Major findings from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018.

BACKGROUND: The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is the only source of province-wide statistics on families investigated by child welfare. OBJECTIVE: This paper presents key findings from the 2018 cycle of the OIS (OIS-2018) and highlights select policy and practice implications of these findings. PARTICIPANTS AND SETTINGS: The OIS-2018 captured information directly from investigating child protection workers about children and families who were the subject of a child protection investigation sampled for inclusion in the study. METHODS: The OIS-2018 sample was drawn in three stages: first, a representative sample of child welfare agencies in Ontario was selected, then cases were sampled over a three-month period within selected agencies, and, finally, investigations that met the study criteria were identified from the sampled cases. The data collected for the OIS-2018 were weighted in order to derive provincial, annual incidence estimates. RESULTS: An estimated 158,476 child maltreatment-related investigations were conducted in Ontario in 2018. In the majority of investigations, there was no documented physical or emotional harm to the child. The overall incidence of investigations remains unchanged between 2008 and 2018. The only statistically significant difference during this time period is an increase in risk investigations between 2013 and 2018. CONCLUSIONS: Data from the OIS gives Ontario child welfare policymakers and practitioners an empirical basis for making evidence-informed decisions. Findings are compared to the United States and Australia.

Characterizing newborn and older infant entries into care in England between 2006 and 2014.

BACKGROUND: The risk of entry to state care during infancy is increasing, both here in England and abroad, with most entering within a week of birth ('newborns'). However, little is known about these infants or of their pathways through care over early childhood. OBJECTIVE: To characterize infant entries to care in England. PARTICIPANTS AND SETTING: All children in England who first entered care during infancy, between April 2006 and March 2014 (n = 42,000). METHODS: We compared sociodemographic and care characteristics for infants entering care over the study period by age at first entry (newborn: <1wks, older infant 1-51wks). Among those who entered before April 2010, we further characterized care over follow-up (i.e. 4 years from first entry) and employed latent class analysis to uncover any common pathways through care. RESULTS: Almost 40 % of infants first entered care as a newborn. Most infants first entered care under s 20 arrangements (i.e. out-of-court, 60 % of newborns vs 47 % of older infants). Among infants entering before April 2010, most were adopted over follow-up (60 % vs 37 %), though many were restored to parental care (20 % vs 32 %) or exited care to live with extended family (13 % vs 19 %). One in six infants (17.7 %) had particularly unstable care trajectories over early childhood, typified by three or more placements or failed reunification. CONCLUSIONS: Evidence-based strengthening of pre-birth social work support is needed to improve preventive interventions before birth, to more effectively target infant placement into care. Linkages between child protection records and information on parents are needed to inform preventive strategies.

Screening for economic hardship for child welfare-involved families during the COVID-19 pandemic: A rapid partnership response.

BACKGROUND: Pandemics have a wide range of economic, health and social consequences related to both the spread of a disease and efforts made by government leaders to contain it which may be particularly detrimental for the child welfare-involved population. This is because child welfare agencies serve some of the highest needs children and families. A significant proportion of these families face economic hardship, and as a result of containment measures for COVID-19, more families inevitably will. OBJECTIVE: Given the range of negative consequences related to the pandemic and the evolving supports available to families, child protection workers needed a clinical tool to guide and support work with families informed by an understanding of economic hardship. The objective of this paper is to report on the development and implementation strategy of a tool to be used for practice intervention during the pandemic. METHODS: Action research methodology was utilized in the creation of the clinical tool. The tool's development and implementation occurred through an academic/child welfare sector partnership involving child welfare agencies representing diverse regions and populations in Ontario, Canada. Factor analysis of representative child welfare data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) on economic hardship was used to inform the development of questions on the clinical tool. RESULTS: The development and implementation strategy of the clinical tool are described, including the results from analyses of the OIS-2018. CONCLUSIONS: Future directions for the project are discussed, including considerations for using this tool beyond the pandemic.

Data-informed recommendations for services providers working with vulnerable children and families during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic and associated response measures have led to unprecedented challenges for service providers working with vulnerable children and families around the world. OBJECTIVE: The goal of the present study was to better understand the impact of the pandemic and associated response measures on vulnerable children and families and provide data-informed recommendations for public and private service providers working with this population. PARTICIPANTS AND SETTING: Representatives from 87 non-government organizations (NGOs) providing a variety of direct services (i.e. residential care, family preservation, foster care, etc.) to 454,637 vulnerable children and families in 43 countries completed a brief online survey. METHODS: Using a mixed methods design, results examined 1) ways in which children and families have been directly impacted by COVID-19, 2) the impact of the pandemic on services provided by NGOs, 3) government responses and gaps in services for this population during the pandemic, and 4) strategies that have been effective in filling these gaps. RESULTS: Data revealed that the pandemic and restrictive measures were associated with increased risk factors for vulnerable children and families, including not having access to vital services. The NGOs experienced government restrictions, decreased financial support, and inability to adequately provide services. Increased communication and supportive activities had a positive impact on both NGO staff and the families they serve. CONCLUSIONS: Based on the findings, ten recommendations were made for service providers working with vulnerable children and families during the COVID-19 pandemic.

"Oh, this is actually okay": Understanding how one state child welfare training system adapted to the COVID-19 pandemic.

BACKGROUND: Training for new and existing child protection system (CPS) caseworkers is critical to developing and maintaining a competent workforce that effectively works towards safety, permanency, and wellbeing outcomes for children in the system. The COVID-19 pandemic required a shift to virtual training to continue training CPS professionals safely. OBJECTIVE: The purpose of our project was to determine if there were differences in learning outcomes between learners who completed training in the usual delivery methods (Pre-COVID) and the fully virtual delivery methods (Post-COVID). We also sought to understand any factors that facilitated or impeded successful virtual training during the pandemic. PARTICIPANTS AND SETTING: Caseworkers-in-training completed learning and satisfaction assessments through standard continuing quality improvement efforts. Training facilitators, course developers, and leadership completed qualitative interviews. METHODS: We assessed quantitative differences in one US state in learner knowledge, satisfaction, and behaviors before and during the COVID-19 pandemic and conducted a qualitative thematic analysis of interviews with training system employees. RESULTS: Overall, there were limited differences in learner outcomes before and after the transition to virtual training delivery. Across the employee interviews, three main themes emerged: organizational culture facilitated the transition, external constraints caused challenges during the transition, and there were opportunities to evolve training practices positively. CONCLUSIONS: The shift to a virtual learning environment had little impact on learner knowledge or satisfaction. Employee perspectives indicated that the pre-COVID investment in organizational culture has substantial dividends for performance during the crisis.

Professional quality of life and intent to leave the workforce: Gender disparities in child welfare.

BACKGROUND: Efforts to enhance professional quality of life (ProQOL) may prove a promising area for intervention to reducing workforce jettison and maintaining a healthy and resilient workforce necessary for supporting children and families in the child welfare system. OBJECTIVE: The current study aimed to describe the relative contributions of measures of ProQOL to intent on leaving the workforce among child welfare professionals. We also aimed to describe gender differences in ProQOL, intent to leave, and associated correlations among child welfare professionals. Such an investigation is a critical extension of earlier efforts as women constitute a markedly larger proportion of the workforce compared to men and evidence exists pointing to gender disparities in helping professionals' work experiences. PARTICIPANTS AND SETTING: Secondary data were used from a survey of child welfare professionals across five sites. METHODS: Univariate and bivariate statistics, hierarchical linear regression, and associated z-scores and p-values were used to meet the aforementioned aims. RESULTS: Burnout accounted for the greatest variation in intent to leave among all professionals. However, gender disparities were found for all ProQOL measures with the largest difference observed for burnout, an effect more pronounced in males. Compassion satisfaction was significantly higher among females. CONCLUSIONS: Burnout shapes intentions to leave for child welfare professionals; however, the effects of emotional exhaustion and hopelessness are stronger predictors of turnover among male than females in the current sample. Organizational strategies to reduce burnout and future research directions are discussed.

Scaling Up Housing Services Within the Child Welfare System: Policy Insights From Simulation Modeling.

OBJECTIVES: Housing insecurity and homelessness contribute to risk of maltreatment among one in five of the nearly 3.5 million children annually investigated for maltreatment in the United States. The Family Unification Program (FUP)-a federal initiative-connects inadequately housed families involved in child welfare with long-term rental subsidies to avoid foster placement. However, FUP remains understudied and underutilized with funding levels that serve only a fraction of eligible households. The present study uses system dynamics modeling to inform decision-making by testing policies for scaling FUP. METHOD: Simulations model delivery of FUP within child welfare from a feedback perspective. Calibrated on national data, models replicate trends in child welfare involvement from 2013 through 2016, and analyses forecast rates through 2019. Experiments test policies that enhance FUP. Outcomes track system-wide rates of family separation and returns on investment of expanded housing interventions. RESULTS: Dramatic expansions of FUP benefit more families and improve marginal return on investment. Yet, scale-up fails to reduce system-wide rates of family separation or generates substantial cost-savings. CONCLUSIONS: Simulations demonstrate structural challenges for scaling FUP. Constant demand for affordable housing constrains sustainable improvements in child protection. Child welfare responses to homelessness require innovations that reduce demand for housing services through prevention and earlier intervention.

What is known about the LGBTQ perspective in child welfare services? A scoping review protocol.

INTRODUCTION: In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives. METHODS AND ANALYSIS: The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. ETHICS AND DISSEMINATION: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.

Child Protective Service Referrals Involving Exposure to Domestic Violence: Prevalence, Associated Maltreatment Types, and Likelihood of Formal Case Openings.

Childhood exposure to domestic violence (CEDV) is widely understood as potentially harmful to children. Accordingly, many child welfare systems in the United States construe CEDV as maltreatment when the exposure results in harm or threatened harm to the child. The purpose of the current study was to investigate substantiated child welfare referrals directly related to CEDV to better understand the prevalence and patterns of CEDV-related maltreatment and how child welfare workers respond under the "harm or threatened harm" standard. Data were drawn from 23,704 substantiated referrals between 2009 and 2013 in a large Midwestern child welfare system. Approximately 20% of substantiated referrals were CEDV related. A plurality of CEDV-related referrals included both a male caregiver and female caregiver who were co-substantiated for maltreatment. The most common maltreatment types substantiated for these referrals were neglect based rather than abuse based, and just under a quarter (23%) of CEDV-related referrals were formally opened for services. Referrals involving co-occurring substance abuse were most likely to be opened for services based on predicted probabilities derived from multilevel modeling. Implications for policy and practice are considered.

Understanding the needs of the Kingdom of Saudi Arabia: Child maltreatment prevention program development.

BACKGROUND: Global efforts are being made to combat child maltreatment (CM); however, in 2011 the Kingdom of Saudi Arabia's (KSA) response to this issue was found to be mediocre. Several developments have been implemented in KSA since then, and reevaluation is now necessary. OBJECTIVE: To assess the CM-prevention readiness (CMPR) of KSA in regard to implementing large-scale, evidence-based CM-prevention programs. PARTICIPANTS AND SETTING: Key informants based in KSA who were decision makers and senior managers in the CM field; face-to-face interviews were conducted in the participants' offices. METHODS: This was a cross-sectional study. We used the multi-dimensional tool "Readiness Assessment for the Prevention of Child Maltreatment - short version," which examines 10 dimensions concerning this topic. Comparison between the results of this study and those of the 2011 examination was performed to determine how the situation in KSA has changed. RESULTS: Sixty informants were interviewed; the majority being females (57%) and from governmental institutions (56%). The average total score for the 10 dimensions was 47.4%, an increase from the 43.7% reported in 2011. The strongest dimensions were legislations and mandates (8.3/10), followed by knowledge (7.1/10) and institutional links and resources (5.8/10). The lowest scores concerned human and technical resources (1.7/10) and attitude towards CM (2.8/10). Compared to the 2011 results, some dimensions showed significant improvements, but the majority had remained consistent. CONCLUSIONS: Time and commitment are necessary to secure CMPR improvement. Periodic assessment of CMPR is required to provide proper recommendations to the government regarding the progress of CM-prevention strategies.

Reporting Maltreatment to Child Protective Services in the Context of Intimate Partner Violence Research.

Given the overlap between intimate partner violence (IPV) and child maltreatment, IPV-exposed child participants in research might disclose instances of child maltreatment. Such disclosures might require researchers to report the maltreatment to child protective services (CPS). However, the literature provides minimal guidance on how to navigate the complex challenges and ethical dilemmas around reporting in the context of research. To help address this gap and stimulate discussion regarding protocols and policies for reporting child maltreatment, this article presents a CPS reporting protocol developed as part of a community-engaged research project evaluating a parenting intervention for system-involved mothers experiencing IPV.

An assessment of child protection in Bangladesh: How effective is NGO-led Child-Friendly Space?

Many underprivileged Bangladeshi children are vulnerable to child trafficking, abuse, and exploitation. Child-Friendly Space (CFS) is a semi-permanent house space where vulnerable children are given the support to have a safe environment to survive and thrive. The purpose of this study is to evaluate the role of CFS in providing a protective environment for the children in Bangladesh. A set of secondary and primary data was used to review child protection situation in Bangladesh, and to evaluate the effectiveness of the CFS within a community. An evaluation of child development among the children who attend in the CFS and who do not attend in the CFS was conducted. CFS was found to benefit vulnerable children and communities in terms of protective environment and child development. Children attending in the CFS had better performance at almost every child development indicator. At the community level, child labor decreased in the areas where CFS exists. To respond to the continuing threats of child insecurity, this study presents a set of recommendations for the sustainability of the CFS in the community.

Care coordination in pediatric health care settings: the critical role of social work.

Background: Care coordination (CC) is integral to improving health care quality. Research on CC by health care social workers (HSWs) in pediatric health care settings is limited. This paper aims to operationalize and quantify CC functions fulfilled by HSWs in one large urban pediatric hospital. Methods: Twenty-three discrete CC tasks across four categories of assessment, meetings, consultations, and facilitation were identified and operationalized by an HSW CC committee through a consensus-driven decision-making process. Over three workdays, 22 HSWs from 18 unique health care clinic settings recorded total time spent daily on each CC activity. Results: Participants spent an average of 78.3% of a typical workday on CC activities. Regardless of setting, participants completed tasks across all general activity categories of assessment, meetings, consults, and facilitation. The most time-consuming CC tasks included biopsychosocial assessment, medical team consultations, multidisciplinary care plan facilitation, and family meetings. Tasks related to child protection were among the least frequently completed. Conclusion: CC is a cornerstone of HSW service provision in pediatric health care settings. HSWs can be vital collaborators in developing innovative transdisciplinary CC models.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.

Emergency residential care settings: A model for service assessment and design.

There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care.

A systematic scoping review of parental satisfaction with child protection services.

Obtaining parent views on child protection services is an essential part of evaluating service quality and effectiveness. It also promotes the principles of listening to parents and involving them in decision-making. The present review analysed published research that investigated parental perspectives on the child protection services they received. It identified 52 studies published between 2000 and 2016 on parent satisfaction. Most used qualitative methods, and eight standardised survey instruments were used in quantitative studies. Factors related to parent satisfaction or dissatisfaction related to the attitudes and skills of workers, the interventions provided, and aspects of the child protection system. The body of research provides guidance for policymakers and practitioners about strategies to measure and improve client satisfaction.

Delivering social work services in collaboration with the legal representation for individual clients: An effective, ethical and economical approach to supporting families in child abuse and neglect legal proceedings.

This article discusses the need to improve the quality of helping relationships between families and social workers in the child protection system and the growing body of evidence that teams of social workers and lawyers are effective at improving outcomes in child protection legal proceedings. The author presents an alternative structure of delivering social work services within the child protection systems once a court gets involved with a family, proposing that social workers should focus on individual clients in collaboration with their legal representation, rather than the traditional model of a governmental agency social worker serving the family as a unit as it also determines placement of the children. Pairing the social worker to an individual client in tandem with their legal representative would help resolve the widely observed relationship problems between service users and governmental agency social workers that include the power imbalance created by the agency's authority to determine placement of children, the conflicts of interest that agency workers face when required to manage differing family members' needs, and the lack of protection of the due process right of confidentiality for parties involved in legal proceedings. This alternative structure also impacts the need to use resources more efficiently and has been demonstrated to result in substantial returns on investment. This article concludes that when a family becomes involved in child abuse and neglect legal proceedings, the child welfare agency should shift the delivery of social work services to the individual parties, away from the governmental agency and in conjunction with their legal representation.

Delivering an empowerment intervention to a remote Indigenous child safety workforce: Its economic cost from an agency perspective.

BACKGROUND: The Family Wellbeing (FWB) program applies culturally appropriate community led empowerment training to enhance the personal development of Aboriginal and Torres Strait Islander people in life skills. This study sought to estimate the economic cost required to deliver the FWB program to a child safety workforce in remote Australian communities. METHOD: This study was designed as a retrospective cost description taken from the perspective of a non-government child safety agency. The target population were child protection residential care workers aged 24 or older, who worked in safe houses in five remote Indigenous communities and a regional office during the study year (2013). Resource utilization included direct costs (personnel and administrative) and indirect or opportunity costs of participants, regarded as absence from work. RESULTS: The total cost of delivering the FWB program for 66 participants was $182,588 ($2766 per participant), with 45% ($82,995) of costs classified as indirect (i.e., opportunity cost of participants time). Training cost could be further mitigated (∼30%) if offered on-site, in the community. The costs for offering the FWB program to a remotely located workforce were high, but not substantial when compared to the recruitment cost required to substitute a worker in remote settings. CONCLUSION: An investment of $2766 per participant created an opportunity to improve social and emotional wellbeing of remotely located workforce. This cost study provided policy relevant information by identifying the resources required to transfer the FWB program to other remote locations. It also can be used to support future comparative cost and outcome analyses and add to the evidence base around the cost-effectiveness of empowerment programs.

[Crisis Intervention in a Health Care Hospital for Child and Adolescent Psychiatry]. / Krisenintervention in einer Versorgungsklinik für Kinder- und Jugendpsychiatrie.

Crisis Intervention in a Health Care Hospital for Child and Adolescent Psychiatry In the past years the pressure in society and psychological problems in Germany have risen up. This can especially be verified by the great influx of utilization of child and adolescent psychiatric clinics through the admission of crisis. In this connection social disadvantaged female adolescents with a low socio-economic status, students of the secondary school, children in care and the ones whose parents have to manage their upbringing alone are preferentially affected. These developments require a fast adaptation of the supply system to the transformed demands, in particular in terms of outpatient treatment, as well as a closely and structured cooperation between the youth welfare and child and adolescent psychiatric clinics in their function as systems of help. In the script statistical data and adaptive approaches of a supply department of child and adolescent psychiatry are presented.