. METHODS: This quasi-experimental study involved statistical testing of caregivers and children using AFCARS data. Propensity-score matching was used to control for differences in the child permanency analysis. RESULTS: With a better understanding of the realities of fostering, NTDC participants were slightly less likely to foster after training (OR = 0.6; p < .001), self-selecting out before taking a child into the home. Those who did foster were more likely to foster a child who is a teen (OR = 1.4; p = .004), Asian/Asian American (OR = 3.8; p = .02), Black/African American (OR = 1.6; p < .001), or Hispanic/Latinx (OR = 1.7; p = .002). Children of NTDC caregivers entered legal adoptions (OR = 2.0; p = .003) and guardianships (OR = 2.9; p = .03) at higher rates than children of comparison caregivers, while rates of reunification (OR = 1.3; p = .11) were not statistically different. CONCLUSIONS: Evidence points to the effectiveness of NTDC in preparing resource parents to provide care for a diverse range of children by age, race, and ethnicity, and for those children to achieve permanency.

Protective role of informal social support and early childhood programs in reducing likelihood of subsequent reports of child maltreatment.

BACKGROUND: While past research has suggested the importance of informal social support and early childhood programs for the well-being of child welfare supervised families and children, little is known about whether or not these mechanisms function as protective factors for child welfare involved families and mediate the likelihood of repeat child maltreatment. OBJECTIVE: The study examined the role of informal social support and early childhood program participation in mediating the effects of initial report of child neglect on subsequent child maltreatment reports. PARTICIPANTS & SETTING: The study sample of children ages 0-6 (N = 1963) was drawn from the NSCAW-II dataset, a nationally representative longitudinal dataset of 5872 child welfare supervised children and their families. METHODS: Structural Equation Modeling was used to examine the direct and indirect pathways: from initial report of neglect to all subsequent child maltreatment reports and from initial report of neglect to all subsequent child maltreatment reports through mediating variables such as informal social support and early childhood programs. RESULTS: Results showed that informal social support plays an important role in reducing the likelihood of subsequent reports (b = -0.00, p = 0.005). One unit increase in informal social support reduced the odds of a child maltreatment re-report by 0.3 % (odds ratio for informal social support OR = 0.997). IMPLICATIONS: It is important that child welfare supervised families are supported in enhancing their informal networks with their family members and friends and expanding non-familial informal networks in the community.

The Child Friendly Cities Initiative-Minneapolis Model.

PURPOSE: The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States. DESCRIPTION: Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment. ASSESSMENT: The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced. CONCLUSION: The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024.

A collaborative practice pilot between child welfare and child health care providers: Lessons in implementation and evaluation of cross-sector interventions.

BACKGROUND: Improved collaboration between child welfare and health care offers the possibility of improved child well-being after child welfare involvement. OBJECTIVE: To pilot a collaborative practice model between CPS caseworkers and pediatric primary care providers (PCPs). PARTICIPANTS AND SETTING: Infants remaining at home following child welfare involvement in 2 regions of a Western state were randomly assigned to collaborative vs. standard practice between 11/2017 and 03/2019. METHODS: CPS caseworkers were trained and randomized into standard vs collaborative practice model developed to promote information sharing between caseworkers and PCPs. A mixed-methods evaluation integrated administrative and qualitative data from child welfare, caregivers, caseworkers and PCPs. Outcomes evaluated included practice implementation; caregiver, caseworker, and PCP satisfaction with collaborative practice; and preliminary descriptions of practice impact. RESULTS: There were 423 eligible cases randomized to either collaborative or standard practice. Uptake of all elements of the collaborative practice by caseworkers was limited. There were no significant differences in parental satisfaction with caseworkers, parental communication with PCPs regarding social risks or CPS involvement or repeat CPS investigations within 6 months of case closure identified between practice arms. Qualitative themes regarding facilitators of and barriers to implementation were explored from both PCP and CPS caseworker perspectives. CONCLUSIONS: Limited uptake challenges our ability to identify potential benefits of a collaborative practice for infant health or welfare outcomes. CPS caseworkers and pediatric PCPs report barriers to implementation as well as potential benefits for children and families with a more successful collaborative practice model.

Rates of out-of-home care among children in Canada: an analysis of national administrative child welfare data. / Taux de placement des enfants hors de leur foyer familial : analyse des données administratives nationales du système de protection de l'enfance au Canada.

INTRODUCTION: As a part of the public health approach to child welfare, data about children placed in out-of-home care are needed to assess population trends, understand drivers of social and health inequities, and examine outcomes for children and families. We analyzed administrative data from Canada to describe the population of children in out-of-home care, and estimate and compare rates of out-of-home care by province/territory, year, sex/gender, age group and placement type. METHODS: We conducted a cross-sectional analysis of point-in-time data from all provinces and territories for the period 2013/2014 to 2021/2022. We used frequencies and percentages to describe the population of children (and youth up to age 21 years) in out-of-home care and estimated overall and stratified rates and rate ratios. RESULTS: An estimated 61 104 children in Canada were in out-of-home care on 31 March 2022. The national rate of out-of-home care was 8.24 children per 1000 population. Rate variations by province/territory were substantial and changed over time. Rates were highest among males and children aged 1 to 3 and 16 to 17 years. Foster homes were the most common type of placement, although kinship homes accounted for an increasing share. CONCLUSION: This analysis demonstrated that administrative data can be used to generate national indicators about children involved in the child welfare system. These data can be used for tracking progress towards health and social equity for children and youth in Canada.