Supporting Parents' Services Access During the COVID-19 Pandemic Through the Infant-Toddler Court Team Program.

INTRODUCTION: Infant-Toddler Court Teams (ITCTs) are a collaborative practice designed to improve timely identification and receipt of needed services for families of infants and toddlers involved in the child welfare system and their families. The goal of the study was to explore the impact of the first year of COVID compared to the previous year, in the context of ITCT support, on: (1) parents' access to services; (2) parents' services receipt and access within 30 days and within 14 days from referral; and (3) predictors of services access and receipt. METHODS: Overall, 897 instances of services needs were analyzed, 411 pre-COVID and 486 during COVID. Logistic regression models were used to test for differences pre- and during COVID, controlling for covariates. RESULTS: A reduction in service access was found across all services during COVID (OR = 0.2, CI: 0.1-0.3, p < .0001). Nevertheless, if a service was still available, parents were able to maintain similar levels of receipt within 30 days and within 14 days as before COVID. Moreover, a higher percentage of parents in need received mental health services in 30 or fewer days and substance use disorder services in both 14 and 30 or fewer days during COVID compared to pre-COVID. DISCUSSION: This success is notable given the significant disruption to the availability of services and barriers to accessing services caused by the pandemic. ITCTs provided a robust platform for supporting the health and well-being of families with very young children in the face of a severely reduced service landscape due to COVID-19.

Risk of early sexual initiation and pregnancy among youth reported to the child welfare system.

This study found that youth involved with the child welfare system have high rates of sexual risk behaviors and outcomes, including forced sex, early age at first sex, low contraceptive use, and pregnancy, which are more than double those of adolescents from the general population. Caseworkers may need training in how to address sexual risk factors and may need to support caregivers in addressing these issues with their children. Findings highlight the importance for case-workers, caregivers, and others to address the sexual and reproductive health needs of maltreated youth.

Evaluation of the Miami Child Well-Being Court model: safety, permanency, and well-being findings.

This study presents preliminary outcomes for a problem-solving court improvement model, the Miami Child Well-Being Court (Miami-CWBC), which makes evidence-based clinical intervention and integration of the treating clinician's ongoing assessment and perspective central in the dependency court process. Records were reviewed for children adjudicated for maltreatment that completed treatment. Several promising findings suggest that this approach can help jurisdictions improve the lives of young children and their families' capacity to care for them.

Caseworker judgments and substantiation.

Substantiation can have an important effect on what interventions are pursued for children investigated for maltreatment, but researchers lack knowledge about how the decision to substantiate is made. Using information from 4,515 children from a national probability study of children investigated for maltreatment, this study examined how caseworker judgments of harm, risk, and evidence predicted substantiation. The substantiation rate was 29.9%, but the majority of cases were substantiated when caseworkers reported at least moderate harm, at least moderate risk, and/or probably to clearly sufficient evidence. Each judgment variable significantly predicted substantiation in a multivariable model, with evidence the strongest predictor. Child gender and age were significant predictors beyond harm, risk, and evidence, suggesting that other judgments also influence substantiation. In 9 of 100 cases, reports were not substantiated despite moderate to severe harm. Thus, substantiation is generally based on judgments of harm, risk, and evidence but not exclusively. The findings underline previous researchers' conclusions that substantiation is a flawed measure of child maltreatment and suggest that policy and practice related to substantiation are due for a fresh appraisal by state child welfare service agencies.

Developmental needs and individualized family service plans among infants and toddlers in the child welfare system.

This study examines levels of developmental need in young children investigated by child protective services, estimates early intervention service use, and examines need and service use variations during the 5-6 years after investigation on the basis of maltreatment substantiation status. Data were from the National Survey of Child and Adolescent Well-Being, the first nationally representative study of children investigated for maltreatment. The sample comprised 1,845 children aged 0 to 36 months at baseline. Logistic regression with covariate adjustment was used to examine the relationship between having an Individualized Family Service Plan (IFSP; a proxy and marker of early intervention services through Part C of the Individuals With Disabilities Education Act) and substantiation status. A high prevalence of developmental problems was found among children with substantiated cases and children with unsubstantiated cases. Few children with developmental needs had an IFSP. Substantiation status and level of child welfare system involvement were significantly associated with having an IFSP.

Intimate partner violence during pregnancy and mothers' child abuse potential.

This research examines whether women who have experienced intimate partner violence (IPV) during pregnancy have a higher child abuse potential than women who have not experienced IPV. Data were analyzed from a longitudinal investigation of IPV during pregnancy. This study recruited 88 pregnant women during prenatal care and followed them for 1(1/2) years. IPV was assessed using the Conflict Tactics Scale 2 (CTS2). The woman's potential for child abuse was assessed using the Child Abuse Potential Inventory (CAPI). There was a significant positive association between IPV and child abuse potential scores (p = .003), even after controlling for sociodemographics. The odds of having a high level of child abuse potential were 3 times greater for women who were victims of IPV compared to nonvictims. Higher child abuse potential scores of the victimized women resulted mainly from the Distress and Problems with Others CAPI scales.

Intimate partner violence and women's depression before and during pregnancy.

Depressive symptoms of 95 prenatal care patients were examined relative to the women's experiences of intimate partner violence. Women who were victims of psychological aggression during the year before pregnancy were not at elevated risk for depression except when the psychological aggression was very frequent. However, during pregnancy, psychological aggression was more closely tied to women's depression levels, regardless of its frequency. In addition, women who experienced any level of physical assault or sexual coercion by their intimate partners (before or during pregnancy) had higher levels of depressive symptoms compared to nonvictims.

Depression among female family planning patients: prevalence, risk factors, and use of mental health services.

BACKGROUND: Depression is a common, yet underdiagnosed mental health problem among women of reproductive age. Whereas risk factors and treatment of depression have been well studied among women of all ages, little attention has been paid to the prevalence of depression and clinical outcomes of clinical depressive symptoms among women who visit public family planning clinics. METHODS: A total of 588 female patients of three North Carolina health department family planning clinics were screened for their depressive symptoms. Women who screened positive for depressive symptoms during the initial assessment were referred for further mental health evaluation and treatment. Multivariate logistic regression was performed to examine risk factors of depressive symptoms, and a flow chart was used to demonstrate referral process and outcomes. RESULTS: Approximately half of the women in the study evidenced high levels of depressive symptoms that were consistent with having a clinically relevant mental health problem. Results from multivariate analysis found that being classified as currently depressed was significantly associated with previous treatment for depression (OR = 5.43), no social support (OR = 3.57), and unemployment (OR = 3.21). Caucasians were significantly more likely than African Americans to be depressed (OR = 2.63), and teenagers and women with low levels of education were more likely to evidence depression (OR = 1.99 and OR = 1.78, respectively). Few of the patients who were classified as depressed and were referred for further mental health evaluation followed through with the referrals. CONCLUSIONS: These findings underscore the importance of providing routine screening of women for depression within the context of family planning services and providing referrals, follow-up, and mental health treatment to those women in need.

Families in need of domestic violence services reported to the child welfare system: Changes in the National Survey of Child and Adolescent Well-Being between 1999-2000 and 2008-2009.

This study aimed to determine if identification of intimate partner violence (IPV) has improved by caseworkers that investigate reports of child maltreatment and if mothers who are victims of IPV are more likely to report receipt of services. The study data were drawn from the two cohorts of the National Survey of Child and Adolescent Well-Being (NSCAW I and II), the first in 1999-2000 with a sample of 5,501 children reported for maltreatment and the second in 2008-2009 with a sample of 5,872 children reported for maltreatment. The analyses focused on IPV victimization of 3,625 mothers in NSCAW I and 3,351 mothers in NSCAW II whose children remained in home after the maltreatment investigation. Multiple group logistic regression was used to compare NSCAW I and II. A significant decrease in mother-reported IPV victimization (28.9-24.7%) was observed, representing a 15% decline. There were no significant changes in caseworker identification of history of domestic violence or active domestic violence. In both cohorts, substance abuse by the secondary caregiver was associated with a lower likelihood for the caseworker to miss a history of active domestic violence, while substantiation reduced the likelihood that the caseworker will miss active domestic violence. There were no changes in caseworkers' service referral, or service receipt among victims. The next decade of efforts to reduce IPV and child maltreatment should focus simultaneously on increasing caseworkers' ability to identify IPV and on funding needed services for families impacted by IPV and child maltreatment.

Caregiver instability and early life changes among infants reported to the child welfare system.

This study describes the extent of caregiver instability (defined as a new placement for 1 week or longer in a different household and/or with a new caregiver) in a nationally representative sample of infants, followed for 5-7 years. Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW), a longitudinal study of 5,501 children investigated for child maltreatment. The analysis sample was restricted to 1,196 infants. Overall, 85.6% of children who were infants at the time of the index maltreatment experienced at least one caregiver instability event during their first 2 years of life. Caregiver instability was associated with the child having a chronic health condition and the caregiver being older than 40 years of age at baseline. The levels of instability reported in this study from infancy to school entry are extremely high. Children with more risk factors were significantly more likely to experience caregiver instability than children with fewer risk factors. The repeated loss of a young child's primary caregiver or unavailable, neglectful care can be experienced as traumatic. Some evidence-based programs that are designed to work with young maltreated children can make a substantial positive difference in the lives of vulnerable infants.

Repeated reports for child maltreatment among intimate partner violence victims: findings from the National Survey of Child and Adolescent Well-Being.

OBJECTIVES: To determine the prevalence of intimate partner violence (defined as any physical violence during the last 12 months or previously) among mothers who maltreat their children, and to examine whether mothers' experiences of intimate partner violence (IPV) are associated with repeated reports (rereports) of children to Child Protective Services (CPS) during the following 18 months. METHODS: Data for the analyses were from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children investigated for child maltreatment. The sample of 5,501 children (ages 0-14) was randomly selected from the families who entered the US child welfare system between October 1999 and December 2000. The analysis sample was restricted to 1,236 families in which caregivers were: (1) the alleged perpetrators of the child maltreatment at baseline (independently of substantiation status) and (2) the biological mothers (n=1,212 or 98.6%), adoptive mothers (n=17 or 1%), or stepmothers (n=7 or 0.3%) of children not placed in out-of-home care. RESULTS: Children of mothers physically abused by an intimate partner during the last 12 months or previously at the intake interview (44%) were twice as likely as children of mothers who had not experienced such violence to be rereported to CPS (29% vs. 14%, Odds Ratio=2.0, 95% Confidence Interval=1.1-3.4). Rereports occurred almost twice as quickly for children of mothers who experienced IPV compared to children of mothers who had not experienced IPV (Hazard Ratio=1.9, 95% Confidence Interval=1.1-3.0). CONCLUSIONS: The higher risk and speedier rereports of child maltreatment associated with intimate partner violence highlights the need for universal assessment and provision of services for IPV among families that are investigated by CPS.

Mental health service use during the transition to adulthood for adolescents reported to the child welfare system.

OBJECTIVE: This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence. METHODS: Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood. RESULTS: Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood. CONCLUSIONS: Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.

Special health care needs among children in the child welfare system.

OBJECTIVE: The aim of this study was to determine levels of special health care need among children in the child welfare system and how these needs may affect children's functioning. METHODS: Data were from the National Survey of Child and Adolescent Well-being, a national probability study of children investigated for child maltreatment. The sample consisted of 5496 children aged 0 to 15 years at baseline. For analysis, we used descriptive statistics to determine special health care needs and children's functioning from baseline to 3-year follow-up. Logistic regression was used to examine correlates of special health care needs. RESULTS: At any point in the study period, approximately one third of the children were identified as having special health care needs. Overall, across 3 years of follow-up data, 50.3% of the children were identified as having special health care needs. Boys were significantly more likely than girls to have had special health care needs, and children aged 0 to 2 years at baseline were significantly less likely to have had special health care needs than older children. Adopted and foster children were significantly more likely to have had special health care needs than children never placed out of the home. The most commonly reported type of chronic health condition was asthma. The most commonly reported type of special need was a learning disability. CONCLUSIONS: Special health care needs are prevalent among children in the child welfare system. Many children with special health care needs have cognitive, language, adaptive, social, or behavioral functional impairments. Mechanisms are needed to ensure that this vulnerable population has access to and receives coordinated health and related social services.