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Children within the child welfare system are more likely to experience emotional and behavioral problems than children not involved with the system. Many states have adopted standardized risk and assessment measures to inform decision-making on appropriate levels of care related to placement or service intensity for children within the system. This study examined the relationship of caseworker ratings of risk across multiple domains to youth functioning and service use for a sample of children open to the child welfare system. The study identified a stratified random sample of youth who were between the ages of five and 21 and open to the child welfare system (n = 184). Stratification was based on current placement (i.e., in-home, foster home, congregate care, and juvenile justice placements). Administrative data was used to access caseworker ratings of risk across child, parent, and family domains using a standardized risk assessment tool. Children's caseworkers (n = 103) completed a standardized measure of child functioning and reported on youth utilization of services across multiple sectors including specialty mental health, school-based, juvenile justice, and medical settings. Regression analyses using variance-corrected estimation for clustered data (by caseworker) revealed higher levels of child risk were associated with poorer child functioning, which, in turn, were associated with higher rates of multi-sector service use. Recommendations and future directions are discussed.

Background A year has passed since COVID-19 began disrupting systems. Although children are not considered a risk population for the virus, there is accumulating knowledge regarding children's escalating risk for maltreatment during the pandemic. Objective The current study is part of a larger initiative using an international platform to examine child maltreatment (CM) reports and child protective service (CPS) responses in various countries. The first data collection, which included a comparison between eight countries after the pandemic's first wave (March–June 2020), illustrated a worrisome picture regarding children's wellbeing. The current study presents the second wave of data across 12 regions via population data (Australia [New South Wales], Brazil, United States [California, Pennsylvania], Colombia, England, Germany, Israel, Japan, Canada [Ontario, Quebec], South Africa). Method Regional information was gathered, including demographics, economic situation, and CPS responses to COVID-19. A descriptive analysis was conducted to provide an overview of the phenomenon. Results Across all of the countries, COVID-19 had a substantial negative impact on the operation of CPSs and the children and families they serve by disrupting in-person services. One year into the COVID-19 pandemic, new reports of CM varied across the regions.1 In some, the impact of COVID-19 on CPS was low to moderate, while in others, more significant changes created multiple challenges for CPS services. Conclusions COVID-19 created a barrier for CPS to access and protect children. The dramatic variance between the regions demonstrated how social, economic and structural contexts impact both CM reports and CPS responses.

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19–1.68); cocaine OR = 1.26 (1.07–1.50)] but not binge alcohol use [OR = 1.44 (0.95–2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Purpose Many questions remain about the effectiveness of behavioral health treatments for children in large systems of care, including the use of evidence-based treatments (EBTs). The goals of this study were to 1) describe outcomes of children receiving treatment in a statewide system, overall and separately for demographic groups; 2) describe penetration rates of EBTs and examine outcomes by treatment type and 3) examine moderation of treatment type by demographic group. Methods Participants were 46,399 children receiving behavioral health services at one of 25 outpatient clinics in a state system between 2013 and 2017. Administrative data included child demographic characteristics, treatment type, and problem severity based on the Ohio Scales. Propensity score methods were used to analyze EBT effects compared to no EBT conditions, and interactions with demographic groups. Results The overall pre- to post-treatment effect size across all treatment types was medium (Cohen’s d = 0.49 to 0.51) and similar to prior research. White children showed greater improvements than Black or Hispanic children, 7 to 12-year olds improved more than younger and older children, and females improved more than males. Almost half (47%) of children received cognitive behavioral therapy, and an additional 12.4% received another EBT. Children receiving EBTs showed greater improvement than those not receiving an EBT. The relative benefits of EBTs were mostly consistent across sex, age, and race/ethnicity, but EBTs were associated with some reductions in disparities by race/ethnicity (particularly for Hispanic youth and more modestly for Black youth) and age. Conclusions Outcomes for children receiving behavioral health treatment in a statewide system were modest. EBTs can be disseminated within large systems and have potential for improving overall outcomes for children from diverse backgrounds.

Objectives This study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment. Method A longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment. Results Children in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification. Conclusions Supports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports. Practice implications This study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.

Purpose Positive youth development (PYD) emphasizes a strengths-based approach to the promotion of positive outcomes for adolescents. After-school programs provide a unique opportunity to implement PYD approaches and to address adolescent risk factors for negative outcomes, such as unsupervised out-of-school time. This study examines the effectiveness of an after-school program delivered in urban settings on the prevention of adolescent substance use. Methods A total of 304 adolescents participated in the study: 149 in the intervention group and 155 in a control group. A comprehensive PYD intervention that included delivery of an 18-session curriculum previously found to be effective in preventing substance use in school settings was adapted for use in urban after-school settings. The intervention emphasizes adolescents' use of effective decision-making skills to prevent drug use. Assessments of substance use attitudes and behaviors were conducted at program entry, program completion, and at the 1-year follow-up to program entry. Propensity scores were computed and entered in the analyses to control for any pretest differences between intervention and control groups. Hierarchical linear modeling (HLM) analyses were conducted to assess program effectiveness. Results The results demonstrate that adolescents receiving the intervention were significantly more likely to view drugs as harmful at program exit, and exhibited significantly lower increases in alcohol, marijuana, other drug use, and any drug use 1 year after beginning the program. Conclusions A PYD intervention developed for use in an urban after-school setting is effective in preventing adolescent substance use.

Introduction This study examines child, family, and case characteristics that impact rates of re-referral to Child Protective Services (CPS) using data on all closed CPS investigations for the state of Rhode Island between 2001 and 2004. Method A longitudinal dataset of all referrals to CPS was created using state submissions to the National Child Abuse and Neglect Data System (NCANDS). After excluding children whose initial CPS investigation resulted in removal from the home, a Cox proportional hazards model was tested to examine factors impacting the likelihood of re-referral. Results Consistent with other research in this area, the initial 6-month period following case disposition is the period of greatest risk of re-referral. Approximately 13% of cases experienced a recurrent allegation during the first 6-month period; an additional 14% experienced a re-referral over the following 12-month period; 7% during the next 12-month period. Family poverty was the strongest predictor of re-referral, though a number of child and case characteristics were significantly related to recurrence. Cases that were substantiated at index were significantly less likely to result in a new allegation, though substantiated cases of physical abuse or those receiving post-investigation services were at higher risk. Conclusions Children from families facing multiple stressors (e.g., low SES, parental substance abuse child disability) are at highest risk of re-referral to CPS and may benefit from the development of preventive services targeted immediately following case closings within CPS.

This longitudinal study examines characteristics associated with the timing of three potential foster care outcomes—reunification, adoption, and running away from care (i.e., AWOL). Cox regression modeling was used to identify child and case characteristics associated with each outcome for a statewide sample of children entering care in Rhode Island following implementation of the Adoption and Safe Families Act (ASFA). Results revealed strong differences in both the rates and patterns of exits from care across discharge categories. Risk for reunification began almost immediately upon entry to care and generally decreased over time (despite a sharp spike in rates at the 10- to 12-month period), while risk for adoption was initially low and began to escalate at about the 9-month mark. AWOL rates were lower than those of reunification and adoption, and remained relatively stable over time. A number of child and case characteristics were associated with likelihood of exiting foster care. In many cases, the characteristics operated differently depending on exit type, though in other instances there was consistency indicating that some risk factors are likely to be associated with delays in achieving permanency (e.g., removal due to sexual abuse, presence of child emotional/behavioral disorder). Implications of these findings for child welfare research and practice are discussed.

Systems of care provide comprehensive services to children with emotional and behavioral disorders through a network of local agencies and providers that function as a multi-agency case review team. A primary objective in any system of care is to provide individuals with access to appropriate services. In the present study, access is defined as services received relative to those recommended by a multi-agency review team and barriers to services identified by that team. These indicators, which provide a system-level assessment of service access and function as a proxy for the development of the system of care, fill a gap in the existing literature for more system-level indicators of outcome. A total of 2073 children and youth are assessed upon entry into Rhode Island's behavioral health system of care and then followed for three months to determine the extent of services received relative to those recommended as well as barriers to services identified at service entry. Multi-agency reviews are conducted over an 8-year-period through three phases of system of care implementation-early in the establishment of the system of care, at the midpoint of implementation after substantial funding was received for service enhancements, and after full implementation of the system of care philosophy. The results indicate that, as a system of care matures, access increases significantly on both of these indicators, and that more and different types of children are served and agencies are involved in the system of care. The results are discussed for their implications for assessing systems of care through establishment of system-level empirical benchmarks of service system development.

Low-income and African American children are at increased risk for school readiness deficits in terms of both cognitive and social development. This study examined the roles of childcare involvement and parent–child interaction quality on the development of school readiness and social skills among a low-income, minority sample of kindergarten children. Findings provide mixed evidence on the role of childcare exposure, with early entry into childcare predicting higher levels of social skills ratings and increased time per week in such settings predicting lower levels of social skills development. Childcare exposure had positive, although trend-level, relationships with other readiness-related outcomes after accounting for demographic characteristics of children and their families. Parent–child interactions characterized as structured and responsive to the child's needs and emotions were positively related to school readiness, social skills, and receptive communication skills development after accounting for demographic characteristics and childcare exposure. Implications for preventive intervention program development and the role of school psychologists in the areas of consultation and intervention are discussed.