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.

Trajectories of Substance Use among Child Welfare-Involved Youth: Longitudinal Associations with Child Maltreatment History and Emotional/Behavior Problems.

BACKGROUND: Maltreated children experience a variety of adverse outcomes including substance use problems. Although previous research indicated that there may be distinct trajectories of substance use among these youth, studies have examined them as if they were a single homogeneous group. OBJECTIVES: The goals of this study were to explore substance use trajectories among child welfare-involved youth and to identify characteristics that distinguish substance use trajectories. METHODS: Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Multilevel latent growth mixture modeling (MLGMM) was performed using a subsample of 625 youth from ages 11-17 years investigated for maltreatment in 2008-2009. Measures included self-reported use of substance use during the previous 30 days, demographic characteristics, maltreatment history, placement in out-of-home care, and behavioral health problems. RESULTS: MLGMM identified two distinct substance use trajectory classes including High Stable Substance Use and Rapid Progression Use. Findings suggest that the experience of physical abuse is the key factor that distinguishes the two groups. When the effects of class-specific covariates were examined, results suggest that involvement in substance use behavior and its escalation vary between groups and are affected by youth's different previous experiences. Conclusions/Importance: The results have important implications for understanding individual differences in substance use behavior over time and how these differences were shaped by youth's experiences of family adversity. Study findings may be helpful for developing and enhancing the effectiveness of interventions targeted at decreasing substance use behaviors in child welfare-involved youth.

Opioid Prescription Rates And Child Removals: Evidence From Florida.

A critical aspect of the opioid epidemic is its effect on the ability of opioid-dependent parents to care for their children. In this article we investigate the association between the rate of removals of children from their homes and the opioid prescription rate in Florida counties during 2012-15. We performed a panel data analysis of opioid prescriptions that also controlled for the prescription rates of benzodiazepines and stimulants and for other risk factors for child removal. We found that a one-standard-deviation increase in the opioid prescription rate was associated with a 32 percent increase in the removal rate for parental neglect. When we obtained subset samples by percentage of white residents, the estimated relationships were approximately twice as large in the counties with the highest concentration of whites than in the counties with the lowest. Policy makers should consider the opioid epidemic's effects on child welfare when determining the appropriate public health response.

Profiles of youth in therapeutic group care: Associations with involuntary psychiatric examinations and readmissions.

The study aims were to identify distinct subgroups among youth placed in therapeutic group care (TGC) and to examine the effect of specific constellations of risk factors on readmission to residential mental health care and involuntary psychiatric examination among youth in TGC. Several administrative databases were merged to examine outcomes for youth placed in TGC during fiscal year FY04-05 through FY07-08 (N = 1,009). Latent class analysis (LCA) was conducted. Two classes were identified: youth with multiple needs (Class 1) and lower risk youth (Class 2). Class 1 represented 45% of youth in TGC. Compared with Class 2, these youth had a greater probability of having physical health problems, parents with substance abuse problems, and more extensive histories of maltreatment. Compared with Class 2, youth with multiple needs were almost twice more likely to exhibit self-injurious behavior leading to involuntary mental health examinations, but they were less likely to be readmitted to a residential mental health care of higher level of restrictiveness, such as state inpatient psychiatric programs (SIPPs). Youth placed in Florida TGC represent a heterogeneous population and services tailored to these youth's needs are important. Youth with multiple risk factors would benefit from interventions that would address multiple areas of risk. Lower risk youth (Class 2) would benefit from interventions that would focus on promoting mental health, especially among those who have experienced threatened harm, and providing services and supports necessary for stabilizing these youth in the community. (PsycINFO Database Record

Utilization of Mental Health Services and Mental Health Status Among Children Placed in Out-of-Home Care: A Parallel Process Latent Growth Modeling Approach.

This longitudinal study examined the parallel trajectories of mental health service use and mental health status among children placed in Florida out-of-home care. The results of growth curve modeling suggested that children with greater mental health problems initially received more mental health services. Initial child mental health status, however, had no effect on subsequent service provision when all outpatient mental health services were included. When specific types of mental health services, such as basic outpatient, targeted case management, and intensive mental health services were examined, results suggested that children with compromised functioning during the baseline period received more intensive mental health services over time. However, this increased provision of intensive mental health services did not improve mental health status, rather it was significantly associated with progressively worse mental health functioning. These findings underscore the need for regular comprehensive mental health assessments focusing on specific needs of the child.

Can the actions of child welfare case managers predict case outcomes?

This study examined the effect of efforts made by child welfare case managers to involve parents in case processes on two divergent case outcomes: reunification and the termination of parental rights (TPR). The sample was comprised of a cohort of children who received child protection services while in out-of-home care during fiscal year 2009-2010 and were randomly selected by the Florida Department of Children and Families (DCF) for their case management quality of practice reviews. Findings revealed that when child welfare case managers made efforts to encourage and support parents in participating in child-related decisions and activities, there were increased chances for timely reunification. However, these same efforts were only associated with a lower risk of TPR for mothers and not for fathers. Implications of these findings are discussed.

Heterogeneity in Trajectories of Child Maltreatment Severity: A Two-Part Growth Mixture Model.

This study examined the trajectories of maltreatment severity and substantiation over a 24-month period among children (N = 82,396) with repeated maltreatment reports. Findings revealed 2 different longitudinal patterns. The first pattern, Elevated Severity, showed a higher level of maltreatment during the initial incident and increased maltreatment severity during subsequent incidents, but the substantiation rates for this class decreased over time. The second pattern, Lowered Severity, showed a much lower level of severity, but the likelihood of substantiation increased over time. The Elevated Severity class was composed of children with an elevated risk profile because of both individual and contextual risk factors including older age, female gender, caregivers' substance use problems, and a higher number of previous maltreatment reports. Implications of the findings are discussed.

Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed.

Risk factors associated with increased depressive symptoms among Latinas diagnosed with breast cancer within 5 years of survivorship.

BACKGROUND: Co-occurring depression in women with cancer can complicate cancer treatment, lead to poor treatment adherence for both conditions, and decrease survival if left untreated. The purpose of this study was to explore risk factors for depression among Latina breast cancer survivors. METHODS: A closed-ended questionnaire was administered by telephone to 68 Latinas diagnosed with breast cancer within the past 5 years. Depression symptoms were measured using the Patient Health Questionaire-9 with the Endicott substitutive criteria applied. The Cognitive Appraisal Health Scale and the Brief COPE were used to measure appraisal and coping. Descriptive statistics, bivariate and multiple linear regression analyses were completed. RESULTS: Approximately 45.6% of women reported depressive symptoms. Multivariate analyses showed that a cognitive appraisal variable (decreased challenge or the potential to overcome), coping variables (increased acceptance, less positive reframing, less active coping, less use of emotional support, substance use and more self-blame), poor body image, less family and peer support to be significantly associated with an increased risk for depression. Intrapersonal variables accounted for the greatest explained variance (69%). CONCLUSIONS: This study identified several risk factors for depression. Study findings highlight the need for intervention programs to help women normalize emotions and thoughts related to cancer and its treatments, and to improve their cognitive abilities to overcome, accept, and positively reframe cancer and other difficult situations women face throughout the cancer continuum. The importance of family and peer support to improve depressive symptoms was also evident.

Predictors for readmission into children's inpatient mental health treatment.

The goal of this study was to examine factors associated with time to first and subsequent readmissions of youth (N = 1,432) to one of Florida's residential mental health treatment programs, known as State Inpatient Psychiatric Program (SIPP). Results of multivariate Cox regression analysis indicated that greater maltreatment severity, shorter length of time spent in SIPP during the initial episode, and longer time to provision of targeted case management services were associated with earlier readmission. When time to subsequent readmission was examined, results of multivariate Cox regression analysis indicated that shorter length of stay during the second hospitalization and having more than one mental health diagnosis increased the odds of experiencing subsequent readmission. One consistent finding across initial and subsequent readmissions was that the timing of service provision but not the amount of services was crucial for preventing readmissions to inpatient residential programs.

Effects of mental health disorders on the risk of juvenile justice system involvement and recidivism among children placed in out-of-home care.

This study examined the effect of specific mental health disorders on the risk of juvenile justice system involvement and subsequent recidivism among maltreated children placed in out-of-home care. The sample was comprised of all children in Florida aged 7-17 years who were investigated for maltreatment and subsequently placed in out-of-home care between July 1, 2004, and June 30, 2005 (N = 5,720). Presence of mental health disorders and absence of a caregiver were both significantly associated with juvenile justice involvement. Among all examined mental health disorders, conduct disorder was the strongest predictor of juvenile justice involvement. Findings also indicated that, compared to children who did not have identified mental health disorders, children diagnosed with mental health disorders were approximately 80% more likely to experience recidivism. Implications of these findings are discussed.

Comparing child protective investigation performance between law enforcement agencies and child welfare agencies.

This study examines the comparative effectiveness of using law enforcement agencies for child protective investigation (CPI), in contrast with the traditional approach of CPI conducted by the public child welfare agency. The analysis uses 2006-2007 data from a natural experiment conducted in Florida to show modest differences in performance and cost-efficiency between the two approaches to CPI. These findings may have implications for other states considering outsourcing CPI to law enforcement.

Contextual and individual-level predictors of abused children's reentry into out-of-home care: a multilevel mixture survival analysis.

OBJECTIVES: This study examined the effects of individual and contextual factors on reentry into out-of-home care among children who were discharged from child protective services in fiscal year 2004-2005. The objectives were to: (1) examine individual and contextual factors associated with reentry, (2) explore whether there are meaningful groups of youth who differ in terms of risk for reentry, and (3) determine whether relatively homogeneous clusters of child welfare agencies, based on contextual characteristics, differ significantly in terms of the reentry rates of the children whom they serve. METHOD: The study design involved a multilevel longitudinal analysis of administrative data based on an exit cohort. Two Cox proportional hazards multilevel mixture models were tested. The first model included multiple individual level predictors and no agency level predictors. The second model included both levels of predictors. RESULTS: The results of multilevel Cox regression mixture modeling indicated that at the individual level, younger age, being placed in out-of-home care because of neglect and having physical, health problems corresponded to a decreased likelihood for reentry. At the agency level, lower average expenditures per child and contracting out case management services were associated with faster reentry into out-of-home care. CONCLUSIONS: This study demonstrates that children who reenter out-of-home care appear to be a homogeneous population and that reentry is associated with both contextual factors and individual characteristics. PRACTICE IMPLICATIONS: The most important implication that can be drawn from the study findings is that reentry may be most effectively prevented by focusing on such factors at the organizational level as contracting out case management services and funding allocation. Child welfare agencies that are responsible for an array of services and decide to contract out case management should consider the use of performance-based contracts and emphasize and strengthen quality assurance approaches for contracted services. In addition, to compensate for lower funding allocated for children served in out-of-home care, child welfare workers should become more familiar with community resources and help connect families to these supports.

Children placed in out-of-home care: risk factors for involvement with the juvenile justice system.

In previous research, child maltreatment has been associated with several negative outcomes, including delinquency. This study uses administrative data to examine risk factors, including the severity and chronicity of maltreatment, for juvenile justice involvement among children, ages 7 to 17, who were placed in out-of-home care in Florida (N = 13,212). The results of multivariate Cox regression analysis indicated that among specific types of maltreatment, sexual abuse was associated with the risk of faster placement only in a detention center. Additionally, findings from this study suggest that maltreatment chronicity but not maltreatment severity increases the chances of earlier involvement with the juvenile justice system among children who were placed in an out-of-home care. Implications of these findings are discussed.

Mental health services expenditures among children placed in out-of-home care.

This study examined Florida Medicaid mental health expenditures for children in out-of-home care. Child welfare and Medicaid administrative databases were analyzed using two-part models to identify characteristics associated with expenditures. Mental health expenditures were higher for older children, boys, children who were abused or lost their caregivers, or with a longer length of stay in out-of-home care. In contrast, African American children were less likely to have positive expenditures than White children, but among youth with positive expenditures, African Americans had higher expenditures. In addition, among youth with positive expenditures, substance use and affective disorders were associated with higher expenditures.

An assessment of the extent of child maltreatment using administrative databases.

This study examined the extent of violence toward children and factors associated with child maltreatment in Florida using a cohort of children (N=499,330) who were adjudged to be victims of maltreatment between July 1, 1996, and June 30, 2003. To assess the extent of maltreatment, five indicators were proposed and examined. Multivariate analyses found that prior referral, having more than one type of maltreatment during an initial incident, and caregiver absence best predicted the recurrence of maltreatment. Caregivers' alcohol and substance use were strong predictors of neglect and threatened harm but not of abuse. Finally, multilevel analyses found that older, nonminority girls with histories of prior referrals were significantly (psuedo-zs>2.00) more likely to experience high degrees of incident severity. Caregivers' substance use, excluding alcohol, also was significantly linked to incident severity. Implications of the findings are discussed.

At-risk high school students in the "Gaining Early Awareness and Readiness" Program (GEAR UP): academic and behavioral outcomes.

The purpose of this study was to assess the effects of a GEAR UP intervention with at-risk high school students at a large urban high school in Florida. The goals of the GEAR UP program were to improve academic performance, decrease behavior-related problems, and reduce truancy and absenteeism. The study design consisted of a three-group comparison of the 447 students in GEAR UP: the No Participation Group, the Low Participation Group, and the High Participation Group. Participation levels were calculated for each category of activity (academic, behavior-related, and social), and propensity scoring was used to match the groups on sociodemographic characteristics and other differentiating variables. Results indicated that race (i.e., African American) and sex (i.e., female) are associated with high participation in program activities. Also, students who spent a substantial amount of time on academic activities improved their GPAs over a semester, and students who took advantage of behavior-related services and participated in social activities significantly reduced disciplinary referrals (p < .05). Suggestions for program refinement resulting from the study are discussed.

Child welfare privatization: quantitative indicators and policy issues.

The purpose of this study was to demonstrate the development of safety, permanency, and child well-being indicators by using administrative data sets as well as by using these indicators as tools for evaluating Florida's Community-Based Care (CBC) initiative. Longitudinal data from 37 counties including 4 counties that implemented community-based care were examined in this study. The results of the study indicated that the overall performance of CBC counties is at least as good as the performance of their comparison run by the state counties. The findings that emerged from this study may provide important lessons for developing a performance measurement system in the child welfare field.

Hospice care in prison: general principles and outcomes.

In recent years, tougher sentencing laws have resulted in larger numbers of elder prison inmates and, consequently, more deaths occurring in prisons. In this context, the introduction of prison hospice programs takes on great significance. The purpose of this study is to identify the principle components and outcomes of prison hospice programs based on data gathered from semistructured telephone interviews with prison hospice providers in state and federal correctional institutions and from other sources. The results suggest that there is a growing effort to provide palliative care to dying inmates across the country and that all of the existing programs share common elements and similar structures. Major outcomes of prison hospice programs include cost-effectiveness, enhanced correction, and comfort care.