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More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children's health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018-2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need-income assistance, health insurance, housing, and food assistance-at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

Childhood and adolescent/young adult (AYA) cancer survivors experience poor health outcomes in adulthood. Adverse Childhood Experiences (ACEs) also portend poor health outcomes for the general population. Resilience can mitigate effects of ACEs. We examined the feasibility of assessing ACEs and resilience in childhood/AYA cancer patients. We also described occurrences of ACEs, resilience, and poor health outcomes. Of 52 participants, most rated their study experience favorably, with privacy in answering sensitive questions. Half reported ACEs, and those with ACEs had lower resilience, X(2)(3,N=52)=9.4,p=0.02. Further investigations of ACEs and resilience in larger cohorts are warranted to delineate associations with long-term health outcomes.

Background Communities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, collective impact (CI) has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality. | Methods. A web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement with six items assessing CI foundation from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means. Qualitative data were analyzed using thematic analysis, an inductive approach, stratified analyses, and co-interpretation. Results. Fifty-eight participants completed the survey, and 21 participated in interviews (n = 12) and focus groups (n = 9). Survey means were highest related to initiative commitment, and lower regarding shared ownership, having multiple perspectives and voices, and adequate resources. Qualitative results indicated the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging community assets that characterizes CI and the current framework. Counties used unique engagement and visibility strategies including mural projects and book clubs. Participants reported communication challenges across sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, contrasting previous CI research. Conclusion. Multiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Results suggest that efforts to launch CI to address SDOH, which are by nature multi-sector, should include robust communication support for local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and collective efficacy that may portend sustainability; however, relying on volunteers threatens sustainability.

Childhood and adolescent/young adult (AYA) cancer survivors experience poor health outcomes in adulthood. Adverse Childhood Experiences (ACEs) also portend poor health outcomes for the general population. Resilience can mitigate effects of ACEs. We examined the feasibility of assessing ACEs and resilience in childhood/AYA cancer patients. We also described occurrences of ACEs, resilience, and poor health outcomes. Of 52 participants, most rated their study experience favorably, with privacy in answering sensitive questions. Half reported ACEs, and those with ACEs had lower resilience, X(3,N=52)=9.39, p=0.02. Further investigations of ACEs and resilience in larger cohorts are warranted to delineate associations with long-term health outcomes.

Purpose: Toxic stress has been identified as a key mechanism by which poverty impacts health and empirical evidence on the relationship between poverty and biological markers of toxic stress is acc...

Background Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

BackgroundHealth care administrators must promote effective partnerships with community agencies to address social determinants of health, including reducing exposure to chronic stress in early childhood. Important targets for mitigating “toxic” levels of young child exposures are through reducing parents’ experiences of chronic stress as well as protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when parents and children are exposed to early life adversity is a first step; bringing in or referring out families to needed support services is an essential component. This paper describes a multi-modal investigation of health care systems innovations to engage and support parents to prevent and mitigate children’s toxic stress exposures through pediatric primary care and community services partnerships.MethodsKey study features include: 1) multi-component, multi-site study in five U.S. communities of pediatric health care clinics and the families they serve, 2) a developmental evaluation approach that describes how systems innovations are experienced over time at three levels (community systems, pediatric providers, and families), and 3) rapid cycle feedback in partnership with communities, clinics and families to co-interpret data and findings. The methodology includes: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, and 3) clinic-recruitment of 908 parents of newborns in a longitudinal survey.ResultsThe sample is briefly characterized based on responses to the enrollment phase of the parent survey.ConclusionsWe discuss the study design elements’ contribution to generate evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations.

Adverse childhood experiences (ACEs) contribute to public health concerns, as they have been linked to chronic diseases in adulthood. From the seminal ACEs study in the mid-1990s (Felitti et al., 1998) to today, the Centers for Disease Control (2016) reports well over 50 studies that link ACEs to adult health conditions such as cancer, heart disease, lung disease, and mental illness. This preponderance of evidence has prompted widespread attention to the possibility that preventing and successfully treating ACE-associated traumatic stress would greatly reduce our country’s incidence of chronic disease and the associated public health burden and cost (Danese et al., 2009). To illustrate, one study suggests that child abuse and neglect alone costs the United States $124 billion annually, with individual lifetime costs that are higher than or equal to the economic burden of diabetes and stroke (Fang, Brown, Florence, & Mercy, 2012). That child maltreatment is just one category of 10 total ACEs sugges...

This study investigates the reliability and construct validity of the Functional Impact of Toxic Stress for Parents (FITS-P) measure in an online crowdsourced pilot sample (n = 202) and a pediatric clinic sample (n = 889). The objective of the FITS-P is to provide a low burden (i.e., four items) measure for capturing aspects of the parental side of the toxic stress equation, specifically defining toxic stress as being severe enough to go beyond feelings of overwhelm to functional impairment in major domains of life. Patterns of item endorsement were analyzed in both samples, and construct validity was assessed in the clinic sample in relation to a series of measures of parental stress and psychological resources also administered to parents. Overall, analyses supported reliability and validity, and suggest utility of this new measure. Most importantly, it was found that only a single FITS-P item endorsed was sufficient to produce a significant increase in risk for most of the construct validity measures. This suggests that, as hoped, functional impact may capture parental variance in the toxic stress constellation more efficiently and effectively than typical methods such as life event stress, adverse childhood experiences, or perceived stressfulness of only the parenting role. Results are discussed in terms of the promise of the FITS-P as a low-burden assessment that can be used in two-generational approaches to ameliorating toxic stress.

Background and Aims: Childhood and adolescent/young adult (AYA) cancer survivors are at increased risk for emotional distress, chronic health conditions, and premature mortality compared to peers with no cancer history. Some, but not all, of this increased risk is explained by cancer- and treatment-related exposures. Because cancer treatment remains necessary to achieve cure, it is critical to identify and target other factors to reduce sub-optimal outcomes. Adverse Childhood Experiences (ACEs) are traumatic events occurring during childhood, such as experiencing violence and/or neglect, which are associated with poor mental health, chronic health conditions, and premature mortality in the adult general population. Little is known on how ACEs impact health in children and AYAs with cancer. Research indicates that otherwise healthy individuals exposed to ACEs experience fewer adverse health outcomes if they possess resilience, which can be learned. This provides a potential target for intervention. This pilot study aimed to identify demographic characteristics associated with ACEs and resilience as well as associations between ACEs, resilience, and the presence of chronic medical conditions, mental health issues, and substance abuse in children and AYAs with cancer. Methods: Childhood and AYA leukemia and lymphoma patients undergoing cancer treatment at the University of Chicago were included for analysis (N=38, 55.26% female, 50% non-Hispanic white, mean age at assessment 14.74±6.97 years). Participants ≤17 years old completed the study with one parent/caregiver. ACEs were measured using age-specific instruments adapted from the original ACEs study by Kaiser Permanente and the Centers for Disease Control and Prevention. Resilience was analyzed using age-specific instruments provided by the Resilience Research Centre, and resilience scores were categorized as low (≤62), moderate (63-70), high (71-76), and exceptional (≥77). For participants 0-11 years old, a parent/guardian completed the study on their behalf. 12-17 year old participants and their parent/guardian both completed the study, and participants over 18 completed the study alone. Descriptive statistics characterized demographic, biologic, treatment, and health behavior variables. The association between total scores for ACEs and resilience were measured using Pearson's correlation. Regression analysis assessed ACEs (logistic model) and resilience scores (linear model) adjusting for age, sex, race/ethnicity, household income, and insurance type. Participants were then stratified, and two sample t-tests compared potential outcomes based on ACE exposures. Results: 23 participants (60.53%) reported prior ACEs (mean total number of ACEs 1.45±1.77; range 1-7), and the mean resilience score for participants was 73.76±9.61 (range 49-85) indicating high resilience overall. Regression analyses showed the odds of reporting ACEs increased with age (OR: 1.18; 95% CI: 1.02-1.37), while resilience scores decreased with age (β=0.76; t(32)=-2.74, p=0.01) holding other variables constant. Sex, race/ethnicity, household income, and insurance type were not associated with ACEs or resilience scores. There was a strong negative correlation between the total number of ACEs and resilience, r(36)=-0.57, p Conclusions: ACEs were associated with endorsement of chronic medical conditions, mental health issues, and substance abuse in our sample of childhood and AYA patients currently receiving cancer treatment. As the total number of ACEs increased, resilience scores decreased for participants. The results of this study provide the groundwork for further investigations of ACEs and resilience in large cohorts of childhood and AYA cancer patients and survivors. This future work could provide valuable information for creating and implementing interventions designed for childhood and AYA cancer patients and survivors who have experienced ACEs, thus potentially reducing additional morbidity and premature mortality for these high-risk patients. Disclosures No relevant conflicts of interest to declare.

Purpose: The Child Abuse Prevention and Treatment Act requires child welfare agencies to have provisions in place to refer young children to early intervention services, yet the socioemotional health needs of children are often challenging to recognize and treat effectively. This study reviews the substantive and psychometric properties of screening instruments designed for children ages 10 and younger. Methods: Major social science databases, websites of national organizations, and the Mental Measurements Yearbook were used to identify instruments for review. Results: Twenty-four instruments met review criteria, and eight show above-average measurement properties and testing, tap children’s strengths and concerns, and have evidence of validity with families similar to child welfare–involved families. Discussion: It is important to effectively screen for children showing concerns in early childhood, so that treatment and prevention can be prioritized. This study indicated several tools with adequate testing and with emerging evidence and applicability to child welfare.

Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare-involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare.

Objective To identify the clustering of adverse childhood experiences (ACEs) that best characterize child welfare-involved children with known complex health concerns. Data source Multi-informant data were obtained from Wave I of the National Survey of Child and Adolescent Well-Being (NSCAW II). Study design This study used a cross-sectional design and classification and regression tree (CART) analyses. Data collection Data were collected from families with children, aged birth to 17, investigated for child maltreatment and their child protective services caseworkers, including demographic characteristics of the children, their histories of adversity, and a wide range of health concerns. Principal findings Results indicate that for children between the ages of six and 17, experiences of physical abuse alone, as well as experiences of physical abuse combined with having a caregiver with mental illness, are most strongly associated with complex health concerns. For children aged 2-5 years, results suggest that caregiver mental illness is a key adverse experience associated with complex health concerns. Conclusions Identifying specific combinations of ACEs may be a critical next step for child- and youth-serving agencies to allow providers to better calculate risk of health problems among children exposed to adversity.

Supervisors play a vital role in workplace productivity and organizational health, and are at the forefront of improving the capacity of the child welfare workforce. Yet there is limited research about their organizational longevity and satisfaction compared with child welfare caseworkers. This study uses data from 85% of supervisors statewide in a child welfare organization to describe intent to leave, supervision provided and received, and job qualities. Questions are: (1) what are the personal and job qualities of child welfare supervisors? (2) To what extent do supervisors report receiving and providing supervision, and (3) what personal and job qualities predict intent to leave among supervisors? Using bivariate and multivariate analyses, results showed that supervisors who receive more frequent supervision report lower levels of job stress and time pressure and more positive perceptions of organization leadership. These supervisors also reported providing more supervision to caseworkers. Greater time pressure predicted intent to leave among supervisors, indicating that there is an important balance between workload and resources in efforts to maintain quality supervisors.

To identify the clustering of adverse childhood experiences (ACEs) that best characterize child welfare-involved children with known complex health concerns.Multi-informant data were obtained from Wave I of the National Survey of Child and Adolescent Well-Being (NSCAW II).This study used a cross-sectional design and classification and regression tree (CART) analyses.Data were collected from families with children, aged birth to 17, investigated for child maltreatment and their child protective services caseworkers, including demographic characteristics of the children, their histories of adversity, and a wide range of health concerns.Results indicate that for children between the ages of six and 17, experiences of physical abuse alone, as well as experiences of physical abuse combined with having a caregiver with mental illness, are most strongly associated with complex health concerns. For children aged 2-5 years, results suggest that caregiver mental illness is a key adverse experience associated with complex health concerns.Identifying specific combinations of ACEs may be a critical next step for child- and youth-serving agencies to allow providers to better calculate risk of health problems among children exposed to adversity.

Custodial grandparenting can be especially challenging for older grandmothers facing age specific issues. Kinship navigator programs are social service delivery programs intended to inform grandparents and other relatives raising children about available resources and services, provide information specific to their individual needs, and help families navigate service systems. Our study utilizes self-report data from one kinship navigator federal demonstration project, which used a randomized control trial, to examine demographic characteristics for grandmothers under and over 55 years of age, whether grandmother caregivers (≥55 years) improve family resilience, social support, and caregiver self-efficacy, and which interventions improved outcomes for grandmothers (≥55 years). Each participant was randomly assigned to one of four groups: Usual Care (traditional child welfare services), Standard Care (family support and case management), Peer-to-Peer Care Only, and Full Kin Tech Care (peer navigators with computer access and interdisciplinary team). Thirty-nine percent of grandmothers (55-75 years) were mostly living in poverty, predominantly Caucasian, with 36% identifying as African American/Black, with at least one to two children at home. Repeated-measures ANOVAs for each subscale showed statistically significant within- and between-group differences for Family Functioning, Social Supports, Concrete Supports, Child Development, and Nurturing and Attachment, with the exception of Usual Care, which showed a decline in protective factors consistently across subscales. Future research with kinship families could qualitatively examine the experiences for older women in navigator programs and replication of kinship navigator programs could build capacity in data collection and maintenance systems to gain better perspective about how systems of care impact families.

This study introduces a new measure that assesses the extent of organizational change tactics usage within a human service organization. The Organizational Change Tactics Questionnaire (OCTQ) was developed based on a comprehensive review of effective organizational change tactics and adapted to the unique needs of human service organizations. This study presents the psychometric properties of the OCTQ using the tool with 13 large child welfare organizations experiencing organizational change. Respondents who saw a greater use of change tactics and those who were more involved with the change process were significantly more likely to perceive the change process as successful.

Head Start is a preschool program for families with low incomes and nearly 85% of child welfare-involved families are low-income, yet little is known about Head Start and child welfare collaboration. This study uses data from 28 Head Start directors to describe collaboration facilitators and barriers, and collaborative mechanisms in place. The mixed-methods study used data from a statewide survey and focus groups. Quantitative analysis used descriptive means and proportions. Qualitative analysis used a general inductive approach. Results show that nearly all Head Start programs prioritise enrollment for child welfare-involved children and know about foster care placement, but lack memoranda of understanding (50%), co-located staff (14%) and policies concerning joint service planning (9%). Directors report that Head Start staff need more support, including making referrals to child welfare. Cross-training, shared case planning, and streamlined processes could help move the organisations further along the d...

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N = 5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.

This study views the extent to which staff buy-in for an organizational innovation in child welfare (CW) relates to implementation progress. The study occurs during implementation of a statewide practice model that was supported with technical assistance from the Mountains and Plains Child Welfare Implementation Center (MPCWIC) and framed around the National Implementation Research Network model. Mixed methods were used to address three study questions: (1) what is the level and nature of buy-in related to the innovation? (2) does buy-in vary according to staff characteristics, and (3) what is the relationship between buy-in, local level agency readiness, and implementation status one year after project start? Survey data were collected from 568 CW staff in 13 local county agencies and 12 implementation specialists assigned as coaches. Focus groups and interviews were conducted with 52 staff in four agencies. Bivariate chi-square analyses and multivariate regression using a cumulative logit model showed that buy-in was related to gender and agency tenure. Implementation progress was higher among smaller agencies, and agencies with lower levels of job stress. Qualitative themes centered on staff inclusivity in project design, communication, and supervisor support. Findings highlight the need to adapt implementation strategies in urban and rural locales, and to attend strongly to staff selection, supervision, and inclusion during implementation. Addressing job stress may help bolster implementation.

This article describes a new measure designed to examine the process of implementation of child welfare systems change. The measure was developed to document the status of the interventions and strategies that are being implemented and the drivers that are being installed to achieve sustainable changes in systems. The measure was used in a Children's Bureau-supported national effort to assess the ongoing implementation of 24 systems-change projects in child welfare jurisdictions across the country. The article describes the process for measure development, method of administration and data collection, and quantitative and qualitative findings.

Many young children investigated for maltreatment have developmental problems qualifying them for early intervention services, yet only a portion of these children receive such services. To address this gap, all children ages 0–3 with child welfare (CW) substantiated maltreatment in Pennsylvania are screened for developmental and socioemotional problems using the Ages and Stages Questionnaires (ASQ). This study views screening results for over 500 children to address whether children's substantiation status, living situation, and administering worker as CW or early intervention (EI) predicts screening rates. Bivariate and logistic regression analyses were used. Results showed that 22% of children scored in the problem-range of at least one developmental area and 18% scored in the problem-range of social–emotional concerns warranting EI referral. Results of bivariate analyses showed that children who spent time in the NICU were more likely to have developmental concerns. Socioemotional concerns were related to child race, foster care living situation, child as the subject of the referral, and physical neglect. Older children and children whose referral involved lacking basic needs showed both developmental and socioemotional concerns. There were no significant differences in screening results of children with substantiated versus unsubstantiated maltreatment. Children whose screening was conducted by EI were more than three times as likely to show developmental concerns compared with those screened by CW. Child welfare workers need more support when conducting developmental screening, and policies that limit screening to children with substantiated maltreatment or to children in out-of-home care should be reconsidered.

In the USA, African-American children are overrepresented in the child welfare system. However, little is known about the child welfare system experiences of biracial children, who are predominately both White and African-American. To better understand this population, data from public child welfare in a US county were used to examine biracial children in the child welfare system. Results showed significant racial differences between children in the child welfare system. Despite the common belief that biracial children will have experiences similar to African-American children, the child welfare system seems to view them differently. Biracial children are more likely to be referred, rated as high risk and investigated compared with White or African-American children. Their mothers were younger, and were more often assessed as having physical, intellectual or emotional problems. These caregivers were also considered to have lower parenting skills and knowledge compared with White or African-American caregivers. Although the disproportionate representation of African-American children in the system has been well documented, this study provides evidence that biracial children are also overrepresented. Despite the fact that this is a rapidly growing population in the USA, there is little research available about biracial children and their families.

This study examined Family Group Decision Making (FGDM) among a nationally representative sample of African-American and White children investigated for maltreatment in the US. While FGDM was developed for work with ethnic minority families, there is no research on how this is being carried out in the US, where African-American children are overrepresented in child welfare services. The study views racial differences in child, caregiver and maltreatment characteristics related to FGDM; composition of FGDM meetings; service referrals and receipt; and service satisfaction. Data are from the National Survey of Child and Adolescent Well-being (NSCAW), a study of 5501 children ages 0–14. Current analyses include African-American and White children (n= 4129). Stratified, bivariate and multivariate regression analyses were used. Results showed that while race was not related FGDM receipt, different characteristics lead to FGDM among African-American and White families. Surprisingly, caregivers report feeling no more involved in decision-making in association with FGDM. FGDM is provided at low rates overall (10%) and less frequently among White caseworkers. Child access to mental health services increases in relation to FGDM. Implications are discussed.

Examination of a nationally representative, longitudinal study of infants and toddlers investigated for maltreatment reveals disproportionate representation of teen mothers, fair/poor health, poverty, and being African-American. Infants are more likely to have special needs reported, subst`ance abusing caregivers, low-quality home environment, out-of-home placement, physical neglect, and substantiated maltreatment. At school-age, approximately one-fifth of all investigated infants and toddlers have an Individualized Education Program (IEP), indicating special education placement. Early characteristics associated with having an IEP include poverty, boys, fair/poor health, and low language scores. Hispanic children and those investigated for physical or sexual abuse were less likely to have an IEP. At school-age, infants had lower Woodcock–Johnson-III math subtests scores, whereas toddlers had lower reading comprehension performance.

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.

National estimates of characteristics of maltreated infants and report of an Individualized Family Service Plan (IFSP) and an Individualized Education Plan (IEP) 54 months later are presented. The study was based on 1,196 infants from the National Survey of Child and Adolescent Well-Being. Measures of neurodevelopment, language, and cognition were collected at baseline. In addition, measures of child behavior and social functioning were collected 54 months later. Caregiver mental health, substance abuse, domestic violence, home environment, and aspects of maltreatment were examined. Nearly one third were reported to have an IFSP. Descriptors of maltreatment were associated with having an IFSP. Approximately 54 months later, 20% were reported to have an IEP. IEP was not related to maltreatment but was related to being male or having a caregiver with cognitive impairment. Having a caregiver with mental illness reduced the likelihood of having an IEP. Findings highlight the need to reconsider criterion for Part C referral.

Child welfare agencies are required to provide services that ensure that children receive adequate mental health care. This study provides a comprehensive view of the emotional and behavioral problems of children who are referred to child welfare services, using nationally representative data. Bivariate analyses compare rates by child demographics, and conditional probability tables present changes in clinical status. Results show that 62% of children have at least one clinical-level score over 3 years. Rates are highest at baseline. Posttraumatic stress most frequently improves, whereas thought, attention, and aggressive/ delinquent behavior problems are most persistent. Sexualized behavior is more common among White and Hispanic children, and boys are reported with more internalizing problems than do girls. Targeted services are needed for young children who experience posttraumatic stress, as is treatment for attention problems that accounts for both biological and environmental components. Distinguishing the effects of age, environment, and assessment methods on boys' internalizing problems is also critical.

This article presents propensity score matching as a method to implement randomized conditions to analyze service effects using nonexperimental data. Most social work research is challenged to implement randomized clinical trials, whereas administrative and survey data are often available and can provide valuable information about services received under naturalistic conditions. This article discusses the assumptions of this method and the analytic steps involved; and it presents three examples of the approach, demonstrating that it is possible to approximate the conditions of a randomized controlled trial, and when selection bias is reduced, investigators can have more confidence in their findings.

Objective: This study tests the hypothesis that information typically collected during a maltreatment investigation can be used to screen children for mental health problems. Method: Data are from the National Survey of Child and Adolescent Well-Being. Cumulative risk scores were created for 3,022 children and compared to reports of clinical-level problems using standardized measures. Bivariate, multivariate, and sensitivity analyses were used. Results: Cumulative risk showed 73% sensitivity to identify children with mental health concerns and 52% specificity to identify children without such concerns. Comparatively, child welfare worker indications showed 48% sensitivity and 78% specificity. Conclusions: Investigative information could serve the dual purpose of screening children for mental health problems, having the potential for benefit and cost avoidance.

Using three waves of data from the National Survey of Child and Adolescent Well-Being, this study examines differences in cognitive, academic, and affective well-being of youth first placed in nonkinship foster care (N = 259) and youth first placed in group care (N = 89). To compare nonrandomized groups, propensity score matching was used. Results from hierarchical linear modeling suggest that both groups of youth show improved behavior and below-average academics over time.

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates children's psychological symptoms and child welfare service (CWS) patterns to understand how children's needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to children's needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed.