Comprehensive Health Assessment for Children in Out-of-Home Care: An Exploratory Study of Service Needs and Mental Health in a Norwegian Population.

A comprehensive model for routine multi-disciplinary health assessment for children in out-of-home care was piloted in a Norwegian region. This paper reports on identified service needs and mental disorders among 196 children (0-17 years) receiving the assessment. Cross-sectional data was extracted from assessment reports. Results show needs across a range of services, with a mean of 2.8 recommended services for children aged 0-6 and 3.3 for children aged 7-17. Mental disorders were identified in 50% of younger children, and 70% of older children. For all children, overall service need was associated with mental disorders, in addition to male gender among younger children. Need for specialized mental health services was associated with mental disorders among younger children and increasing age among older children. The high frequency of service needs and mental disorders illustrate the importance of offering comprehensive health assessments routinely to this high-risk child population and necessitates coordinated service delivery.

The impact of case factors on the initial screening decision in child welfare investigations in Norway.

BACKGROUND: When a child welfare service agency receives a report of concern, there is an initial screening to decide whether an investigation needs to be initiated. In addition to the decision maker, case factors, external factors, and organizational factors have an impact on decision making in Child Welfare Services (CWS). Few recent studies have considered the impact of case factors on the initial screening. OBJECTIVE: This study examined case factors that have an impact on the decision to investigate in the Norwegian CWS. PARTICIPANTS AND SETTING: Participants included randomly drawn samples of case files from 16 agencies (N = 1365). METHODS: The study was designed as a cross-sectional case file study. Researchers coded the data on site at the agencies. To examine the association between a decision to investigate and case specific variables, multilevel logistic regression (generalized linear mixed model) analysis was conducted to account for case clustering effects within agencies. RESULTS: The rate of investigation was 82.3 %. Concerns of physical and sexual abuse (OR = 2.61***), parents' health and stressful events (OR = 2.20***), domestic violence or witnessing violence (OR = 2.52***), and concerns related to finances, housing, and employment (OR = 3.25**) lowered the threshold for investigation. Prior referrals were found to raise the threshold for investigation (OR = 0.88). (**p < .01, ***p < .001). CONCLUSION: Although large differences between agencies exist in decision-making processes in the Norwegian CWS, there are common case factors affecting the initial screening of referrals.

Do the Child Welfare and Protection Services Involve Children in Cases With Parental Mental Health Problems? A Norwegian Case-File Study.

Background: Parental mental health problems is a common source of concern reported to child welfare and protection services (CWPS). In this study we explored to what extent the child was invited to participate in the investigation process. We aimed to study: (a) what was the current practice in the child protection service in Norway when the CWPS received a report of concern about children whose parents were affected by mental health problems or substance abuse, (b) to what extent were children involved and consulted, (c) which factors predicted the decision to involve the children, and (d) in cases in which conversations with children were conducted: what was the main content of the conversations. Method: The study was a cross-sectional case file study (N = 1,123). Data were collected retrospectively from case records in 16 different child protection agencies. The cases were randomly drawn from all referrals registered in the participating agencies. Differences in how investigations were conducted in cases with and without concerns about parental mental health were analyzed using t-tests and chi-square testes. Predictors of child involvement in cases with parental mental health problems (N = 324) were estimated by logistic regression analyses. Results: When the referral to the CWPS contained concerns about parental mental health, there were more consultations with parents, more frequent home visits and the investigation took longer to conclude. The children, however, were less likely to be involved. Children in such cases were consulted in 47.5% of cases. Predictors for involving the children in those cases were child age, concern about the child's emotional problems and if the child was known from previous referrals. Conclusion: In Norwegian child protection investigations, in which there were concerns about the parent's mental health, conversations with children were conducted to a significantly lower degree compared to cases where the child's problem was the main concern. In such cases, the CWPS workers have to overcome a threshold before they consult with the child. The threshold decreases with child age and when case worker already knows the child.