State Spending on Public Benefit Programs and Child Maltreatment.

BACKGROUND: To determine the association between states' total spending on benefit programs and child maltreatment outcomes. METHODS: This was an ecological study of all US states during federal fiscal years 2010-2017. The primary predictor was states' total annual spending on local, state, and federal benefit programs per person living ≤100% federal poverty limit, which was the sum of (1) cash, housing, and in-kind assistance, (2) housing infrastructure, (3) child care assistance, (4) refundable Earned Income Tax Credit, and (5) Medical Assistance Programs. The main outcomes were rates of maltreatment reporting, substantiations, foster care placements, and fatalities after adjustment for relevant confounders. Generalized estimating equations adjusted for federal spending and estimated adjusted incidence rate ratios (IRRs) and 95% confidence intervals (CIs). RESULTS: States' total spending was inversely associated with all maltreatment outcomes. For each additional $1000 states spent on benefit programs per person living in poverty, there was an associated -4.3% (adjusted IRR: 0.9573 [95% CI: 0.9486 to 0.9661]) difference in reporting, -4.0% (adjusted IRR: 0.903 [95% CI: 0.9534 to 0.9672]) difference in substantiations, -2.1% (adjusted IRR: 0.9795 [95% CI: 0.9759 to 0.9832]) difference in foster care placements, and -7.7% (adjusted IRR: 0.9229 [95% CI: 0.9128 to 0.9330]) difference in fatalities. In 2017, extrapolating $1000 of additional spending for each person living in poverty ($46.5 billion nationally, or 13.3% increase) might have resulted in 181 850 fewer reports, 28 575 fewer substantiations, 4168 fewer foster care placements, and 130 fewer fatalities. CONCLUSIONS: State spending on benefit programs was associated with reductions in child maltreatment, which might offset some benefit program costs.

The economic burden of dissociative disorders: A qualitative systematic review of empirical studies.

OBJECTIVE: Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. METHOD: We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. RESULTS: A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. CONCLUSIONS: Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Medical foster home is less costly than traditional nursing home care.

OBJECTIVE: To compare the costs of Community Nursing Homes (CNHs) to Medical Foster Homes (MFHs) at Veteran Health Administration (VHA) Medical Centers that established MFH programs. DATA SOURCES: Episode and costs data were derived from VA and Medicare files (inpatient, outpatient, emergency room, skilled nursing facility, dialysis, and hospice). STUDY DESIGN: Propensity scores matched 354 MFH to 1693 CNH Veterans on demographics, clinical characteristics, health care utilization, and costs. DATA EXTRACTION METHODS: Data were retrieved for years 2010-2011 from the VA Corporate Data Warehouse, VA Health Data Repository, and the VA MFH Program through the VA Informatics and Computing Infrastructure (VINCI). PRINCIPAL FINDINGS: After matching on unique characteristics of MFH Veterans, costs were $71.28 less per day alive compared to CNH care. Home-based and mental health care costs increased with savings largely attributable to avoiding CNH residential care. When average out-of-pocket payments by Veterans of $74/day are considered, MFH is at least cost neutral. Mortality was 12 percent higher among matched Veterans in CNHs. CONCLUSIONS: MFHs may serve as alternatives to traditional CNH care that do not increase total costs with mortality benefits. Future work should examine the differences for functional disability subgroups.

Effects of individual risk and state housing factors on adverse outcomes in a national sample of youth transitioning out of foster care.

INTRODUCTION: Compared to their peers, youth who leave the foster care system without permanency experience greater risks for adverse young adult outcomes, including homelessness, incarceration, substance abuse, and early child birth. Extant literature focuses on individual-level factors related to adversity. In this study, we estimated the impact of state and individual-level risk and protective factors on adverse 19-year-old outcomes among a cohort of U.S. transition age youth. METHODS: We used multilevel modeling to analyze prospective, longitudinal data from two waves of the National Youth in Transitions Database (N = 7449). These data were linked to the Adoption and Foster Care Reporting System, the Administration for Children and Families budget expenditures, and the American Community Survey for the period from 2011 to 2013. RESULTS: Approximately 30% of the variation in each of the 19-year-old outcomes could be attributed to state-level effects. Residence in a state that spent above average of CFCIP budget on housing supports reduced the risk of homelessness and incarceration. Living in a state with a higher proportion of housing-burdened low-income renters significantly increased the risk of substance abuse and child birth. Individual-level risks were significant: racial/ethnic minority, male gender, past risk history, placement instability, child behavioral problems, residence in group home or runaway. Remaining in foster care at age 19 reduced the odds of homelessness, incarceration, and substance abuse. CONCLUSION: Macro factors, including financial support for transition-age youth, and broader housing market characteristics, have a bearing on young adult outcomes, and raise policy questions across social and human service sectors.

Health Outcomes of Medically and Economically Vulnerable Adults: A Comparison of Former Foster Youth and Nonfoster Youth.

Medically and economically vulnerable adults experience various challenges that can impact their health. Within this vulnerable population, there may be individuals who are even more vulnerable, those who have a history of involvement with the foster care system. The purpose of this study was to evaluate the difference of reported health-related problems between adults with previous foster care experience and other vulnerable adults. Physical, mental, and relational health was evaluated in this study. Practice and policy implications for mental health and medical professionals are discussed.

Differences in Medicaid Antipsychotic Medication Measures Among Children with SSI, Foster Care, and Income-Based Aid.

BACKGROUND: Concerns about antipsychotic prescribing for children, particularly those enrolled in Medicaid and with Supplemental Security Income (SSI), continue despite recent calls for selective use within established guidelines. OBJECTIVES: To (a) examine the application of 6 quality measures for antipsychotic medication prescribing in children and adolescents receiving Medicaid and (b) understand distinctive patterns across eligibility categories in order to inform ongoing quality management efforts to support judicious antipsychotic use. METHODS: Using data for 10 states from the 2008 Medicaid Analytic Extract (MAX), a cross-sectional assessment of 144,200 Medicaid beneficiaries aged < 21 years who received antipsychotics was conducted to calculate the prevalence of 6 quality measures for antipsychotic medication management, which were developed in 2012-2014 by the National Collaborative for Innovation in Quality Measurement. These measures addressed antipsychotic polypharmacy, higher-than-recommended doses of antipsychotics, use of psychosocial services before antipsychotic initiation, follow-up after initiation, baseline metabolic screening, and ongoing metabolic monitoring. RESULTS: Compared with children eligble for income-based Medicaid, children receiving SSI and in foster care were twice as likely to receive higher-than-recommended doses of antipsychotics (adjusted odds ratio [AOR] = 2.4, 95% CI = 2.3-2.6; AOR = 2.5, 95% CI = 2.4-2.6, respectively) and multiple concurrent antipsychotic medications (AOR = 2.2, 95% CI = 2.0-2.4; AOR = 2.2, 95% CI = 2.0-2.4, respectively). However, children receiving SSI and in foster care were more likely to have appropriate management, including psychosocial visits before initiating antipsychotic treatment and ongoing metabolic monitoring. While children in foster care were more likely to experience baseline metabolic screening, SSI children were no more likely than children eligible for income-based aid to receive baseline screening. CONCLUSIONS: While indicators of overuse were more common in SSI and foster care groups, access to follow-up, metabolic monitoring, and psychosocial services was somewhat better for these children. However, substantial quality shortfalls existed for all groups, particularly metabolic screening and monitoring. Renewed efforts are needed to improve antipsychotic medication management for all children. DISCLOSURES: This project was supported by grant number U18HS020503 from the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare & Medicaid Services (CMS). Additional support for Rutgers-based participants was provided from AHRQ grants R18 HS019937 and U19HS021112, as well as the New York State Office of Mental Health. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, CMS, or the New York State Office of Mental Health. Finnerty has been the principle investigator on research grants/contracts from Bristol Myers Squibb and Sunovion, but her time on these projects is fully supported by the New York State Office of Mental Health. Scholle, Byron, and Morden work for the National Committee for Quality Assurance, a not-for-profit organization that develops and maintains quality measures. Neese-Todd was at Rutgers University at the time of this study and is now employed by the National Committee for Quality Assurance. The other authors have no financial relationships relevant to this article to disclose. Study concept and design were contributed by Finnerty, Neese-Todd, and Crystal, assisted by Scholle, Leckman-Westin, Horowitz, and Hoagwood. Scholle, Byron, Morden, and Hoagwood collected the data, and data interpretation was performed by Pritam, Bilder, Leckman-Westin, and Finnerty, with assistance from Scholle, Byron, Crystal, Kealey, and Neese-Todd. The manuscript was written by Leckman-Westin, Kealey, and Horowitz and revised by Layman, Crystal, Leckman-Westin, Finnerty, Scholle, Neese-Todd, and Horowitz, along with the other authors.

Can Medicaid Claims Validly Ascertain Foster Care Status?

Medicaid claims have been used to identify populations of children in foster care in the current literature; however, the ability of such an approach to validly ascertain a foster care population is unknown. This study linked children in the National Survey of Child and Adolescent Well-Being-I to their Medicaid claims from 36 states using their Social Security numbers. Using this match, we examined discordance between caregiver report of foster care placement and the foster care eligibility code contained in the child's Medicaid claims. Only 73% of youth placed in foster care for at least a year displayed a Medicaid code for foster care eligibility. Half of all youth coming into contact with child welfare displayed discordance between caregiver report and Medicaid claims. Children with emergency department utilization, and those in primary care case management health insurance arrangements, had the highest odds of accurate ascertainment. The use of Medicaid claims to identify a cohort of children in foster care results in high rates of underascertainment. Supplementing administrative data with survey data is one way to enhance validity of ascertainment.

Child disability and siblings' healthcare expenditures in a context of child fostering.

Many studies have assessed the impact of disability on healthcare expenditures for the disabled child, but practically none has considered the externalities of a child's disability in terms of healthcare expenditures for his/her siblings. This study therefore seeks to measure the impact of a child's disability on the allocation of healthcare expenditures among children of a household. It uses data from the 2011 Demographic Health and Multiple Indicator Cluster Survey (DHS-MICS) conducted in Cameroon by the National Statistics Institute (INS), with support from UNFPA, UNICEF, the World Bank and USAID. The disability module of the survey was administered to 17,864 children under age 18. Multivariate analyses (two-part model with logistic then GLM regression) showed that a disability significantly increases the monthly healthcare expenditures for the disabled child by XAF 204. This effect does not differ significantly whether or not the disabled child is fostered (does not live with his/her mother). Living with a disabled child has no impact on healthcare expenditures of a child. However, if the child is a true sibling (same mother), having a disabled sibling reduces the healthcare expenditures allocated to that child by XAF 102. Childhood disability therefore has a potentially wider effect on the health of siblings.

SROI in the pay for success context: Are they at odds?

The Pay For Success (PFS) and Social Impact Bond (SIB) movements to date have focused heavily on shorter-term outcomes that can be monetized and show clear savings to government entities. In part, this focus derives from the need to specify contract payments based on a narrow set of well measured outcomes (e.g., avoided days in jail and foster care, decreased use of behavioral health services). Meanwhile efforts to measure the social return on investment (SROI) of interventions have sought to expand the view of relevant outcomes to include domains that lend themselves less clearly to monetization. This paper explores the intersection between these two movements with illustrations from a SIB initiative underway focused on homeless families with children in foster care. Challenges and potential for SROI in a third-party payor environment will be discussed as well as opportunities to better leverage the strengths of both types of initiative.

Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

The VA Medical Foster Home Program, Ambulatory Care Sensitive Conditions, and Avoidable Hospitalizations.

This quality control study analyzes whether the Veterans Administration Medical Foster Home (VA MFH) program has been successful in improving access and effectiveness of ambulatory care. Individuals hospitalized for one or more of 22 adult ambulatory care sensitive conditions were identified. Pre and post comparisons of a specified population of participants in the program were conducted to determine rates of avoidable hospitalizations for 6 months prior to and following MFH enrollment. The overall rate of avoidable hospitalizations declined from 18.5 to 14.9 per 100 enrollees following enrollment. The number of bed days used declined by 39%, as did the cost associated with avoidable hospitalizations. Enrollment in the VA MFH program resulted in an overall reduction in the rate of avoidable hospitalizations, resource utilization, and costs. Studies are needed comparing these results with other matched cohorts of nursing home eligible veterans.

Development of a radical foster care intervention in Glasgow, Scotland.

Services for maltreated children are inadequate and lack infant mental health input in many parts of the world. A recent audit of Glasgow services revealed that children frequently 'revolve' between maltreating birth parents and various temporary foster placements for many years. Addressing infant mental health in this population will require radical change to current services. The New Orleans programme developed by the Tulane Infant Team in Louisiana is one such radical programme. Prior to the design of a randomized controlled trial (RCT) to test this programme in Glasgow, it was essential that policy-makers had some insight into the local model of service delivery and how a New Orleans model could impact. This article explores the structure and costs of the current Glasgow system and the potential costs and consequence impact of implementing a New Orleans model in Glasgow, using data obtained from the research literature, Glasgow City Council audit data and expert's opinion. A New Orleans-Glasgow model would likely shift resources from social services on to the NHS. The resource intensive nature of this model could increase the cost of an episode in care from £66 300 in the current system to £86 070; however, the probability of repeated episodes in care is likely to fall substantially, making the cost per child fall from £95 500 in the current system to £88 600. This study informed the design of a phase II explorative RCT, identified appropriate outcomes for measurement and areas of uncertainty for further research.

Growing Financial Assets for Foster Youths: Expanded Child Welfare Responsibilities, Policy Conflict, and Caseworker Role Tension.

The study reported in this article explores the role child welfare workers play in elevating the financial capability (FC) of foster youths transitioning to adulthood. It draws on an examination of Opportunity Passport, a component of the Jim Casey Youth Opportunities Initiative, which operates across the United States. The authors held in-depth, structured interviews with eight staff and 38 current and former foster youths age 18 years and older in four sites across three states. Findings indicate that (a) program participants require professional financial assistance that is beyond the role of the traditional child welfare caseworker; (b) caseworkers who address FC in young adults face uncertainty in their roles; and (c) broader policies relevant to young adults transitioning to adulthood exhibit tension, if not conflict, regarding enhancing FC. The authors highlight the importance of expanding the role of caseworkers to incorporate elements of FC in serving the needs of foster youths.

Examining the role of methamphetamine in permanency: A competing risks analysis of reunification, guardianship, and adoption.

Parental methamphetamine use has drawn significant attention in recent years. Despite prior research that shows that parental substance abuse is a risk factor for lengthy foster care stay, little is known about the effect of specific types of substance use on permanency. This study sought to compare the impact of parental methamphetamine use to alcohol use, other drug use, and polysubstance use on the timing of 3 types of permanency: reunification, guardianship, and adoption. Using an entry cohort of 16,620 children who had entered foster care during a 5-year period, competing risks event history models were conducted for each permanency type. Findings showed that, after controlling for several case characteristics, parent illicit drug use significantly impacted the timing of the 3 types of permanency, but alcohol use did not. Methamphetamine, other drug, and polysubstance with methamphetamine use were associated with lower rates of reunification and higher rates of adoption. Guardianship was also predicted by other drug and polysubstance use without methamphetamine; however, methamphetamine use was not associated with guardianship. Notably, the methamphetamine groups comprised the youngest children and had the shortest median time to adoption. Results suggest that type of parental substance use is predictive of permanency exits and that parental illicit drug use may require tailored strategies for improving permanency outcomes. Further implications of the findings are discussed.

La jaima alimentaria, guía alimentaria para las familias de acogida de los niños/as saharauis / The food jaima, food guide for the Saharawi children hot families

Introducción: Durante los meses de verano, un grupo de niños/as saharauis es acogido por familias españolas con el objetivo de que aprendan una realidad diferente y mejoren su estado de salud. Al revisar las herramientas educativas existentes para este tipo de población infantil dirigidas a las familias de acogida, se vio la necesidad de desarrollar una guía alimentaria educativa y específica con el fin de resolver las posibles dudas sobre alimentación y nutrición. Objetivos: Elaboración de una guía alimentaria, la jaima alimentaria, dirigida a las familias de acogida de los niños/as saharauis con la que se contribuya a mejorar su salud durante su estancia en España. Métodos: Desarrollo de la jaima alimentaria y de las actividades diarias para los niños/as saharauis acogidos. Resultados: Nuestra propuesta trata de una jaima alimentaria, un modelo gráfico-cromático, similar a las conocidas pirámides alimentarias. En cada uno de los escalones se detallan los diferentes alimentos y por orden descendente en cantidad diaria recomendada y a un lateral de la misma aparecen las actividades diarias para los niños/as saharauis acogidos. Discusión y conclusiones: La jaima alimentaria es una guía alimentaria que permite cubrir las necesidades nutricionales de este tipo de población en la prevención de las enfermedades relacionadas con la dieta, como la anemia o el bocio, y el normal crecimiento (AU)

Introduction: During the summer months, a large group of children are welcomed by Spanish families in order to learn a different reality and improve their state of health and nutrition. Reviewing existing for this type of kids educational tools to foster families, was the need to develop an educational and specific dietary guide in order to solve any doubts about food and nutrition. Objectives: Elaboration of a food guide, the food jaima, to host families of the Saharawi children that will help improve their health during their stay in Spain. Methods: Development of the food jaima and daily activities for the hosted Saharawi children. Results: Our proposal is a food jaima, a graphic-chromatic model, similar to the well-known food pyramids. Different foods are listed in each of the steps and by descending order in recommended daily amount and to one side of it appear daily activities for the hosted Saharan children. Discussion and conclusions: The food jaima is a food guide that allows you to meet the nutritional needs of this type of population in the prevention of diseases related to diet, such as anemia and goiter, and normal growth (AU)

Faith-based partnerships and foster parent satisfaction.

Throughout the last several decades, there has been a chronic shortage of foster and adoptive families in the United States. Recruiting families to begin the licensure process to become foster and adoptive parents is already a difficult undertaking. But research shows that a very large proportion of families drop out of the licensure process early on due to frustration or a lack of support. This paper studies two faith-based partnerships that have arisen to create new capacity in the child welfare system. These programs recruit prospective families from churches and then provide training and ongoing support to those families throughout the licensure process. Using survey data collected from program participants, respondent perceptions of the licensure process are compared to a nationally representative sample of foster parents from the National Foster Care Adoptions Attitude Survey. Statistical results demonstrate that participants with the faith-based programs reported much higher levels of satisfaction with the process than the national sample. These findings provide evidence that these faith-based partnerships may provide an important additional source of capacity for an overburdened child welfare system.

Youth transitioning out of foster care: an evaluation of a Supplemental Security Income policy change.

Youths with disabilities face numerous challenges when they transition to adulthood. Those who are aging out of foster care face the additional challenge of losing their foster care benefits, although some will be eligible for Supplemental Security Income (SSI) payments after foster care ceases. However, the time needed to process SSI applications exposes those youths to a potential gap in the receipt of benefits as they move between foster care and SSI. We evaluate the effects of a 2010 Social Security Administration policy change that allows such youths to apply for SSI payments 60 days earlier than the previous policy allowed. The change provides additional time for processing claims before the applicant ages out of the foster care system. We examine administrative records on SSI applications from before and after the policy change to determine if the change has decreased the gap between benefits for the target population.