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Background: The Adoption Assistance and Child Welfare Act mandates an Administrative Case Review (ACR) for every child in foster care every 6 months regarding their safety, adherence to case planning, and progress towards permanency. Despite limited research, a well-implemented ACR process should improve child welfare outcomes., Objective: To systematically examine the reliability of one state's ACR process., Participants and Setting: In a large Midwestern state child welfare system, the authors partnered with the state child welfare agency's ACR administrators and five independent, external experts to examine the reliability of their ACR ratings across key priority areas., Methods: Intraclass correlation coefficients (ICCs) and percentage agreement on ACR ratings between the ACR reviewers and external experts were calculated. In December 2021 - May 2022 (Round 1) and December 2022 - May 2023 (Round 2), a random representative sample of 290 foster care cases were selected whose ACRs were completed by the ACR reviewers and external experts. Results from Round 1 informed documentation and training efforts prior to Round 2., Results: The ICCs and percentage agreement on four combined priority areas in Round 1 was 0.43 and 40 %, respectively, compared to 0.63 and 63 %, respectively, in Round 2 on five combined priority areas. Both rounds showed variability in reliability across priority areas., Conclusions: Reliability improved from Round 1 to Round 2. Rigorous examination of the reliability of the ACR process, in addition to compliance with federal legislation, should be the basis for states to harness the full capacity of ACR to improve child welfare outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Despite the almost global ratification of the United Nations Convention on the Rights of the Child, Ireland and the international community fall short on the full realisation of these standards. Among the many pervasive and enduring failures are the persistence of child poverty, inadequate access to healthcare services, inequality of access to education, and continued discrimination based on race, ethnicity, gender, and disability. A highly relevant concern in today's world is the increasing exposure of children to armed conflict and our inability to effect change. This paper reviews the progress made in upholding children's rights and areas of ongoing concern., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Hospital policies play a role in healthcare providers' decision-making about reporting birthing people who use drugs to child welfare. This study sought to understand how these specific hospital policies are made., Methods: We conducted semi-structured interviews with healthcare professionals involved in developing or revising hospital policies related to child welfare reporting for birthing people who use drugs. The interview guide was informed by an implementation science framework and focused on participants' experiences developing or revising these policies. We coded transcripts inductively, focusing on themes that emerged in the interviews themselves, and deductively, focusing on pre-determined aspects of the policy development process., Results: Participants ( N  = 16) were physicians (69%), registered nurses (19%), and social workers (12%). The sample was drawn from all regions of the United States. Two themes emerged in data analysis. The first theme was that urine drug testing policies for pregnant and birthing individuals are seen as part of hospital child welfare reporting policies. Specifically, participants often described child welfare reporting policies as including criteria for urine drug testing and explained that the connection between urine drug testing and child welfare reporting policies was by design. The second theme was that the content of hospital child welfare reporting policies is a result of hospital politics and a focus on legal compliance. They described the legal compliance aspects of the hospital policies as serving to protect the institution and, occasionally, individual employees from legal consequences., Conclusion: The content of hospital policies regarding birthing people who use drugs appears influenced by political and legal considerations more than considerations of patient or public health., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Against the background of 30 years of discussion in medicine and law about unfounded accusations and the existence of reasonable suspicion of intra-family violence in contact and custody proceedings, this article emphasises the importance of focusing on child protection by all professionals.Based on a case report in connection with the Federal Ministry of Justice's handout "Dealing with violence in custody and contact proceedings", the article describes the relevance of child protection in Austrian case law and the means by which it is undermined. In the name of science, ideological diagnoses are used instead of evidence-based treatment diagnoses [1]. "Professionals from the healthcare system, youth welfare, justice and education should cooperate in child protection with the aim of recognising, identifying and ending child abuse, maltreatment and/or neglect as such (cf. § 3 KKG) [2]."In legal practice, however, practitioners in the psychosocial, psychosomatic and psychotherapeutic fields are often not recognised as witnesses because of the assumption they are influenced by parents or patients themselves. In Austria, the evaluation of evidence is the responsibility of the judge and it is often assumed that practitioners cannot take an objective position towards their patients and their relatives. Specialist medical or psychological experts are therefore of crucial importance. When taking their oath, they have committed themselves to objectivity and impartiality in the recording of findings and orientation towards scientific principles and standards ("state of the art") and their application, as well as to continuous further training and education in the preparation of expert opinions [3].The specific case in question is a child with a diagnosis of post-traumatic stress disorder following suspected sexualised violence, enuresis and enkopresis in connection with the traumatic experiences.The connection between violent situations and child and adolescent psychiatric disorders and the course of the custody and contact proceedings are described. Relevant legal interests such as the will of the child, the best interests of the child, attachment tolerance and protection against violence are addressed and put up for discussion. Topics such as domestic, psychological, sexualised, institutional violence and intimate terror are presented.The case report is an example of how child psychiatrists deal with points relevant to the Federal Ministry of Justice's handbook "Dealing with violence in custody and contact proceedings", which was published in January 2024. It represents a guideline for the area of court proceedings, assessment and treatment., Competing Interests: Interessenkonflikt: U. Altendorfer-Kling gibt an, dass kein Interessenkonflikt besteht., (© 2024. Der/die Autor(en), exklusiv lizenziert an Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Background: Children impacted by substances are at increased risk for child welfare involvement, which often leads to out-of-home care. Substance use disorder (SUD) impacts the family unit, and thus, prevention and intervention efforts need to target the family, not just the individual with a SUD. There are efficacious interventions for families impacted by SUD, but limited information exists on family reunification outcomes following services., Objective: This study examined whether participation in the Attachment and Biobehavioral Catch-Up (ABC) model was associated with a higher likelihood of reunification among families involved with a family treatment court (FTC) per conditions of an open child welfare case., Methods: The study sample includes a total of 215 children from 112 families, ages six months to forty-seven months, and their caregivers, all enrolled in an FTC due to SUD. Children were considered exposed to the intervention (N = 39; 18.1 %) if either they or a sibling participated with either a biological or foster parent. The ABC treatment was delivered by a trained therapist either in the home or via telehealth., Results: 74 % of children exposed to the ABC model reunified by study end compared to 57 % of children who were not exposed to the intervention. In a multivariable Cox regression model controlling for covariates, reunification was driven by cases with biological parent participation. Compared to no exposure, cases with biological parent exposure were 2.3 times more likely to reunify. Reunification was not impacted by foster parent exposure., Conclusions: Families impacted by substances need interventions that target the caregiver-child dyad. Facilitating family bonding and attachment with direct caregiver involvement is critical to serving caregivers and their children. This study shows the ABC model, particularly when delivered to biological parent-child dyads, is associated with a higher likelihood of reunification for children in child welfare, an outcome that, when safe, secure, and stable, critically improves long-term, healthy development., Competing Interests: Declaration of competing interest Bard and Lloyd Sieger were sub-award recipients on the project described in this manuscript., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Little is known about the impact of child welfare system-level factors on child mortality as an outcome within foster care. Using data from the Adoption and Foster Care Analysis and Reporting System, 2009-2018, we examined the associations between county-level sociodemographic, foster care performance, and judicial reform characteristics with all-cause mortality rates. Results of random effects negative binomial regression analyses showed that higher proportions of younger children (<1 year: IRR = 1.06, 95% CI [1.02, 1.11]; 5-9 years: IRR = 1.05, 95% CI [1.01, 1.09]); children of color (i.e., non-Hispanic Asian: IRR = 1.07, 95% CI [1.01, 1.13]; multiracial: IRR = 1.03, 95% CI [1.01, 1.04]; non-Hispanic Black: IRR = 1.02, 95% CI [1.01, 1.02]; Hispanic: IRR = 1.01, 95% CI [1.01, 1.02]); and male children (IRR = 1.10, 95% CI [1.05, 1.15]) were associated with higher mortality risks at the county level. Current class action lawsuits (IRR = 0.79, 95% CI [0.63, 0.99]) and active consent decrees (IRR = 0.77, 95% CI [0.63, 0.94]) were associated with lower mortality risks. None of the foster care performance characteristics (e.g., foster care entry, placement stability, permanency) were associated with mortality risks. These findings have implications for addressing health disparities and reforming foster care systems through programmatic and policy efforts., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Competing interests: JG and TA declare they have no competing interests to declare. No commercial entities provided support for the work reported in the submitted manuscript. No commercial entities can be viewed as having an interest in the general area of the submitted manuscript. There are no similar financial associations involving their spouses or their children under 18 years of age. Finally, there are no non-financial associations that may be relevant to the submitted manuscript.

Background: Child protection notifications aim to secure the wellbeing of children. However, there is a large variation in the implementation of notifications across the municipalities in Finland., Objective: This article explores whether the threshold of child protection notifications is higher in municipalities with a high level of socio-economic risk factors, as assumed by the inverse intervention law., Participants and Setting: The study is based on the system-level data of Finnish municipalities, and their socio-economic indicators for the period of 2010-2021., Methods: A cluster analysis is used to group Finnish municipalities, based on the level of socio-economic risk factors, and a panel regression analysis, to verify whether these factors act as risk factors or as driving forces of inverse intervention law., Results: The municipalities with a high level of risk factors have the higher threshold level for child protection notifications compared to other municipalities. In all municipalities, the share of single-parent families acts as a risk factor, while the share of residents with higher education acts as a driver of the inverse intervention law. Reduction of unemployment and income inequalities are also recognised as drivers of this law, but only in municipalities with a relatively higher level of risk factors., Conclusions: This study promotes the inverse intervention law, and contribute to the understanding of the driving forces of this law. Further, there is a difference in the threshold level of child protection notifications among municipalities which is based on their socio-economic context. Children are in an unequal position in relation to the municipality in which they live., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

To promote open and safe access to court hearings for families and professionals during the COVID-19 pandemic, juvenile and family courts across the United States shifted towards virtual hearings in child welfare cases. Drawing on findings from a four state court observation study conducted pre and post emergence of the pandemic, as well as from a national survey of court professionals and a survey of parents, we reflect on the experiences of courts and court participants with virtual hearings in child welfare cases and specific impacts on hearing quality. Findings indicate that despite stakeholder perceptions, there is little difference in the quality of hearings with respect to judicial engagement and discussion. Differences were found however, in the attendance of fathers and relatives at hearings, with less fathers and relatives attending virtual hearings. Parents had mixed experiences with the virtual hearing process. Professionals noted challenges, as well as strategies for overcoming challenges, to engage parents and ensure their access to virtual hearings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Child welfare agencies around the world have experimented with algorithmic predictive modeling as a method to assist in decision making regarding foster child risk, removal and placement., Objective: Thus far, all of the predictive risk models have been confined to the employees of the various child welfare agencies at the early removal stages and none have been used by attorneys in legal arguments or by judges in making child welfare legal decisions. This study will show the effects of a predictive model on legal decision making within a child welfare context., Participants and Setting: Lawyers, judges and law students with experience in child welfare or juvenile law were recruited to take an online randomized vignette survey., Methods: The survey consisted of two vignettes describing complex foster child removal and placement legal decisions where participants were exposed to one of three randomized predictive risk model scores. They were then asked follow up questions regarding their decisions to see if the risk models changed their answers., Results: Using structural equation modeling, high predictive model risk scores showed consistent ability to change legal decisions about removal and placement across both vignettes. Medium and low scores, though less consistent, also significantly influenced legal decision making., Conclusions: Child welfare legal decision making can be affected by the use of a predictive risk model, which has implications for the development and use of these models as well as legal education for attorneys and judges in the field., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Background: The Nigerian Convention on the Rights of the Child (CRC) 2008 enacted prohibitive laws against child streetism. However, in metropolises like Ibadan, there is a growing epidemic of street children, particularly the category with existing family ties known as "children on the streets". Children on the street come from home daily to engage in economic-oriented activities on the streets and return home to their families at night time., Objective: We focused on perceptions of formal responses to the problem of child streetism in Ibadan., Methods: This was qualitative research. Participants were selected from each of the five urban LGA of Ibadan, purposively and by snowball technique. In-depth Interviews (IDI) were conducted, audio-recorded and transcribed. Framework analysis of data was supported by ATLASTi version 22., Results: Fifty-three (53) interviews were conducted including IDI with ten (10) child-welfare officers, ten (10) street shop owners, eleven (11) children on the street, and ten (10) pairs of parent-child dyads. Two themes emerged including governmental shortcomings with six subthemes and suboptimal governmental interventions with four subthemes. Child streetism in Ibadan is a consequence of the State's failed education systems, inadequate children's vocational and rehabilitation programs, lax child welfare laws, lack of empowerment of skilled children, and poor implementation of the policy on ideal family size. Interventions that were existing but sub-optimal included communitybased child welfare programs, parental poverty alleviation, public sensitisation and child welfare monitoring programmes., Conclusion: There is an urgent need to update, enforce laws, and amalgamate efforts against child streetism in Ibadan., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

2024 is the 100th Anniversary of the Geneva Declaration of the Rights of the Child. Endorsed by the League of Nations in 1924 following World War I, the Geneva Declaration is the first international legal instrument recognizing the inherent rights of children worldwide-indeed, it is the first human rights document ever recognized by an intergovernmental organization, thus giving rise to the international human rights era that transformed policy, law, and ethics in the 20th century. As we approach the 100th anniversary of the Geneva Declaration, we have the opportunity to reflect on the progress we have made in the first century of intentional work recognizing and advancing the human rights of children internationally. This commentary looks at the international children's rights legal framework that was developed by the global community from 1924 to the present. It then highlights advancements and shortcomings in key thematic areas, such as child health and well-being, poverty, child labor, and education. It closes by focusing on the path and priorities before us as we enter our second century of advancing international children's rights. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Policy Points Over the past several decades, states have adopted policies intended to address prenatal drug use. Many of these policies have utilized existing child welfare mechanisms despite potential adverse effects. Recent federal policy changes were intended to facilitate care for substance-exposed infants and their families, but state uptake has been incomplete. Using legal mapping and qualitative interviews, we examine the development of state child welfare laws related to substance use in pregnancy from 1974 to 2019, with a particular focus on laws adopted between 2009 and 2019. Our findings reveal policies that may disincentivize treatment-seeking and widespread implementation challenges, suggesting a need for new treatment-oriented policies and refined state and federal guidance., Context: Amid increasing drug use among pregnant individuals, legislators have pursued policies intended to reduce substance use during pregnancy. Many states have utilized child welfare mechanisms despite evidence that these policies might disincentivize treatment-seeking. Recent federal changes were intended to facilitate care for substance-exposed infants and their families, but implementation of these changes at the state level has been slowed and complicated by existing state policies. We seek to provide a timeline of state child welfare laws related to prenatal drug use and describe stakeholder perceptions of implementation., Methods: We catalogued child welfare laws related to prenatal drug use, including laws that defined child abuse and neglect and established child welfare reporting standards, for all 50 states and the District of Columbia (DC), from 1974 to 2019. In the 19 states that changed relevant laws between 2009 and 2019, qualitative interviews were conducted with stakeholders to capture state-level perspectives on policy implementation., Findings: Twenty-four states and DC have passed laws classifying prenatal drug use as child abuse or neglect. Thirty-seven states and DC mandate reporting of suspected prenatal drug use to the state. Qualitative findings suggested variation in implementation within and across states between 2009 and 2019 and revealed that implementation of changes to federal law during that decade, intended to encourage states to provide comprehensive social services and linkages to evidence-based care to drug-exposed infants and their families, has been complicated by existing policies and a lack of guidance for practitioners., Conclusions: Many states have enacted laws that may disincentivize treatment-seeking among pregnant people who use drugs and lead to family separation. To craft effective state laws and support their implementation, state policymakers and practitioners could benefit from a treatment-oriented approach to prenatal substance use and additional state and federal guidance., (© 2022 Milbank Memorial Fund.)

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

In Latin America, violence is a major public health issue causing many families to flee to the United States to seek safety. Current US immigration policies fail to address why families are forced to depart their home country or the needs of families once arriving in the United States. This article identifies root causes of family displacement, examines the insufficient protections for children in families during US immigration processing, and provides practice and policy recommendations on how to transform the US immigration system so that it is more humane for children and families forcibly displaced by violence., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and objectives : To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods : To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results : SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion : With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.

Legal Aspects of Child Protection Several legal codes (e. g. family, social and criminal law) are of importance in child protection cases in Germany. The intention of legal codes differs between family law (relations between family members), social law (support for families) and criminal law (penal aspects). Mental health professionals have to know the prevailing legal norms concerning child-welfare. Collaborative work between medicine and youth welfare and child protection services (CPS) requires a weighing of data protection issues and the risk for the child. German child protection law provides a stepped model for health care professionals to inform CPS. This includes a careful weighing of the risk for child abuse and own competences to provide support. Medical personnel should be aware of several further legislative regulations concerning child protection issues.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Background: In spite of the progress achieved over the years since the adoption of the CRC, violence against children (VAC) is still widespread in the African continent. Although some progress has been made in addressing violence through the implementation of the CRC and its use in the courts, there are still gaps particularly in ensuring access to remedies for child victims of violence., Participants and Setting: The strongest factors that impede measures to eliminate VAC in Africa are its broad societal acceptance and weak remedial tools to deal with the issue, including access to justice and assistance to child victims. The article analyses the CRC's implementation and influence on national courts' jurisprudence on VAC in South Africa, Nigeria and Kenya., Objective: The objective of the article' is to provide evidence of the positive impact of the CRC on the right to a remedy for child victims of violence in selected African states, while highlighting existing gaps., Methods: Evidence is provided through the CRC reporting process, and the impact of the CRC on national courts in Kenya, Nigeria and South Africa., Results: Facts and cases of redress for child victims of violence in the three states, as well as roles and paths that the stakeholders undertake, reflect the strength, value, role and influence of the CRC on the recent progress in these states. The law and legal advocacy in the selected African states have proved to be a powerful tool for children., Conclusions: There is a need for more evidence and more research on the topic in each African state, so that real impact of the CRC on national remedial activities, as well as its relatedness to the level and types of violence against children is properly evaluated., (Copyright © 2019. Published by Elsevier Ltd.)

Since its adoption by the United Nations in November 1989, the Convention on the Rights of the Child (CRC) has become the most universally ratified human rights treaty in history; presently only the United States has not ratified it. The CRC articulates children's human rights and notably includes freedom from sexual abuse and exploitation. Yet thirty years after the Convention was adopted, child sexual abuse and exploitation (CSA/E) remain serious, persistent, and evolving global issues. This overview both describes the current state of research on child sexual abuse and exploitation and evaluates the CRC's legacy in terms of State-level responses to CSA/E. Points of agreement and disagreement over what constitutes CSA/E and how widespread it is are explored. Also presented are the contexts in which CSA/E takes place, and factors associated with children's risk of being sexually abused or exploited. Emerging issues in these areas are the internet and children's use of it, as children may now become subject to abuse or exploitation even when physically alone. The second part of the paper addresses the CRC's influence on States' domestic legislation and States' responses to CSA/E more broadly. Gaps in efforts to monitor and report on the CRC's implementation with respect to its impact on CSA/E are described. The discussion offers guidance for future efforts to research and respond to child sexual abuse and exploitation, and in particular the ongoing need for support to survivors beyond the legal response paradigm., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

In 2016, federal law changed state child welfare mandates related to prenatally substance-exposed infants. Little is known regarding the status or implications of policy implementation. The current study examined thematic clusters among states' policies responsive to this 2016 mandate. Cluster analysis identified four distinct categories of states' implementation: (1) "innovators/early adopters," (2) "early majority," (3) "late majority," and (4) "laggards." Innovator/early adopter states ( n = 14) were most likely to have implemented plan of safe care policies consistent with Child Abuse Prevention and Treatment Act (CAPTA). Early majority states ( n = 15) have started developing some aspects of CAPTA 2016 but have some aspects that are still in development. Late majority states ( n = 17) have adopted few aspects of CAPTA 2016 but had implemented more CAPTA 2003 and 2010 aspects than states in the laggard cluster. Laggard states ( n = 6) have implemented the fewest CAPTA prenatal substance exposure domains. In bivariate analyses, the only variable associated with clusters was Census region (e.g., New England), suggesting that states' implementation decisions may be influenced by their regional neighbors.

Importance: States have enacted criminal justice-related substance use policies to address prenatal substance use and protect infants from adverse health effects of parental substance use. However, little is known about the consequences of these policies for permanency outcomes among infants in the foster care system in the United States., Objectives: To evaluate the consequences of criminal justice-related prenatal substance use policies for family reunification and to examine differences in parental reunification by racial/ethnic group., Design, Setting, and Participants: In this cohort study using data from the 2005 to 2017 Adoption and Foster Care Analysis and Reporting System, 13 cohorts of infants who entered the foster care system were followed up. States with criminal justice-related prenatal substance use policies were compared with states without such policies before and after their enactment using a discrete-time hazard model adjusted for individual covariates, state, and cohort fixed effects. The sample consisted of 350 604 infants 1 year or younger who had been removed from their home because of parental drug or alcohol use., Main Outcomes and Measures: Length of time from entering the child welfare system to first reunification with a parent and hazard rates (HRs)., Results: Of the 350 604 infants 1 year or younger, 182 314 (52%) were boys, 251 572 (72%) were non-Hispanic white children, and 160 927 (46%) lived in US states with a criminal justice-focused prenatal substance use policy. Among those who were reunified, 36% of the reunifications occurred during the first year and 45% in the second year. Foster care infants who were removed from their homes because of parental substance use who live in states that have adopted criminal justice-oriented policies had a lower chance of reunification with a parent compared with states that have not adopted those policies (HR, 0.95; 95% CI, 0.94-0.96). Specifically, non-Hispanic black children who live in a state that has adopted criminal justice-oriented policies had a lower chance of reunification with a parent than non-Hispanic black children who live in a state that has not adopted those policies (HR, 0.87; 95% CI, 0.81-0.94)., Conclusions and Relevance: Given the child welfare system's legal mandate to make every effort toward parental reunification, a more comprehensive treatment and supportive policy approach toward parental substance use might be warranted.

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

The Multi-agency Investigation & Support Team (MIST) was a new approach to abuse investigations that aimed to minimize the distress and uncertainty experienced by children and non-abusive caregivers in dealing with the many agencies typically involved in a case post-disclosure, while also attempting to improve the accessibility of supportive and therapeutic services. As part of a broader evaluation, this study examined worker perceptions early in the implementation of this new approach. Thirty-three (33) interviews were conducted with workers affected by this new pilot. The interviews identified almost exclusively positive perceptions of the changes relative to practice as usual, particularly in terms of improvements to collaboration and communication across agencies, and the benefits of providing support alongside the investigation process. Some areas of difficulty and areas for improvement were identified, particularly the need for stronger governance of the cross-agency protocol and improved connection to some of the groups involved in the response that were not co-located. The study suggests professionals working in the MIST model consider the model beneficial to the quality of the response to severe child abuse while highlighting that the process of change into this new way of working was challenging at times.

The present study is the largest and most rigorous study to date on the effects of being appointed a Court Appointed Special Advocate (CASA) on permanency outcomes of children in foster care. The intent-to-treat study accounts for selection bias by applying inverse probability weighting to logistic and sequential logistic regressions in a large sample of children in foster care in the state of Texas ( N = 31,754). Overall, children appointed a CASA have significantly lower odds than children without a CASA of achieving permanency. They have lower odds of being reunified, greater odds of being adopted (if not reunified), and lower odds of being placed in permanent kin guardianship (if not reunified or adopted) than children who are not appointed CASA. This study makes an additional contribution by looking beyond the aggregate effect of CASA on permanency by examining the effect of CASA for different age groups and different types of first placement after removal.

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

This literature review appraises how the justice system of the United Kingdom deals with child on child sexual abuse allegations. It is crucial to consider the impact of minor sexual abuse within the community. Sensationalized reporting of sex crimes demonizes offenders and unintentionally hides some perpetrators by not representing children can cause harm. Cases where children demonstrate sexual agency are confusing and uncomfortable to appropriate blame. A freedom of information request to the Metropolitan Police uncovered 5,500 minor sex abuse allegations in England and Wales between 2011 and 2014, including, 4,000 physical assaults and 600 rape allegations. Officials caution these figures only represent a small proportion of known sexual abuse cases but the full extent of the problem is yet to be seen. Children are being exposed to explicit imagery far beyond their developmental age causing a blurring of the lines between normal sexual curiosity, harmful behavior, sexual deviance, and abuse. Evidence suggests societal failings and technological advances have created vulnerabilities from which new and dangerous sexual norms have evolved. Therefore, this paper reviews the justice, welfare, and restorative justice frameworks to explore the efficacy of the justice system in dealing with child on child sexual abuse in the UK.

Background: Early intervention efforts designed for youth with problematic sexual behavior (PSB) have strong promise. Prompt identification of youth with PSB is critical to ensuring early intervention and effective response., Objective: The current study explored the complexities of how PSB of youth is identified in the community., Setting: A qualitative semi-structured interview approach was utilized to explore the perceptions and experiences of community members involved in cases of youth with PSB., Participants: Participants included 100 community members from eight geographically diverse locations in the United States., Method: Themes involving identification of PSB were classified by qualitative analyses, beginning with thematic analysis followed by focused coding., Results: Results indicated multiple pathways for the identification of youth with PSB involving a variety of professionals and agencies. Victim disclosure and witnessing the PSB were the most common identification pathways, with caregivers and school personnel the most common initial identifiers. Once identified, cases were reported to child welfare, law enforcement, and/or behavioral health agencies. Complications due to unclear response pathways and fears held by caregivers were notable., Conclusions: Developmentally appropriate, evidence-informed policies and procedures for the identification of and response to PSB in youth within and across professions would facilitate a public health response to for prevention and early responses to PSB of youth., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The Amajuba Child Health and Wellbeing Research Project measured the impact of orphaning due to HIV/AIDS on South African households between 2004 and 2007. Community engagement was a central component of the project and extended through 2010. We describe researcher engagement with the community to recruit participants, build local buy-in, stimulate interest in study findings, and promote integration of government social welfare services for families and children affected by HIV/AIDS. This narrative documents the experience of researchers, drawing also on project reports, public documents, and published articles, with the objective of documenting lessons learned in this collaboration between researchers from two universities and a community in South Africa during a period that spanned seven years. This experience is then analyzed within the context of an applied research, community-engagement framework.

Background: School wellness legislation has potential to impact the health of children and alter the obesity crisis in the United Sates. Little is known about how state lawmakers perceive child wellness legislation effectiveness relative to obesity prevention. Our purpose was to understand state lawmakers' perceptions of childhood obesity and school wellness policies relative to the Social Ecological Model (SEM)., Methods: Twenty-one state representatives and nine state senators from one US state completed in-depth interviews. Member checks and peer debriefing occurred throughout data collection and analysis. Transcripts were coded and triangulated. A conventional content analysis generated consistent themes., Results: Five main themes developed: (1) child overweight and obesity is problematic; (2) current legislation is ineffective; (3) funding and enforcing child wellness legislation is difficult; (4) it is difficult to legislate personal behavior; and (5) efforts from other levels of the SEM are more effective at promoting wellness., Conclusions: Lawmakers understand negative impacts of child obesity, but perceive immediate legislative issues like budgetary concerns inhibit robust policy-oriented action. Participants believe parents, guardians, and individuals should ultimately be responsible for child wellness. Community, school, and family efforts to address childhood obesity and support wellness may be more effective in achieving positive outcomes than state and federal policy., (© 2020, American School Health Association.)

Background: Safe harbor laws have been implemented to change the way systems of care respond to juveniles exploited in commercial sex in the U.S., yet there is little research on the way these laws have impacted the identification and rehabilitation of juveniles., Objective: Using administrative data, this study investigates the impact of a safe harbor law enacted in one state in the U.S., Participants and Setting: This study examines secondary data on juveniles with prostitution-related charges from 2007 to 2017 (n = 17); juveniles who were screened for human trafficking by juvenile court personnel (n = 56,937); (3) screenings for human trafficking with juveniles in the juvenile justice system (n = 12,223); and (4) juveniles who were reported to the child welfare agency as possible victims of human trafficking (n = 697). The number of criminal cases of human trafficking involving victims under the age of 18 years old from 2007 to 2017 were analyzed by calendar year (n = 61)., Methods: Aggregate, administrative data was accessed and analyzed., Results: Findings show that juvenile justice and juvenile court personnel are screening for trafficking at an increasing rate and making referrals to the child welfare system as mandated by law. However, a relatively low percentage of these cases are substantiated, confirmed and/or result in criminal charges to the trafficker. Despite safe harbor mandates that prohibit the charging of juveniles with prostitution offenses, there is evidence that this is still occurring in small numbers., Conclusions: Based on these findings, researchers have identified next steps to facilitate future investigations of safe harbor laws., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: In a case of child pornography, only the dorsum of the offender's hand was clearly visible. After identification of a suspect, the question arose of whether and how it is possible to identify or exclude the suspect as perpetrator according to the morphology of the hand vein pattern., Material and Methods: A simple approach to use the hand vein pattern in crime suspects as a tool for identification was tested. In this study, the hand vein patterns of 30 study participants were analysed from conventional frames on videography. A standardised grid system consisting of six lines and four sectors was applied on the dorsum of the hands. Vein branchings within the sectors and line crossings of the veins were counted, leading to a total of 11 variables for each hand., Results: A positive identification of each of the 30 test participants was possible for each hand when taking only the first five variables into account. A random overlapping prediction was obtained by statistically simulating hand vein patterns of different numbers of persons using this sample. Considering the hand vein frequencies in this sample, the results indicate that the chance for two persons having the same pattern is smaller than 1:1000., Conclusions: It can be concluded that the introduced grid system approach can be an appropriate simple and non-costly tool for the analysis of the pattern of hand veins for identification purposes., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This study of attrition compares the prosecution of child sexual offenses reported while the complainant was still a child with those in which the report was delayed into adulthood; it also compares matters involving adult and young (under 18 years) suspects/defendants. It is based on an analysis of police and court administrative data in New South Wales, Australia over a 14-year period (2003-2016). Only one in five (21.6%) proceeded beyond the investigation stage. Criminal proceedings were more likely to commence when the alleged victim was 7-12 years old at the time of the incident, when the suspect was an adult and at least 10 years older than the victim, and also when the report to police was made when the victim was an adult. Just over half (55.5%) of the matters finalized in court resulted in a conviction. Cases in the higher courts were less likely to be dismissed and more likely to feature guilty pleas and convictions at trial than cases in the lower courts. The overall estimate is that only 12% of offenses reported to police resulted in a conviction, at a relatively stable rate over 14 years. These findings are consistent with those of comparable studies.

This viewpoint welcomes the recent announcement of the Government of Aotearoa/New Zealand to ban smoking in cars with children. However, it notes that the thorny issue of enforcement and punishment remains. Internationally there is a deficit on research on this issue. The experiences of the UK and Ireland are examined, where there was little or no enforcement of such laws, as well as a comparison with the State of Victoria in Australia, where the law was more robustly enforced. This viewpoint argues that enforcement is an important element in safeguarding the health and wellbeing of children., Competing Interests: Nil.

Competing Interests: Competing interests: NM is the Immediate Past-President of the UK Royal College of Paediatrics and Child Health and the President-Elect of the UK Medical Women’s Federation. NM is a member of the Nestle International Scientific Advisory Board; she accepts no personal financial remuneration for this role. In the last 5 years, NM has received research grants from the UK Medical Research Council, National Institute for Health Research, March of Dimes, British Heart Foundation, Westminster Medical School Research Trust, HCA International, Chiesi, Nestle, Prolacta Life Sciences, Shire Pharmaceuticals, Collaboration for Leadership in Applied Health Research and Care for Northwest London, Healthcare Quality Improvement Partnership, Bliss, NHS England and UK Department of Health; conference travel and accommodation from Chiesi, Nestle and Prolacta Life Sciences and speaker honoraria from Chiesi.

In this commentary, we highlight the US government's proposed changes to the Flores Settlement Agreement, a federal legal settlement from the 1990s that ensures that child welfare principles are applied to immigrant children.We describe how Flores should be understood as mitigating child trauma by ensuring a baseline standard of treatment of immigrant children. We outline how children experience trauma throughout the migration course and argue that the proposed changes decrease standards of care through indefinite child detention, separation, and delicensing immigrant child detention facilities.We draw on the Adverse Childhood Experiences Study to consider the effect these multiplying forms of trauma may have on children.

Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

Class action lawsuits have become an increasingly common way to facilitate institutional reform. The purpose of this article is to provide an introduction to social workers of child welfare reform by class action lawsuits and subsequent consent decrees. The authors provide an overview of class action lawsuits, with a focus on their role in implementing systematic change in the United States. They highlight consent decrees as a means of settling class action lawsuits. They illustrate the current state of the child welfare system and how child advocacy groups have used class action lawsuits to initiate reform. Authors provide two case examples of child welfare reform by consent decree and engage in comparative analysis to investigate similarities and differences in the two cases. Finally, they note implications for social work practice and education and provide recommendations to equip and train social workers involved in child welfare services., (© 2019 National Association of Social Workers.)

Introduction: In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives., Methods and Analysis: The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach., Ethics and Dissemination: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In February 2018, President Trump signed into law the Family First Prevention Act, legislation in the United States aimed at providing prevention services for families at risk of entering the child welfare system. The effectiveness of these prevention efforts is dependent on the formation of collaborative relationships between prevention-programs and child welfare., Objective: To identify factors that influence the ability of the Nurse-Family Partnership (NFP) and Child Protective Services (CPS) to collaborate in serving high-risk mothers and their children., Participants: 123 NFP, CPS workers, and community partners., Setting: Seven sites in the U.S. state of Colorado selected to include an array of community sizes, geographies, apparent levels of collaboration, and variations in internal structures and practices., Methods: Using an adapted grounded theory approach, we conducted semi-structured interviews with frontline NFP and CPS workers and supervisors. Interviews were recorded, transcribed, validated, and coded in NVivo 10., Results: Alignment of core organizational mission and methods was key in determining collaboration levels between NFP and CPS. Only when workers perceived there to be alignment in organizational mission, did other factors such as program eligibility, communication channels, and risk and safety assessment practices influence the perceived benefits and efforts undertaken to enhance collaboration., Conclusions: High-risk families frequently require services that go beyond the scope of any one organization. As programs that serve high-risk families refine their efforts to serve them effectively, collaborative efforts should focus on examining opportunities and challenges involved in creating greater mission alignment., (Copyright © 2019. Published by Elsevier Ltd.)

There is a large child work force in India reported to be about 40 million. Child labor is being regarded as a form of modern slavery, as children are forced to work or have no choice to refuse work. Children are employed in a variety of occupations, many of which are hazardous. Exposure to machinery, pesticides, dust in agricultural work and fumes, chemicals, acids, cotton and wool fiber in other forms of work is detrimental to health. A large number are held in bonded servitude. In urban areas, children are employed as domestic helpers and engaged in eateries and auto-repair work. Trafficking and trading of children for work and sexual slavery are also major concerns. Poverty and illiteracy are root causes of child labor, but iniquitous societal attitudes are responsible for abuse and exploitation. Working children are deprived of proper health care and education, and lose their childhood and dignity. Several legal measures exist to prevent child labor and protect them from harm, but are thwarted by the distressing socioeconomic conditions. Although child labor would be difficult to abolish, exploitation can be prevented with concerted efforts of the government agencies, professional bodies and the civil society.

Child pornography on the internet is one of the crimes with highest increasing incidence worldwide. In this specific type of crime, the victim's age has important legal implications. To overcome the lack of scientifically established protocols, European researchers explored and proposed a set of facial proportions obtained from images to estimate age. Within a validation scope, the present study aimed to test the applicability of morphological proportions from frontal photographs of the face to estimate age in a Brazilian population. Standardized frontal view photographs from 800 Brazilians (400 females and 400 males) homogeneously distributed in 4 age groups (6, 10, 14 and 18 years ± 30 days) were randomly selected from a Civilian Database of the Brazilian Federal Police. The selected images were analyzed with the aid of cephalometric landmarks. After landmarking the photographs, eighteen metric relations pre-established by Cattaneo et al. (C. Cattaneo, Z. Obertová, M. Ratnayake, L. Marasciuolo, J. Tutkuviene, P. Poppa, D. Gibelli, P. Gabriel, S. Ritz-Timme, Can facial proportions taken from images be of use for ageing in cases of suspected child pornography? A pilot study, Int. J. Leg. Med. 126 2012 139-144) were assessed and analyzed through parametric statistical tests and discriminant analysis. Two indexes had a moderate correlation with age, while ten had a weak correlation and six were not correlated with age. Eleven indexes were statistically different between sexes (p < 0.05). The discriminant analysis showed that 49.6% of the pooled sample was correctly classified into the respective age group. This percentage increased when each sex was analyzed separately: 50.2% for females and 53.5% for males. The set of facial proportions from frontal images proposed by Cattaneo et al. (2012) is related to facial development. As expected, the discriminant power of this approach did not reach optimal effectiveness in the Brazilian sample. In practice, this age estimation method must be adapted for more reliable application in Brazilians., (Copyright © 2019 Elsevier B.V. All rights reserved.)