Complex, Co-occurring Needs Patterns and Evidence-Based Service Planning for Families Involved in Foster Care: A Map for Research and Practice.

This study described the complexity of service need co-occurrence among foster care-involved families and identified prevalent patterns of needs to inform future evidence-based service planning research. We utilized state administrative child maltreatment records, and restricted data to cases where the child entered foster care in 2019 and the caseworker indicated the presence of at least one need from the Family Assessment of Needs and Strengths (FANS; n = 1631). We extracted all unique combinations of needs (i.e., needs profiles), and we used association rule mining to identify patterns within these profiles. A total of 780 unique needs profiles emerged among the 1631 cases, which we condensed into 78 patterns. Although the variability and complexity of needs profiles makes evidence-based service planning difficult, the present analysis mapped prevalent needs patterns to guide future research intended to assist caseworkers in this task. Identification of maltreatment determinants among families involved in foster care, and future research into the needs within different needs patterns that might undermine treatment effectiveness, may result in a better balance between parsimonious service plans and a full consideration of co-occurring service needs.

A text-based approach to measuring opioid-related risk among families involved in the child welfare system.

BACKGROUND: The public health significance of the opioid epidemic is well-established. However, few states collect data on opioid problems among families involved in child welfare services. The absence of data creates significant barriers to understanding the impact of opioids on the service system and the needs of families being served. OBJECTIVE: This study sought to validate binary and count-based indicators of opioid-related maltreatment risk based on mentions of opioid use in written child welfare summaries. DATA AND PROCEDURES: We developed a comprehensive list of terms referring to opioid street drugs and pharmaceuticals. This terminology list was used to scan and flag investigator summaries from an extensive collection of investigations (N = 362,754) obtained from a state-based child welfare system in the United States. Associations between mentions of opioid use and investigators' decisions to substantiate maltreatment and remove a child from home were tested within a framework of a priori hypotheses. RESULTS: Approximately 6.3% of all investigations contained one or more opioid use mentions. Opioid mentions exhibited practically signficant associations with investigator decisions. One in ten summaries that were substantiated had an opioid mention. One in five investigations that led to the out-of-home placement of a child contained an opioid mention. CONCLUSION: This study demonstrates the feasibility of using simple text mining procedures to extract information from unstructured text documents. These methods provide novel opportunities to build insights into opioid-related problems among families involved in a child welfare system when structured data are not available.

Using administrative data to uncover how often and why supervisory neglect happens: Implications for child maltreatment prevention.

BACKGROUND: Despite supervisory neglect being the most prevalent and fatal neglect sub-type, the most common reasons why caregivers are substantiated for this type of maltreatment remains unknown. OBJECTIVE: Our study describes cases substantiated for supervisory neglect in a Midwestern state in an effort to inform prevention strategies against supervisory neglect. PARTICIPANTS AND SETTING: This study utilized state administrative data from substantiated child maltreatment investigations conducted between May 1st and October 31st, 2019 (N = 11,208). METHODS: We first identified the substantiated investigations where supervisory neglect was present and established investigation-level correlates for these cases. We then selected a random sample of investigations with a substantiated allegation of supervisory neglect (n = 150) for a qualitative review of written investigative narratives to uncover the contextual factors of supervisory neglect and identify which factors frequently co-occur. RESULTS: Supervisory neglect was the most common maltreatment type, present in 71% (n = 7945) of substantiated child welfare investigations. Our qualitative review of 150 randomly selected cases identified ten distinct, non-mutually exclusive contextual factors of supervisory neglect. Child exposure to domestic violence was the most prevalent contextual factor (45%), followed by caregiver's substance-related problems (42%). Childhood exposure to domestic violence and caregiver's substance-related problems was the most common co-occurrence of factors, present in 18% of cases. CONCLUSIONS: Supervisory neglect accounts for the vast majority of child maltreatment incidents. To prevent the largest share of supervisory neglect cases, policy and programs are needed to address domestic violence and substance-related problems among caregivers.

Identification of Domestic Violence Service Needs Among Child Welfare-Involved Parents With Substance Use Disorders: A Gender-Stratified Analysis.

The current study examined the prevalence and associations of a need for domestic violence services among child welfare-involved mothers and fathers with substance use disorders. Data were drawn from 2,231 child welfare-involved parents in Illinois with an identified substance use disorder. Approximately 42% of mothers and 33% of fathers with a substance use disorder had a concurrent need for domestic violence services. The sample was stratified by gender and logistic regression models were fit to determine the adjusted odds of an identified need for domestic violence services. For both mothers and fathers, the strongest association was an additional need for mental health services. Age, education status, alcohol use, marijuana use, and a reported history of physical violence victimization were also associated with a need for domestic violence services among mothers, while race, age, marital status, annual income, alcohol use, cocaine use, and a reported history of physical violence perpetration were associated with a need for domestic violence services among fathers. The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare-involved parents with identified substance use disorders, and that associations with this need vary by gender.

Prevalence and context of firearms-related problems in child protective service investigations.

BACKGROUND: Despite the significance of firearm safety, we need additional data to understand the prevalence and context surrounding firearm-related problems within the child welfare system. OBJECTIVE: Estimate proportion of cases reporting a firearm-related problem during case initiation and the contexts in which these problems exist. SAMPLE AND SETTING: 75,809 caseworker-written investigation summaries that represented all substantiated referrals of maltreatment in Michigan from 2015 to 2017. METHODS: We developed an expert dictionary of firearm-related terms to search investigation summaries. We retrieved summaries that contained any of the terms to confirm whether a firearm was present (construct accurate) and whether it posed a threat to the child. Finally, we coded summaries that contained firearm-related problems to identify contexts in which problems exist. RESULTS: Of the 75,809 substantiated cases, the dictionary flagged 2397 cases that used a firearm term (3.2 %), with a construct accuracy rate of 96 %. Among construct accurate cases, 79 % contained a firearm-related problem. The most common intent for a firearm-related problem was violence against a person (45 %). The co-occurrence of domestic violence and/or substance use with a firearm-related problem was high (41 % and 48 %, respectively). 49 % of summaries that contained a firearm-related problem did not provide information regarding storage. CONCLUSION: When caseworkers document a firearm within investigative summaries, a firearm-related risk to the child likely exists. Improved documentation of firearms and storage practices among investigated families may better identify families needing firearm-related services.

A scoping review of WeChat to facilitate professional healthcare education in Mainland China.

AIM: WeChat is the most popular social media platform in mainland China, with over 1 billion active users. Although social media is widely used in professional healthcare education in western countries, research on WeChat-based education in healthcare in mainland China is disparate and not systematic. The current study seeks to address this gap. METHOD: A scoping review was conducted to systematically describe studies of WeChat use in professional healthcare education. A comprehensive search involving three international databases in English and Chinese literature was conducted in April 2019. Articles were retained in this study if they were original studies that used WeChat as a tool to facilitate healthcare education in mainland China. RESULTS: 25 studies met the inclusion criteria and the majority of studies were either experimental or quasi-experimental. WeChat was used in both university settings and hospital settings. Hybrid education-which integrates WeChat education and face-to-face education-was more common in university settings, whereas hospitals used a combination of hybrid and WeChat-only strategies. Significant heterogeneity was observed regarding the type of accounts and methods for delivering content and facilitating online conversations. A majority of studies found positive outcomes with WeChat education. CONCLUSIONS: This scoping review addressed a large gap in knowledge about the usage of WeChat in professional healthcare education. Of the existing studies identified, we observed considerable promise for future practice. We provide additional suggestions for conducting future research involving patients and other helping professionals in healthcare education to expand the usage of WeChat.

Developmental Differences in the Association of Peer Relationships with Traumatic Stress Symptoms.

Although childhood trauma exposure has a high incidence, traumatic stress often goes untreated in children and youth. We investigated peer relationship quality as a prevention strategy for reducing traumatic stress across different developmental periods. We analyzed longitudinal data from the National Survey of Child and Adolescent Wellbeing (NSCAW I) using a time-varying effect model (TVEM) to investigate the association between peer relationship quality and traumatic stress symptoms across ages 8-17 years. We controlled for a robust set of confounders identified through a Directed Acyclic Graph (DAG). The unique association between peer relationship quality and traumatic stress symptoms was negative and significant from ages 8 to 8.5 years, and again from ages 9.4 to 10.9 years and at age 16.4 to 16.8 years, with maximum associations of - 1.45 T score points at age 8.5 years (95% CI = [- 2.87, - 0.40]), - 1.57 at age 9.4 years (95% CI = [- 3.13,- 0.01]), and - 1.89 at 16.7 years (95% CI = [- 3.70, - 0.09]). Peer relationship quality protected against traumatic stress during specific times during adolescent development. Our results suggest that helping youth establish and maintain positive peer relationships may be a useful prevention approach for helping them cope with trauma experiences.

Detecting substance-related problems in narrative investigation summaries of child abuse and neglect using text mining and machine learning.

BACKGROUND: State child welfare agencies collect, store, and manage vast amounts of data. However, they often do not have the right data, or the data is problematic or difficult to inform strategies to improve services and system processes. Considerable resources are required to read and code these text data. Data science and text mining offer potentially efficient and cost-effective strategies for maximizing the value of these data. OBJECTIVE: The current study tests the feasibility of using text mining for extracting information from unstructured text to better understand substance-related problems among families investigated for abuse or neglect. METHOD: A state child welfare agency provided written summaries from investigations of child abuse and neglect. Expert human reviewers coded 2956 investigation summaries based on whether the caseworker observed a substance-related problem. These coded documents were used to develop, train, and validate computer models that could perform the coding on an automated basis. RESULTS: A set of computer models achieved greater than 90% accuracy when judged against expert human reviewers. Fleiss kappa estimates among computer models and expert human reviewers exceeded .80, indicating that expert human reviewer ratings are exchangeable with the computer models. CONCLUSION: These results provide compelling evidence that text mining procedures can be a cost-effective and efficient solution for extracting meaningful insights from unstructured text data. Additional research is necessary to understand how to extract the actionable insights from these under-utilized stores of data in child welfare.

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.

A randomized controlled trial for aggression and substance use involvement among Veterans: Impact of combining Motivational Interviewing, Cognitive Behavioral Treatment and telephone-based Continuing Care.

Physical aggression (towards partners or non-partners) is common among patients in treatment for substance use disorders (SUDs), including among Veteran samples; however, few treatment programs provide adjunct intervention approaches targeting reduction or prevention of aggression. The primary objectives of this comparative efficacy study were to examine the impact of adjunct aggression interventions delivered during treatment on aggression and substance use outcomes, including: a) an acute treatment phase 6-session integrated Motivational Interviewing-Cognitive Behavioral Treatment intervention (MI-CBT) for aggression and substance use prevention, b) MI-CBT plus a 12-week telephone-based Continuing Care (MI-CBT + CC) intervention, and c) an acute phase single session control condition [including some discussion of violence prevention and local violence prevention resources (Enhanced Treatment as Usual (E-TAU))]. Participants (N = 180; 165 males and 15 females) were Veterans with SUD problems and past-year severe aggression who were randomized to one of three conditions: MI-CBT, MI-CBT + CC, or E-TAU. Primary 12-month outcomes included physical aggression and injury to partners, non-partners, and total aggression (collapsing across partner and non-partner relationships). Substance use outcomes included heavy drinking, marijuana use, cocaine use, and overall illicit substance use. Due to low representation in the sample (n = 4 women in each group at follow-up), women were excluded from primary analyses. According to unadjusted analyses of male participants, all groups showed similar significant declines in aggression over time, with the MI-CBT and MI-CBT + CC groups showing significant reductions in more substance use outcomes (heavy drinking, cocaine use, overall illicit drug use) than the E-TAU group. The only significant group x time interaction was for partner physical aggression by men (those in the MI-CBT + CC group showed a significantly greater decrease from baseline to follow-up). Also, neither the MI-CBT nor MI-CBT + CC groups reported any injuring of partners during the follow-up. For heavy drinking, cocaine, marijuana and overall illicit drug use, there were significant reductions over time, but no group by time interaction effects. The findings illustrate significant reductions in aggression and substance use over time for those involved in VA SUD treatment, and a potential modest benefit of additional integrated treatment approaches (MI-CBT, MI-CBT + CC) on reducing aggression. Future studies should examine dissemination efforts in the VA, cost-effectiveness, and moderators of outcome.

Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain.

PURPOSE: To describe patterns of cannabis withdrawal among a large sample of those who use medical cannabis and test the association between withdrawal symptomology and functioning. PROCEDURES: Adults ages 21 and older (N = 801) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, withdrawal symptomology, functioning and other related constructs. Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). FINDINGS: Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables. CONCLUSIONS: Cannabis withdrawal symptomology is highly prevalent among patients who use medical cannabis at least three times a week. Helping patients recognize the association between poorer functioning and withdrawal may be an effective way to highlight potentially negative consequences of regular and moderate heavy use.

Early Exposure to Child Maltreatment and Academic Outcomes.

Early childhood trauma increases the risk of academic difficulties. The purpose of this study was to investigate the prevalence of early contact with child protection services (CPS) and to determine whether early exposure to maltreatment investigations was associated with important academic outcomes. The authors focused specifically on standardized test scores (math and reading), grade retention, and special education status in third grade. The sample was diverse and included all children born between 2000 and 2006 and enrolled in Michigan's public schools ( N = 732,838). By the time these students reached third grade, approximately 18% were associated with a formal CPS investigation. In some school districts, more than 50% of third graders were associated with an investigation. African American and poor students were more likely to be investigated for maltreatment. Children associated with maltreatment investigations scored significantly lower on standardized math and reading tests, were more likely to be identified as needing special education, and were more likely to be held back at least one grade. These findings indicate that involvement with CPS is not an infrequent event in the lives of young children and that within some school districts, maltreatment investigations are the norm. Child welfare and educational systems must collaborate so that the early academic struggles experienced by victims of maltreatment do not mature into more complicated difficulties later in life.

Domestic violence, parental substance misuse and the decision to substantiate child maltreatment.

Families that experience domestic violence and parental substance misuse are disproportionately involved with the child welfare system. Prior research suggests that child protective services (CPS) caseworkers are more likely to substantiate maltreatment allegations when domestic violence and parental substance misuse are identified during the investigation, pointing to one possible mechanism for this disproportionate involvement. While previous studies have relied on nationally representative data sets, the current study used administrative records from a large Midwestern child welfare agency that accounts for state-level variation in child welfare policy and practice. A total of 501,060 substantiation decisions made between 2009 and 2013 were examined to assess the influence of caseworker-perceived domestic violence and parental substance misuse on the decision to substantiate reported maltreatment. Results from multilevel modeling suggest that the identification of domestic violence and parental substance misuse during an investigation significantly increased the probability that an allegation would be substantiated. The implication of these findings for child welfare practice are considered in light of the fact that many child welfare agencies do not consider exposure to domestic violence and parental substance misuse in and of themselves to constitute child maltreatment.

In Utero Exposure to Opioids: An Observational Study of Mothers Involved in the Child Welfare System.

BACKGROUND: Women are underrepresented in the current substance abuse research; however, women are a particularly vulnerable population when it comes to opioid use and abuse. Pregnant women are even more so, because of the potential that exists for in utero exposure (IUE) to substances. OBJECTIVES: To identify trends in IUE to opioids in order to ensure that resources are allocated effectively to address the current opioid epidemic and to assist the populations most affected by it. METHODS: This study draws on 15 years' worth of clinical assessment data collected from 3598 child welfare-involved mothers to assess for trends in IUE to substances over time. Data from the last 5 year period (N = 852) are then analyzed to identify recent demographic correlates associated with IUE to opioid substances. RESULTS: A substantial increase in the rates of IUE to opioids over the past 15 years is observed among child welfare-involved mothers. Moreover, we find that race is a significant correlate of IUE to opioids. CONCLUSION: Study findings are consistent with other recent research that demonstrates racial differences in the populations that are most affected by the opioid epidemic; however, more research is needed to determine how these racial differences in rates of IUE to opioids affect child welfare outcomes.

Differences between African Americans and Non-Hispanic Whites Utilization of Clergy for Counseling with Serious Personal Problems.

There is a paradox in research on African Americans and non-Hispanic whites in the utilization of clergy. Research finds that African Americans have higher levels of religious service attendance and higher levels of contact with clergy. Research also finds that despite this, African Americans are less likely than non-Hispanic whites to seek out assistance from clergy for psychiatric disorders including depression and anxiety. The goal of this paper was to investigate race differences in the use of clergy for counseling for serious personal problems. It uses the National Survey of American Life. We find that non-Hispanic whites were more likely than African Americans to use clergy for a serious personal problem. The significant difference between African Americans and non-Hispanic whites appeared to be mediated by the fact that African Americans were more likely to have seen clergy in a religious setting and non-Hispanic whites were more likely to have seen clergy in other settings including hospitals.

Timing matters: A randomized control trial of recovery coaches in foster care.

Substance use disorders are a major problem for child welfare systems. The abuse of and dependence on alcohol and drugs by parents increases the risk of child maltreatment and interferes with efforts to locate a permanent home for children in foster care. The current study focuses on an intervention designed to increase the probability of reunification for foster children associated with substance using families. We focus specific attention on the timing of the intervention, in particular the timing of comprehensive screening and access to substance abuse services in relation to the temporary custody hearing. A diverse group of children (n=3440) that were placed in foster care and associated with a parent diagnosed with a substance use disorder were randomly assigned to either a control (services as usual) or experimental group (services as usual plus a recovery coach for parents). Binomial logistic regression models indicated that early access to substance use services matters (within two months of the temporary custody hearing) but only when parents were connected with a recovery coach. Additional findings indicated that the recovery coach model eliminated racial disparities in reunification. The implications of these findings are discussed.

Prevalence and correlates of "Vaping" as a route of cannabis administration in medical cannabis patients.

PURPOSE: To examine the prevalence and correlates of vaporization (i.e., "vaping") as a route of cannabis administration in a sample of medical cannabis patients. PROCEDURES: Adults ages 21 and older (N=1485M age=45.1) who were seeking medical cannabis certification (either for the first time or as a renewal) at medical cannabis clinics in southern Michigan completed a screening assessment. Participants completed measures of route of cannabis administration, cannabis use, alcohol and other substance use. FINDINGS: An estimated 39% (n=511) of the sample reported past-month cannabis vaping, but vaping as the sole route of cannabis administration was rare. Specifically, only 30 participants (2.3% of the full sample and 5.9% of those who reported any vaping) indicated vaping as the sole route of cannabis administration. The majority (87.3%) of those who reported vaping also reported smoking (combustion) as a route of cannabis administration. Being younger than age 44, having more than a high school education, engaging in nonmedical stimulant use, being a returning medical cannabis patient, and greater frequency of cannabis use were associated with higher odds of vaping at the bivariate level and with all variables considered simultaneously. CONCLUSIONS: Vaping appears to be relatively common among medical cannabis patients, but is seldom used as the sole route of cannabis administration. RESULTS: highlight the importance of monitoring trends in vaping and other substance use behaviors in this population and underscore the need for longitudinal research into the motives, correlates, and consequences of cannabis vaping in medical cannabis patients.

Changing perspectives on marijuana use during early adolescence and young adulthood: Evidence from a panel of cross-sectional surveys.

INTRODUCTION: Prior research has often overlooked potential cohort differences in marijuana views and use across adolescence and young adulthood. To begin to address this gap, we conduct an exploratory examination of marijuana views and use among American youth using a panel of cross-sectional surveys. METHOD: Findings are based on repeated, cross-sectional data collected annually from adolescents (ages 12-17; n=230,452) and young adults (ages 18-21; n=120,588) surveyed as part of the National Survey on Drug Use and Health between 2002 and 2014. For each of the birth years between 1986 and 1996, we combined a series of nationally representative cross-sections to provide multi-year data strings designed to approximate nationally representative cohorts. RESULTS: Compared to youth born in the mid-to-late 1980s, youth born in the mid-1990s reported significantly higher levels of marijuana disapproval during the early adolescent years (Age 14: 1988=64.7%, 1994=70.4%) but lower levels of disapproval during the young adult years (Age 19: 1988=32.0%, 1994=25.0%; Age 20: 1988=27.9%, 1994=19.7%). Moreover, the prevalence of marijuana use among youth born in 1994 was significantly lower-compared to youth born in 1988-at age 14 (1988: 11.39%, 1994: 8.19%) and significantly higher at age 18 (1988: 29.67%, 1994: 34.83%). This pattern held even when adjusting for potential confounding by demographic changes in the population across the study period. CONCLUSIONS: We see evidence of changes in the perceptions of marijuana use among youth born during the late twentieth century.

Foster home placements and the probability of family reunification: Does licensing matter?

The concept of foster care has been widely studied in child welfare. The literature is well developed with regard to the risk of initial placement, length of stay in care, placement stability, exits to permanency, and emancipation. Yet, the literature is woefully underdeveloped when it comes to understanding if variations in the types and characteristics of foster homes impact important child welfare outcomes. The current study utilizes entry cohorts pulled from statewide administrative data (N=17,960) to investigate the association between types of foster care and the probability of reunification. We focus specifically on the licensing status of foster homes. Reflecting federal benchmarks, we examined the odds of reunification at one- and two-year intervals. Propensity score analysis was used to reduce selection bias. Adjusted logistic regression models revealed that youth placed in licensed relative care (LRC) homes were the least likely to achieve reunification compared with youth placed in licensed non-relative care (LNC) homes and unlicensed relative care (URC) homes. Conversely, youth placed in URC homes were more likely to achieve reunification as compared with youth placed in LRC and LNC homes. These findings will help states to efficiently target scarce resources to specific types of foster homes that may be impacting federal reunification benchmarks.