Pathways of Care: A longitudinal study of children in care in Australia: Introductory article for special issue on Pathways of Care Longitudinal Study.

The Pathways of Care Longitudinal Study (POCLS) is the first large-scale prospective longitudinal study of children and young people in out-of-home care in Australia. It includes a cohort of all 4126 children and young people (age 0 to 17 years) who entered out-of-home care for the first time over an 18-month period from May 2010 to October 2011 in New South Wales, with a focus on 2828 of these children with final court orders. It involved interviews with participating caregivers for children on final orders and standardised assessments for the children in their care as well as interviews for 7-17 year-olds, together with linked administrative data from a range of agencies for all 4126 children. Data for the interview cohort includes information on children's development, permanency and wellbeing while in care, tracking their physical health, socio-emotional wellbeing and cognitive development, as well as their experiences in care, and after they exit care to return home, or to guardianship and adoption. POCLS currently includes data from five waves of interviews with caregivers and the children in their care. This special issue includes articles that present findings from a range of analyses across various domains from the first four waves of the study. This introductory article outlines the Australian context of the study, its conceptual framework, design and methodology. Using a range of analytical approaches, the nine articles expose an array of issues, including children's developmental, socio-emotional and academic outcomes and trajectories (including reunification), associated with factors such as placement type, stability, pre-care maltreatment, disability, and age at entry to care, and caregiver stress.

Agent-based simulation and child protection systems: Rationale, implementation, and verification.

BACKGROUND AND OBJECTIVE: Simulation models are an important tool used in health care and other disciplines to support operational research and decision-making. In the child protection literature, simulation models are an under-utilized source of research evidence. PARTICIPANTS AND SETTING: In this paper, we describe the rationale for and the development of an agent-based simulation of a child protection system in the US. Using the investigation, prevention service, and placement histories of 600,000 children served in an urban child welfare system, we walk the reader through the development of a prototype known as OSPEDALE. METHODS: The governing equations built into OSPEDALE probabilistically simulate the onset of investigations. Then, drawing from empirical survival distributions, the governing equations trace the probability of subsequent interactions with the system (recurrence of maltreatment, service referrals, and placement) conditional on the characteristics of children, their assessed risk level, and prior child protection system involvement. RESULTS: As an initial test of OSPEDALE's utility, we compare empirical admission counts with counts generated from OSPEDALE. Though the verification step is admittedly simple, the comparison shows that OSPEDALE replicates the empirical count of new admissions closely enough to justify further investment in OSPEDALE. CONCLUSIONS: Management of public child protection systems is increasingly research evidence-dependent. The emphasis on research evidence as a decision-support tool has elevated evidence acquired through randomized clinical trials. Though important, the evidence from clinical trials represents only one type of research evidence. Properly specified, simulation models are another source of evidence with real-world relevance.

Race, Poverty, and Foster Care Placement in the United States: Longitudinal and Cross-Sectional Perspectives.

Although the connections between race, poverty, and foster care placement seem obvious, the link has not in fact been studied extensively. To address this gap, we view poverty and placement through longitudinal and cross-sectional lenses to more accurately capture how changes in poverty rates relate to changes in placement frequency. The longitudinal study examines the relationship between poverty rate changes and changes in the placement of Black and White children between 2000 and 2015. The cross-sectional study extends the longitudinal analysis by using a richer measure of socio-ecological diversity and more recent foster care data. Using Poisson regression models, we assess the extent to which changes in race-differentiated child poverty rates are correlated with Black and White child placement frequencies and placement disparities. Regardless of whether one looks longitudinally or cross-sectionally, we find that Black children are placed in foster care more often than White children. Higher White child poverty rates are associated with substantially reduced placement differences; however, higher Black child poverty rates are associated with relatively small changes in placement disparity. Black and White child placement rates are more similar in counties with the fewest socio-ecological assets.

Parental absence, early reading, and human capital formation for rural children in China.

In this study, we adopt the human capital formation framework to understand the association of the various risk and protective factors in the family settings of rural children with their cognitive performance as measured by vocabulary and math test scores. We examine the role of caregiver reading or storytelling to children at younger age and the deprivation of parental care due to labor migration at different stages of childhood on child performance in vocabulary and math tests when they are over 10 years old. Our findings confirm the crucial role of parental presence in child's cognitive development both during early childhood and later ages. Extended periods of parental absence during early and later years of childhood are most pernicious for child cognitive performance. Our analysis also reveals significantly positive effect of caregiver reading and storytelling on children's vocabulary test performance. This study provides strong evidence for the benefits of programs that promote good parenting practice and caregiver involvement in child cognitive development.

Human capital and child protection: A research framework in the CRC context.

Since it was adopted November 1989, the Convention on the Rights of the Child has shaped the objectives for child protection systems around the world. Generally, those objectives fall along three dimensions: permanency, safety, and well-being. However, despite well-being receiving increasing attention in light of evidence that points to the importance of early childhood experiences on life course outcomes, child protection systems have so far struggled to find clear definition of well-being as a developmental construct. In this article, we propose a definition of child well-being that draws on the economic literature pertaining to skill formation and human capital. We argue that human capital, as a multidimensional concept that incorporates cognitive skills, non-cognitive skills, and health, should be added to the list of considerations policy makers contemplate when their attention turns to well-being provided there is research evidence for doing so. To that end, we discuss the several advantages the human capital framework offers within a child protection context. We then describe a theoretical framework and analytical approach to the study of skill formation. We are particularly interested in dynamic models wherein the skills one has influence the rate at which new skills are acquired, with specific emphasis on risk and protective factors across the life course of childhood. Overall, our discussion highlights how a dynamic model of human capital formation aligns with Convention on the Rights of the Child and notions that children in child protection systems have a right to develop the abilities they will need to be responsible adults.

Data on children reentering foster care from kinship guardianship.

This article describes a dataset containing information on children exiting to kinship guardianship in California between 2003 and 2010 (N = 18,831). Children and young people in the sample were followed for up to fourteen years. The data presented here show summary statistics of the sample included in the analysis. Furthermore, the data consist of life tables showing counts of children at risk of reentry, counts of children who reentered the foster care system as well as nonparametric estimates of the survival function and the cumulative hazard function for the period 2003-2017.

Age and other risk factors related to reentry to care from kin guardian homes.

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (N = 18,831). Specifying time-dependent Cox relative risk models, children's age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and children's development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13-15 years (HR = 1.63, p < .001), and late adolescents, age 16-17 years (HR = 1.93, p < .001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HR = 2.18, p < .001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.

Foster Care Dynamics and System Science: Implications for Research and Policy.

Although system is a word frequently invoked in discussions of foster care policy and practice, there have been few if any attempts by child welfare researchers to understand the ways in which the foster care system is a system. As a consequence, insights from system science have yet to be applied in meaningful ways to the problem of making foster care systems more effective. In this study, we draw on population biology to organize a study of admissions and discharges to foster care over a 15-year period. We are interested specifically in whether resource constraints, which are conceptualized here as the number of beds, lead to a coupling of admissions and discharges within congregate care. The results, which are descriptive in nature, are consistent with theory that ties admissions and discharges together because of a resource constraint. From the data, it is clear that the underlying system exerts an important constraint on what are normally viewed as individual-level decisions. Our discussion calls on extending efforts to understand the role of system science in studies of child welfare systems, with a particular emphasis on the role of feedback as a causal influence.

Implementation and evaluation of linked parenting models in a large urban child welfare system.

During the past decade, there have been increased efforts to implement evidence-based practices into child welfare systems to improve outcomes for children in foster care and their families. In this paper, the implementation and evaluation of a policy-driven large system-initiated reform is described. Over 250 caseworkers and supervisors were trained and supported to implement two evidence-based parent focused interventions in five private agencies serving over 2,000 children and families. At the request of child welfare system leaders, a third intervention was developed and implemented to train the social work workforce to use evidence-based principles in everyday interactions with caregivers (including foster, relative, adoptive, and biological parents). In this paper, we describe the policy context and the targeted outcomes of the reform. We discuss the theory of the interventions and the logistics of how they were linked to create consistency and synergy. Training and ongoing consultation strategies used are described as are some of the barriers and opportunities that arose during the implementation. The strategy for creating a path to sustainability is also discussed. The reform effort was evaluated using both qualitative and quantitative methods; the evaluation design, research questions and preliminary results are provided.

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs.

BACKGROUND: U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. DATA AND METHODS: We assembled a unique, longitudinal, state-level panel dataset (1990-2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. FINDINGS: State foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, >50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates. CONCLUSIONS: Despite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services.

Cost calculator methods for estimating casework time in child welfare services: A promising approach for use in implementation of evidence-based practices and other service innovations.

Estimating costs in child welfare services is critical as new service models are incorporated into routine practice. This paper describes a unit costing estimation system developed in England (cost calculator) together with a pilot test of its utility in the United States where unit costs are routinely available for health services but not for child welfare services. The cost calculator approach uses a unified conceptual model that focuses on eight core child welfare processes. Comparison of these core processes in England and in four counties in the United States suggests that the underlying child welfare processes generated from England were perceived as very similar by child welfare staff in California county systems with some exceptions in the review and legal processes. Overall, the adaptation of the cost calculator for use in the United States child welfare systems appears promising. The paper also compares the cost calculator approach to the workload approach widely used in the United States and concludes that there are distinct differences between the two approaches with some possible advantages to the use of the cost calculator approach, especially in the use of this method for estimating child welfare costs in relation to the incorporation of evidence-based interventions into routine practice.

A computational future for preventing HIV in minority communities: how advanced technology can improve implementation of effective programs.

African Americans and Hispanics in the United States have much higher rates of HIV than non-minorities. There is now strong evidence that a range of behavioral interventions are efficacious in reducing sexual risk behavior in these populations. Although a handful of these programs are just beginning to be disseminated widely, we still have not implemented effective programs to a level that would reduce the population incidence of HIV for minorities. We proposed that innovative approaches involving computational technologies be explored for their use in both developing new interventions and in supporting wide-scale implementation of effective behavioral interventions. Mobile technologies have a place in both of these activities. First, mobile technologies can be used in sensing contexts and interacting to the unique preferences and needs of individuals at times where intervention to reduce risk would be most impactful. Second, mobile technologies can be used to improve the delivery of interventions by facilitators and their agencies. Systems science methods including social network analysis, agent-based models, computational linguistics, intelligent data analysis, and systems and software engineering all have strategic roles that can bring about advances in HIV prevention in minority communities. Using an existing mobile technology for depression and 3 effective HIV prevention programs, we illustrated how 8 areas in the intervention/implementation process can use innovative computational approaches to advance intervention adoption, fidelity, and sustainability.

Evaluating child welfare policies with decision-analytic simulation models.

The objective was to demonstrate decision-analytic modeling in support of Child Welfare policymakers considering implementing evidence-based interventions. Outcomes included permanency (e.g., adoptions) and stability (e.g., foster placement changes). Analyses of a randomized trial of KEEP-a foster parenting intervention-and NSCAW-1 estimated placement change rates and KEEP's effects. A microsimulation model generalized these findings to other Child Welfare systems. The model projected that KEEP could increase permanency and stability, identifying strategies targeting higher-risk children and geographical regions that achieve benefits efficiently. Decision-analytic models enable planners to gauge the value of potential implementations.

Economic evaluation research in the context of Child Welfare policy: a structured literature review and recommendations.

OBJECTIVES: With over 1 million children served by the US Child Welfare system at a cost of $20 billion annually, this study examines the economic evaluation literature on interventions to improve outcomes for children at risk for and currently involved with the system, identifies areas where additional research is needed, and discusses the use of decision-analytic modeling to advance Child Welfare policy and practice. METHODS: The review included 19 repositories of peer-reviewed and non-peer-reviewed "gray" literatures, including items in English published before November, 2009. Original research articles were included if they evaluated interventions based on costs and outcomes. Review articles were included to assess the relevance of these techniques over time and to highlight the increasing discussion of methods needed to undertake such research. Items were categorized by their focus on: interventions for the US Child Welfare system; primary prevention of entry into the system; and use of models to make long-term projections of costs and outcomes. RESULTS: Searches identified 2,640 articles, with 49 ultimately included (19 reviews and 30 original research articles). Between 1988 and 2009, reviews consistently advocated economic evaluation and increasingly provided methodological guidance. 21 of the original research articles focused on Child Welfare, while 9 focused on child mental health. Of the 21 Child Welfare articles, 81% (17) focused on the US system. 47% (8/17) focused exclusively on primary prevention, though 83% of the US system, peer-reviewed articles focused exclusively on prevention (5/6). 9 of the 17 articles included empirical follow-up (mean sample size: 264 individuals; mean follow-up: 3.8 years). 10 of the 17 articles used modeling to project longer-term outcomes, but 80% of the articles using modeling were not peer-reviewed. Although 60% of modeling studies included interventions for children in the system, all peer-reviewed modeling articles focused on prevention. CONCLUSIONS: Methodological guidance for economic evaluations in Child Welfare is increasingly available. Such analyses are feasible given the availability of nationally representative data on children involved with Child Welfare and evidence-based interventions. PRACTICE IMPLICATIONS: Policy analyses considering the long-term costs and effects of interventions to improve Child Welfare outcomes are scarce, feasible, and urgently needed.

Epidemiological perspectives on maltreatment prevention.

Fred Wulczyn explores how data on the incidence and distribution of child maltreatment shed light on planning and implementing maltreatment prevention programs. He begins by describing and differentiating among the three primary sources of national data on maltreatment. Wulczyn then points out several important patterns in the data. The first involves child development. Based on official reports, maltreatment rates are highest during certain periods of children's lives, especially infancy and adolescence. Bringing a new baby into the home, in particular, heightens stress and increases the risk of maltreatment by parents, who tend to be younger and less experienced as parents. These data patterns should help shape strategies that target these families. A second pattern in the data involves social context and the contribution of race and poverty to maltreatment. Children of color, for example, are much more likely than white children to be reported. Research, however, suggests that when the whites and minorities who are being compared live in a similar social context, disparities in maltreatment rates narrow to some extent. What scholars must examine more closely is the means by which community processes contribute to maltreatment. Thus, the question for researchers is not whether investments in communities are an important part of the prevention strategy, but rather what type of investment is most likely to replace what is missing in a given community. Wulczyn also explores substance abuse and maltreatment recurrence. He points out that substance abuse not only increases the risk that a parent will neglect a child but also appears to affect that child's experience in the child welfare system: when substance abuse is part of an allegation history, decisions affecting the child tilt in favor of deeper involvement with the system. Patterns of recurrence mirror those already described. Base rates of recurrence are about 9 percent but are higher for infants when allegations involve substance abuse and when children received services following the initial report. Wulczyn stresses that much more research remains before analysts understand the mechanisms that underpin these persistent patterns-knowledge that is essential to designing sound interventions.

Covariates of length of stay in residential treatment.

This study explores variables associated with length of stay in a child welfare residential treatment center. The study followed three entry cohorts (416 boys) from admission through discharge. The researchers conducted event history analyses to examine the rates of discharge over time and the covariates of length of stay. They conducted analyses by discharge destination (reunified, transferred, or ran away). The results demonstrated that mental health issues slowed down rates of discharge for youth who were reunified or transferred. For children who left by running away, age and prior substance history were associated with faster rates of exit. These results have important public policy implications for improving the application of length of stay variables in planning and treatment.

Family reunification.

Reunifying children placed in foster care with their birth parents is a primary goal of the child welfare system. Yet, relatively little is known about the reunification process. This article analyzes new data on trends in family reunification and discovers: Although most children still exit foster care through family reunification, exit patterns have changed over the last 8 years. Currently, reunification takes longer to happen, whereas adoptions happen earlier. A child's age and race are associated with the likelihood that he or she will be reunified. Infants and adolescents are less likely to be reunified than children in other age groups, and African-American children are less likely to be reunified than children of other racial/ethnic backgrounds. Although many children who are reunified exit the system within a relatively short period of time, reunifications often do not succeed. Nearly 30% of children who were reunified in 1990 reentered foster care within 10 years. The principle of family reunification is deeply rooted in American law and tradition, and reunification is likely to continue as the most common way children exit foster care. Thus, greater efforts should be made to ensure that reunifications are safe and lasting. The article closes with a discussion of changes in policy and practice that hold promise for improving the safety and stability of reunified families, such as instituting better measures of state performance, and continuing to provide monitoring and supports for families after a child is returned home.