Trajectories of mental health services for youth in foster care with attention deficit hyperactivity disorder.

Youth in foster care with Attention Deficit Hyperactivity Disorder (ADHD) often have significant needs for mental health services. The degree to which youth taking medication for ADHD use mental health services in relation to sibling co-placement and their level of need over time is unclear. To examine these issues, caregivers (N = 54) provided information on youth mental health service use across an 18-month study period. Results show that siblings living apart had a higher probability of mental health service use. For youth with higher CBCL scores, probability of mental health service use was both high and stable over time. However, youth with lower CBCL scores showed a decrease in probability of mental health service use over time. The sustained commitment to receipt of mental health services among youth with ADHD is something all behavioral health providers who work with foster care involved youth can benefit from, as well as the youth themselves.

Exploring mechanisms of change in a dyadic relationship intervention for siblings in foster care.

There is increasing recognition of the potential for sibling relationships to promote the well-being of youth in out-of-home care. Efficacious interventions now exist to strengthen the sibling relationships for youth in out-of-home care, yet the processes through which these interventions work to enhance sibling relationships remains largely speculative. The current study therefore aimed to identify the critical components of an efficacious dyadic relationship enhancement intervention for siblings in foster care through a secondary analysis of fidelity of implementation and trial outcome data. Data for 168 youth from the treatment condition of the Supporting Siblings in Foster Care study were analysed. Fidelity of implementation was assessed across seven intervention domains: Sibs 4 Life, Positive/Sib Thinking, Activity Planning, Problem Solving, Cooperation, Managing Feelings and Adult Allies. Trial outcome data were drawn from efficacy test results and included a multi-agent construct of sibling relationship quality. Descriptive statistics detailed intervention implementation, and hierarchical linear models examined associations between intervention coverage, comprehension, and engagement, and 18-month improvements to the sibling relationship. Results indicate high fidelity to implementation, and Positive/Sib Thinking was the primary intervention domain associated with sibling relationship improvements. Considerations for future mechanisms-based intervention research with siblings in out-of-home care are provided.

Service Coordination by Public Sector Managers in a Human Service Contracting Environment.

Despite emerging evidence of contracting for evidence-based practices (EBP), little research has studied how managers lead contract-based human service delivery. A 2015 survey of 193 managers from five San Francisco Bay Area county human service departments examined the relationship between contract-based service coordination (i.e., structuring cross-sector services, coordinating client referrals and eligibility, overseeing EBP implementation) and the predictors of managerial role, involvement, and boundary spanning. Multivariate regression results suggested that county managers identified fewer service coordination challenges if they were at the executive and program levels, had greater contract involvement, and engaged in contract-focused boundary spanning. In conclusion, we underscore the organizational and managerial dimensions of contract-based service delivery.

Validation of a Measure of Foster Home Integration for Foster Youth.

OBJECTIVES: This article introduces a youth-reported measure (Essential Youth Experiences [EYE]) developed to assess the experiences of foster youth in their home environment and their critical relationships across a number of service systems. Empirically, the article reports on the psychometric properties of a 9-item scale within the EYE that measures the construct of positive home integration (PHI). METHODS: The EYE was administered to 328 preadolescent and adolescent youth (164 sibling dyads) enrolled in a larger randomized clinical trial. RESULTS: Correlational analysis suggests that the PHI Scale shows good psychometric properties and strong current and predictive validity. CONCLUSION: The PHI is a reliable and valid scale that measures youth perspectives of inclusion in the foster home and relationships with their foster care provider. This scale quickly gathers youth perspectives and differentiates between youth who have more versus less significant needs. Implications for research and social work practice are discussed.

A longitudinal analysis of school discipline events among youth in foster care.

Youth in foster care experience major deficits on standardized measures of academic functioning, are at high risk of academic failure, and are more likely than their non-foster peers to be disciplined at school. School discipline-related problems increase risk of problematic educational and behavioral outcomes including dropping out of school, repeating a grade, and engagement in delinquent and criminal behavior. Identifying which youth are at greatest risk for experiencing school discipline is needed in order to improve the educational experiences of youth in foster care. The current investigation examined the effects of youth and contextual characteristics on school discipline events among 315 youth in foster care. Results revealed that being male, in a higher-grade, and a student of color, living apart from one's sibling, and school mobility significantly predicted discipline events. An additional statistical model divided youth into groups based on race, sex, and disability status taking into account the multiple identities youth have. These results suggest that gender, race, and disability status cumulatively inform school discipline experienced among youth in foster care.

Foster home integration as a temporal indicator of relational well-being.

This study sought to identify factors that contribute to the relational well-being of youth in substitute care. Using data from the [BLIND] study, youth responded to a 9-item measure of positive home integration, a scale designed to assess the relational experiences of youth to their caregivers and their integration into the foster home. Data were collected from youth in six month intervals, for an 18-month period of time. Latent growth curve modeling procedures were employed to determine if child, family, and case characteristics influenced youth's home integration trajectories. Results suggest stability in youth reports of home integration over time; however, children who were older at the time of study enrollment and youth who experienced placement changes during the period of observation experienced decreased home integration during the 18-month period. Results suggest youth's perspectives of home integration may in part be a function of the child's developmental stage and their experiences with foster care placement instability. Implications for practice and future research are discussed.

Network Indicators of the Social Ecology of Adolescents in Relative and Non-Relative Foster Households.

Though the presence, composition, and quality of social relationships-particularly as found in family networks-has an important influence on adolescent well-being, little is known about the social ecology of youth in foster care. This study examined the social networks of foster youth participating in a large RCT of an intervention for siblings in foster care. Youth reported on the people they lived with and the relatives they were in contact with, which provided indicators of network size, composition, and relationship quality. Cluster analysis was used to identify five family network profiles for youth living in foster homes. Two identified subgroups reflected robust family networks where youth were living with relative caregiver(s) and related youth, and also reported multiple family ties outside the household, including with biological parents. The remaining three profiles reflected youth reports of fewer family connections within or beyond the foster household, with distinctions by whether they lived with siblings and/or reported having positive relationships with their mothers and/or fathers. The identified network profiles were validated using youth- and caregiver-reported measures of mental health functioning, with increased caregiver report of post-traumatic stress symptoms indicated for the three subgroups that were not characterized by a robust family network.

Foster care placement change: The role of family dynamics and household composition.

Sibling co-placement and kinship care have each been shown to protect against the occurrence of placement change for youth in substitute care. However, little is known about the effects of different combinations of sibling placement and relative caregiver status on placement change. Nor does the field fully understand how family dynamics may differ in these households. Utilizing data from the Supporting Siblings in Foster Care study, this paper examines family dynamics across four typologies of living composition, and tests the effects of living composition membership on the odds of experiencing a placement change over an 18-month period of time. Findings suggest that across living composition typologies, children who were placed separately from their siblings in non-relative care were more likely to be older, have more extensive placement histories, and experience more placement changes both prior to and during the study than were children in other living composition groups. Family living composition was found to influence the occurrence of placement change. Specifically, children co-placed in kinship care were least likely to experience movement; however, sibling co-placement in non-relative care was also protective. Results reveal the need to conduct additional research into the experiences of children in different family living arrangements, and tailor case management services and supports to children in substitute care accordingly. Implications and future directions are discussed.

Trends in local public child welfare agencies 1999-2009.

US public child welfare agencies have faced increasing pressure in the first decade of this century to demonstrate efficiency and accountability, even as the Great Recession increased pressures on millions of families and undermined human service funding. This paper reports on analyses of the two cohorts of local public child welfare agencies from the National Survey of Child and Adolescent Well-Being to identify changes in their structure and practice. Local agency adaptations have included some structural integration and apparently increased use of subcontracting, including investigations. Collectively, these trends appear to be fostering a tighter coupling of local child welfare agencies with other service providers. Some of these connections may improve families' access to a range of services. However, the increased reliance on private providers may also undermine accountability and flexibility to respond to changing needs.

An empirical typology of private child and family serving agencies.

Differences in how services are organized and delivered can contribute significantly to variation in outcomes experienced by children and families. However, few comparative studies identify the strengths and limitations of alternative delivery system configurations. The current study provides the first empirical typology of private agencies involved with the formal child welfare system. Data collected in 2011 from a national sample of private agencies were used to classify agencies into five distinct groups based on internal management capacity, service diversification, integration, and policy advocacy. Findings reveal considerable heterogeneity in the population of private child and family serving agencies. Cross-group comparisons suggest that differences in agencies' strategic and structural characteristics correlated with agency directors' perceptions of different pressures in their external environment. Future research can use this typology to better understand local service systems and the extent to which different agency strategies affect performance and other outcomes. Such information has implications for public agency contracting decisions and could inform system-level assessment and planning of services for children and families.

Collaboration, Competition, and Co-opetition: Interorganizational Dynamics Between Private Child Welfare Agencies and Child Serving Sectors.

Human service agencies are encouraged to collaborate with other public and private agencies in providing services to children and families. However, they also often compete with these same partners for funding, qualified staff, and clientele. Although little is known about complex interagency dynamics of competition and collaboration in the child-serving sector, evidence suggests that competition can undermine collaboration unless managed strategically. This study explores the interrelationship between competition and collaboration, sometimes referred to as "co-opetition." Using a national dataset of private child and family serving agencies, we examine their relationships with other child serving sectors (N=4460 pair-wise relationships), and explore how variations in patterns of collaboration and competition are associated with several organizational, environmental and relational factors. Results suggest that most relationships between private child welfare agencies and other child serving agencies are characterized by both competition and collaboration (i.e. "co-opetition"), and is most frequently reported with other local private child welfare agencies. Logistic regression analyses indicate that co-opetition is likely to occur when private child welfare agencies have a good perceived relationship or a sub-contract with their partner. Findings have implications for how agency leaders manage partner relationships, and how public child welfare administrators structure contracts.

Intervening to Improve Outcomes for Siblings in Foster Care: Conceptual, Substantive, and Methodological Dimensions of a Prevention Science Framework.

In recent years, the child welfare field has devoted significant attention to siblings in foster care. Policymakers and practitioners have supported efforts to connect siblings via shared foster placements and visitation while researchers have focused on illuminating the empirical foundations of sibling placement and sibling intervention in child welfare. The current paper synthesizes literature on sibling relationship development and sibling issues in child welfare in the service of presenting a typology of sibling-focused interventions for use with foster youth. The paper provides two examples of current intervention research studies focused on enhancing sibling developmental processes and understanding their connection to child welfare outcomes. The paper concludes by presenting an emerging agenda informing policy, practice, and research on siblings in foster care.

Promoting cross-sector partnerships in child welfare: qualitative results from a five-state strategic planning process.

Little is known about effective strategic planning for public and private child welfare agencies working together to serve families. During a professionally facilitated, strategic planning event, public and private child welfare administrators from five states explored partnership challenges and strengths with a goal of improving collaborative interactions in order to improve outcomes for children and families. Summarizing thematic results of session notes from the planning event, this article describes effective strategies for facilitation of such processes as well as factors that challenge or promote group processes. Implications for conducting strategic planning in jurisdictions seeking to improve public/private partnerships are discussed.

Facilitating Mental Health Service Use for Caregivers: Referral Strategies among Child Welfare Caseworkers.

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers' use of different referral strategies and the extent to which these strategies are associated with caregivers' receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers' direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed.

Infusing culture into practice: Developing and implementing evidence-based mental health services for African American foster youth.

The lack of culturally appropriate health and mental health care has contributed to the large number of African American youth and families involved in the child welfare system. This article reviews the consequences of the insufficient access to culturally sensitive, evidence-supported interventions for African American foster youth. The authors describe a framework for the development of culturally appropriate mental health interventions responsive to the needs of African Americans.

Visualizing and Describing Foster Care Placement Pathways.

This paper introduces a flowchart-based methodology for describing the movement of foster youth in and out of placements of differing types and durations. This longitudinal methodology is designed to be sufficiently simple to appeal to policymakers and administrators seeking to chart the movement of groups of youth over time and the sequencing of their placements, and sufficiently descriptive to be of use to researchers seeking to predict the placement trajectories of subgroups of foster youth. The paper provides an example of the use of the method drawing upon state administrative data from a large study of preadolescent and adolescent youth in foster care situated in Oregon. Implications for the application of the methodology to different issues of interest to researchers, policymakers, and administrators are discussed.

Organizational supports used by private child and family serving agencies to facilitate evidence use: a mixed methods study protocol.

BACKGROUND: Challenges to evidence use are well documented. Less well understood are the formal supports-e.g., technical infrastructure, inter-organizational relationships-organizations may put in place to help overcome these challenges. This study will identify supports for evidence use currently used by private child and family serving agencies delivering publicly funded behavioral health and/or human services; examine contextual, organizational, and managerial factors associated with use of such supports; and determine how identified supports affect evidence use by staff at multiple levels of the organization. METHODS: We will use a sequential explanatory mixed methods design, with study activities occurring in two sequential phases: In phase 1, quantitative survey data collected from managers of private child and family serving agencies in six states (CA, IN, KY, MO, PA, and WI) and analyzed using both regression and qualitative comparative analysis (QCA) will identify organizational supports currently being used to facilitate evidence use and examine the contextual, organizational, and managerial factors associated with the use of such supports. In phase 2, data from phase 1 will be used to select a purposive sample of 12 agencies for in-depth case studies. In those 12 agencies, semi-structured interviews with key informants and managers, focus groups with frontline staff, and document analysis will provide further insight into agencies' motivation for investing in organizational supports for evidence use and the facilitators and barriers encountered in doing so. Semi-structured interviews with managers and focus groups with frontline staff will also assess whether and how identified supports affect evidence use at different levels of the organization (senior executives, middle managers, frontline supervisors, and frontline staff). Within- and between-case analyses supplemented by QCA will identify combinations of factors associated with the highest and lowest levels of staff evidence use. DISCUSSION: This study will inform efforts to improve sustainment, scale-up, and spread of evidence by providing insight into organizational and managerial strategies that facilitate evidence use, the contexts in which these strategies are most effective, and their effect on evidence use by staff at different levels of the organization.

Child Welfare Practice within the Context of Public-Private Partnerships.

Frontline and managerial child welfare practice occurs within the context of a "partnership" among public agencies that have statutory mandate for child protection and related services and private agencies that provide an array of services to children and families through contractual or informal means. Empirical literature has begun to develop around key questions within this interorganizational system, including how public and private child welfare agency relationships and contracting procedures should be structured to promote effective service delivery; how performance measurement and management systems can be developed to promote child safety, permanency, and well-being; and how managers can help promote the delivery of effective and culturally appropriate services. Yet the impact of these organizational and institutional child welfare trends on practitioners has not been clarified. This article synthesizes the literature on these questions to draw implications for practice for the frontline staff, both public and private, driving service delivery.

An intervention to improve sibling relationship quality among youth in foster care: Results of a randomized clinical trial.

Sibling programming is an important part of a prevention framework, particularly for youth in foster care. After children are removed from their families and placed into foster care in the aftermath of maltreatment, the sibling relationship is often the most viable ongoing relationship available to the child, and may be critical to a youth's sense of connection, emotional support, and continuity. The promise of dyadic sibling programming in particular rests on the ability of interventions to enhance the quality of sibling relationships; yet little research exists that suggests that sibling interventions can improve relationship quality among foster youth. The primary aim of the current study was to examine the effects of a specific dyadic sibling-focused intervention for older and younger siblings on sibling relationship quality. One hundred sixty four dyads (328 youth) participated in the study, with each dyad consisting of an older sibling between 11 and 15 years of age at baseline and a younger sibling separated in age by less than 4 years. Hierarchical linear models were applied to self-reported, observer-reported and observational data over the 18-month study period. Findings suggest that the sibling intervention holds promise for improving sibling relationship quality among youth in foster care. Implications and future directions for research are discussed.

Trajectories of Health and Behavioral Health Services Use among Community Corrections-Involved Rural Adults.

This article seeks to establish time-based trajectories of health and behavioral health services utilization for community corrections-involved (CCI) adults and to examine demographic and clinical correlates associated with these trajectories. To accomplish this aim, the authors applied a latent class growth analysis (LCGA) to services use data from a sample of rural CCI adults who reported their medical, mental health, and substance use treatment utilization behavior every 60 days for 1.5 years. LCGA established 1.5-year trajectories and demographic correlates of health services among rural CCI adults. For medical services, three classes emerged (stable-low users, 13%; stable-intermediate users, 40%; and stable-high users, 47%). For mental health and substance use services, three classes emerged (stable-low, 69% and 61%, respectively; low-baseline-increase, 10% and 12%, respectively; high-baseline decline, 21% and 28%, respectively). Employment, gender, medication usage, and depression severity predicted membership across all services. Results underscore the importance of social workers and other community services providers aligning health services access with the needs of the CCI population, and highlight CCI adults as being at risk of underservice in critical prevention and intervention domains.