Psychopharmaceutical Prescription Monitoring for Children in the Child Welfare System.

OBJECTIVE: Children in the child welfare system are more likely to receive psychotropic medication prescriptions than children in the general population. The authors used prescription- and administrative-level data to quantify variability in prescribing practices among prescribers for the child welfare population in a southern U.S. state. METHODS: Using administrative- and prescription-level child data and Administration on Children, Youth and Families guidelines, the authors defined the primary outcome, potentially inappropriate psychotropic prescriptions (i.e., red-flagged prescriptions). A hierarchical-logistic regression model was fit to account for case complexity and estimate the adjusted probability of a prescription being red-flagged. A funnel plot was used to visualize standardized prescribing rates for every prescriber and identify outlying prescribers. RESULTS: From May 2016 to September 2017, 506 prescribers issued 64,923 prescriptions for 4,093 children with a median (interquartile range) age of 14 (10-16) years. Most prescribers (76.9%) issued at least one red-flagged prescription, 1,263 (30.9%) children received at least one red-flagged prescription, and 14,806 (22.8%) prescriptions were red-flagged. The standardized prescribing rate for each prescriber was compared with a benchmark of 22.8%, defined a priori as the proportion of red-flagged prescriptions in the overall sample. Forty-seven prescribers (9%) prescribed red-flagged prescriptions between two and three standard deviations above the benchmark, and 72 prescribers (14%) more than three standard deviations above the benchmark. CONCLUSIONS: It is vital to monitor psychotropic prescriptions for children in the child welfare system. Quantifying variability in prescribing practices among prescribers for these children might be used to guide oversight.

Incidence and neighborhood-level determinants of child welfare involvement.

BACKGROUND: Child maltreatment is a global public health issue that has been linked with multiple negative health and life outcomes. OBJECTIVE: This study evaluates the association between children placed in out-of-home care and neighborhood-level factors using eight years of administrative data. PARTICIPANTS AND SETTING: Between 2011-2018, 33,890 unique instances of child welfare involvement were captured in a department of child and family services database in a southern state in the United States. METHODS: Removal addresses were geocoded and linked to the U.S. Census Bureau's American Community Survey to obtain census tract socioeconomic factors. Incidence overall and stratified by individual and neighborhood-level factors was computed. Rate ratios, relative indexes of inequality, and concentration curves quantified disparities in incidence of child welfare involvement by neighborhood-level factors. RESULTS: Incidence of children less than 19 years old placed into out-of-home care was 255 per 100,000 person-years (95 % CI: 252, 258). At the individual level, incidence was highest among children <5 and 15-17 years old, comparable between male and female children, and higher among Black children. At the neighborhood level, incidence was highest in census tracts with lower median household incomes, higher percentages of households below poverty or of female-headed or single-parent households, higher unemployment rates, and fewer residents with some college education or health insurance. CONCLUSIONS: Incidence of children placed into out-of-home care is disproportionally higher for those who live in disadvantaged communities. Understanding neighborhood-level risk factors that may be linked to child welfare involvement can help inform policy and target prevention efforts.

Predictors of placement disruptions in foster care.

BACKGROUND: Many children who are removed from a dangerous or neglectful home and placed in state custody subsequently experience additional disruptions while in custody, which can compound the effects of ongoing stress and instability. As such, placement stability has been identified as a critical objective and a key indicator of success for children residing in substitutive care. OBJECTIVE: To examine the utility of child protective services data in identifying predictors of placement disruption. PARTICIPANTS AND SETTING: The current study examined data from youth in Tennessee state custody who had been assessed using the Child and Adolescent Needs and Strengths (CANS) assessment within 30-days of their first, out-of-home placement. The sample included 8,853 youth ages 5-19 years old (M = 13.1; SD = 4.0; 44.8 % female). METHODS: Demographics, placement information, and the CANS assessment were collected by the Tennessee Department of Children's Services for all child welfare episodes for children as part of the system's usual standard of care. Bivariate correlation and linear regression models were conducted. RESULTS: Multiple risk indices from the CANS appeared to significantly increase risk of placement disruption, including child internalizing and externalizing symptoms, school difficulties, youth affect dysregulation, and child age. CONCLUSIONS: The current findings suggest that data collected as part of standard practice by child welfare workers such as the CANS is both feasible and has utility for identifying sources of risk for placement disruptions and to inform possible targets of intervention to enhance placement stability.

Installing trauma-informed care through the Tennessee Child Protective Services Academy.

The Child Protective Services (CPS) Academy was designed to equip members of the child-welfare workforce with knowledge that would assist them with addressing trauma in the lives of children and families. In its design, the CPS Academy applied principles of trauma-informed care, integrating evidence-based research, and a variety of clinical strategies into a comprehensive training program. Over a 2-year period, 277 frontline workers completed training through the CPS Academy. Data were collected as part of a quality-improvement effort to gauge participant satisfaction with the training platform. Participants reported that all components of the training were beneficial and relevant to their work in child welfare. Participants also demonstrated statistically significant improvement in trauma knowledge after participation in the CPS Academy (z = -4.73, p < .001), regardless of their level of education or years of experience in child welfare, F(3, 196) = 1.85, p = .14, ηp² = .03, 95% CI [0.00, 0.07]. Therefore, the content and structure of the CPS Academy can be implemented within large organizational systems to train child-welfare and CPS workforces efficiently and effectively. (PsycINFO Database Record (c) 2019 APA, all rights reserved).