Re-Imagining Child Welfare to Support Children and Families.

Children and adolescents in foster care include many of the most severely traumatized victims of child abuse and neglect. They deserve the best possible care and treatment, yet their outcomes remain poor. The persistence of poor outcomes for youth in foster care reflects challenges of psychiatric diagnostic formulation and of service system design/access, both areas in which child and adolescent psychiatrists have a key role to improve care and outcomes.

State Implementation of Congregate Care Reforms for Children in Foster Care.

OBJECTIVES: The Family First Prevention Services Act (FFPSA) allows states to use federal Title IV-E funds to provide time-limited, clinically appropriate use of congregate care, including Qualified Residential Treatment Programs (QRTPs), for youth in foster care. October 1, 2021 marked the deadline for states to begin implementing these FFPSA congregate care reforms. From June to September 2022, we conducted a mixed-methods study to obtain a baseline understanding of implementation barriers, successes, and recommendations to inform congregate care policy and practice. METHODS: We fielded a national survey with state child welfare agency directors and conducted focus groups with youth with QRTP experiences, child welfare agency administrators, and QRTP executive leaders. We integrated a descriptive analysis of survey data with focus group themes to summarize state implementation progress. RESULTS: A total of 47 states (90%) responded to the survey. Most states reported ongoing congregate care reforms aligned with FFPSA, reducing the use of congregate care and increasing kinship foster care. QRTPs have become the primary congregate care setting. Top implementation barriers concerned workforce resource and capacity constraints, funding, and access to therapeutic foster care models and foster families. Focus group themes converged on the lack of tailored treatment, quality staff, coordinated aftercare, and a need for QRTP outcome evidence. CONCLUSIONS: Early implementation lessons of FFPSA congregate care reforms call for additional funding and technical assistance, oversight of congregate care, professionalization and investment in QRTP staff, youth advisory boards to promote youth-driven treatment, and performance- and outcome-based monitoring of QRTPs.

The role of primary care in improving health outcomes in young foster children.

ABSTRACT: Children removed from their biological families because of abuse, neglect, and/or violence have increased healthcare needs and are susceptible to poor health outcomes compared with children who are not in the child welfare system. Developmental delays occur in about 75% of children in foster care. Up to 80% of children entering out-of-home care have at least one physical health problem and more than 40% experience educational challenges. In most US states, newly removed children are required to have a medical evaluation shortly after placement in a foster or kinship family. The initial evaluation is important for identifying urgent concerns and developing a rapport with children who may not have had regular medical care. In addition, the child's complete social, trauma, and medical history may be unknown because of system barriers such as inconsistent medical care by biological parents, privacy laws protecting records, and unavailability of birth histories and biological parents' medical and psychosocial histories. As a result, a series of visits is required to fully evaluate the child's development and healthcare needs. This article provides guidance for physician associates/assistants who provide care to children in foster care.

Videoconferencing in mental health services for children and adolescents receiving child welfare services: a scoping review.

BACKGROUND: Videoconferencing is considered an alternative to face-to-face consultations and a possibility to help overcome access-to-care barriers in mental health care services. Barriers to child and adolescent mental health services are particularly apparent in the case of children and adolescents receiving child welfare services. This scoping review aims to provide an overview of research on videoconferencing in the mental health treatment of children and adolescents receiving support from child welfare services. METHODS: This scoping review follows the review framework outlined by the Joanna Briggs Institute. The following databases were searched from January 2012 to April 2024: Scopus, Web of Science, PubMed, PsycINFO (Ovid), CINAHL Plus, Social Services Abstracts (ProQuest), Sociological Abstracts (ProQuest), and Google Scholar. RESULTS: The search yielded 4322 unique records and resulted in the inclusion of 22 articles that met the inclusion criteria. The studies originated from Denmark, England, Australia, Norway, Canada, Chile, and the USA, and were grouped into four areas: (1) videoconferencing to increase access to mental health treatment for vulnerable groups (2) young people's perspectives (3) videoconferencing in interdisciplinary collaborative meetings, and (4) use, awareness, and acceptance of videoconferencing among health and social care providers. CONCLUSIONS: This scoping review shows that if videoconferencing in mental health care is to become an established and trusted method aimed at children and adolescents receiving child welfare services, several unresolved and potentially negative issues need attention and more research. This particularly applies to whether videoconferencing decreases or exacerbates inequalities in access to mental health services. A further question is whether new barriers are raised by screen-based treatment to threaten good therapeutic relationships, and by extension treatment quality and clinical outcomes.

Childhood Interests: what they are and why it matters.

This paper examines the concept and moral significance of "childhood interests." This concept is important in medical decision-making for children and more broadly in the field of pediatric ethics. The authors argue that childhood interests are identifiable components of childhood well-being that carry moral weight. Parents have a special role in protecting and promoting these interests and special obligations to do so. These parental obligations are grounded by the independent interests of the child, as well as the good of society more generally. Because parents have these child-rearing obligations, they must also have the authority and wide discretion necessary to fulfill them. However, while parental discretion is wide, it is not unlimited, for it must be used to safeguard and advance childhood interests.

Evaluation of "Cognitive Behavioral Intervention for Trauma in Schools" (CBITS) in child welfare programs in Germany: study protocol of a randomized controlled trial.

BACKGROUND: Children and adolescents growing up in child welfare institutions have been frequently exposed to traumatic events and psychosocial stress and show elevated rates of mental disorders. Yet, there is a lack of empirically supported treatments to provide adequate mental health care for children in care suffering from trauma-related mental disorders such as posttraumatic stress disorder (PTSD), depression, and anxiety. The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evaluated trauma-focused cognitive-behavioral group intervention, which has proven to be effective in reducing symptoms of PTSD, depression, and anxiety for traumatized children in group settings. The trial will evaluate the effectiveness of the CBITS intervention as an outreach treatment compared with an enhanced treatment-as-usual condition (TAU +) within the German mental health and child welfare system. METHODS: In a randomized controlled trial (RCT) involving N = 90 children and adolescents, we will compare CBITS with TAU + . Participants between 8 and 16 years, reporting at least one traumatic event and moderate posttraumatic stress symptoms (PTSS), will be randomized within their child welfare institution to either one of the conditions using a CATS-2 severity-stratified block randomization. Assessments will take place at baseline, as well as 4 months and 10 months after baseline. The primary outcome is the severity of PTSS after 4 months. Secondary outcomes are depression, anxiety, irritability/anger, quality of life, and global functioning level. DISCUSSION: The results of our trial will provide evidence regarding effective treatment options for traumatized children in care, which represent an understudied population with limited access to mental health care. Additionally, it could serve as a blueprint for implementing trauma-focused outreach group treatments for children in care and increase the accessibility to appropriate treatment. TRIAL REGISTRATION: Clinical Trials.gov NCT06038357 D. September 13, 2023.

Family group conferencing for children and families: Evaluation of implementation, context and effectiveness (Family VOICE). Study protocol.

BACKGROUND: Family group conferences (FGCs) in child welfare bring immediate and wider family members together to decide on the best way to meet a child's needs. Unlike professionally led meetings, the aim is for decisions to be made by or with family members. Qualitative and mixed-method research with FGC participants tends to show positive experiences: most participants feel their voices are heard; FGCs facilitate family-driven solutions and closer relationships-within families and with social workers. Although there is existing literature on FGCs, there is a paucity of robust comparative UK evaluations, i.e., randomised controlled trials or quasi-experimental studies. Comparative studies internationally have focused on a narrow range of outcomes, not recognised the importance of context, and paid little attention to the quality of delivery. Some qualitative studies have considered process and context but there is scant measurement of these. The aims of this study are, firstly, to establish how FGCs improve outcomes for families and what factors vary their quality, and, secondly, to assess longer-term outcomes in terms of service use and associated costs. METHODS: Given the importance of process and context, evaluation informed by realist and complex systems approaches is needed. This multi-method evaluation includes a survey of FGC services in all UK local authorities (n = 212) to map service provision; co-design of programme theory and evaluation measures with family members who have experienced an FGC (n = 16-24) and practitioners (n = 16-24) in two sites; a prospective single-arm study of FGC variability and outcomes after six months; and comparison of service use and costs in FGC participants (n≥300 families) and a control group (n≥1000) after two years using a quasi-experiment. DISCUSSION: This is a pragmatic evaluation of an existing intervention, to identify what mechanisms and contexts influence effective process and longer-term outcomes. The study is registered with Research Registry (ref. 7432).

The impact of the COVID-19 pandemic for children in custody: An analysis of inspection reports.

BACKGROUND: Children in custodial settings are a vulnerable group. Prior to the COVID-19 pandemic there were concerns about the safety of children in these settings. COVID-19 has had an impact on everyone but given the vulnerability of children in custody, there were concerns about the impact of COVID-19 restrictions. All custody settings for children are independently inspected and this research aimed to analyse data from inspection reports. Twenty-six inspection reports undertaken between March 2020 and October 2021 were analysed to understand the impact of COVID-19 on delivery of usual care/regime. RESULTS: Data showed that across all site's children spent considerable amounts of time isolated and in some cases, this was deemed to amount to solitary confinement. There was evidence of some positive experiences, in the smaller sites, around COVID-19 slowing the pace of life allowing staff and children could foster relationships. However, in the larger sites, isolation was extreme and COVID-19 policies such as 'bubbles' appear to have created unintended consequences as sites have moved into recovery, leading to increased violence and stress. COVID-19 directly impacted staffing levels. This and the COVID-19 policies to reduce mixing also had an impact on how children's behaviour, welfare and safeguarding was managed. In some larger sites, being COVID-19 secure was prioritised over the needs of the children. CONCLUSIONS: This research highlights the importance of multi-site longitudinal research to understand how children, staff and institution's function. The experiences of children in custody during COVID-19 differed by site type. The research suggests that the larger sites are struggling to keep children safe and there should be a shift towards smaller, more therapeutic environments. More research is needed to understand the longer-term unintended consequences of COVID-19 policy in custody, for these vulnerable children.

Children on the Streets of Ibadan Nigeria: Neglect of Children's Rights.

BACKGROUND: The Nigerian Convention on the Rights of the Child (CRC) 2008 enacted prohibitive laws against child streetism. However, in metropolises like Ibadan, there is a growing epidemic of street children, particularly the category with existing family ties known as "children on the streets". Children on the street come from home daily to engage in economic-oriented activities on the streets and return home to their families at night time. OBJECTIVE: We focused on perceptions of formal responses to the problem of child streetism in Ibadan. METHODS: This was qualitative research. Participants were selected from each of the five urban LGA of Ibadan, purposively and by snowball technique. In-depth Interviews (IDI) were conducted, audio-recorded and transcribed. Framework analysis of data was supported by ATLASTi version 22. RESULTS: Fifty-three (53) interviews were conducted including IDI with ten (10) child-welfare officers, ten (10) street shop owners, eleven (11) children on the street, and ten (10) pairs of parent-child dyads. Two themes emerged including governmental shortcomings with six subthemes and suboptimal governmental interventions with four subthemes. Child streetism in Ibadan is a consequence of the State's failed education systems, inadequate children's vocational and rehabilitation programs, lax child welfare laws, lack of empowerment of skilled children, and poor implementation of the policy on ideal family size. Interventions that were existing but sub-optimal included communitybased child welfare programs, parental poverty alleviation, public sensitisation and child welfare monitoring programmes. CONCLUSION: There is an urgent need to update, enforce laws, and amalgamate efforts against child streetism in Ibadan.

CONTEXTE: La Convention nigériane relative aux droits de l'enfant (CRC) de 2008 a promulgué des lois interdisant le travail des enfants dans la rue. Cependant, dans des métropoles comme Ibadan, il existe une épidémie croissante d'enfants des rues, en particulier la catégorie ayant des liens familiaux existants connue sous le nom d'"enfants des rues". Les enfants des rues viennent de chez eux tous les jours pour participer à des activités orientées vers l'économie dans les rues et rentrent chez eux auprès de leurs familles le soir. OBJECTIF: Nous nous sommes concentrés sur les perceptions des réponses formelles au problème du travail des enfants dans la rue à Ibadan. MÉTHODES: Il s'agissait d'une recherche qualitative. Les participants ont été sélectionnés dans chacun des cinq LGA urbains d'Ibadan, de manière délibérée et par la technique de la boule de neige. Des entretiens approfondis (IDI) ont été réalisés, enregistrés et retranscrits. L'analyse thématique des données a été soutenue par ATLAS-Ti version 22. RÉSULTATS: Cinquante-trois (53) entretiens ont été menés, comprenant des IDI avec dix (10) agents de protection de l'enfance, dix (10) propriétaires de magasins de rue, onze (11) enfants des rues et dix (10) paires de dyades parent-enfant. Deux thèmes ont émergé, comprenant des lacunes gouvernementales avec six sous-thèmes et des interventions gouvernementales suboptimales avec quatre sous-thèmes. Le travail des enfants dans la rue à Ibadan est une conséquence des systèmes éducatifs défaillants de l'État, des programmes de formation et de réadaptation insuffisants pour les enfants, des lois laxistes sur la protection de l'enfance, du manque d'autonomisation des enfants qualifiés et de la mauvaise mise en œuvre de la politique sur la taille idéale de la famille. Les interventions existantes mais suboptimales comprenaient des programmes communautaires de protection de l'enfance, l'alleviation de la pauvreté des parents, la sensibilisation du public et les programmes de suivi de la protection de l'enfance. CONCLUSION: Il est urgent de mettre à jour, d'appliquer les lois et de regrouper les efforts contre le travail des enfants dans la rue à Ibadan. MOTS-CLÉS: Travail des enfants dans la rue, Protection sociale, Droits de l'enfant, Lois, Famille.

Life-course trajectories of children through the U. S foster care system.

OBJECTIVE: Foster care is surprisingly commonplace in the United States, with more than one in twenty children experiencing placement in their lifetimes. Due to the complexity of foster care (e.g. age at contact, length of stay), we still lack a clear idea of how children move through the child welfare system. We pose the question, "do distinct typologies of system trajectories exist that may be used to inform policy analyses?" METHODS: We used child maltreatment reports and foster care case records for all U.S. children born in FY2006 and placed in care between birth and age 15. Using sequence analysis, we classified child-level system trajectories into distinct clusters. Then, we employed multilevel multinomial regression to explore child and system characteristics associated with each. RESULTS: Three typologies were identified: 1) early-entry-exit, 2) school-age-entry, and 3) late-entry. Early-entry-exit cases typically entered and left foster care before turning three, were frequently adopted, and had little ongoing system contact. School-age-entry children typically entered between ages 5-10, were in care for the shortest amount of time, and mostly exited to reunification. Late-entry children typically entered between ages 9-11, entered with substantial CPS history and remained in care into mid-adolescence. CONCLUSIONS: Our findings provide the first description of foster care trajectories in the US. Both practice and policy formulation can benefit from these empirically supported descriptions. Using such trajectory typologies, researchers can now explore how trajectories may predict wellbeing outcomes. We discuss how the differences among the typologies may inform identification of service needs and outcomes.

Authentic Behavior and Job Satisfaction among Child Welfare Caseworkers.

This study was designed to investigate the relationship between authentic behavior and job satisfaction among child welfare caseworkers in Pennsylvania. Confirmatory factor analysis was conducted to validate the domains of the Authentic Behavior Scale (balanced processing, relational transparency, and internalized morality) and Job Satisfaction Scale, and the results provided consistent support for the factorial structure of the scales across child welfare caseworkers. The findings of this study revealed a positive correlation between authentic behavior and job satisfaction. To further explore this relationship, a path model was developed that included the elements of authentic behavior, job satisfaction, and demographic variables. The results indicated an association between the type of agency and internalized morality, impacting job satisfaction. Private workers showed a higher level of authentic behavior compared with public workers, with authentic behavior associated with greater job satisfaction. The findings suggest that authentic behavior can play a crucial role in social work practice and warrants considerable attention.

Transformational Leadership, Secondary Traumatic Stress, and Burnout of Child Welfare Workers: Multilevel Moderation Effects.

This study examines the moderating effects of distant leader's practice of transformational leadership on the relationship between secondary traumatic stress (STS) and burnout among child welfare workers. Caseworkers and supervisors in a Midwest U.S. state (N = 210) rated their regional director's use of transformational leadership skills using a survey. Given the nature of the clustered data, multilevel modeling was employed to examine the main effects of transformational leadership on worker burnout and its cross-level interaction effect on the association between worker STS and burnout. Multilevel modeling demonstrated that worker burnout was positively associated with STS and negatively associated with organizational-level transformational leadership. The cross-level interaction between transformational leadership and STS was significant. Specifically, the positive association between workers' STS and burnout decreased as transformational leadership increased. These findings suggest that organizational approaches such as transformational leadership can influence workforce results. Further research will guide child welfare policymakers to develop more sophisticated training programs in leadership skills and strategies.

Mandated Parent Education: Applications, Impacts, and Future Directions.

Mandated participation in parent education programs is a common practice across the United States for families who are undergoing divorce or who are involved in the child welfare or juvenile justice systems. Mandates to participate in parenting programs create substantial challenges for families, service providers, and service systems. Furthermore, the type and quality of the parenting services accessed vary widely, and their impacts need to be better understood. To address this need, an overview of the current state of the empirical literature on the impacts and outcomes of mandated parenting interventions for divorce and in child welfare and juvenile justice settings is provided, and suggestions to the field are offered to refine research related to mandated parenting programs. Given the challenges that mandated parenting programs pose, an alternative approach that views parenting through a public health lens is highlighted to build on the growing body of research on the impacts of population-wide applications of parenting support programs, and as a possible way to decrease the number of parents who are required to attend parenting programs. Opportunities to advance universal parenting support within a range of community settings, including primary care, early childhood education, and community mental health systems are offered. Gaps in knowledge regarding mechanisms of action of universal supports and impacts on the number of parents mandated to treatment are highlighted, and future directions for research in this area are suggested.

Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts.

BACKGROUND: Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed. OBJECTIVE: To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts. PARTICIPANTS AND SETTING: Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America. METHOD: Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison. RESULTS: Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones. CONCLUSIONS: Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Evidence-based practice criteria's effect on the implementation of the Family First Prevention Services Act in Nebraska and Colorado.

Child abuse, particularly neglect, is often preventable because many causes of harm stem from poverty, lack of social connections, substance use disorders, mental illness, lack of childcare, and other family support shortages. Prevention of child abuse and neglect starts with family support in these areas. The federal government recognized this need for prevention, and through considerable bipartisan support, passed the Family First Prevention Services Act on February 9, 2018. The Family First Prevention Services Act was designed to divert investment away from long-term foster care and toward programs that prevent unnecessary placement and child protective services interventions. The Family First Prevention Services Act restricts the state's use of federal funds for institutional foster care placements and uses those savings to fund reimbursements for evidence-based family preservation. The requirement for evidence-based prevention is a first in child-welfare federal law, and compliance with this requirement requires public-private partnership with agencies implementing the models, infrastructure, and evaluation standards that most states must build to be eligible for the new funding. This evaluation research analyzed how the stringent guidelines for prevention funding and the requirement of federally approved evidence-based practice programming affect the implementation of the Family First Prevention Services Act in Nebraska and Colorado.

Training health professionals to reduce overreporting of birthing people who use drugs to child welfare.

BACKGROUND: Health care providers are a key source of reports of infants to child welfare related to birthing people's substance use. Many of these reports are overreports, or reports that exceed what is legally mandated, and reflect racial bias. We developed and evaluated a webinar for health professionals to address overreporting related to birthing people's substance use. METHODS: This evaluation study collected data from health professionals registering to participate in a professional education webinar about pregnancy, substance use, and child welfare reporting. It collected baseline data upon webinar registration, immediate post-webinar data, and 6 month follow-up data. Differences in both pre-post-and 6 month follow-up data were used to examine changes from before to after the webinars in beliefs, attitudes, and practices related to pregnant and birthing people who use drugs and child welfare reporting. RESULTS: 592 nurses, social workers, physicians, public health professionals, and other health professionals completed the baseline survey. More than half of those completing the baseline survey (n = 307, 52%) completed one or both follow-up surveys. We observed statistically significant changes in five of the eleven opioid attitudes/beliefs and in four of the nine child welfare attitudes/beliefs from baseline to follow-ups, and few changes in "control statements," i.e. beliefs we did not expect to change based on webinar participation. All of the changes were in the direction of less support for child welfare reporting. In particular, the proportion agreeing with the main evaluation outcome of "I would rather err on the side of overreporting to child welfare than underreporting to child welfare" decreased from 41% at baseline to 28% and 31% post-webinar and at 6-month follow up (p = 0.001). In addition, fewer participants endorsed reporting everyone at the 6 month follow-up than at baseline (12% to 22%) and more participants endorsed reporting no one at the 6-month follow-up than at baseline (28% to 18%), p = 0.013. CONCLUSIONS: Webinars on the legal, scientific, and ethical aspects of reporting that are co-developed with people with lived experience may be a path to reducing health professional overreporting to child welfare related to birthing people's substance use.