Parenting attitudes and behaviors among parents involved with the child welfare system and affected by substance use disorders.

BACKGROUND: Co-occurring parental substance use and child maltreatment is a serious concern in the U.S child welfare system. OBJECTIVE: The aim of the study was to examine parenting attitudes and practices among parents who participated in Ohio START (Sobriety, Treatment, And Reducing Trauma), a statewide initiative that provides support to families affected by co-occurring parental substance use and child maltreatment. PARTICIPANTS AND SETTING: Study 1 involved quantitative data collected from 73 enrolled parents through pre-test and post-test telephone surveys. Study 2 (parent interviews) involved qualitative data collected through in-depth interviews with 34 enrolled parents. METHODS: The paired-sample t-test and the McNemar test were conducted in Study 1 and thematic analysis was conducted in Study 2. RESULTS: Quantitative analysis indicated significant improvements in parental expectations of children (t = -3.42, p = .001, Cohen's d = -0.40), parent-child family roles (t = -5.74, p < .001, Cohen's d = -0.67), and children's power and independence (t = -3.42, p = .001, Cohen's d = -0.40). Qualitative analysis revealed six themes related to changes in parenting after participation in Ohio START: (1) Being present for children, (2) Engaging in activities with children, (3) Enjoyment in providing care to children, (4) Maintaining employment for financial stability, (5) Better emotion regulation and stress management, and (6) a sense of pride. CONCLUSIONS: Our findings demonstrate positive changes in parenting attitudes and practices among parents who participated in Ohio START and provide further support for the potential merits of this model and its continued expansion throughout Ohio.

Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review.

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

Who makes the call? Examining the relationship between child maltreatment referral sources and case outcomes in the United States, 2008-2018.

BACKGROUND: Research shows general increases in child maltreatment reports in the U.S. However, less is understood about how reporting varies across states and changes over time, from a perspective of referral sources. While recent studies during COVID-19 reported a reduction in maltreatment referrals, predominantly school referrals, little research has examined changes in maltreatment referrals by referral sources before the pandemic and how different referral sources are associated with case outcomes, particularly out-of-home placement. OBJECTIVES: This study examined 1) variations across states and changes over time in maltreatment reporting by referral source and 2) the relationship between referral sources type and two case outcomes: substantiated maltreatment and out-of-home placement. PARTICIPANTS AND SETTING: We used 2008-2018 data (N = 24,349,293) from the National Child Abuse and Neglect Data System. METHODS: We used descriptive trend analysis and pooled, fixed effects binary logistic regression. RESULTS: We found gradual increases in reporting during 2008-2018, with substantial variations across states and referral sources. States rely differently on certain reporter types, while we see the largest increase in education referrals and a small decrease in social services referrals. Regression results showed that education referrals were less likely to result in out-of-home placement; law enforcement referrals were most likely to be substantiated, while social service referrals were most likely to result in out-of-home placement. CONCLUSION: This study makes unique contributions to literature by expanding our knowledge of referral sources and examining the likelihood of substantiation and out-of-home placement by referral source type. We provide child welfare policy and practice implications.

Implementing a Text Messaging Intervention to Engage Fathers in Home Visiting.

PURPOSE: This "From the Field" article reports on the Text4Dad text messaging intervention designed to engage fathers in home visiting. We introduce implementation process components from our pilot study across three Healthy Start home visitation sites. DESCRIPTION: Three Fatherhood Community Health Workers (F-CHWs) and three fathers from one Text4Dad site were interviewed. Using content analysis, we examined the experiences of F-CHWs who implemented Text4Dad and program participants who used Text4Dad. ASSESSMENT: Results highlighted five implementation process components related to: (1) F-CHWs' use of Text4Dad and enrolling fathers; (2) F-CHWs' interactions with fathers, perceptions of Text4Dad content, and integration of Text4Dad into home visits with fathers; (3) training and technical assistance for F-CHWs; (4) father program participants' acceptability and usability of Text4Dad; and (5) fathers' barriers to interactive use of Text4Dad. CONCLUSION: The F-CHWs were able to successfully enroll fathers into Text4Dad. F-CHWs and fathers found Text4Dad content acceptable to their circumstances. Text4Dad technology was viewed as usable, with some limitations. F-CHWs experienced challenges accessing the Text4Dad platform while on home visits. Results suggested that F-CHWs did not use Text4Dad to facilitate interaction, and accordingly, fathers had a lower than anticipated response rate to texts sent by their F-CHWs. We conclude with future directions for improving the implementation of text messaging programs in community-based fatherhood programs.

Examining mechanisms linking economic insecurity to interparental conflict among couples with low income.

Objective: The current study used the family stress model to test the mechanisms by which economic insecurity contributes to mothers' and fathers' mental health and couples' relationship functioning. Background: Although low household income has been a focus of poverty research, material hardship-defined as everyday challenges related to making ends meet including difficulties paying for housing, utilities, food, or medical care-is common among American families. Methods: Participants were from the Building Strong Families project. Couples were racially diverse (43.52% Black; 28.88% Latinx; 17.29% White; 10.31% Other) and living with low income (N = 2,794). Economic insecurity included income poverty and material hardship. Bayesian mediation analysis was employed, taking advantage of the prior evidence base of the family stress model. Results: Material hardship, but not income poverty, predicted higher levels of both maternal and paternal depressive symptoms. Only paternal depressive symptoms were linked with higher levels of destructive interparental conflict (i.e., moderate verbal aggression couples use that could be harmful to the partner relationship). Mediation analysis confirmed that material hardship operated primarily through paternal depressive symptoms in its association with destructive interparental conflict. Conclusion: The economic stress of meeting the daily material needs of the family sets the stage for parental mental health problems that carry over to destructive interparental conflict, especially through paternal depressive symptoms. Implications: Family-strengthening programs may want to consider interventions to address material hardship (e.g., comprehensive needs assessments, connections to community-based resources, parents' employment training) as part of their efforts to address parental mental health and couples' destructive conflict behaviors.

Father-Mother Co-Involvement in Child Maltreatment: Associations of Prior Perpetration, Parental Substance Use, Parental Medical Conditions, Inadequate Housing, and Intimate Partner Violence with Different Maltreatment Types.

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother-father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, and prior maltreatment history were investigated as key risk factors at the dyadic parental level. Logistic regression analysis was conducted using national child welfare administrative data from the National Child Abuse and Neglect Data System. The results showed differential associations between risk factors and four child maltreatment types: physical abuse, neglect, emotional abuse, and sexual abuse. Intimate partner violence was associated with higher odds of mother-father co-involved neglect and emotional abuse. Parental substance use, inadequate housing, and prior maltreatment history were all associated with higher odds of mother-father co-involved neglect, but lower odds of physical abuse. Parental disability and medical conditions were associated with higher odds of mother-father co-involved sexual abuse, whereas parental substance use was associated with lower odds of sexual abuse. Implications include more nuanced ways of addressing multiple risk factors within the family to prevent future occurrences of child maltreatment involving both mothers and fathers.

Child Welfare System-Level Factors Associated with All-Cause Mortality Among Children in Foster Care in the United States, 2009-2018.

Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.06, 95% CI [1.02, 1.11]; 5-9 years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts.

Parental Relationship Status as a Moderator of the Associations Between Mothers' and Fathers' Conflict Behaviors and Early Child Behavior Problems.

This study examines interparental conflict and associations with child behavior problems among a large, diverse sample of families with low income (N = 2,691) using path model analyses of mothers' and fathers' reports of constructive interparental conflict, destructive interparental conflict, and intimate partner violence (IPV) victimization at 15 months and child emotional insecurity and child behavior problems at 36 months. Multigroup models examined whether parental relationship status (i.e., married, cohabiting, and churning) moderated these associations. Fathers' perceptions of interparental conflict behaviors showed few direct associations with child outcomes, whereas mothers' perceptions of interparental conflict showed more robust associations with child outcomes. Specifically, mother-reported destructive conflict was associated with higher levels of child emotional insecurity and child behavior problems across parental relationship status subgroups. Mother-reported constructive conflict had a small negative association with child behavior problems in cohabiting families. Child emotional insecurity mediated the association of maternal destructive conflict on child behavior problems. Although churning families experienced higher levels of moderate and severe interparental conflict, associations linking destructive conflict to child behavior problems were consistent across parental relationship subgroups. There were few direct effects of father-reported constructive and destructive conflict on child well-being. However, the results supported the notion that fathers play an influential role in the family system via maternal reports of IPV victimization. Results of this study suggest that the mechanisms underlying emotional security theory, in which child emotional insecurity mediates the associations between maternal destructive conflict and child behavior problems, apply to a large and racially diverse sample of socioeconomically disadvantaged children.

Parental Social Isolation and Child Maltreatment Risk during the COVID-19 Pandemic.

On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The social isolation and economic stress resulting from pandemic have the potential to exacerbate child abuse and neglect. This study examines the association of parents' perceived social isolation and recent employment loss to risk for child maltreatment (neglect, verbal aggression, and physical punishment) in the early weeks of the pandemic. Participants (N = 283) were adults living in the U.S. who were parents of at least one child 0-12 years of age. Participants completed an online survey approximately 2 weeks after the World Health Organization declared that COVID-19 was a pandemic. The survey asked about recent changes (i.e., in the past 2 weeks) to employment status, parenting behaviors, use of discipline, use of spanking, and depressive symptoms. Nearly 20% of parents had hit or spanked their child in the past two weeks alone. Parents' perceived social isolation and recent employment loss were associated with self-report of physical and emotional neglect and verbal aggression against the child, even after controlling for parental depressive symptoms, income, and sociodemographic factors. Parents' perceived social isolation was associated with parental report of changes in discipline, specifically, using discipline and spanking more often in the past 2 weeks. Associations were robust to analyses that included two variables that assessed days spent social distancing and days spent in "lockdown." Study results point to the need for mental health supports to parents and children to ameliorate the strain created by COVID-19.

Supporting Fathers to Prevent Child Maltreatment: How Paid Family Leave and Child Care Subsidies are Part of a Public Health Approach.

There are multiple components of a public health approach for preventing child maltreatment. One of these components is the question of who to intervene with. Fathers are an under-targeted and under-studied group for child maltreatment prevention. In this conceptual article, we describe a public health approach for intervening with fathers. Acknowledging financial stress as a key risk factor for child maltreatment among fathers, we explore two policy interventions that aim to increase economic support for families during the early years of a child's life: paid family leave and child care subsidies. During the weeks following the child's birth, paid family leave can promote child-father bonding and enable fathers to engage in more caregiving during a critical family transition. After paid family leave ends, child care subsidies can make child care affordable for families with low income, thereby promoting parents' employment and earnings. We conclude by highlighting ways in which fathers can take an active role in preventing child maltreatment.

Patterns of Father Involvement and Child Development among Families with Low Income.

This study examined patterns of father involvement and their relations with social, behavioral, and cognitive development among low-income children < 5 years. Latent class analysis on data from 2650 fathers (Mage = 29.35 years) in the Supporting Healthy Marriages program revealed four father involvement patterns: (1) High positive involvement (48%); (2) engaged but harsh discipline (42%); (3) low cognitive stimulation (8%); and (4) lower involvement (2%). The low cognitive stimulation pattern was associated with greater father- and mother-reported child behavior problems and lower child socioemotional and cognitive functioning. The engaged but harsh discipline pattern was associated with more father-reported child behavior problems. These findings highlight the need for active engagement of fathers in parenting interventions to promote child development.

Material Hardship in Families With Low Income: Positive Effects of Coparenting on Fathers' and Mothers' Parenting and Children's Prosocial Behaviors.

Families with low income experience high levels of economic insecurity, but less is known about how mothers and fathers in such families successfully navigate coparenting and parenting in the context of material hardship. The current study utilized a risk and resilience framework to investigate the underlying family processes linking material hardship and children's prosocial behaviors in a sample of socioeconomically disadvantaged mother-father families with preschoolers from the Building Strong Families project (N = 452). Coparenting alliance and mothers' and fathers' responsive parenting were examined as mediators. Results of structural equation modeling showed that coparenting alliance was associated with higher levels of both mothers' and fathers' responsive parenting. Subsequently, both parents' responsive parenting were associated with higher levels of children's prosocial behaviors. Material hardship was not associated with coparenting alliance and either parent's responsive parenting. Tests of indirect effects confirmed that the effects of coparenting alliance on children's prosocial behaviors were mediated through both mothers' and fathers' responsive parenting. Overall, these results suggest that when mothers and fathers have a strong coparenting alliance, they are likely to withstand the negative effects of material hardship and thus engage in positive parenting behaviors that benefit their children's prosocial development. Family strengthening interventions, including responsible fatherhood programs, would do well to integrate a strong focus on enhancing a positive coparenting alliance between mothers and fathers.

Using social media Reddit data to examine foster families' concerns and needs during COVID-19.

BACKGROUND: COVID-19 is likely to have negatively impacted foster families but few data sources are available to confirm this. OBJECTIVE: The current study used Reddit social media data to examine how foster families are faring in the pandemic. Discussion topics were identified and examined for changes before and after COVID-19. PARTICIPANTS AND SETTING: Comments were collected from three Reddit online discussion boards dedicated to foster families (N = 11,830). METHODS: We used machine learning techniques, including Latent Dirichlet Allocation, for topic modeling and textual analysis for qualitative coding of the Reddit comments. RESULTS: Results showed that three main topics had both significant quantitative and meaningful qualitative changes before and after COVID-19. There were significant increases in conversation about becoming a foster parent (F = 5.75, p = 0.02) and activities for foster children (F = 10.61, p = 0.001), whereas there was a significant decrease in discussing permanency (F = 9.46, p = 0.003) before and after the onset of COVID-19. Qualitative coding showed that regarding the topic of becoming a parent, excitement over approval of foster care license before COVID-19 shifted to foster families' increased anxieties about delays in their licensing cases after COVID-19. For permanency, content changed from the best interest of the child and reunifications before COVID-19 to concerns over family separations and permanency challenges after COVID-19. Regarding activities for foster children, content related to everyday activities before COVID-19 changed to specific activities foster children and families could do during lockdowns. Results suggest areas child welfare workers may focus on to better support foster families during and after the pandemic.

Men's Knowledge of Anticipatory Guidance Topics: Results From a Nationally Representative Survey.

OBJECTIVE: 1) To describe young men's knowledge of infant routines, discipline, development, safety, sleep, and nutrition, using items assessing the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2) To report differences in knowledge between fathers and non-fathers. 3) To examine factors associated with men's greater knowledge. METHODS: Participants were men (N = 1303) aged 18 to 35 years responding to a cross-sectional survey that was administered to a national panel established through probability sampling of the civilian, non-institutionalized US population. Survey weights allow reporting of nationally representative analyses. RESULTS: Participants (mean age = 27; 58% white, 36% fathers) correctly answered 52% of the infant knowledge questions. Fathers and non-fathers answered 64% and 46% of the items correctly, respectively. The difference in knowledge between fathers and non-fathers was statistically significant (B = 0.16, P< .001). The subscale with the highest number of correct responses was routines (80% accuracy), followed by discipline (59% accuracy), safety (52% accuracy), sleep (51% accuracy), development (50% accuracy), and nutrition (40% accuracy). Multivariate analyses showed that depressive symptoms (B = -0.07, P < .05) were associated with lower infant knowledge, while higher education (B = 0.06, P < .05) and current employment (B = 0.06, P < .01) were associated with higher infant knowledge. CONCLUSIONS: Significant gaps exist in men's knowledge of infant development. Pediatric health care providers can address gaps in parenting knowledge by providing anticipatory guidance to fathers.

The Associations of Constructive and Destructive Interparental Conflict to Child Well-Being Among Low-Income Families.

Interparental conflict is a well-established precursor to child maladjustment. However, little is understood of the role of different interparental conflict in shaping the developmental outcomes of young children, especially those from socioeconomically disadvantaged backgrounds. This study uses data from a large and racially diverse sample of low-income, unmarried mothers with young children (n = 1,297) to examine the processes linking parental constructive conflict, destructive conflict, intimate partner violence (IPV) to child behavior problems, and child emotional insecurity as a mediator of these processes. Path analyses were conducted to estimate structural paths between (a) conflict constructs and child behavior problems, (b) conflict constructs and child emotional insecurity, and (c) child emotional insecurity and child behavior problems. Results demonstrated that constructive conflict was associated with decreased levels of both child emotional insecurity and child behavior problems, whereas destructive conflict was associated with increased levels of both child outcomes. IPV was associated with increased levels of child emotional insecurity only. Child emotional insecurity mediated the links between all three conflict constructs and child behavior problems. Such findings suggest the need for clinicians to help raise awareness regarding the consequences of children's exposure to different interparental conflict and educate parents about children's sense of emotional security in the family.

Longitudinal relations between coparenting and father engagement in low-income residential and nonresidential father families.

Coparenting relationship quality and father involvement are closely linked but few studies have investigated this relationship using samples of socioeconomically disadvantaged families. The current study used family systems theory to examine the longitudinal and bidirectional relations between coparenting relationship quality and father engagement in caregiving and play, using a large and racially diverse sample of low-income residential and nonresidential fathers in the Building Strong Families project (N = 1,908). Structural equation modeling tested cross-lagged relations between couple-level coparenting and father engagement at two time points for both residential and nonresidential father families. For residential fathers, positive coparenting at 15 months predicted father engagement in caregiving at 36 months. There was no support for a bidirectional or unidirectional model between coparenting and father engagement in play for either residential or nonresidential fathers. There were significant concurrent relations between coparenting and father engagement in caregiving and play for both residential and nonresidential fathers, providing support for positive spillover in line with family systems theory. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Reforming a System That Cannot Reform Itself: Child Welfare Reform by Class Action Lawsuits.

Class action lawsuits have become an increasingly common way to facilitate institutional reform. The purpose of this article is to provide an introduction to social workers of child welfare reform by class action lawsuits and subsequent consent decrees. The authors provide an overview of class action lawsuits, with a focus on their role in implementing systematic change in the United States. They highlight consent decrees as a means of settling class action lawsuits. They illustrate the current state of the child welfare system and how child advocacy groups have used class action lawsuits to initiate reform. Authors provide two case examples of child welfare reform by consent decree and engage in comparative analysis to investigate similarities and differences in the two cases. Finally, they note implications for social work practice and education and provide recommendations to equip and train social workers involved in child welfare services.

Chapter IV: In Search of the Father-Infant Activation Relationship: A Person-Centered Approach.

The current study explored whether fathers and mothers from 195 two-parent U.S. families engaged in a form of activation parenting (i.e., sensitivity, cognitive stimulation, and moderate intrusiveness) with their secondborn, 12-month-old infants during a 15-min challenging teaching task, and to determine if this type of interaction was more common among fathers. Mean comparisons showed that fathers were lower on sensitivity, positive regard, and stimulation of development, and were more detached than mothers. Latent Profile Analyses revealed similar supportive, disengaged, and activation parenting profiles for fathers and mothers, with more fathers in the activation class. Chi-square analyses found significant associations across mothers and fathers; most infants (30%) had activation fathers and mothers, with 26% having supportive mothers and activation fathers, and 11.4% having two supportive parents. Parenting profiles were unrelated to attachment security. Results need to be replicated with children of different ages, with families from different backgrounds, and beyond the challenging teaching paradigm.

The effect of paternal cues in prenatal care settings on men's involvement intentions.

A father's involvement in prenatal care engenders health benefits for both mothers and children. While this information can help practitioners improve family health, low paternal involvement in prenatal care remains a challenge. The present study tested a simple, easily scalable intervention to promote father involvement by increasing men's feelings of comfort and expectations of involvement in prenatal settings through three randomized control trials. Borrowing from social psychological theory on identity safety, the three studies tested whether the inclusion of environmental cues that represent men and fatherhood in prenatal care offices influenced men's beliefs and behavioral intentions during the perinatal period. Men in studies 1 and 3 viewed online videos of purported prenatal care offices, while men in study 2 visited the office in person. Those who viewed or were immersed in a father-friendly prenatal care office believed that doctors had higher expectations of father involvement compared to treatment-as-usual. This perception predicted greater parenting confidence, comfort, and behavioral intentions to learn about the pregnancy and engage in healthy habits, such as avoiding smoking and alcohol during their partner's pregnancy. Study 3 replicated these studies with an online sample of expectant fathers. The results suggest that shifting environment office cues can signal fathering norms to men in prenatal settings, with healthier downstream behavior intentions.