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A substantial proportion of children and youth in the child welfare system have mental health concerns that warrant attention. While these youth are more likely to receive treatment in general, they are less likely to receive evidence-based treatments. Cognitive Behavioral Therapy Plus (CBT+) is a training approach in evidence-based treatments for anxiety, depression, behavior problems, and symptoms of traumatic stress. Included in the model is an emphasis on symptom and outcome monitoring. Though based on well-established evidence-based treatments, clinical effectiveness of CBT+ has not been evaluated for child welfare populations. Embedded within a broader initiative called Partnering for Success, the current study evaluated the impact of CBT+ training on treatment outcomes for the mental health symptoms of a racially diverse sample of 1281 children and youth in four different states. Symptom data were collected by community-based mental health therapists as part of standard CBT+ treatment adherence procedures. Multilevel linear growth modeling was used to evaluate symptom change over time. Significant improvements were observed across all four clinical targets, with a slight curvilinear relationship found for anxiety, depression, and behavior problems. This promising initial evidence suggests CBT+ is a viable training option for treatment of child welfare-involved children and youth with a range of mental health concerns.

Purpose: This randomized controlled study examines the efficacy of two innovative methods to teach beginning motivational interviewing (MI) skills: live supervision (LS), a small group experiential learning interaction with standardized client actors and in-the-moment guidance from a supervisor, and a coding learning (CL) method, where students in a classroom setting are introduced to MI skill development via learning to code MI practice behaviors. Methods: Seventeen social work students in a child welfare training program were randomized to receive either LS or CL training method. Changes in MI knowledge, attitudes, and MI skill were assessed through self-report and observational measures pretraining, posttraining, and at 5 months follow-up, after a semester of learning-as-usual. Results: Both training groups demonstrated an improvement in MI knowledge and attitudes from pretest to follow-up. MI skill gain within groups varied for specific MI skills. Discussion: Implications for maximally efficient MI training are advanced.

A number of programs, policies, and practices have been tested using rigorous scientific methods and shown to prevent behavioral health problems (Catalano et al., Lancet 379:1653–1664, 2012; National Research Council and Institute of Medicine, 2009). Yet these evidence-based interventions (EBIs) are not widely used in public systems, and they have limited reach (Glasgow et al., American Journal of Public Health 102:1274–1281, 2012; National Research Council and Institute of Medicine 2009; Prinz and Sanders, Clinical Psychology Review 27:739–749, 2007). To address this challenge and improve public health and well-being at a population level, the Society for Prevention Research (SPR) formed the Mapping Advances in Prevention Science (MAPS) IV Translation Research Task Force, which considered ways to scale up EBIs in five public systems: behavioral health, child welfare, education, juvenile justice, and public health. After reviewing other efforts to scale up EBIs in public systems, a common set of factors were identified as affecting scale-up in all five systems. The most important factor was the degree to which these systems enacted public policies (i.e., statutes, regulations, and guidance) requiring or recommending EBIs and provided public funds for EBIs. Across systems, other facilitators of scale-up were creating EBIs that are ready for scale-up, public awareness of and support for EBIs, community engagement and capacity to implement EBIs, leadership support for EBIs, a skilled workforce capable of delivering EBIs, and data monitoring and evaluation capacity. It was concluded that the following actions are needed to significantly increase EBI scale-up in public systems: (1) provide more public policies and funding to support the creation, testing, and scaling up of EBIs; (2) develop and evaluate specific frameworks that address systems level barriers impeding EBI scale-up; and (3) promote public support for EBIs, community capacity to implement EBIs at scale, and partnerships between community stakeholders, policy makers, practitioners, and scientists within and across systems.

Although foster care homes play a crucial role in providing stable placements to children who enter the child welfare system due to maltreatment, there is currently no federal minimum rate nor standard methodology to establish adequate rates to support foster parents to meet these children's needs. Therefore, it is important to establish a model to estimate the real costs associated with caring for children to serve as a foundation for states to set adequate reimbursement rates. The objectives of this study are to: use the methodology of a 2007 study to establish foster care minimum adequate rates for children (MARC) based on the child's age and geographical location in every state; update the MARC with cost of living adjustments to 2016; examine changes in gaps between the MARC and the current foster care rates; and identify states that have made increases to their reimbursement rates, relative to the MARC over time. Results found that all but four states provide lower foster care reimbursement rates than the adequate costs in 2016. This study recommends that, at the federal level, enhanced precision in operational definitions of care categories could increase consistency in the way that states reimburse foster families. Additionally, findings provide policy suggestions to establish a national methodology standard and increase foster care rates to the level that will meet children's needs. This study will enhance the scant body of literature found on establishing an economic model to estimate foster care costs.

Purpose The purpose of this paper is to discuss ways of equipping the child welfare (CW) workforce to improve the well-being of children through graduate education and post-MSW training. Design/methodology/approach This paper analyses the barriers to providing mental health (MH) services to vulnerable children and families and discusses three evidence-based ways of overcoming them. Findings Child and family social workers need to do more than case management if they are to influence the well-being of the children and families they seek to help. A variety of methods is necessary to implement this changed role and three initiatives – Partnering for Success, Motivational Interviewing for Child Welfare Trainees and Training Adoption-Competent Welfare Professionals – show promising results. CW workers can learn to implement evidence-informed MH practices with high fidelity. Research limitations/implications None of the studies are controlled studies. Practical implications The paper offers innovative ideas about workforce implications and implementation strategies. Social implications Abused and neglected children’s well-being is deserving of more effective methods. Originality/value The paper provides details of three innovative evidence-based projects – national models in the USA – concerned with promoting children’s well-being.

Many children and youth involved with child welfare services receive mental health services. Yet, substantial evidence suggests efforts are frequently uncoordinated and clinical outcomes are inconsistent. Enhancing the coordination of mental health services is a potential mechanism for improving outcomes when combined with the use of evidence-based practices. The Partnering for Success (PfS) model provides comprehensive coordination support while ensuring children and youth have access to cognitive-behavioral approaches to treating anxiety, depression, and trauma, and/or a parent management approach for behavior problems. PfS leverages a co-training collaborative model for mental health and child welfare professionals to understand the optimal interplay between professionals and families and the targeting of treatment. PfS uses a High-Fidelity Performance Indicator framework organized and assessed at two distinct levels: (1) Delivery System Partnership & Leadership Performance and (2) Child Welfare & Mental Health Workforce Performance. Results across four sites indicate that the model is generally feasible and training efforts result in significant knowledge gain for child welfare workers and mental health practitioners. Over the course of the project, 2285 clients were served using the clinical model and, across all treatment targets, significant improvements in symptoms were observed. The results of this collaborative model are sustained implementation of mental health services that are evidence-based, coordinated between child welfare workers and mental health practitioners, and offered evidence of improved mental health treatment outcomes.

Findings from Maryland KEEP, a replication of KEEP (keeping foster and kinship parents trained and supported), a foster and kinship parent training intervention are presented. The purposes of this study were to evaluate child behavior change, changes in caregiver parenting style, and permanency and placement stability at baseline and then after the KEEP intervention. The KEEP intervention was provided to 65 foster and kinship parents providing care for children ages 4–12. Children who participated in the study were referred due to behavior problems, as reported by foster parents: they all scored in the clinical range for externalizing behavior on the child behavior checklist (CBCL). Baseline and posttest analyses assessed for child behavior and parenting style changes. Permanency data, including placement moves and exits from child welfare were examined. Overall, foster and kinship parents reported significantly fewer child behavior problems at posttest; severity levels on the CBCL decreased from baseline to posttest and scores on the Parent Daily Report decreased from 7.25 at baseline to 3.0 at posttest. Placement stability significantly increased between baseline and post KEEP intervention. The results provide support for the effectiveness of KEEP for a child welfare population with a high level of behavior problems and for the effectiveness of KEEP as a training program for foster and kinship parents.

Shared family care involves the planned provision of out-of-home care to parents and their children so that the parent and the host caregivers simultaneously shared the care of the children and work toward independent in-home care by the parent. This article describes several innovative types of shared family care arrangements that demonstrate promise in the protection of children and the promotion of family well-being. Emphasis is placed on the shared family foster care model, including its key elements, funding, and evaluation.

Family violence is a common American tragedy. Assaults by parents, intimate partners, and adult children frequently result in serious injury and even death. Such violence costs billions of dollars annually in social and criminal justice spending. Proven interventions can prevent abuse, identify abuse sooner, and help families survive and thrive by breaking the cycle of violence or finding safe alternatives.

Intensive family preservation services (IFPS) draw on four major theories for articulating ideal service delivery systems and treatments: crisis intervention theory, family systems theory, social learning theory, and ecological theory. This chapter addresses each of these theories and their derivative practices and describes their contribution to the delivery of IFP services. The general evidence indicating the usefulness of the theories and services based on them is reviewed. The junctures between theories and approaches are considered as are aspects of these services needing better articulation. Crisis intervention theorists differ in how they organize and conceptualize crises. The great contribution of Bandura and the social learning theorists arises from their grasp of the way that family members learn from each other. Social learning theorists and practitioners have a sometimes uneasy alliance with therapists employing strategies developed in Rational Emotive Therapy. Family systems theorists argue about the importance of avoiding systemic confusion caused by having multiple outside helpers with conflicting roles and plans.

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

Background Positive family environments are crucial in promoting children's emotional and behavioural well-being, and may also buffer development of attention-deficit/hyperactivity disorder (ADHD). ADHD is highly heritable, but psychosocial factors in the family environment, particularly family cohesion and communication, may mediate genetic predispositions. The purpose of the current study is to examine the mediating influence of the adoptive family environment between pre-adoptive risk factors and youths' ADHD symptomatology at 14 years post adoption. Methods The data used in this study were obtained from the fourth wave of the California Long-Range Adoption Study (CLAS) (n = 449). Using structural equation modelling (SEM), family sense of coherence and family adaptability were tested as possible mediators between environmental and biological predictors and ADHD symptomatology. Predictors included birthweight, gender, age at adoption, adoption from foster care, transracial adoption status, ethnicity and having a previous diagnosis of ADHD. Results Results show that, while adoption from foster care is negatively associated with family functioning, higher family cohesion and adaptability mediate this influence on children's ADHD symptomatology. Older age of adoption directly predicts greater ADHD symptoms with no mediating influence of the family environment. Conclusions The mediating influence of the family environment between children's risk factors and ADHD symptoms suggests that family intervention strategies may be helpful in improving adopted children's outcomes. Once children are adopted, targeting family communication patterns and dynamics may be an additional part of developing an evidence-based, post-adoption services toolkit.

Procedures to identify and serve high-risk infants in three jurisdictions (New York City, Maryland, and Michigan) are explored. Utilizing existing technology, these procedures, referred to as birth match, offer a timely, low-cost, intervention squarely based on current legal premises to increase the protection of newborns and very young children who were born to a parent with a prior termination of parental rights or has a child currently in out of home care. This procedure demonstrates the real time use of administrative data to influence child welfare decisions.

Parenting during adolescence is often followed by a range of untoward outcomes of young parents and their children. The birth rate and experience of pregnancy and parenting for youth in foster care are, however, little studied. Emerging research suggests greater risk for early pregnancy or parenthood for this population. The research on possible reasons for this elevated risk is considered. This review reports the findings related to prevalence, risk factors, and protective factors for pregnancy and parenting among youth in foster care. Youth report their motivations for parenting and barriers to preventing pregnancy. Child welfare workers and administrators report lack of policy and practice guidance related to pregnancy prevention and reproductive healthcare for youth in foster care.

‘‘Evidence-based service planning’’ (EBSP) is a phrase new to me. Yet the concept is consistent with the work of Stein, Gambrill, and Wiltse (1984) that the role of the child welfare professional is timely decision making, at least as much as it is treatment provision, and that referral should be made to programs with evidence of effectiveness. In 1984, these child welfare scholars could only point to the importance of using research to guide decision making but had little more to go on because there were no organized bodies of research on screening or interventions for child welfare–involved families. Now, as this innovative and important report (Berliner, Fitzgerald, Dorsey, Chaffin, Ondersma & Wilson, this issue) describes, we have many more resources to use to ensure that our clients are referred to the most fitting interventions and achieve the best possible outcome. This report is intended for the use of child welfare service (CWS) professionals and others who are involved with children and families, especially mental health professionals, court personnel, attorneys, and Child Advocacy Centers. The most elemental formulation in this important report is that principles of evidence-based interventions should also be principles of EBSP (also known as case management). In particular, EBSP is of shorter term, focused (not necessarily comprehensive), skills based, and shaped by the periodic measurement of outcomes. Likely to be the most controversial assertion of this report is the proposition that a focused and parsimonious plan is the key to an EBSP rather than the traditional standard of comprehensive service. One piece of this rationale is that some improvements in the main priority problems, for example, a reduction in the sense of having out-of-control children, will cascade to other areas (e.g., a reduction in depression). The argument for stepped care is certainly appealing and straightforward: that the minimally intrusive and demanding form of intervention is provided first and only moves to more intensive interventions, if necessary, in time. Yet, there is little mention of the alternative hypothesis that even if one area improves the gains may be short-lived if other areas are not addressed. Surely, we do know that some relief from the problems of parenting can reduce depression (DeGarmo, Patterson, & Forgatch, 2014), but it is also the case that if depression is more endogenous and a result of more ingrained biopsychosocial influences, it may not abate, even with improved parenting. Families with unstable housing may also have significant problems continuing with the progress made during evidence-based interventions. We have much work to do to understand the issues that are the most pivotal for a family’s lasting success. The child welfare professional and family must also be mindful of the tight CWS timelines that require a relatively quick case resolution. If the stepped approach does not address more serious underlying mental health problems of the child or parent at the same time that they address parenting, the overall impact may not unfold in time and the service period may end before there is an optimal outcome. Although there is certainly a reason to think that most problems specifically related to child abuse and neglect are parenting problems, and not adult behavioral health problems, there seems to be less than overwhelming evidence that these problems are really better addressed sequentially rather than concurrently. We do have evidence that CWS-involved families are often overwhelmed by the demands on them to get therapeutic services and are often not consulted about what is feasible (Estefan, Coulter, WandeWeerd, Arrmstrong, & Gorski, 2012). This American Professional Society on the Abuse of Children (APSAC) report is rightfully critical of such approaches. Estefan, Coulter, WandeWeerd, Arrmstrong, and Gorski (2012) report that the 21 clients they studied were referred to 61 services, and 7 indicated that they also needed to maintain a stable income and housing. In addition, eight parents were expected to enroll their children in therapeutic services or have engagement with a guardian ad litem. On average, each family was being directed to about four services. That sounds unfocused, but the

Adolescents comprise a substantial portion of the children in child welfare supervised out-of-home care. This article considers the evidence base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.

Group care programs, while ubiquitous, are not clearly differentiated despite differences in the population served, size, auspices, and program activities, to name a few. Words like group care, residential care and residential treatment are often used interchangeably in policy, research and practice. This paper introduces reporting standards that can be used to promote the availability of descriptive information and build towards a nomenclature and classification system that reflects the variety within the service delivery system. These reporting standards were developed and vetted with input from several national group care scholars. An index of reporting standards has implications for state systems, accreditation and licensing groups, practitioners and researchers.

OBJECTIVE: Cases of child abuse and neglect that involve black children are reported to and substantiated by public child welfare agencies at a rate approximately twice that of cases that involve white children. A range of studies have been performed to assess the degree to which this racial disproportionality is attributable to racial bias in physicians, nurses, and other professionals mandated to report suspected child victimization. The prevailing current explanation posits that the presence of bias among reporters and within the child welfare system has led to the current large overrepresentation of black children. A competing explanation is that overrepresentation of black children is mainly the consequence of increased exposure to risk factors such as poverty. METHODS: We tested the competing models by using data drawn from national child welfare and public health sources. We compared racial disproportionality ratios on rates of victimization from official child welfare organizations to rates of key public health outcomes not subject to the same potential biases (eg, general infant mortality). RESULTS: We found that racial differences in victimization rate data from the official child welfare system are consistent with known differences for other child outcomes. We also found evidence supporting the presence of cultural protective factors for Hispanic children, termed the “Hispanic paradox.” CONCLUSIONS: Although our findings do not preclude the possibility of racial bias, these findings suggest that racial bias in reporting and in the child welfare system are not large-scale drivers of racial disproportionality. Our data suggest that reduction of black/white racial disproportionality in the child welfare system can best be achieved by a public health approach to reducing underlying risk factors that affect black families.

Child specific recruitment efforts are designed to facilitate permanent placements for children in foster care by finding them potential adoptive families among people already known to the child. This process relies heavily on gathering thorough and accurate information about prospective families, and much of this information is often contained in families’ home study assessments. Yet, little is known in the research literature about the way that home studies operate in conjunction with the recruitment of adoptive families. The purpose of this study is to explore how home studies are perceived and used in the context of child specific recruitment. Findings suggest that home studies perform best in gathering general family information, but poorly in capturing sensitive information, which may be one of the most critical dimensions to capture. These findings highlight important practice changes needed in current adoption practice.

This general population survey study evaluates the association between past 12-month exposure to police violence and concurrent mental health symptoms among urban residents in 2 US cities., Key Points Question What is the prevalence of police violence exposure in cities in the United States, and what is the association of police violence exposure with adverse mental health outcomes independent of other forms of trauma exposure and crime involvement? Findings In this cross-sectional, general population survey study of 1000 adults residing in Baltimore, Maryland, and New York City, New York, police violence exposure was reported at a prevalence ranging from 3% for sexual violence to 15% for neglect, inequitably distributed across demographic groups, and was associated with concurrent mental health symptoms. Meaning The findings suggest that police violence is experienced by many urban residents in the United States and may be associated with mental health disparities., Importance Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence.

Objective: The purpose of this study was to review empirical evidence of the effects of placement in group care compared to other interventions. Method: Two-group empirical studies were identified and effect sizes for all reported outcomes were calculated. Results: Nineteen two-group studies were found that compared group care with family foster care, treatment foster care, no placement, and different group care models. Most effects were small to moderate, with strongest effects for shorter lengths of stay for family-centered group care models and decreased delinquency for Multidimensional Treatment Foster Care (MTFC) compared to group care. Conclusion: Based on the limited number of two-group studies of varying quality, outcomes of group care are often worse than alternative interventions. However, some group care models seem more promising than others.

This article uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to examine multi-sector service use for mental health problems by youth in contact with social service agencies. At 18-months post-investigation for abuse/neglect, 24% was receiving some service for a mental health problem. Among served youth, 33% received services from multiple sectors. Likelihood of service use was higher for youth who were older, male, in non-kin foster care, had more severe mental health problems, and more parental risk factors. Among service users, few factors differentiated youth who used multiple sectors from those served in only one sector.

Income assistance programs (e.g., Temporary Assistance to Needy Families; TANF) and child welfare service (CWS) programs have implicit intentions to prepare children for an adulthood that is free from serious criminal activity. This cross-sectional study compares the felonious arrests as adults of youth who were involved with TANF (n = 6,596) with those who were involved with CWS (n = 1316). In the CWS population, we compare youth who emancipated from foster care (n = 841), those who reunified (n =278), and those with other exits (n = 197). Outcomes of interest include the severity of the felony an individual was charged with as an adult as well as the hazard of being arrested after age 16 years. Findings show that as adults, TANF-involved youth are less likely than former foster youth to be charged with a felony; moreover, when former TANF youth are charged with felonies as adults, the felonies are less severe than felony charges incurred by former foster youth. Overall, as young adults, males and Africa...

Child welfare agencies serve as gate keepers for children's mental health services (MHS). Yet, the impact of offered services on behavioral outcomes has not been well studied. Data from the National Survey of Child and Adolescent Well-Being (NSCAW) were examined to measure caregivers' reported change in children's emotional-behavioral problems. Over 600 children in three age groups were matched and problem levels compared across 3 years. Although behavioral problems for the total group improved across time, scores for children who received MHS slightly worsened. Children who received MHS scored 1.4-3.7 points worse than children who did not receive MHS. Additionally, young Black, Hispanic, and other racially identified children had more problems than young White children, regardless of service. Higher behavior problem scores were noted for school-age children and adolescents. Although child welfare appears to rely on a cluster of MHS, including school-based counseling and private practitioner services, future service delivery should expand from improving access to achieving outcomes.

Recent discussions of evidence-based practices have focused on translating programmatic conceptual frameworks and best practices into the “real world” of practice settings. This article discusses the implementation and expansion of the Structured Analysis Family Evaluation (SAFE) home study methodology over the course of 4 years. Survey data include the evaluations of frontline employees (n = 220), from multiple sites, regarding SAFE's ability to identify effectively families' potential issues of concern during the home study process. Perceptions of SAFE's usefulness as a home study method for a variety of family and practice situations are also measured and illuminated with qualitative accounts. Respondents indicated that SAFE more effectively identifies most issues of concern when compared with conventional methods, and that SAFE is a useful method for evaluating prospective resource families across a variety of situations. Some respondents expressed that SAFE still requires some improvements, and that some areas of home study practice in general are beyond reach for any method (e.g., applicant honesty). Given the positive responses for SAFE regarding increased thoroughness, however, this study adds to evidence that SAFE may lead to both improved practice and more accurate home studies, and lays the groundwork for further empirical exploration of the SAFE home study method.

This study examines the prevalence and correlates of heightened posttraumatic stress (PTS) symptoms in a nationally representative sample of 1,848 children and adolescents (ages 8-14) who were referred to child welfare for investigation of abuse or neglect based on the National Survey of Child and Adolescent Well-Being. The severity of current PTS symptoms was assessed using the PTS subscale of the Trauma Symptom Checklist for Children, a standardized child-report scale evaluating common symptoms associated with trauma. The overall prevalence of clinically significant PTS symptoms was 11.7% (overall mean T score = 49.5). The prevalence was higher for cases that were placed in out-of-home care (19.2%) than those maintained at home (10.7%). Multivariate hierarchical regression identified four contributors to heightened PTS symptoms: younger child age, abuse by a nonbiological parent, violence in the home, and child depression. The authors discuss the modest but still lower than expected prevalence of self-reported, clinically significant PTS symptoms and the variables associated with greater risk for heightened PTS symptoms found among cases referred to child welfare services.

Although much is known about the mental health and behavioral functioning of youth who enter residential care programs, very little research has focused on examining the family characteristics of this population. Knowledge about family characteristics is important, however, as it can aid in tailoring programs to meet the needs of families who are involved in treatment and help them address concerns in order to facilitate the transition home. Therefore, the purpose of the present study was to examine the characteristics of youth's families at the time of entry into a residential care program. Using data from archived youth files, family characteristics were examined across several areas, including: (a) youth variables related to family (e.g., out-of-home placements, legal guardian), (b) family risk (e.g., substance abuse, domestic violence, financial problems), and (c) parenting (e.g., adequate supervision, discipline, communication). Findings suggested that youth entering residential care programs have fa...

Family group decision making (FGDM) has been increasingly adopted as a decision making strategy in child welfare agencies, although little research exists on how FGDM facilitates connections to services for children and families. This study utilizes 36 months of nationally-representative data from the National Survey of Child and Adolescent Well-Being (NSCAW) to evaluate the impact of FGDM meetings on children and families' services. Specifically, the study sample consists of 3220 children referred due to child maltreatment who were residing at home during the initial study interview, including 325 children who experienced FGDM meetings during the initial placement or planning assessment. Propensity score matching was used to generate a comparison group of non-FGDM cases, which aimed to mitigate the factors contributing to FGDM selection bias. Analysis using the matched comparison group showed that around the time of the initial case assessment a higher percentages of children who experienced FGDM meetings than those who had not experienced FGDM were connected with some services, specifically parenting services, children's counseling services, and mental health treatment for parents. After 36 months, however, receipt of child and family services was not statistically different between children who experienced FGDM meetings and those who did not.

Summary Researchers have identified four common co-occurring parental risk factors—substance abuse, mental illness, domestic violence, and child conduct problems—that lead to child maltreatment. The extent to which maltreatment prevention programs must directly address these risk factors to improve responsiveness to parenting programs or can directly focus on improving parenting skills, says Richard Barth, remains uncertain. Barth begins by describing how each of the four parental issues is related to child maltreatment. He then examines a variety of parent education interventions aimed at preventing child abuse. He cautions that many of the interventions have not been carefully evaluated and those that have been have shown little effect on child maltreatment or its risk factors. Although some argue that parent education cannot succeed unless family problems are also addressed, much evidence suggests that first helping parents to be more effective with their children can address mental health needs and improve the chances of substance abuse recovery. Barth recommends increased public support for research trials to compare the effectiveness of programs focused on parenting education and those aiming to reduce related risk factors. Child welfare services and evidence-based parent training, says Barth, are in a period of transformation. Evidence-based methods are rapidly emerging from a development phase that has primarily involved local and highly controlled studies into more national implementation and greater engagement with the child welfare system. The next step is effectiveness trials. Citing the importance and success of multifaceted campaigns in public health policy, Barth discusses a multifaceted parenting campaign that has demonstrated substantial promise in several large trials. The goal of the Triple P-Positive Parenting Program is to help parents deal with the full gamut of children’s health and behavioral issues. The campaign includes five levels of inter vention, each featuring a different means of delivery and intensity of service. More broadly, Barth suggests that the evidence-based Triple P approach offers a general framework that could be used to guide the future evolution of parenting programs.

Nearly every state in the nation requires training for foster parents and treatment foster parents. However, very little is known about the effectiveness of this required training. The current paper provides a comprehensive research synthesis on training of caregivers for youth in these out-of-home settings. The review shows potentially promising directions; however, there is little empirical support for the most widely-used curricula of foster parent training. Scattered research on a wide variety of training protocols and approaches provides little empirical evidence for any specific program. Additionally, research on treatment foster care shows promising and positive results, but has paid little attention to requirements or variations in training for treatment foster parents. Evidence-based programs from other areas (e.g., treatment foster care, parent training) have begun to be tested with foster parents with positive results. The article includes highlights of promising current directions and a discussion of challenges and possibilities for advancing the evidence base on this key topic.

The most common service provided to parents involved with Child Protective Services (CPS) is parenting training. Nevertheless, most of the programs currently in use with CPS families lack empirical research documenting the effect of parenting training. Moreover, studies of these programs lack observational data with independent reports about changes in parent–child behaviors. Using a nationally representative sample of families investigated by CPS, the authors assessed whether parenting training was related to changes in parenting practices 18 months after training, controlling for maternal, child, and family characteristics. Mothers who received parenting services were compared with mothers who did not receive services even though they had a similar need for services as determined by Propensity Score Matching. This study found some modest benefits in maternal responsiveness and total parenting scores for mothers of 3- to 5-year-old children when these mothers received parenting services, as compared with mothers that did not receive parenting services. However, these findings could not be confirmed with multivariate analysis. These results parallel previous findings that parent training obtained through the Child Welfare System lacks the requisite features to significantly change parenting practices, and they highlight the need for cohesive, national, evidence-based effective parenting training for families involved with CPS.

Children identified as having emotional and behavioral disorders (EBD) may have different out-of-home care placements than their peers without EBD.This study compared the factors influencing placement movements for 362 children with EBD and 363 children without EBD, using clinical Child Behavior Checklist (CBCL) scores at baseline data collection of the National Survey of Child and Adolescent Well-Being. The analyses explored potential case characteristics influencing the number of placements for children with a clinical CBCL score at baseline data collection. Poisson regression models were used to explain the number of placements experienced during the first 36 months of placement. Overall, children with a clinical-level CBCL score were 2.5 times as likely to experience four or more placements as their nonclinical peers. Findings indicated that the presence of depression and not residing with siblings predicted movement among children with EBD. Among children without EBD, only older age was strongly associated with placement moves. Although the direction of effects is equivocal, these results call for greater attention to children's experience of out-of-home placement and the lack of homogeneity among children who are placed outside their homes.

When experimental designs are infeasible, researchers must rely on observational data to discern differential impacts of social services on treated and untreated clients. More generally, when assignment to conditions is nonrandom, analyses of services data require special procedures to correct biased selection into conditions. This paper reviews the rationale and history of propensity score matching (PSM). It then illustrates its use in estimating the causal effects of child welfare and parental substance abuse services on maltreatment re-reports and developmental well-being for children of substance abuse treatment service recipients and nonrecipients. The use of 12 variations of PSM methods that rely on one-to-one matching strategies and secondary event history analysis results in the generation of comparable treated and nontreated cases and directional consistency in the findings. The difference-in-differences estimation, of behavioral problems, using one-to-many matching, illustrates the ability of this method to preserve statistical power and generate interpretable findings without additional analyses. Strategies for employing and interpreting PSM are discussed.

This study examined the associations between intimate partner violence (IPV) and children's use of the emergency room (ER) for an illness or injury, and care of the child by a doctor or nurse for a serious injury, accident or poisoning. We hypothesized that a mother's mental health (depression, alcohol abuse and drug abuse) and a child's lack of supervision would mediate these associations. Data were from the National Survey of Children and Adolescent Well-Being (NSCAW), a national probability study of children investigated for abuse and neglect. The analysis was limited to 2929 female caregivers who were the biological, adoptive, or stepmothers of the children. Exposure of the mother to current severe intimate partner violence was positively associated with children's use of the ER. There was no association between maternal current or past exposure to IPV and children's injuries. Current moderate IPV, current severe IPV and past severe IPV were significantly and positively associated with maternal depression. Maternal depression was not associated with child's lack of supervision. However, maternal alcohol abuse and drug abuse were positively associated with child's lack of supervision. The relationship between IPV and children's use of the ER was mediated by maternal depression. Maternal depression and lack of supervision of the children were positively associated with children's injuries. Identification of maternal IPV and depression during children's ER visits can help guide services to prevent future use of the ER and injuries to children.

This paper uses data from the National Survey of Child and Adolescent Well Being to examine the identification of domestic violence (DV) by child welfare workers during investigations of maltreatment and determine how this contributes to the receipt of DV services. The study focuses on female caregivers of children remaining in the home following the investigation (n = 3165). While child welfare workers indicate that active DV is present in only 12% of families investigated for maltreatment, 31% of caregivers reported DV victimization in the past year. The sensitivity of reports of DV is low between caregivers and workers, with both reporting active or recent DV in only 8% of families. Substance abuse by the primary caregiver is a strong predictor of under identification of DV by the child welfare worker (OR = 7.6). Overall, about half of the caregivers with active DV identified by the worker received DV services over the 18 months following the investigation. Logistic regression analyses examined whether receipt of child welfare services (CWS) increases the likelihood that a referral will be made to DV services and whether caregivers will then obtain these services. Both the identification of DV by the worker and having an open CWS case are significant contributors to receipt of DV services.

Domestic violence (DV) and child maltreatment co-occur in many families and this may lead to involvement with child welfare services (CWS). This study explores the role of domestic violence in CWS using data from the National Survey of Child and Adolescent Well-Being, a large, national probability sample of families investigated for child maltreatment. It relies on child welfare worker report of active DV or a history of DV to examine the association of DV with child maltreatment type, substantiation, and placement of children into out of home care. Maltreatment type classification was similar for children with and without exposure to DV. Families with active DV were substantiated for child maltreatment at higher rates than other groups, but DV was not a powerful contributor to the CWS decision-making process. Families with co-occurring DV and maltreatment often had high levels of cumulative risks, and children in families with the highest level of cumulative risk were 10 times more likely to be placed into foster care than children in families assessed with low levels of risk. The policy and practice implications of these findings are discussed.

The Children and Domestic Violence Services (CADVS) study is a project to collect detailed, contextual data at the state and local levels on the organization and relationship of child welfare services for children, and domestic violence services for women. Although previous research has found a high rate of domestic violence in families involved with child welfare services (CWS), little systematic research on a national scale is available about state and local policies and practices related to these families. The project reported in this article is a supplemental study of the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of more than 5000 children and adolescents who become involved with CWS. Whereas, the NSCAW study contains detailed information on children and families, the CADVS study uses the same sample as NSCAW to gain information about the way that CWS and domestic violence service (DVS) agencies operate on behalf of victimized children and caregivers. The CADVS study design allows for linkage of this new contextual information to the individual level survey data collected in NSCAW. The purpose of this paper is to provide an overview of the methodology used in CADVS, including sampling, data collection, and instrument development. Future plans for data analyses, including linkage between CADVS and NSCAW, are discussed.

Postadoption services are an expanding service sector. This study determined the characteristics of families and children using a postadoption services program in New England. On average, children were 11 years of age at case opening and had been adopted for 6 years. Most had a history of maltreatment (57%), were adopted domestically (67%), and lived in adoptive families with married parents (82%). Almost all had received at least 1 other postadoption service (90%) and many (47%) had received 4 or more. Families' greatest concerns were child development and family relationships, with fewer concerns about culture, race, or birth parents. Although managing their children's behavior was a concern, families reported feeling effective and expressed considerable closeness to their child.

Child welfare service agencies provide parent training as part of their legally mandated responsibility to provide services to assist families to keep their children at home or to achieve reunification. The use of parent-training programs for families in the child welfare system has undergone relatively little examination. Mental health, special education, and juvenile justice have been identifying evidence-based approaches that have demonstrated effectiveness with children and families with conduct disorders and other behavioral problems, although few of these interventions have been tested with child welfare services clientele. This article brings together evidence about the most promising programs from other child service sectors with information about the current parent training approaches in child welfare and generates a range of proposals about next steps to enhance the capacity of parent training and fulfill the high expectations set in law and practice.