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Research Watch

Research Watch, a periodical review of research articles published in the leading child welfare journals, is a joint initiative of the Canadian Child Welfare Research Portal (CWRP) and the CRCF. Faculty and graduate students from the Universities of McGill and Toronto meet on a monthly basis to review recently published child welfare studies. The most relevant and well-designed studies are summarized and disseminated through the CWRP's list of over 2,500 subscribers across Canada.

For any PhD student at McGill potentially interested in joining the Research Watch team or to receive more information, please contact jaime [dot] wegner-lohin [at] mail [dot] mcgill [dot] ca (Jaime Wegner-Lohin). To join the CWRP mailing list and receive all the latest updates from Research Watch, visit the CWRP subscriber page.

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The articles listed below can be accessed through the corresponding journal website or accessed at a local library or university.

20 November 2014

Understanding child welfare staff buy-in of organizational change

Source: McCrae, J.S., Scannapieco, M., Leake. R., Potter, C.C., Menefee, D. (2014). Who's on board? Child welfare worker reports of buy-in and readiness for organizational change. Children and Youth Services Review, 37, 28-35. doi: http://dx.doi.org/10.1016/j.childyouth.2013.12.001.

Reviewed by: Denise Michelle Brend

Introducing change throughout large child welfare networks comprised of diverse points of service poses many challenges. This mixed method study investigated how the process of implementing change impacted staff buy-in, following the implementation of a new statewide practice model in the Rocky Mountain region of the U.S. The researchers were interested in: the level and nature of buy-in in the context of a new set of standard child welfare practice, values, and protocols; how buy-in varied according to staff characteristics; and the relationship between buy-in, the readiness of local agencies, and the status of the implementation one year following the changes. Survey data were collected from 568 child welfare staff in 13 local agencies (58% response rate) in one U.S. state. Baseline data came from the first round of agencies that implemented the organizational changes. From the participating agencies, four were randomly selected for the qualitative portion of the study. Twenty-two qualitative data gathering sessions occurred with this subset, including case study interviews, focus groups, and individual interviews. Finally, one year after the initial quantitative data collection and concurrent to the qualitative data collection, 12 implementation specialists were assigned to rate the status of implementation in all agencies through a follow-up survey at 12 months.

The use of a statewide framework and consensus-building model proved successful. Workers seemed motivated by participatory decision-making and transparent methods of communication. Workers’ supervisors were also shown to powerfully effect worker buy-in. Being female and newer to the job showed negative impacts and larger organizations posed particular challenges not seen in small to medium sized organizations. This study also found that buy-in was not a “driving factor in implementation” rather manageable job stress hastened the process and high job stress created an obstacle to implementation. Individual workers appeared to weigh participating in change processes against the demands of their caseloads.

Methodological notes:

Multiple measures were used to obtain the survey data in the quantitative component of this study. Selections from the Comprehensive Organizational Health Assessment (COHA) were used to measure organizational factors believed to relate to successful change and leadership. An adapted version of the job stress subscale of the Organizational Readiness for Change (ORC) addressed job stress and the Implementation Process Measure (IPM), designed to capture the process of implementing change in child welfare systems, was also applied. Buy-in was captured using four items developed for the project. Qualitative data was gathered using a standard interview guide focusing on three content areas: workers initial reactions to change, what they experienced and needed throughout the process and the impact of the changes upon the agency. Additional probes to elicit data concerning buy-in were also included.

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4 November 2014

Neighborhood ratings by caregivers in child welfare cases: Social order and social capital

Source: Abner, K.S. (2013). Dimensions of structural disadvantage: A latent class analysis of a neighborhood measure in child welfare data. Journal of Social Service Research, 1-14.

Reviewed by: Sydney Duder

Recent studies have shown the importance of community factors—especially poverty levels—as predictors of child abuse and neglect. Previous work has largely been based on census tract-level indicators, which make it hard to identify specific community risk factors; this present study takes an entirely different approach. Data are individual caregivers’ responses to the Community Environment Scale (CES) from the first wave of the National Survey of Child and Adolescent Wellbeing-II (NSCAW-II); this scale provides measures of two concepts; social order (crime and safety) and social capital (neighbourliness). Latent class analysis (LCA) of these CES responses was used to divide the total NSCAW-II sample (N = 5,872) into three groups:

Class 1: High social order/medium social capital (n = 2055) Class 2: High social order/low social capital (n = 2801) Class 3: Low social order/low social capital (n = 1016).

Multinomial logistic regression was then used to examine the relationships between class membership and a set of “covariates” (family and caregiver characteristics from the NSCAW-II). Many of these covariates were found to significantly predict class membership; results were generally consistent with earlier studies: (a) poor and minority group caregivers were significantly overrepresented in Classes 2 and 3—that is, these caregivers rated their neighbourhoods as having low social capital, suggesting the possibility that social capital might be the link between community poverty level and child neglect; (b) the risk of physical abuse was significantly higher for Class 3 than for Class 2, suggesting a possible link between social order and child maltreatment.

The author points out that future work is needed to understand additional possible risk factors, and goes on to make a number of useful suggestions for developing neighbourhood-based interventions for possible preventive work in communities.

Methodological notes:

Data were based on the abridged 9-item version of the CES, all items calling for 3-category Likert-type responses: 5 social order items (how big a problem?) and 4 social capital items (how does your neighbourhood compare to others?). A program called Latent Gold was used for the LCA of the responses; 1-class through 10-class solutions were calculated, and the 3-class solution chosen, based on model interpretability and parsimony. A parallel analysis of the subsample of permanent caregivers was also done, but only the results for the full NSCAW-II sample are reported. Separate multinomial logit regressions were done for each set of covariates. Multiple imputation (Stata 12) was used to replace missing values for all variables.

In this study, the main emphasis was on the LCA; the logistic regression was presented mainly as a way to “validate” the resulting grouping of subjects. However, the most potentially useful result seems to have been the identification of social capital as a possible link between community poverty and child maltreatment. Though the study was generally well conducted, this was a rather elaborate way of getting there. An alternative might have been to omit the LCA completely, and simply correlate individual caregivers’ CES scores with the set of covariates.

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7 October 2014

Teen birth rates of those who have experienced substantiated maltreatment

Source: Noll, J., & Shenk, C. (2013). Teen Birth Rates in Sexually Abused and Neglected Females. Pediatrics. 131(4), 1181 – 1187.

Reviewed by: Rachael Lefebvre and Wendy Rha

Although recent years have seen a decline in the US teen birthrate, it remains the highest amongst industrialized nations. This prospective, longitudinal cohort study, conducted from 2007 to 2012, examined whether experiencing maltreatment placed females at higher risk for teen childbirth.

Adolescent females (aged 14 to 17) who had never given birth to a child and experienced substantiated maltreatment in the previous 12 months were recruited from local child welfare agencies in the catchment area of a large urban children’s hospital in the Midwest region of the United States. Comparison females, matched on race, age, family income, and family constellation (single vs. two parent households) were recruited from an outpatient health center located within the hospital. Participants were assessed annually through to the age of 19 years. Teen childbirth was measured via self-report and births were confirmed using hospital delivery records. During the course of the study, if a participant in the comparison group reported maltreatment (which was confirmed using child welfare records), they were excluded from the final analyses. The final sample consisted of 435 female adolescents (266 maltreated, 169 comparison) which was a 97.5% retention rate.

During the course of the study, a total of 70 participants gave birth (54 in the maltreated group and 16 in the comparison group). Logistic regression was used reflect the degree of risk for teen childbirth associated with maltreatment. Maltreated females were twice as likely to experience teen childbirth after controlling for age (at study entry), family income level, minority status, degree of sexual activity, and contraceptive use. The examination of whether specific subtypes of maltreatment predicted teen birth rates were also assessed. After controlling for previously identified risk factors and any previous occurrences of maltreatment, sexual abuse and neglect at study entry were found to significantly increase the odds of a subsequent teen childbirth by 2.74 fold and 3.14 fold, respectively.

Methodological notes:

This study has much methodological strength, which includes its prospective cohort design, a demographically matched comparison group, use of child welfare services substantiation of maltreatment (to enhance fidelity of group membership), and use of medical records to confirm childbirths. Moreover, the use of risk factors for teen births common in the general population as control variables also contributes to the rigor of the study.

Despite its methodological strengths, the study also has its limitations. The authors indicated that in many cases, adolescents had experienced multiple maltreatment types yet were categorized based on a “primary designation”. Moreover, only substantiated cases of maltreatment were considered. The authors also noted that their findings could not be generalized to the Hispanic ethno-racial group, as Hispanic adolescents were not well represented in the study. Lastly, the study focused on the outcome of teen child birth, and thus did not consider other pregnancy outcomes such as abortion or miscarriage.

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15 September 2014

Child maltreatment increased by both poverty and income inequality

Source: Eckenrode, J., Smith, E.G., McCarthy, M.E., & Dineen, M. (2014). Income inequality and child maltreatment in the United States. Pediatrics, 133 (3), 454-461.

Reviewed by: Sydney Duder

Recent studies have shown the importance of community factors—especially poverty levels—as predictors of child abuse and neglect; this current national study appears to be the first attempt to examine the added effect of income inequality. The unit of analysis here was county (N = 2877); data were annual rates, averaged over five years (2005–2009), for the following variables:

  • Child maltreatment rate (substantiated reports per 1,000 children): Data from the US Children’s Bureau, National Child Abuse and Neglect Data System (NCANDS), collected annually from state child welfare systems.
  • Poverty level (percentage of children living at or below federal poverty line): Data from the US Census Bureau, American Community Survey (ACS).
  • Income inequality (Gini coefficient, where 0 = perfect equality, and 1 = perfect inequality; a single individual has all the income): Data also from ACS.

Bivariate correlations between these three variables were all positive and highly significant; the correlation between poverty and child maltreatment was consistent with earlier studies. Nonparametric regression modelling was used to predict child maltreatment rate from poverty level and income inequality, controlling for possible confounding variables (ethnicity, education, public assistance income & infant death rate). Income inequality was found to be significantly associated with child maltreatment rates at all poverty levels, but the effect was greater at higher levels of poverty.

The authors state that these findings contribute to the growing literature linking greater income inequality to a range of poor health and well-being outcomes in infants and children. They cite evidence that inequality effects are generally larger for larger units of analysis (e.g., nations, states) and smaller for smaller units such as neighborhoods, where income is a stronger predictor.

Methodological notes:

The research appeared to be generally well-conducted, and the methods appropriate; a number of strategies were used to deal with various data problems. Because of differences in reporting practices in some states, 259 actual counties were combined into regions, or “statistically equivalent entities,” to give the total N of 2877. State child maltreatment rates varied widely, from 0.2% to 3.1%; state was included as a fixed effect in the analysis to control for this difference. A natural log transformation was used in the regression analysis to deal with a skewed distribution of county child maltreatment rates. Analysis was performed using the generalized additive model (GAM) in SAS—a flexible nonparametric regression-modelling technique.

Further research is clearly needed to determine how income inequality actually works. At a given poverty level, why should the mere presence of rich people make it more likely that children are maltreated? If this effect is really more common in larger geographic units, perhaps it reflects geographic subdivisions with different social climates (e.g., levels of social order or social capital). This might suggest avenues for possible future preventive work in communities.

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10 June 2014

Treatment foster care for improving outcomes in children and adolescents with complex needs

Source: Turner, W., and G. Macdonald (2011). "Treatment foster care for improving outcomes in children and young people: A systematic review." Research on Social Work Practice 21(5): 501-527.

Reviewed by: Julia Busch

This study examines the impact of treatment foster care (TFC) outcomes for children and adolescents living in out-of-home care in restrictive settings, or are at risk of such placement due to severe psychological, behavioural, social and/or medical problems. This study reviewed existing data from five studies to assess the usefulness of TFC as an intervention for psychosocial and behavioural outcomes, delinquency, placement stability, and discharge status for children/adolescents in the aforementioned placement setting.

The studies reviewed contained data collected from randomized controlled trials, with the majority of studies having randomized individual children. One study randomized foster caregivers rather than children; however the foster caregivers provided data about these children living with them at the time. Due to the variety of outcomes measured in the five studies, data on specific outcomes were only available from at most two studies, which limit the overall understanding of the effectiveness of TFC. For example, one study administered the Parent Daily Report Checklist over the phone at multiple time periods to measure the occurrence of problem behavioural symptoms in the child. This measure was not used by researchers in any of the other studies. However, the key finding from each study suggests that TFC may be a suitable intervention for children and adolescents with complex psychological, emotional, and behavioural needs, particularly those with conduct disorders and delinquency, who are at risk of placement settings that may restrict their opportunities for social inclusion.

This study examined TFC programs that provided different levels of service through multicomponent TFC, an intervention with multiple elements that support foster parents through training and daily supervision, individualize treatment plans for children and adolescents, and make case managers available 24 hours a day to both foster caregivers and biological parents (as appropriate). These programs also served varied populations. The studies assessed the effectiveness of multicomponent TFC with male and female youth at risk of arrest or incarceration and young people discharged from psychiatric hospitals, as well as less intensive TFC with abused/neglected children. Given the variance in TFC program structure and implementation, findings cannot be assumed applicable to all programs or populations.

Methodological notes:

All five studies reviewed originate from the United States, with the majority of participants identifying as Caucasian. The results, therefore, lack diversity in terms of participant ethnicity, and geographical and cultural contexts. Studies are currently underway in England, the United States, and Sweden, which may provide insight into the applicability of TFC in different cultural contexts. Due to the limited number of studies in the area of TFC, there is a need for further research to increase the evidence base. In the meantime, the authors recommend additional consideration of the effectiveness of TFC with children who are at risk of social exclusion due to medical conditions, learning or physical impairments. Finally, there has been little attention in the evidence base to the cost of programs and therefore, cost-benefit analyses for future programs and past data are recommended.

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7 April 2014

Child neglect: The importance of both family and community poverty levels

Source: Jonson-Reid, M., Drake, B., & Zhou, P. (2012). Neglect subtypes, race, and poverty: Individual, family, and service characteristics. Child Maltreatment 18(1) 30-41.

Reviewed by: Sydney Duder

This was a detailed analysis of the relationships between race, poverty, child neglect and initial child welfare response, with two particularly interesting features: 1) the simultaneous consideration of two levels of poverty—family poverty and community poverty, and 2) the comparison of seven subtypes of neglect. The sample comprised child abuse/neglect reports, for families first reported in 1993-94, that were investigated in a Midwestern metropolitan area; only children categorized as Black (N = 4,296) or White (N = 2,522) were included, as there were too few children in other racial groups.

A major finding was that the context of poverty for Black and White children was very different; Black children in the welfare system live in far poorer communities than White children. The authors argue that “the importance of this finding is substantial,” and that both the family and community levels of poverty should be considered in cases of maltreatment. The use of family poverty alone is likely to systematically understate the problems faced by Black children, which may also reflect community factors, such as resource availability and levels of social disorganization. Specific neglect categories reported for Black and White children also showed a number of significant differences—for example Black children were more commonly reported and substantiated for severe and basic needs neglect.

Much of the continuing analysis of racial disproportionality has focused on agency response to Black children. These current findings underline the importance of the effects of income and other risk factors, and the need to “focus policy on ameliorating such disparities in living conditions.” The authors also speculate that neglect categories “could potentially be turned into a checklist” to guide workers in selecting the most appropriate intervention.

Methodological notes:

All data were extracted from electronic information systems in state and regional agencies. Address data were geocoded to allow for the linkage of administrative records from multiple agencies to census data. Use or non-use of Aid to Families with Dependent Children (AFDC) served as a dichotomous proxy measure of family poverty; census tract data (median income, percentage below poverty and residential mobility) were used as measures of community poverty. This use of exclusively administrative data was in one sense a limitation; most child maltreatment events are not officially reported, so results cannot be generalized to the entire population of maltreated children.

In the analysis, Black and White children were treated as separate, parallel samples (Tables 2 & 3) as opposed to the more commonly-used procedure of treating race as a control variable in a single sample. Groups were compared for child, family and community characteristics by the use of standard bivariate procedures (crosstabs & chi-square, t-tests and one-way ANOVA). Logistic regressions, including control for clustering at the community level, were used to analyze possible predictors of agency action (substantiation, need for service). Overall, this analytical approach appeared to be appropriate and well-conducted.

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19 March 2014

Direct instruction tutoring program shows improvements in academic achievement for children in out-of-home care

Sources: Flynn, R.J., Marquis, R.A., Paquet, M.P., Peeke, L.M., & Aubry, T.D. (2012). Effects of individual direct-instruction tutoring on foster children’s academic skills: A randomized trial. Children and Youth Services Review, 34, 1183-1189. Harper, J. & Schmidt, F. (2012). Preliminary effects of a group-based tutoring program for children in long-term foster care. Children and Youth Services Review, 34, 1176-1182.

Reviewed by: Jaime Wegner-Lohin

Children in foster care are at increased risk of poor educational outcomes compared to their non-maltreated peers. A randomized control trial was conducted across nine child welfare organizations in Ontario to determine whether primary school age foster children’s post-test reading and math scores would improve as a result of an individualized direct-instruction tutoring intervention delivered by foster parents.

Flynn et al. (2012) evaluated the Teach Your Children Well (TYCW) tutoring program, with a total of 77 children placed in foster care, who were randomly assigned to the tutoring group (n=42) and the wait-list control group (n=35). Workers and supervisors nominated child-foster parent pairs, aged six to 13 in grades two to seven, as candidates for the study believed to be likely to benefit from tutoring from one foster parent. Children identified as being either a “very strong student”, a “very weak student” or “very behaviourally disturbed” were excluded from the study.

Academic achievement was measured at pre-test and post-test using the Wide Range Achievement Test (WRAT4), which measures word reading, sentence comprehension, spelling and math computation and yields a reading composite score. The foster parents in the intervention group were also required to report the number of lessons completed during the intervention year in reading, the number of weeks spent on reading and math tutoring, the average amount of time spent weekly on different components of the tutoring program, and their use of the tutoring supports made available to them during the school year.

Analysis was undertaken using ANCOVA, controlling for differences in pre-test scores, to determine whether the tutoring program contributed to improvements in academic achievement scores. Results indicated improvements in some areas of academic achievement for the tutoring group. Tutoring had a substantively important effect on reading composite scores that was significant at the level of a trend. In addition, a statistically significant relationship was found for both sentence comprehension and math computation. No significant effects were found for the tutoring program on either word reading or spelling.

Similarly, Harper & Schmidt (2012) conducted a separate randomized study of the same tutoring program, but replaced individual tutoring with small group instruction led by university student volunteers. The sample primarily consisted of Aboriginal children and used multi-level modeling to analyze the effects of the tutoring program on academic achievement scores. Unlike the results found by Flynn et al. (2012), the TWC tutoring program had a significant effect on word reading and spelling, but no significant effects were found on sentence comprehension and math computation. The inconsistencies in findings may be accounted for by a number of factors including the tutoring format used (individual vs. group) and differences in the implementation of the reading and math components of the program.

Overall, the findings of both studies indicate that the TYCW tutoring program may be an effective intervention to improve academic achievement for children in foster care. The small sample size in both studies limits the ability to generalize findings; however, the positive improvements in academic achievement scores offer important considerations for the use of both foster parents and students to help improve education outcomes for children in foster care.

Methodological notes:

While usage of a randomized wait-list control design offers the advantage of a comparison group, it prevents the ability to compare academic achievement outcomes following the commencement of the tutoring program for the wait-list control group. Further research is needed to determine whether the findings can be generalized to other children in foster care and to evaluate whether improvements in academic achievement scores are sustained over longer periods of time.

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16 December 2013

Study Finds Maltreatment Subtype Matters

Source: Petrenko, C.L.M., Friend, A., Garrido, E.F., Taussig, H.N., & Culhane, S.E. (2012). Does subtype matter? Assessing the effects of maltreatment on functioning in preadolescent youth in out-of-home care. Child Abuse & Neglect, 36, 633-644.

Reviewed by: Melissa Van Wert

More information is needed on the impact of various maltreatment subtypes on child functioning outcomes. There are two objectives for this study: to assess the effects of maltreatment subtypes on the cognitive, academic, and mental health functioning of preadolescent youth (ages nine to 11) living in out-of-home care; and, to examine different approaches to analyzing maltreatment subtypes. Four maltreatment subtypes were examined in this study, including physical abuse, sexual abuse, physical neglect, and supervisory neglect.

Data utilized in this study were collected from baseline interviews in a randomized controlled trial of a preventive intervention for preadolescent youth not living with their caregivers of origin. The sample included 334 youth, most who were living in non-relative foster or kinship care. Cognitive, academic, and mental health functioning were assessed through youth- and caregiver-report measures, and youth maltreatment histories were assessed from administrative records using the Maltreatment Classification System.

The researchers found a robust association between physical abuse occurrence/severity and externalizing behaviour problems. In addition, there was a consistent relationship between externalizing behaviours and physical neglect as well as sexual abuse. Physical neglect and physical abuse were also associated with internalizing behaviour problems. Children who experienced low severity supervisory neglect tended to have higher verbal IQ scores than other maltreated children, and fewer internalizing and externalizing behaviour problems, although their scores on these measures were still worse than normative samples.

Methodological notes:

Of those youth and caregivers eligible to be included, 92% agreed to participate in the baseline interviews. The sample was racially diverse. Several analytic approaches were used, enhancing the methodological rigour of this study. Regression models, hierarchical models, and latent class models were all used to examine the effects of maltreatment subtypes on functioning. This is the first study to use all of these approaches, and one of only a few studies to compare different approaches for analyzing maltreatment subtypes.

Only maltreatment that fell within the four subtypes (physical abuse, sexual abuse, physical neglect, and supervisory neglect) was considered, as these are the most reliably reported subtypes; emotional abuse was not included in the study. In addition, due to concerns about the consistency and availability of information only maltreatment that occurred within two years of the court filing was assessed. It is therefore possible that the youth in the sample experienced many other subtypes of maltreatment over the life course. These experiences of earlier maltreatment were not accounted for in the current study.

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3 December 2013

Foster care reunification rates -- Comparing two types of analyses

Source: Putnam-Hornstein, E. & Shaw, T. (2011). Foster care reunification: An exploration of non-linear hierarchical modeling. Children and Youth Services Review, 33, 705-714.

Reviewed by: Kristen Lwin

The California Child Welfare/Case Management System tracks every child who has had contact with California’s child welfare system This article compares two statistical methods for predicting which children end up being reunified with their caregiver of origin within six months of entering out-of-home care. The first analysis used the child as the first unit of analysis. Since these children were nested within families, and children within a given family were assumed to be more similar than children from different families, the family unit was the second level of analysis (clustering unit).

In the second analysis, a single child was randomly sampled from each family (thus removing the family as a higher level or clustering unit) and the clustering unit became the county in which the child was removed. Child level predictors include race/ethnicity, gender, age at entry, removal reason, placement type, substance use, and number of placed siblings. Family level predictors include drug or alcohol treatment recommended in the case plan, and number of siblings living in out-of-home care. The county level predictors include the out-of-home care child entry rate, the teen birth rate (risk factor strongly associated with child maltreatment), and percentage of the population that was Black.

The findings in the first analysis are consistent with prior reunification research. The odds of being reunified within six months for a child removed for physical or sexual abuse were significantly greater than those for a child removed for neglect. Further, the odds of reunification within six months were significantly lower for children placed with kin than for children placed with non-kin. Additional factors that decreased the odds of reunification were parental substance abuse, larger number of siblings.

The second analysis, which included the county as a clustering level, similar factors as the first analysis remained significant predictors of reunification. However, in the second analysis Black children were found to have significantly reduced odds of reunification compared with Hispanic children, which was a different result than in the first analysis where race was a non-significant coavariate. Although the caseworker, supervising county, or state were found to have some influence on reunification, the greatest contributors to reunification were identified at the child or family level.

Methodological notes:

Hierarchical or multilevel models are becoming more common in the field of social work and specifically child welfare. Most statistical models assume that observations are independent. However, multilevel statistical models consider the nested structure of data and that observations may be dependent upon various micro and macro level factors. This article compares two multilevel models using standard logistic regression and non-linear multilevel models to analyze the odds of reunification of a cohort of children in out-of-home care in California.

Authors note several limitations to the study. The manner in which siblings were used to construct family units is distinctive and there are several other classification schemes that could have been used. Authors suggest that ideally the data would have been analyzed using a three-level hierarchical model, where there is statistical consideration that siblings are nested within families, and families nested within counties. However, the binary nature of the outcome variable, the extremely high correlation within families, and smaller cluster size of family units created mathematical issues.

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13 November 2013

Individual and Organizational Factors that Contribute into Reentry into Out-of-home Care

Source: Yampolskaya, S., Armstrong, M. I., et al. (2011). "Contextual and individual-level predictors of abused children's reentry into out-of-home care: A multilevel mixture survival analysis." Child Abuse and Neglect, 35(9), 670-679.

Reviewed by: Carrie Smith

This study examines the effect of child and child welfare organization characteristics on the re-entry rate of children to out-of-home-care. The authors describe re-entry as an important indicator given that it may suggest that an additional allegation of serious maltreatment has occurred, that permanency has not yet been achieved, and the well-being of the child could be in jeopardy.

Using secondary data analysis of three administrative data sets, the study followed all children in the state of Florida who were discharged from out-of-home-care in the 2004-2005 fiscal year (n=17,695). Although others have examined the link between child characteristics and re-entry into out-of-home care, this study also examined contextual factors that have not been studied before.

Both individual and organizational characteristics were found to be associated with re-entry. Older children were more likely to re-enter care while children placed because of neglect and those with physical health problems were less likely to re-enter. Contextual factors associated with faster re-entry included lower average expenditure per child and contracting out of case management services. The authors recommend considering the use of programs to support older youth, given the higher risk of re-entry for this population. The authors also recommend assessing the appropriateness of the length of stay and type of placement for individual children. These factors may explain the effect of lower average expenditure on re-entry rates as some children may be requiring higher-level services.

Methodological notes:

The authors used three existing data sets in order to answer the research questions. Multilevel cox regression analysis was applied to the data. This technique allowed for the study of two levels of data (individual and contextual) to be measured simultaneously. This is the appropriate type of analysis given the research questions. Limitations include those related to the use of secondary data analysis. For example, the original purpose of the administrative data was not for research, the quality of data could be questioned and the researchers were limited to variables that were included in the original data set. The generalizability of the findings is also limited given the uniqueness of the child welfare system studied.

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10 October 2013

Mothers Involved with Child Welfare: Service Needs, Socio-demographics, and Psychosocial Characteristics

Source: Marcenko, M.O., Lyons, S.J. & Courtney, M. (2011). Mothers’ experiences, resources and needs: The context for reunification. Children and Youth Services Review, 33(3), 431-438.

Reviewed by: Eavan Brady

This study builds on existing research regarding the needs of families involved with the child welfare system and provides a strong basis for effectively targeting support services. Service needs, socio-demographics, and psychosocial characteristics of a large representative sample of child welfare involved mothers were examined using standardized measures in face-to-face interviews.

The authors conducted face-to-face, structured interviews with mothers involved with the child welfare system (n=747); children remaining in the care community (n=318) and children living in out-of-home care (n=429). Interviews were conducted using a structured questionnaire that measured demographic characteristics, domestic violence, mental health, substance abuse, trauma, parenting stress, financial hardship, and services received and needed. Univariate and bivariate analyses were conducted in order to describe the overall sample and compare the experiences of mothers whose child(ren) had been placed in out-of-home care or remained living in care of their caregivers of origin.

Results indicate that 70% of participants were unemployed and 46% had an annual household income of less than $10,000. A significantly larger proportion of participants whose child(ren) was living in out-of-home care had an income of less than $10,000 as compared to participants whose child(ren) remained in the home. Participants whose children were living in out-of-home care were more likely to have used a food bank or meal program, been evicted or moved in with family or friends, and to have been homeless. Further, 57% of the sample met the clinical criteria for one or more assessed mental health disorders. Depression (47%) and anxiety (40%) were most prevalent. Criteria for substance abuse/dependence in the past 12 months were met by 30% of the participants and 23% met the criteria for co-occurring substance abuse. Over half of the participants (58%) reported being sexually abused as a child and 35% had experienced domestic violence. Larger numbers of participants whose child(ren) were living in out-of-home care had substance abuse issues, co-occurring substance abuse and mental health disorders and had experienced domestic violence.

A majority of participants needed assistance with getting enough food, transportation, and clothing and approximately half required financial assistance and help finding a place to live. Further, over one third of participants reported needing assistance obtaining education and finding or maintaining a job. Significantly larger proportions of mothers whose child(ren) were living in out-of-home care required assistance with the aforementioned services. Additionally, mothers whose child(ren) was living in out-of-home care were also significantly less likely than those whose child(ren) who remained in the community to have had their service needs met in the following areas: clothing, housing, transportation, education, financial, employment, and food. Moreover, a significantly greater proportion of mothers with children living in out-of-home care than those with children living in the community required services. However, fewer mothers received these services than needed them.

Methodological notes:

The sample only included mothers within 30 to 120 days within case and was drawn from one U.S. state, thus limiting generalizability. The study relies on self-reports which may lead to reporting error and/or social desirability bias.

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12 September 2013

Overrepresentation of First Nations children in child welfare: More supports needed to help families address socioeconomic risk factors

Source: Sinha, V., Trocme, N., Fallon, B., & MacLaurin, B. (2013). Understanding the investigation-stage overrepresentation of First Nations children in the child welfare system: An analysis of the First Nations component of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008. Child Abuse & Neglect, (in press). (6): 740-750.

Reviewed by: Sydney Duder

The overrepresentation of Aboriginal children in child welfare systems is well documented. The present analysis, part of a continuing effort to disentangle factors that contribute to this overrepresentation, uses data from the First Nations component of the Canadian Incidence Study (FNCIS-2008). This analysis starts with overrepresentation at the original referral for investigation, in contrast to previous studies, which have generally only focused on the later agency substantiation stage.

The present sample comprised new maltreatment-related investigations opened between October 1 and December 31 in 2008 (n=3,106 First Nations children; n=12,240 non-Aboriginal children). Cases were drawn from 111 agencies, 89 provincial/territorial (a stratified random sample) plus 22 Aboriginally-governed (a purposive sample, thought to be capable enough for study participation), in each case representing ¼ of the agencies that conduct child welfare investigations in Canada. Variables considered were referral source, focus of investigation, child demographics and functioning issues, caregiver and household risk factors, and case dispositions. Bivariate analyses were performed for each variable, comparing the incidence (rates per 1000 children) for First Nations and non-Aboriginal children, and calculating the “disproportionality ratio” of these incidence rates.

The incidence of investigations in every maltreatment category was found to be significantly higher for First Nations children than for non-Aboriginals, and a higher proportion involved non-professional referrals. The overrepresentation was highest for the neglect category and lowest for physical abuse. This significant disproportionality was found to be associated with highly significant differences in many risk categories: for example, for First Nations and non-Aboriginals respectively, low income was found in 53.6% and 31.8% of investigations, substance abuse in 55.7% and 25.3%, and domestic violence in 43.7% and 31.6%. The authors argue that, if this observed overrepresentation is to be reduced, child welfare agencies must be equipped to help families address these risk factors.

This overrepresentation at the investigation stage was compounded at the later case disposition stage, though the disproportionality here was not as great. Ratios ranged from 1.2 for substantiation of maltreatment (42.5% vs. 35.2%, First Nation and non-Aboriginal cases respectively) to 3.0 for placement in substitute care (9.7% vs. 3.2%). As a result of the compounding effect of investigation overrepresentation and placement overrepresentation, the incidence of placement in the jurisdictions served by the sampled agencies was 13.6 per 1,000 First Nations children, more than 12 times the rate of 1.1 per 1,000 for non-Aboriginal children. The authors suggest that these differences point to the need for complementary research on practice models in Aboriginally governed agencies.

Methodological notes:

A better understanding of the reasons for this observed overrepresentation is clearly needed, to guide possible future corrective action. However, there appear to have been some methodological issues in this present study that made this difficult. For example, an elaborate weighting and geocoding procedure was described, “appropriate for use in . . . comparisons of Aboriginally-governed and provincial/territorial agencies.” Such a comparison would appear to be important, but apparently was not attempted in this study. Also, the authors point out that the purposive sampling of Aboriginally-governed agencies means that these results cannot be generalized beyond the study sample. A further limitation is the fact that only bivariate analyses were used here; multivariate methods should have made it easier to tease out the relative effects of community risk factors and agency procedures on the observed disproportionality.

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2 July 2013

Promising results of an intervention to reduce substance use and delinquency among middle school girls in foster care

Source: Kim, H. K. & L. D. Leve (2011). Substance use and delinquency among middle school girls in foster care: A three-year follow-up of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(6): 740-750.

Reviewed by: Jennifer Nutton

Adolescent girls in foster care are at increased risk of engaging in unhealthy behaviours such as substance misuse and delinquency yet little research has been done to evaluate the efficacy of interventions to reduce health-risking behaviours among this population. This study evaluated the Middle School Success Intervention Program, which is designed to promote prosocial skills and self-efficacy, and decrease levels of delinquency, substance use, and internalizing/externalizing symptoms among adolescent girls in foster care who are transitioning from elementary to middle school. The program included components for both the girls and their caregivers (foster parent). The girls’ curriculum included practicing sharing/cooperating with peers and meeting new people, talking to friends and teachers about what life is like in foster care, and gaining knowledge of accurate norms on substance abuse and risks of problem behaviours. The girls participated in six group sessions during the summer between elementary and middle school and weekly individual sessions with a training coach, who also served as a role model, during the first year of middle school. Foster parents participated in six group sessions, with curriculum aimed at increasing their ability to prevent adjustment problems (as the girls transitioned from elementary to middle school) and to encourage adaptive behaviours at home, in school, and within the community.

The authors used a randomized control trial design to evaluate the effects of the intervention at a 36-month follow-up period. The sample included (n = 100) girls, with a mean age of 11.54 years, and their caregivers. The girls were randomly assigned to the intervention (n = 48) or to regular foster care (n = 52). The authors hypothesized that girls assigned to the intervention would show lower levels of substance use, delinquent behaviours, and internalizing/externalizing symptoms than the girls in the control group. Results indicated that the girls in the intervention had significantly lower levels of substance abuse than did girls in the control group at 36 months post baseline and marginally significant lower levels of delinquency. The intervention was most effective in reducing risk for tobacco and marijuana use. Indirect effects of the intervention through an increase in prosocial behaviours resulted in a decrease in internalizing and externalizing symptoms.

Methodological notes:

Although the results of this study are promising, there are limitations worth noting such as the small sample size (n = 100), many of the variables relied on a single measure, and the lack of assessment of intervention effects on parenting behaviours. The authors also note that this is the first intervention they are aware of that focuses on middle school aged girls in foster care, and the majority (63%) of the girls in the study were European American. Thus, further studies with larger more ethnically diverse samples are required before recommendations can be drawn.

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2 April 2013

Child welfare: Organizational culture can affect worker retention

Source: Lee, J., Forster, M., & Rehner, T. (2011). The retention of public child welfare workers: The roles of professional organizational culture and coping strategies. Children and Youth Services Review 33, 102-109.

Reviewed by: Sydney Duder

This was a study of the effect of organizational culture on workers’ intentions to remain employed in child welfare, with worker coping strategies included as mediating variables. The sample comprised 234 front-line workers in Family and Children’s Services offices in a state in the southeastern US. The following measures were used:

• The Professional Organizational Culture (POC) scale (Ellett et al., 2003).

• Latack’s (1986) coping scale, used to measure worker responses to stressful situations at work. Two factors were used: control coping and avoidance coping.

• The Intent to Remain Employed in Child Welfare (IRE) scale (Ellett et al., 2003)

The most significant finding was the strong positive relationship between professional organizational culture and workers’ intentions to remain employed. This showed up in two ways: 1) Directly; and 2) Indirectly, through control coping as a mediating variable. Other variables in the model, avoidance coping, worker experience, and salary, were not found to be significantly related to intention to remain employed.

Methodological notes:

Both the original model and the eventual results of the analysis were illustrated in useful path diagrams. Structural equation modeling was used to test the proposed model; though the sample was not large, fit indices reflected a good fit between the model and the sample data. Overall, the model explained 36% of the variance in workers’ intentions to remain employed.

The authors point out several limitations that could limit the generalizability of the findings. For example, data were limited to only one state, and the proportion of workers with social work degrees (77%) was higher than reported in comparable studies. Also, in a cross-sectional study like this, the causal sequence in the model is theoretical; alternatively, workers more committed to a career in child welfare might be more likely to engage in pro-active control coping. A longitudinal study could clarify this relationship, and also potentially make it possible to examine the relationship between organizational climate and actual recorded worker turnover.

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26 February 2013

Can buy me love: the effect of child welfare expenditures on maltreatment outcomes

Source: Malcolm, M. (2012). Can buy me love: the effect of child welfare expenditures on maltreatment outcomes. Applied Economics, 44(28), 3725-3736.

Reviewed by: Andreas Jud

While the association between adverse economic circumstances and child maltreatment outcomes is well documented in the literature, few have bothered to control this association for child welfare expenditures. Malcolm (2012) presents evidence that increases in state child welfare expenditures are strongly associated with reduced child maltreatment victimization and even fatality rates over time.

As child welfare expenditures are positively correlated with good economic circumstances, much of the measured effect of economic circumstances on child maltreatment appears to be a statistical artifact rather than a causal link. This assumption is tested by measuring the impact of the 2000 recession on the rate of maltreatment victimization in the United States while controlling for state child welfare expenditures. The multivariate regression analysis covers administrative data from the annually collected National Child Abuse & Neglect Data System (NCANDS) between 1996 and 2002. The total number of substantiated child maltreatment victims in a given state and the count of child deaths due to maltreatment were analyzed as dependent variables. Data on child welfare expenditures were available through the Urban Institute’s biennial analysis and cover the whole range of expenditures on child welfare systems (including services contracted out to private agencies, salaries and other overhead). To further control for the economic environment separately from child welfare spending at the state level, the author introduces excess revenues, education spending per child, and generosity of income transfer programs. Poverty and economic insecurity as potential contributors to increased child maltreatment were covered as covariates by including the states’ poverty and unemployment rate.

The study findings indicate that higher expenditures on child welfare were convincingly associated with less child abuse. A $100 increase in child welfare expenditures is associated with a decline in the victimization rate by 15.5% of its mean value. The effect on fatalities was less pronounced with a decline in the arrival rate of 10.1% of its mean value. Second, and more surprisingly, the well-documented effect of poverty and economic insecurity on child maltreatment incidence seems to be overstated if one fails to control for policy differences. Finally, the effect of adverse negative circumstances diminishes further upon controlling for social attitudes correlated with income, as measured by aggregates of the General Social Survey (included attitudes towards harshness of courts, religious attendance, spanking and importance of obedience as a parenting outcome).

Methodological notes:

Some aspects are highlighted to underscore the author’s methodological rigor. First, as the linear model is inappropriate for fatality data since the counts are small, the Poisson model was applied. Second, endogeneity, correlation between variable and parameter and error term, of child welfare expenditures is a natural concern. However, the author demonstrates that endogenity would work against the main result as increased child maltreatment incidence ‘reverse causes’ higher child welfare expenditures, either through direct channels (increasing caseloads), or indirect channels (heightened attention of policymakers). While the author proves his strengths in analyzing economic circumstances the inclusion of social trends is of limited value as the chosen variables seem somewhat random and new theoretical developments had not been considered.

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29 January 2013

The economic burden of child maltreatment: Preventive measures could yield huge savings

Source: Fang, X., Brown, D.S., Florence, C.S., & Mercy, J.A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse & Neglect, 36, 156-165.

Reviewed by: Sydney Duder

Child maltreatment (CM) is a serious and prevalent public health problem, which can result in both individual trauma and also huge financial costs for society. This article estimates the economic burden in the U.S., and suggests the possible benefits of preventive measures. The best available secondary data were used to estimate costs per case. Whenever possible, studies based on quasi-experimental longitudinal prospective designs were used; no relevant studies could be found that were based on experimental designs. The authors argue that these estimates are significant new contributions that use a consistent robust approach in incidence-based costing methods; this directly facilitates comparison with other health conditions. The following are the estimated social costs of CM (in 2010 dollars): • Average lifetime cost per victim of nonfatal CM = $210,012 (includes the costs of short-term child health care, long-term adult medical care, productivity losses, child welfare services, criminal justice and special education) • Average lifetime cost per victim of fatal CM = $1,272,900 (includes the costs of medical care and productivity losses) As a result, the total lifetime cost of all new cases in 2008 (estimated to be 579,000 nonfatal and 1,740 fatal cases of CM) = $124 billion. The figure of $210,012 for nonfatal CM is comparable to the costs of other high profile public health problems (e.g., stroke, $159,846; type 2 diabetes, $181,000 - $253,000), which certainly suggests that costs are high enough to justify allocating resources to effective prevention and mitigation strategies. Though this study is based on incidence and costs in the U.S., it seems reasonable to expect that the implications for Canada would be similar.

Methodological notes:

The authors list a number of methodological problems; some of the more significant were: (1) the above figure of 579,000 new substantiated cases is very likely to be too low, as not all maltreated cases may have been reported, and state trimming of social service budgets may have artificially reduced the number of cases that could be substantiated; (2) the costs of some additional adverse outcomes (e.g., reduced life expectancy, decreased quality of life, and negative parenting behaviors, which can lead to negative intergenerational outcomes) were not included, as sufficient data were not available on the magnitude of these effects and their costs; (3) In most of the studies used, the estimates of long-term medical costs did not include the impact of psychological abuse; (4) data were not available to allow reliable estimates of burden by type and severity of maltreatment; (5) long-term medical costs for adults 65 or older could not be estimated. As a result, the cost estimates reported above almost certainly underestimate the true costs to society of child maltreatment.

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15 January 2013

Child welfare: Organizational climate can affect youth outcomes

Source: Glisson, C., & Green, P. (2011). Organizational climate, services, and outcomes in child welfare systems. Child Abuse and Neglect, 35(8), 582-591.

Reviewed by: Sydney Duder

The current study analyzes the relationships between organizational climate in child welfare systems, the casework services provided, and the outcomes for maltreated youth. Data were from all 5 waves of the US National Survey of Child and Adolescent Well-being (NSCAW) over a seven-year follow-up period. The study sample comprised youth aged four to16 years (N = 1,678) and caseworkers from 88 child welfare systems (N = 1,696).

The most important finding was the relationship between organizational climate and youth outcome—long-term outcomes for maltreated children were significantly more positive for children served by agencies with more engaged organizational climates. This was true, when the effects of age, gender and ethnicity were held constant. The relationship between climate and outcome was not affected by the reported quantity and quality of casework services actually provided; this was puzzling. The authors argue that further research is needed, both on ways to improve organizational climates, and on the mechanisms linking climate to youth outcomes.

The following measurement procedures were used:

• Organizational climate was measured by the Organizational Social Context (OSC) measurement system, a well-established instrument. Scores for two dimensions, engagement and stress, were calculated for each system by aggregating responses for all caseworkers who provided child welfare services in that system.

• Original scales developed for this study measured casework services provided to each child; the tools were completed by the primary caregiver and child’s caseworker.

• The Child Behavior Checklist (CBCL) measured youth outcomes. The Total Problem T-score, completed by the primary caregiver, was used as a measure of a child’s overall psychosocial functioning.

Methodological notes:

Several strong points are worth noting: 1) Casework services and outcomes were measured for individual children, while climate was measured only as agency averages; therefore, hierarchical linear modeling (HLM) was an appropriate analytical procedure; 2) Completely different data sources were used for organizational climate (worker averages) and youth outcomes (caregiver ratings); and 3) There was no possibility of any common method error variance.

While the authors had expected increased casework services to be associated with better outcomes, the only significant effect actually found was in the opposite direction; in hindsight it seems obvious that cases with more serious problems would receive more, rather than fewer casework services. On the other hand, service quality, as described by caseworkers, was the only service variable associated with improved outcomes.

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18 December 2012

Children discharged from kin and non-kin foster homes: Do the risks of foster care re-entry differ?

Source: Koh, E., & Testa, M.F. (2011). Children discharged from kin and non-kin foster homes: Do the risks of foster care re-entry differ? Children and Youth Services Review, 33, 1497-1505.

Reviewed by: Sarah L. Beatty

A primary goal of the child welfare system is to provide permanence and stability for children, through out-of-home care, or through reunification with their primary caregivers or kin. Extant literature illustrates that children are more likely to be reunited with their caregivers from kinship foster homes versus non-kinship foster homes. This study aims to contribute to the literature and measure the net effect of discharges from kinship foster homes versus non-kinship foster homes. The study is unique in that it uses propensity score matching (PSM). PSM is a statistical method that uses observational data to artificially create matched samples for outcomes measurement when random assignment cannot be used. PSM, in this case, takes into account many of the selection biases that can influence child placement into kin or non-kin foster homes, allowing for a more accurate comparison of outcomes. Child-level variables examined in this analysis include age, gender, race, disability, reason for out-of-home care, year of foster care discharge, number of previous placements, length of stay in out-of-home care, location of out-of-home care (i.e., urban versus rural), and Title IV-E eligibility (proxy for parental poverty status). The research questions include whether children residing in kin foster homes versus non-kin foster homes are more likely to: 1) be reunified; 2) be adopted; 3) or remain in child welfare out-of-home care. To examine their hypotheses the authors utilized the Adoption and Foster Care Analysis and Reporting System (AFCARS) data from Illinois. Analyses include 12,088 children who resided in out-of-home care for at least one week between October 1, 2000 to September 30, 2004. The 12,088 children exited out-of-home care (either kinship or non-kinship foster homes) and entered into one of the following arrangements: 1) reunification (n=6,110); 2) adoption (n=4,752); or 3) guardianship (n=1,226). Analyses with the PSM method revealed that the kin and non-kin groups had an equal likelihood of re-entry into out-of-home care. The authors suggest that there may be selection biases that differentiate the type of children who are accepted into kin foster placements versus non-kin foster placements.

Methodological notes:

While the study was well-designed, the authors indicate limitations: (1) external validity is restricted to Illinois; (2) the statistical models could not incorporate all theoretical assumptions due to a limited number of covariates; and (3) PSM relies upon observed data and does not control for any unobserved conditions that may influence outcomes. The authors point out that several potentially important variables were not available, thus limiting the study.

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4 December 2012

Child welfare decisions: Significant differences in agency referral patterns

Source: FJud, A., Fallon, B., & Trocmé, N. (2012). Who gets services and who does not? Multi-level approach to the decision for ongoing child welfare or referral to specialized services. Children and Youth Services Review 34, 983-988.

Reviewed by: Sydney Duder

This was a study of the services provided in child welfare cases after a report is investigated. Possible actions were ongoing agency service or referral to a specialized service, compared to no additional services beyond the investigation. A number of factors thought to be associated with the service decision were studied, including both case characteristics and agency characteristics. The multi-level strategy was based on a secondary analysis of the data from the Canadian Incidence Study of Reported Child Abuse and Neglect (Trocmé et al., 2008). The sample consisted of 15,980 cases from 111 agencies throughout Canada; in almost 60% of these cases some type of service was offered. The following case characteristics were found to be significantly associated with the decision to provide services: • Any type of actual maltreatment either suspected or substantiated. The strongest association was with exposure to intimate partner violence. • Risk investigations involving caregiver and household concerns (e.g., few social supports, teen parenting, low socioeconomic status). These risks seemed to drive service decisions almost more than substantiation status. Ethnic minority status was not found to be associated with the provision of services; this was surprising, since in many earlier studies ethnicity has been associated with increased placement in foster care. An unexpected finding was the marked effect of agency characteristics on referral rates; this was noted at both the provincial and agency levels. The proportion of cases referred ranged from 30% to 70% for provinces; from 15% to 77% for individual large agencies. Factors accounting for these differences remain largely unexplained; possible reasons might be differences in provincial legislation or funding, or in agency organization (e.g., supervisory support, working climate or staff retention). The authors argue this warrants further investigation.

Methodological notes:

This analysis was based on very sophisticated multi-level statistical procedures, including univariate and multivariate logistic regressions, using specialized statistical software (Mplus 5). Given the large sample size, the findings reported above were at a very high level of statistical significance. However, the authors pointed out a number of limitations. Longer-term service outcomes could not be measured and analysis was only of the referrals stage of the process. Very few agency-level variables were available in the analysis. In future studies it would be useful if more variables at both provincial and individual-agency levels could be included. In the latter case, this could potentially provide information to support improvements in practice.

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20 November 2012

Fully delegated community child welfare model appears to be more effective than a hybrid state managed service contract model in Florida

Source: Lamothe, M. (2011). Redesigning the Hollow State: A Study of Florida Child Welfare Service Reform through the Lens of Principal-Agent Theory, International Journal of Public Administration, 34, 497–515.

Reviewed by: Nico Trocmé

Contracting child welfare service delivery to third party service providers is being used increasingly in across Canada. While third party service providers, often relatively small not-for profit community-based agencies, may, in some instances, be in a better position to build on community resources and tailor programs to the specific needs of children and their families, careful consideration needs to be given to developing contracting mechanisms that allow government administrators to ensure service quality and control costs. In her study of child welfare service reform in Florida, Meeyoung Lamothe examines the challenge of aligning the priorities of government administrators with contract service providers through the lens of Principal (government) Agent (contract agencies) Theory. Through a series of key informant interviews and analysis of government documents, the author describes Florida’s transition from a service delivery model where the government run child welfare authority administered caseloads but contracted most direct services to hundreds of service providers, to a model where case management responsibilities were transferred to 22 “lead agencies”, who provide some services directly and sub-contract other services. State and agency administrators interviewed for the study generally viewed the transition as a success. The previous contracting process was perceived to be a fragmented compromise between a state run and agency run model, where responsibility for outcomes remained with the state and service contracts were compliance and process driven. By delegating most of the state’s authority and functions to a small number of not-for profit community agencies, state and agency administrators noted that the reporting relationship was refocused on service outcomes, allowing the lead agencies more flexibility in developing their own program models. The study revealed some unintended consequences; for example, in addition to delegating more authority to the lead agencies, the reform also stressed increased community involvement, which led to an unexpected shift to “parochial” concerns, hindering statewide policymaking ability. Interestingly, from a Canadian perspective, the Florida model looks very much like the delegated agency model that has been in place for over a century in several jurisdictions across the country.

Methodological notes:

Semi-structured interviews with senior state administrators and administrators in six of the 22 lead agencies were conducted by the author or her co-investigator. State reports, contracts and agency planning documents were also reviewed. The study did not attempt to assess the impact of reforms through analysis of caseload statistics, nor were clients or community service providers interviewed.

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6 November 2012

A person-centered approach to understanding the parenting behaviours of biological fathers

Source: Lee, S.J., Kim, J., Yaylor, C., & Perron, B. (2011). Profiles of disciplinary behaviors among biological fathers. Child Maltreatment, 16(1), 51-62.

Reviewed by: Jennifer Nutton

Research suggests that when fathers are positively involved in the care of their children (e.g., by providing emotional support, appropriate discipline, supervision), the risk of negative youth behaviours such as delinquency are reduced. Conversely, when fathers are negatively involved with family members (i.e., substance abuse, mental health problems, intimate partner violence), there is increased risk of harm to the children in the home. This exploratory study focuses on the parenting behaviours among involved, biological fathers to better understand the effects of both positive and negative disciplinary techniques. Unlike much of the research on parenting, this study focuses on paternal not maternal disciplinary behaviours. This study is also unique in its use of a person-centered approach, such as latent class analysis (LCA), to better understand the disciplinary behaviours of fathers by assigning them to mutually exclusive subgroups based on their responses to 14 variables. This study used data from the Fragile Families and Child Wellbeing Study (which collects data through interviews with mothers and fathers at birth and again when the child is one and three years of age) and the follow-up In-Home Longitudinal Study of Pre-School Aged Children (interviews conducted with mothers only who completed the FFCWS core interview). To assess fathers’ discipline of their three year old child, data were collected from a subsample of (n=1,238) mother and father participants. Information was collected only on the parenting behaviours of biological fathers residing in the home. The Parent-Child Conflict Tactics Scales was used in the LCA model to assess both nonaggressive and aggressive disciplinary behaviours. Participants were assigned to subgroups based on four paternal parenting profiles (low discipline, low aggression, moderate physical aggression and high physical and psychological aggression). Results of the study indicated the most serious form of discipline, psychological aggression (e.g., calling the child dumb/lazy, shaking the child and pinching) were uncommon among all groups. The most prevalent forms of discipline were nonaggressive, which included explaining what was wrong and giving the child something else to do and taking away privileges. Fathers in the high physical and psychological aggression group were more likely to have children with higher levels of aggression. Parental arguing and father’s perceived support from the child’s mother were virtually equal among all four parenting profiles. The authors suggest that normative parental arguing may not differentiate fathers in relation to their parenting style. However, results demonstrated that more serious forms of marital conflict increased the risk of psychological or physical aggression towards the child.

Methodological notes:

As an exploratory study, it is important to note the potential benefits of using a person-centered approach. For example, the LCA revealed qualitative differences among the subgroups of parenting profiles that total scores from the Parent-Child Conflict Tactics Scales (PCCTS) would not. However, the LCA model also revealed limitations as the ability to detect differences between groups is determinant on having a large enough sample within each of the subgroups; and, in this study, the size of the high physical and psychological aggression parenting profile group was small (n=42). The Parent-Child Conflict Tactics Scales used in this study has been widely used in parenting research and in many countries, which speaks to the reliability and validity of this measurement. However, there are methodological limitations around scales of self-reports particularly when participants are asked about their own socially undesirable behaviours leading to underreporting. Finally, the sample only included biological fathers residing in the home so the findings are not generalizable to non-biological fathers residing in the home or biological fathers not residing in the home.

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16 October 2012

Why do African American children have more out of home placements than white children, even when controlling for identified risk factors?

Source: Foster, E. M., M. M. Hillemeier, et al. (2011). Explaining the disparity in placement instability among African-American and white children in child welfare: A Blinder-Oaxaca decomposition. Children and Youth Services Review, 33(1), 118-125.

Reviewed by: Pamela Weightman

There is an overrepresentation of African Americans residing in out-of-home care in the U.S. child welfare system, the reasons for which are unclear. In addition, African Americans in foster care experience more frequent placement changes. This is especially concerning as frequent placement changes can have a negative impact on a child’s development. This quantitative study compares out-of-home placement instability among African American and Caucasian children in the National Survey of Child and Adolescent Well Being (NSCAW) and attempts to identify mechanisms that may be at the root of racial disparities. Many of the identified risk factors associated with placement instability (e.g., emotional and behavioural problems, chronic medical conditions, lower socioeconomic status) are disproportionally found in African American children in the child welfare system. However, the findings show that when controlling for these factors, African American children still have more out-of-home placements than Caucasian children. Additional factors not accounted for in the study may explain African American’s increased risk of out-of-home placement instability. Authors posit a potential explanation could be a difference in the way the child welfare system treats children of different races. Predictors of placement instability among African American children include older age, initial placement in a setting other than kinship care, and behavioural problems. Among Caucasian children only the initial placement in foster care predicted placement instability.

Methodological notes:

The authors analyzed data from the Child Protective Services cohort of NSCAW which is a national study of child welfare in the United States that collects data directly from children and families involved with child welfare as well as child welfare workers. Interviews were conducted at four time points after the conclusion of the investigation or assessment: between two and six months; 12 months; 18 months; and 36 months. Children were selected for inclusion in the study if they were aged two years or older at the initial interview (this limit was imposed as the Child Behaviour Checklist is not available for children under two years), were African American or Caucasian, and were placed in an out-of-home setting at the initial interview. The authors point out that several potentially important variables were not available, thus limiting the study.

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2 October 2012

Despite moderate decline in corporal punishment in the US, spanking and slapping young children remains normative; Canadian review raises concerns about effects on child development

Source: Zolotor, A. J., Theodore, A. D., Runyan, D. K., Chang, J. J., & Laskey, A. L. (2011). Corporal punishment and physical abuse: population-based trends for three-to-11-year-old children in the United States. Child Abuse Review, 20(1), 57-66; Durrant, J. & Ensom, R. (2012). Physical punishment of children: lessons from 20 years of research. Canadian Medical Association Journal Early release, published at www.cmaj.ca on February 6, 2012.

Reviewed by: Nico Trocmé

Analysis of results from four surveys using a standardized measure conducted between 1975 and 2002 in the Unites States (three national samples, and one conducted across the Carolina states) shows a moderate decrease in parent-reported use of spanking and slapping. Across all four surveys rates of spanking or slapping dropped most rapidly for six to eight year olds, from 80% in 1975 to 60% in 2002, while remaining high for children in the three to five year old range (over 80%). While the authors note that the decline in self-reported rates of spanking or slapping may reflect the beginning in an encouraging trend, they note, however, that nearly a third of parents reported using an object to hit and discipline their children. A review of 20 years of research on the effects of physical punishment on children published in the Canadian Medical Association’s Journal raises concerns about negative long-term developmental outcomes as well as increased risk of physical abuse. The authors also draw attention to evidence of the efficacy of programs that teach non-violent approaches where parents are taught communicate clearly and apply contingent consequences. In light of these findings, the authors encourage physicians to promote non-violent approaches to discipline and raise concern about Section 43 from the Criminal Code, which provides legal justification for the use of physical punishment, and undermines public education efforts to promote positive parenting.

Methodological notes:

Three of the four studies reviewed by Zolotor et al. were telephone surveys, while the 1975 study was based on a face-to-face household survey. Sample sizes ranged from 1,000 to 3,360 randomly selected parents. In all four surveys, the Conflict Tactics Scales or a modified version, the Parent-Child Conflict Tactics Scales, was used. Changes to the question about hitting with an object limit comparability between the earlier and more recent surveys. Assessing the effect of social desirability on response rates is a challenge in interpreting the results of these self-report studies, however, even the results remain relevant even if they are partially measuring a shift in public attitudes. While the Durrant and Ensom CMAJ analysis was not a systematic review, it presents a concise review of some of the key methodological challenges that physical punishment researchers have attempted to address, and provides a useful analysis of the Canadian practice and policy implications of these studies.

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18 September 2012

Predictors of early childhood neglect: A tri-study comparison

Source: Slack, K., Berger, L., DuMont, K., Yang, M., Kim, B., Ehrhard-Dietzel, S. & Holl, J. (2011). Risk and protective factors for child neglect during early childhood: A cross-study comparison. Children and Youth Services Review, 33(8), 1354-1363.

Reviewed by: Kristen Lwin

There is a dearth in research identifying predictors of child neglect during early childhood. Factors that are associated with neglect, either risk or protective, are important to understand, as this information can inform prevention and intervention efforts.

The authors conducted secondary analysis of three longitudinal studies of families with young children. The three studies are different in their sample size, variables and methodology. However, all three include families with children under the age of five years, involve predominantly low-income families, and measures of neglect. The studies (Fragile Families and Child Wellbeing (FFCW), n=3033; Healthy Families New York (HFNY), n=1173; and Illinois Families Study-Child Wellbeing (IFS-CWB), n=583) distinguish neglect from other types of maltreatment and encompass more than one type of neglect (e.g., financial, emotional).

Within the FFCW, results indicated that several economic variables (e.g., receipt of financial assistance from family members, use of a food bank, inability to see a doctor) were significantly associated with child welfare involvement for concerns of neglect. The results of the FFCW also indicated that caregiver self-efficacy was inversely associated with child welfare contact (i.e., higher self-efficacy was associated with fewer contacts). The HFNY also established numerous economic predictors (e.g., receipt of public benefits, inability to see a doctor, difficulty paying rent) to be significantly associated with increased odds of a child welfare report of neglect. Similarly, the IFS-CWB study found economic variables (e.g., receipt of food stamps, food bank use, difficulty paying rent) were associated with increased odds of contact with child welfare for neglect concerns.

All variables measured amongst the three studies were statistically similar except for the measures of caregivers’ employment, receipt of food stamps, and involvement with children’s activities. Thus, associations between variables and investigated child welfare neglect were not strongly influenced by differences among the three studies.

Economic resource variables such as receiving financial assistance from family members, food bank use, housing subsidy and being unemployed predicted involvement with child welfare for concerns of neglect within all three studies (non-significantly in HFNY, p<.10). Economic hardship factors (e.g., reduced meal size, utility shut off, and difficulty paying rent) predicted child welfare neglect concerns within the FFCW and HFNY studies.

Authors suggest findings are important for prevention efforts. Child welfare organizations may focus too heavily on parental characteristics as the source of maltreatment and focus of interventions, whereas poverty-reduction efforts are likely more important.

Methodological notes:

Variation in several measures was not given full consideration. Child welfare official records were available for two of the three samples. The third sample includes a self-report measure of child welfare involvement, which may have caused an under-estimation of this involvement.

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10 July 2012

Study looks at contextual effects on externalizing behaviors in children in out-of-home care

Source: Cheung, C., Goodman, D., Leckie, G., & Jenkins, J.M. (2011). Understanding contextual effects on externalizing behaviors in children in out-of-home care: Influence of workers and foster families. Children and Youth Services Review, 33(10), 2050-2060.

Reviewed by: Sarah L. Beatty

Some research suggests that children residing in out-of-home care are more likely to exhibit externalizing behaviours (e.g., destruction of property, violation of societal norms, harm towards others) than children living with their biological parents. There is considerable individual variation in levels of externalizing behaviour. The expression of externalizing behaviour is likely impacted by many factors, including cognitive ability, placement disruptions, and maltreatment experiences. In addition to child specific features, some research shows that foster parent characteristics influence the externalizing behaviour of children in their care.

Using the Assessment and Action Record (AAR) data from the Ontario Looking After Children (OnLAC) project (2007-2008), the authors conducted secondary cross-sectional data analysis to explore the relationship between worker and foster families characteristics and externalizing behaviours of children in-care (i.e., foster, n=865, 81%; kinship, n=91, 9%; and group care, n=107; 10%) aged 10-17 years (average age of 13 years, 7 months). Results reveal two important findings: (1) child protection workers with less formal education tend to work more with children that have higher levels of externalizing behaviours (24% of the variance seen at the worker level); and (2) foster parent negativity (such as disfavouring an individual foster child) tends to be associated with higher levels of externalizing behaviour in the disfavoured child. These findings imply that child-level, worker-level, and foster family-level characteristics should be considered when developing policy and practice approaches.

Methodological notes:

The authors examined three sources of data: (a) AAR data from 2007-2008 for 1,063 children in-care who were randomly selected from 12 Children’s Aid Societies (9 urban agencies, 3 rural agencies); (b) Information on 528 workers, who were identified through cross-referencing worker-specific variables (of which 221, 42%, worked with multiple children in-care); and (c) Information on 962 foster parents, who were identified through cross-referencing foster parent specific variables. Five models were created to test the participant specific variables. The authors did acknowledge limitations to the study, including its cross-sectional design, which was unable to address the long-term relationships between the variables. There was also a low participant rate from child welfare agencies, and a lack of information on genetic influences.

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27 April 2012

Home-based intervention for high-risk rural families: A randomized clinical trial

Source: Silovsky, J., Bard, D., Chaffin, M., Hecht, D., Burris, L., Owora, A. et al. (2011). Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review, 33(8), 1435-1444.

Reviewed by: Kristen Lwin

There has been little research in the area of child maltreatment prevention within high-risk rural populations. Rural caregivers struggling with substance use, intimate partner violence (IPV), and depression may be at high risk for perpetrating child maltreatment, yet few home-based prevention programs are customized for this population. SafeCare (SC) is a skills-based model designed to alter parenting behaviours related to child maltreatment and delivered by trained home based service providers. For the purposes of this study, the SC method was adapted for high-risk rural communities (SC+) enhanced with Motivational Interviewing and compared to a standard home-based mental health service (SAU). It was hypothesized that families who received SC+ (n=48), as compared to SAU (n=57), would have: 1) enhanced engagement in services; 2) lower rates of out-of-home placements; and 3) greater improvement of risk factors (i.e., depression, substance misuse, IPV) and parenting skills (e.g., dealing with child health and home hazards).

Families randomized to SC+ were significantly more likely than SAU participants to complete the initial intake meeting where home visitors obtain demographic information and a needs assessment of the family. Providers of SC+ were more likely to refer and connect families to additional services, compared to SAU service providers. Further, SC+ participants were much more likely to be satisfied with the service they received. Caregiver self-reports indicated participants randomized to SC+ were better able to address child health and home hazards, as well as prevent child behaviour problems. Ten participants (21%) of SC+ and 18 participants (32%) of SAU had a future referral to child welfare services. Amongst families with additional child welfare referrals the median length until a first report was 103 days for SAU participants and 200.5 days for those receiving SC+. Differences in re-referral rates and time were not statistically significant. Although preliminary results suggest engagement and satisfaction with SC+ service, further examination with a larger sample size is required for more rigorous results.

Methodological notes:

One hundred and five parents of children 5 years or less who had identifiable risk of depression, IPV, or substance abuse were randomized to SC+ or SAU. There were no significant differences between the two groups with respect to demographic characteristics (i.e., age, gender, ethnicity, marital status, education, pregnancy and employment status). The average age of caregivers was 27 years (SD=9), and families had an average of two children. Both African American and First Nation populations were overrepresented compared to their rates in the general population in the United States.

This study was limited by drop out over time, although all analyses are based on results for the full randomized samples. The sample size was also quite small, which may explain the lack of significance on some outcome measures.

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13 March 2012

Major Findings from the Fourth National Incidence Study of Child Abuse and Neglect (NIS)

Source: Sedlak, A.J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., and Li, S. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families.

Reviewed by: Jennifer Ma

The National Incidence Study (NIS) examines the incidence of child abuse and neglect in the United States. The Fourth National Incidence Study (NIS-4) collected data from a representative sample of 122 counties across 126 Child Protection Service (CPS) agencies. The NIS-4 examines children who are maltreated including those investigated by CPS agencies and others not reported to CPS or screened out by CPS without investigation but recognized as maltreated by community professionals. The findings of the NIS-4 demonstrate a general decrease in the incidence of maltreatment since the Third National Incidence Study (NIS-3), with decreases in particular maltreatment categories and increases in others. Further analyses of the data need to be completed to understand the observed changes in the incidence of maltreatment.

The NIS-4 collected 6,208 forms from community professionals and 10,677 forms on the investigation outcomes from participating CPS agencies over a three-month period. National estimates were derived from the collected data to reflect the numbers of abused and neglected children in the United States. The NIS uses standard definitions of abuse and neglect therefore the incidence rates of maltreated children are standardized across various CPS and community agencies and NIS cycles. Abuse includes physical abuse, sexual abuse, and emotional abuse. Neglect includes physical neglect, emotional neglect, and educational neglect. The NIS-4 further defines maltreatment by employing two definitional standards: the Harm Standard and the Endangerment Standard. The Harm Standard identifies abuse or neglect as situations where an act or omission results in substantiated harm. The strength of the Harm Standard is its objectivity while its limitation is its rigidity in the inclusion of children who are maltreated. Conversely, the Endangerment Standard includes all children who meet the Harm Standard in addition to children who have not yet been harmed by abuse or neglect if a professional deemed that the maltreatment endangered the child or if a CPS investigation substantiated their maltreatment.

Under the Harm Standard category, more than 1.25 million children (an estimated 1,256,000 children or a rate of 17.1 children victimized per 1,000 children) experienced maltreatment during the NIS-4 study year (2005-2006). The NIS categorizes children in every applicable type of abuse or neglect; as such the portions may amount to more than 100%. An estimated total of 553,300 children were abused (44%) while 771,700 children were neglected (61%). Most of the abused children were physically abused (58% or an estimated 323,000 children), approximately a quarter experienced sexual abuse (24% or an estimated 135,500 children) while more than quarter experienced emotional abuse (27% or an estimated 148,500 children). Almost half of the neglected children experienced educational neglect (47% or an estimated 360,500 children), more than a third were physically neglected (38% or an estimated 295,300 children) and a quarter were emotionally neglected (25% or an estimated193,300 children). Overall, the incidence rate of Harm Standard maltreatment in the NIS-4 declined by 19% since the NIS-3. The number of children who experienced Harm Standard abuse decreased significantly by 26% (an estimated 743,200 children in the NIS-3 to an estimated 553,300 children in the NIS-4). There are no statistically significant changes from the incidence of Harm Standard neglect since the NIS-3.

Under the Endangerment Standard category, more than 2.9 million children (an estimated 2,905,800 children or a rate of 39.5 children victimized per 1,000 children) experienced maltreatment during the NIS-4 study year. An estimated total of 835,000 children were abused (29%) while an estimated 2,251,600 children (77%) were neglected. Most of the abused children were physically abused (57% or an estimated 476,600 children) while approximately a third (36% or an estimated 302,600 children) were emotionally abused and less than a quarter (22% or an estimated 180,500 children) were sexually abused. More than half of the neglected children experienced physical neglect (53% or an estimated 1,192,200 children). Almost half were emotionally neglected (52% or an estimated 1,173,800) and 16% (an estimated 360,500 children) were educationally neglected. A statistically significant change was not observed in the overall incidence rate of Endangerment Standard maltreatment in the NIS-4 from the NIS-3. Nevertheless, there was a significant 32% decrease in the number of children who experienced Endangerment Standard abuse (an estimated 217,700 children in the NIS-3 to an estimated 135,300 in the NIS-4). There were no statistically significant changes from the incidence of Endangerment Standard neglect since the NIS-3.

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