Complex, Co-occurring Needs Patterns and Evidence-Based Service Planning for Families Involved in Foster Care: A Map for Research and Practice.

This study described the complexity of service need co-occurrence among foster care-involved families and identified prevalent patterns of needs to inform future evidence-based service planning research. We utilized state administrative child maltreatment records, and restricted data to cases where the child entered foster care in 2019 and the caseworker indicated the presence of at least one need from the Family Assessment of Needs and Strengths (FANS; n = 1631). We extracted all unique combinations of needs (i.e., needs profiles), and we used association rule mining to identify patterns within these profiles. A total of 780 unique needs profiles emerged among the 1631 cases, which we condensed into 78 patterns. Although the variability and complexity of needs profiles makes evidence-based service planning difficult, the present analysis mapped prevalent needs patterns to guide future research intended to assist caseworkers in this task. Identification of maltreatment determinants among families involved in foster care, and future research into the needs within different needs patterns that might undermine treatment effectiveness, may result in a better balance between parsimonious service plans and a full consideration of co-occurring service needs.

A text-based approach to measuring opioid-related risk among families involved in the child welfare system.

BACKGROUND: The public health significance of the opioid epidemic is well-established. However, few states collect data on opioid problems among families involved in child welfare services. The absence of data creates significant barriers to understanding the impact of opioids on the service system and the needs of families being served. OBJECTIVE: This study sought to validate binary and count-based indicators of opioid-related maltreatment risk based on mentions of opioid use in written child welfare summaries. DATA AND PROCEDURES: We developed a comprehensive list of terms referring to opioid street drugs and pharmaceuticals. This terminology list was used to scan and flag investigator summaries from an extensive collection of investigations (N = 362,754) obtained from a state-based child welfare system in the United States. Associations between mentions of opioid use and investigators' decisions to substantiate maltreatment and remove a child from home were tested within a framework of a priori hypotheses. RESULTS: Approximately 6.3% of all investigations contained one or more opioid use mentions. Opioid mentions exhibited practically signficant associations with investigator decisions. One in ten summaries that were substantiated had an opioid mention. One in five investigations that led to the out-of-home placement of a child contained an opioid mention. CONCLUSION: This study demonstrates the feasibility of using simple text mining procedures to extract information from unstructured text documents. These methods provide novel opportunities to build insights into opioid-related problems among families involved in a child welfare system when structured data are not available.

Using administrative data to uncover how often and why supervisory neglect happens: Implications for child maltreatment prevention.

BACKGROUND: Despite supervisory neglect being the most prevalent and fatal neglect sub-type, the most common reasons why caregivers are substantiated for this type of maltreatment remains unknown. OBJECTIVE: Our study describes cases substantiated for supervisory neglect in a Midwestern state in an effort to inform prevention strategies against supervisory neglect. PARTICIPANTS AND SETTING: This study utilized state administrative data from substantiated child maltreatment investigations conducted between May 1st and October 31st, 2019 (N = 11,208). METHODS: We first identified the substantiated investigations where supervisory neglect was present and established investigation-level correlates for these cases. We then selected a random sample of investigations with a substantiated allegation of supervisory neglect (n = 150) for a qualitative review of written investigative narratives to uncover the contextual factors of supervisory neglect and identify which factors frequently co-occur. RESULTS: Supervisory neglect was the most common maltreatment type, present in 71% (n = 7945) of substantiated child welfare investigations. Our qualitative review of 150 randomly selected cases identified ten distinct, non-mutually exclusive contextual factors of supervisory neglect. Child exposure to domestic violence was the most prevalent contextual factor (45%), followed by caregiver's substance-related problems (42%). Childhood exposure to domestic violence and caregiver's substance-related problems was the most common co-occurrence of factors, present in 18% of cases. CONCLUSIONS: Supervisory neglect accounts for the vast majority of child maltreatment incidents. To prevent the largest share of supervisory neglect cases, policy and programs are needed to address domestic violence and substance-related problems among caregivers.

Identification of Domestic Violence Service Needs Among Child Welfare-Involved Parents With Substance Use Disorders: A Gender-Stratified Analysis.

The current study examined the prevalence and associations of a need for domestic violence services among child welfare-involved mothers and fathers with substance use disorders. Data were drawn from 2,231 child welfare-involved parents in Illinois with an identified substance use disorder. Approximately 42% of mothers and 33% of fathers with a substance use disorder had a concurrent need for domestic violence services. The sample was stratified by gender and logistic regression models were fit to determine the adjusted odds of an identified need for domestic violence services. For both mothers and fathers, the strongest association was an additional need for mental health services. Age, education status, alcohol use, marijuana use, and a reported history of physical violence victimization were also associated with a need for domestic violence services among mothers, while race, age, marital status, annual income, alcohol use, cocaine use, and a reported history of physical violence perpetration were associated with a need for domestic violence services among fathers. The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare-involved parents with identified substance use disorders, and that associations with this need vary by gender.

Prevalence and context of firearms-related problems in child protective service investigations.

BACKGROUND: Despite the significance of firearm safety, we need additional data to understand the prevalence and context surrounding firearm-related problems within the child welfare system. OBJECTIVE: Estimate proportion of cases reporting a firearm-related problem during case initiation and the contexts in which these problems exist. SAMPLE AND SETTING: 75,809 caseworker-written investigation summaries that represented all substantiated referrals of maltreatment in Michigan from 2015 to 2017. METHODS: We developed an expert dictionary of firearm-related terms to search investigation summaries. We retrieved summaries that contained any of the terms to confirm whether a firearm was present (construct accurate) and whether it posed a threat to the child. Finally, we coded summaries that contained firearm-related problems to identify contexts in which problems exist. RESULTS: Of the 75,809 substantiated cases, the dictionary flagged 2397 cases that used a firearm term (3.2 %), with a construct accuracy rate of 96 %. Among construct accurate cases, 79 % contained a firearm-related problem. The most common intent for a firearm-related problem was violence against a person (45 %). The co-occurrence of domestic violence and/or substance use with a firearm-related problem was high (41 % and 48 %, respectively). 49 % of summaries that contained a firearm-related problem did not provide information regarding storage. CONCLUSION: When caseworkers document a firearm within investigative summaries, a firearm-related risk to the child likely exists. Improved documentation of firearms and storage practices among investigated families may better identify families needing firearm-related services.

Detecting substance-related problems in narrative investigation summaries of child abuse and neglect using text mining and machine learning.

BACKGROUND: State child welfare agencies collect, store, and manage vast amounts of data. However, they often do not have the right data, or the data is problematic or difficult to inform strategies to improve services and system processes. Considerable resources are required to read and code these text data. Data science and text mining offer potentially efficient and cost-effective strategies for maximizing the value of these data. OBJECTIVE: The current study tests the feasibility of using text mining for extracting information from unstructured text to better understand substance-related problems among families investigated for abuse or neglect. METHOD: A state child welfare agency provided written summaries from investigations of child abuse and neglect. Expert human reviewers coded 2956 investigation summaries based on whether the caseworker observed a substance-related problem. These coded documents were used to develop, train, and validate computer models that could perform the coding on an automated basis. RESULTS: A set of computer models achieved greater than 90% accuracy when judged against expert human reviewers. Fleiss kappa estimates among computer models and expert human reviewers exceeded .80, indicating that expert human reviewer ratings are exchangeable with the computer models. CONCLUSION: These results provide compelling evidence that text mining procedures can be a cost-effective and efficient solution for extracting meaningful insights from unstructured text data. Additional research is necessary to understand how to extract the actionable insights from these under-utilized stores of data in child welfare.

Child Protective Service Referrals Involving Exposure to Domestic Violence: Prevalence, Associated Maltreatment Types, and Likelihood of Formal Case Openings.

Childhood exposure to domestic violence (CEDV) is widely understood as potentially harmful to children. Accordingly, many child welfare systems in the United States construe CEDV as maltreatment when the exposure results in harm or threatened harm to the child. The purpose of the current study was to investigate substantiated child welfare referrals directly related to CEDV to better understand the prevalence and patterns of CEDV-related maltreatment and how child welfare workers respond under the "harm or threatened harm" standard. Data were drawn from 23,704 substantiated referrals between 2009 and 2013 in a large Midwestern child welfare system. Approximately 20% of substantiated referrals were CEDV related. A plurality of CEDV-related referrals included both a male caregiver and female caregiver who were co-substantiated for maltreatment. The most common maltreatment types substantiated for these referrals were neglect based rather than abuse based, and just under a quarter (23%) of CEDV-related referrals were formally opened for services. Referrals involving co-occurring substance abuse were most likely to be opened for services based on predicted probabilities derived from multilevel modeling. Implications for policy and practice are considered.

Early Exposure to Child Maltreatment and Academic Outcomes.

Early childhood trauma increases the risk of academic difficulties. The purpose of this study was to investigate the prevalence of early contact with child protection services (CPS) and to determine whether early exposure to maltreatment investigations was associated with important academic outcomes. The authors focused specifically on standardized test scores (math and reading), grade retention, and special education status in third grade. The sample was diverse and included all children born between 2000 and 2006 and enrolled in Michigan's public schools ( N = 732,838). By the time these students reached third grade, approximately 18% were associated with a formal CPS investigation. In some school districts, more than 50% of third graders were associated with an investigation. African American and poor students were more likely to be investigated for maltreatment. Children associated with maltreatment investigations scored significantly lower on standardized math and reading tests, were more likely to be identified as needing special education, and were more likely to be held back at least one grade. These findings indicate that involvement with CPS is not an infrequent event in the lives of young children and that within some school districts, maltreatment investigations are the norm. Child welfare and educational systems must collaborate so that the early academic struggles experienced by victims of maltreatment do not mature into more complicated difficulties later in life.

Domestic violence, parental substance misuse and the decision to substantiate child maltreatment.

Families that experience domestic violence and parental substance misuse are disproportionately involved with the child welfare system. Prior research suggests that child protective services (CPS) caseworkers are more likely to substantiate maltreatment allegations when domestic violence and parental substance misuse are identified during the investigation, pointing to one possible mechanism for this disproportionate involvement. While previous studies have relied on nationally representative data sets, the current study used administrative records from a large Midwestern child welfare agency that accounts for state-level variation in child welfare policy and practice. A total of 501,060 substantiation decisions made between 2009 and 2013 were examined to assess the influence of caseworker-perceived domestic violence and parental substance misuse on the decision to substantiate reported maltreatment. Results from multilevel modeling suggest that the identification of domestic violence and parental substance misuse during an investigation significantly increased the probability that an allegation would be substantiated. The implication of these findings for child welfare practice are considered in light of the fact that many child welfare agencies do not consider exposure to domestic violence and parental substance misuse in and of themselves to constitute child maltreatment.

In Utero Exposure to Opioids: An Observational Study of Mothers Involved in the Child Welfare System.

BACKGROUND: Women are underrepresented in the current substance abuse research; however, women are a particularly vulnerable population when it comes to opioid use and abuse. Pregnant women are even more so, because of the potential that exists for in utero exposure (IUE) to substances. OBJECTIVES: To identify trends in IUE to opioids in order to ensure that resources are allocated effectively to address the current opioid epidemic and to assist the populations most affected by it. METHODS: This study draws on 15 years' worth of clinical assessment data collected from 3598 child welfare-involved mothers to assess for trends in IUE to substances over time. Data from the last 5 year period (N = 852) are then analyzed to identify recent demographic correlates associated with IUE to opioid substances. RESULTS: A substantial increase in the rates of IUE to opioids over the past 15 years is observed among child welfare-involved mothers. Moreover, we find that race is a significant correlate of IUE to opioids. CONCLUSION: Study findings are consistent with other recent research that demonstrates racial differences in the populations that are most affected by the opioid epidemic; however, more research is needed to determine how these racial differences in rates of IUE to opioids affect child welfare outcomes.

Timing matters: A randomized control trial of recovery coaches in foster care.

Substance use disorders are a major problem for child welfare systems. The abuse of and dependence on alcohol and drugs by parents increases the risk of child maltreatment and interferes with efforts to locate a permanent home for children in foster care. The current study focuses on an intervention designed to increase the probability of reunification for foster children associated with substance using families. We focus specific attention on the timing of the intervention, in particular the timing of comprehensive screening and access to substance abuse services in relation to the temporary custody hearing. A diverse group of children (n=3440) that were placed in foster care and associated with a parent diagnosed with a substance use disorder were randomly assigned to either a control (services as usual) or experimental group (services as usual plus a recovery coach for parents). Binomial logistic regression models indicated that early access to substance use services matters (within two months of the temporary custody hearing) but only when parents were connected with a recovery coach. Additional findings indicated that the recovery coach model eliminated racial disparities in reunification. The implications of these findings are discussed.

Foster home placements and the probability of family reunification: Does licensing matter?

The concept of foster care has been widely studied in child welfare. The literature is well developed with regard to the risk of initial placement, length of stay in care, placement stability, exits to permanency, and emancipation. Yet, the literature is woefully underdeveloped when it comes to understanding if variations in the types and characteristics of foster homes impact important child welfare outcomes. The current study utilizes entry cohorts pulled from statewide administrative data (N=17,960) to investigate the association between types of foster care and the probability of reunification. We focus specifically on the licensing status of foster homes. Reflecting federal benchmarks, we examined the odds of reunification at one- and two-year intervals. Propensity score analysis was used to reduce selection bias. Adjusted logistic regression models revealed that youth placed in licensed relative care (LRC) homes were the least likely to achieve reunification compared with youth placed in licensed non-relative care (LNC) homes and unlicensed relative care (URC) homes. Conversely, youth placed in URC homes were more likely to achieve reunification as compared with youth placed in LRC and LNC homes. These findings will help states to efficiently target scarce resources to specific types of foster homes that may be impacting federal reunification benchmarks.

Child Welfare and the Transition to Adulthood: Investigating Placement Status and Subsequent Arrests.

Studies of the transition to adulthood in child welfare focus almost exclusively on youth in foster care. Yet, research indicates that maltreated children who remain in the home may display similar risks as compared with their peers in formal foster care settings. Utilizing administrative data from child welfare, juvenile justice and adult corrections, the current study fills a gap in the literature by analyzing justice outcomes for older adolescents involved with the child welfare system regardless of their placement status. We focus on both intact family cases and formal foster care placements. The diverse sample (11% Hispanic, 8% African American, 6% Native American, 9% multi-racial, 56% female) included open child welfare cases involving 17 year olds (n = 9874). Twenty-nine percent of adolescents were associated with a long term out of home placement and 62% were associated with an intact family case. Event history models were developed to estimate the risk of subsequent offending. Adolescents associated with long term foster care placement were significantly less likely to experience a subsequent arrest as compared with adolescents associated with a long term intact family case. Males, African Americans and adolescents associated with neglect were also more likely to experience a subsequent arrest. Limited focus on the intact family population in child welfare represents a lost opportunity to support critical developmental gains and facilitate a smooth transition to adulthood.

Termination of parental rights for parents with substance use disorder: for whom and then what?

The purpose of this study is to investigate the correlates of termination of parental rights (TPR) for parents with substance use disorder (SUD) and to determine what happens with regard to permanency once a TPR decision is made. Bivariate techniques and hierarchical nonlinear modeling are used. Parents of older youth, boys, and Hispanics were less likely, whereas parents who failed to make progress in substance use treatment and parenting skills are more likely to experience TPR. At follow up, 85% of the children were adopted, 7% remained in a substitute care settings, and 7% were reunified with their parents. Concerns remain for children without a permanent home setting.

The effect of recovery coaches for substance-involved mothers in child welfare: impact on juvenile delinquency.

Despite the documented relationship between parental substance abuse and youth delinquency, the effects of parental interventions on delinquency outcomes are unknown. Such interventions are particularly vital for families in the child welfare system who are at heightened risk for both parental substance involvement and youth delinquency. The current study tested the impact of intensive case management in the form of a recovery coach for substance-involved mothers on youth delinquency outcomes among a randomized sample of 453 families involved in a Title IV-E experimental waiver demonstration in Cook County, Illinois. In comparison to control group participants, families enrolled in the Alcohol and Other Drug Abuse (AODA) waiver demonstration experienced a lower rate of juvenile arrest, net of factors such as demographic characteristics, primary drug of choice, and time spent in substitute care. Findings support efforts to curb delinquency among child-welfare involved youth by providing recovery coaches to their substance abusing or dependent parents.

Adolescent neglect, juvenile delinquency and the risk of recidivism.

Victims of child abuse and neglect are at an increased risk of involvement with the juvenile justice and adult correctional systems. Yet, little is known about the continuation and trajectories of offending beyond initial contact with law enforcement. Neglect likely plays a critical role in continued offending as parental monitoring, parental rejection and family relationships are instrumental in explaining juvenile conduct problems. This study sought to determine whether neglect is associated with recidivism for moderate and high risk juvenile offenders in Washington State. Statewide risk assessments and administrative records for child welfare, juvenile justice, and adult corrections were analyzed. The sample was diverse (24 % female, 13 % African American, 8 % Hispanic, 5 % Native American) and included all moderate and high risk juvenile offenders screened by juvenile probation between 2004 and 2007 (n = 19,833). Official records from child protection were used to identify juvenile offenders with a history of child neglect and to identify juvenile offenders with an ongoing case of neglect. Event history models were developed to estimate the risk of subsequent offending. Adolescents with an ongoing case neglect were significantly more likely to continue offending as compared with youth with no official history of neglect. These findings remain even after controlling for a wide range of family, peer, academic, mental health, and substance abuse covariates. Interrupting trajectories of offending is a primary focus of juvenile justice. The findings of the current study indicate that ongoing dependency issues play a critical role in explaining the outcomes achieved for adolescents in juvenile justice settings. The implications for improved collaboration between child welfare and juvenile justice are discussed.

Substitute care in child welfare and the risk of arrest: does the reason for placement matter?

This study sought to investigate whether the reason for placement was associated with the subsequent risk of arrest. The author has focused on youth entering care for reasons of maltreatment and for child behavioral problems. The author stratified the sample based on a history of juvenile delinquency. The sample was diverse and included youth between 8 and 16 years of age with at least one episode in a substitute care child welfare setting (n = 5,528). Approximately 23% of youth were placed in child welfare for reasons others than maltreatment; specifically child behavioral problems. Youth placed for behavioral problems were significantly more likely to live in congregate care facilities, experience placement instability, and more likely to experience at least one arrest. A prevailing argument is that child welfare offers a broader range of family-based services as compared with the secure settings of juvenile justice. High rates of congregate care placement reported in the current study indicate that family-based services are infrequently associated with youth placed for behavioral problems in child welfare. High rates of subsequent arrest indicate that the congregate care approach for youth with behavioral problems in child welfare is limited.

Recovery coaches and substance exposed births: an experiment in child welfare.

OBJECTIVES: Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes. The objective of the current study is to evaluate the use of recovery coaches in child welfare. METHODS: The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth. RESULTS: Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth. CONCLUSIONS: The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.