Self-Determination, Public Accountability, and Rituals of Reform in First Peoples Child Welfare

BACKGROUND: About 7% of youth in Ontario will have child welfare involvement at some point in their life. (Fallon, 2011) Up to 60% of children will meet criteria for a mental health diagnosis, and upon transition out of care 30% will have unaddressed health care needs. Following coroner recommendations from inquests into the deaths of Katelynn Sampson and Jeffrey Baldwin, last year another twelve youth died while in the care of the child welfare system. The 2018 coroner’s report again concluded there was lack of information sharing between societies and healthcare providers. (Cromarty, 2018) It has been established that social determinants of health contribute to the unaddressed health needs of these youth. In contrast, modifiable system level factors that can improve the collaboration and coordination between the healthcare system and Children’s Aid Societies has not been extensively analyzed. OBJECTIVES: To use a policy analytic framework to outline the linkages between the healthcare system and the Children’s Aid Societies (CAS)s with the purpose of identifying factors that increase coordination, collaboration and information sharing within the child welfare system, and between the child welfare system and the healthcare system in Ontario. DESIGN/METHODS: This paper will explore policy developments and choices that influence the information sharing structures between the child welfare and health care system using the policy analysis “3-i” conceptual framework – an analysis of the role of interests, ideas, and institutions. Interests refers to agendas of societal groups, civil servants, researchers etc. Ideas refers to knowledge and beliefs including research. Institutions refers to formal and informal rules (legislation) and organizational factors. Although some of the issues presented in this paper intersect with those of Indigenous child wellbeing societies, the health needs for this overrepresented population in the child welfare system necessitates a distinct analysis, and are not included in this paper. RESULTS: Institutions: Children are admitted to one of 49 CASs in Ontario. On admission or transfer to any CAS, legislation requires physician physical examinations within 48 hours. In Ontario these are most often completed at walk-in-clinics without medical history. No mental health screening or plan for healthcare follow-up is mandated. The current legislation does not does not track child health outcomes and the current funding formula for CASs does not include healthcare. See Figure 1.Ideas: Despite access to healthcare children did not use healthcare if a need was not identified by their CAS worker, or if workers were not equipped with resources to navigate the healthcare system. (Stiffman, 2004) In Ontario, only 1/3 of children in the child welfare system who were self-harming or voiced suicidality were referred to a mental health professional by their worker. (Baiden, 2018) The gateway providers for healthcare for children in care are their CAS workers. Interests: The Canadian Paediatric Society (CPS) is one of the governing medical bodies with interest in providing the primary health care to children and youth in care. A joint position statement by the CPS and family physicians could set the standard of medical care for children in the welfare system. The Ontario Association of CASs (OACAS) has the potential to systematically report upon performance indicators and outcomes without attributing results to specific CASs thereby providing a form of liability protection. CONCLUSION: Adverse childhood events and social determinants of health contribute to the health of children in the child welfare system. However, this analysis has identified modifiable system level factors that need to be targeted or else health advocacy initiatives will not have their expected impact. Importantly, we have identified child health workers as the gateway providers for the health of children in care, implying that future advocacy initiatives should include workers as key collaborators. [Image: see text]

Involvement in the Child Welfare System Among Mothers With Serious Mental Illness

Due to harmful narratives within child welfare and child protection services and systems, mothers in contact with these services who aim to meet the symbolic representation of the ‘ideal mother’ frequently find themselves being portrayed as the ‘bad mother’, even when their referral is ‘non-traditional’ (i.e., not specifically due to their perceived harmful actions or inactions). Through ‘ideal mother’ symbolism and narratives, there is disenfranchisement of service-engaged mothers; they are mistreated by services, which is normalised by wider discourses around motherhood. Mothers within these child welfare systems consistently experience judgement, the problematising of their parenting practices, and disempowerment despite not being the direct cause of harm to their children. This creates a sense of shame and makes the injustice of mothers’ experiences within child welfare systems invisible. This is a conceptual paper combining data generated from previously published work and a lived experience example (work with young mothers; mothers in contact with the criminal justice system; mothers with children who cause harm; and those with children experiencing extra-familial harm) using qualitative, participatory, and action-based approaches, and through emancipatory interview processes, disenfranchised mothers described their contact with child welfare and child protection systems as a source of structural, political, and/or societal injustice. Thus, such qualitative emancipatory work provides ways to acknowledge mothers in contact with child welfare services due to non-traditional harms, as they are a disadvantaged group who are too often disempowered to action change. Thus, we argue that participatory and action-based research should be a preferred method of exploring mothers’ experiences of child welfare systems, opening routes for reforming, as well as understanding systematic potential of services as oppressive and problematising rather than supportive and empowering.

<p>The primary purpose of this study was to examine differences in the attributions teachers make toward students in the child welfare and juvenile justice systems. The study utilized vignettes and asked teachers to attribute the responsibility for declines in behavior and academic performance to one of five sources (the student, the parents, the teacher, the court system, or the student's friends). The study further asked teachers to identify the extent to which the changes were due to the student's internal traits and external factors, the likelihood of changes in behavior and academic performance with and without intervention, the teachers' beliefs about their ability to impact change, the amount of time the teachers reported being willing to spend with the students outside of class, and the likelihood of the student pursuing post-secondary education. Teachers were also asked to identify to whom they would first refer the student in the vignette for outside assistance due to declines in behavior and academic performance and then provide all referrals they would make.</p> <p>A total of 224 certified 6th -12th grade teachers in the state of Iowa completed the vignette survey between January 2014 and April 2014. Results indicated that teachers made different attributions toward students on the basis of their involvement in either the child welfare or juvenile justice system. Specifically, teachers attributed the reason for behavioral and academic declines to different sources for students in the child welfare system, the juvenile justice system, and the control condition. Teachers were more likely to attribute academic and behavioral declines to internal factors for students in the juvenile justice system and external factors for students in the child welfare system. Teachers reported students in the juvenile justice system as least likely to change without intervention. The majority of teachers across the three conditions indicated their first referral would be to mental health services within the school. Teachers did not differ in the total number of referrals made, the amount of time until making the referral, the amount of time they would be willing to spend with the student outside of class time in order to impact change, their feelings of efficacy to impact change, and the likelihood of the student obtaining post-secondary education. Finally, limitations of the study are presented, suggestions for future research are discussed, and the implications of this study for teachers and school psychologists are discussed.</p>

sidney goldberg studied at New York University and also with psychologist Albert Ellis, founder of Rational Emotive Behavior Therapy. He now works as a college counselor in New York City. The child welfare system in the United States is not living up to its name. Rather than nurturing the intellectual potential, capacity for joy, and emotional wellness of foster children, the system too often takes a narrow approach to maintaining only the children’s physical well-being. I speak from my experience as a caseworker, administrator, and creator of a unique program in child welfare. Twenty-five years of butting up against the constraints of this system have made clear to me that the problem is structural. The occasional caseworker who would seek to nurture a child’s potential interests or passions would usually be thwarted by the limited paradigm around which the system is constructed. Year after year, most caseworkers go through the motions, while heeding the entrenched and narrow mandates set forth by their agencies as the lives of children under their care stagnate. I believe another system is possible — one that starts from the foundational premise that all people are capable of building satisfying lives through the pursuit of their interests — and that is staffed by workers who treat children and their parents with deep care and respect. To create such a system, we will need to transform the entire structure and pedagogy of social work school, drawing on insights gained through a careful look at the problems with the current system.

<p>The report outlines how the Child Welfare Immigration Centre of Excellence (CWICE) bridges the gap between child welfare and immigration by supporting children, youth, and families with immigration issues. Through participatory systems mapping (PSM), we gained insights from workers’ perspectives on how CWICE interacts with both child welfare and immigration systems. The systems map (see Appendix 2) visually represents the support systems for child welfare considerations at entry ports, highlighting CWICE's role in connecting these systems to build holistic support and safety for families and communities.</p> <p>The challenges and benefits of CWICE's involvement are explored through worker interviews. Participants acknowledged the expertise of CWICE workers in navigating the complex immigration process, while indicating that challenges like worker turnover and the lack of clarity in designated representatives can complicate circumstances for families. The report emphasizes collaboration and training as factors leading to more effective services, as well as the need for greater awareness of CWICE's services among settlement agencies to provide comprehensive support. Lastly, we recommend future research initiatives to better understand unaccompanied children's experiences in various child welfare systems across Canada. The report concludes by encouraging continued innovation and proactive collaboration in the child welfare sector to increase the safety and well-being of families and children dealing with immigration issues.</p>

<p>The report outlines how the Child Welfare Immigration Centre of Excellence (CWICE) bridges the gap between child welfare and immigration by supporting children, youth, and families with immigration issues. Through participatory systems mapping (PSM), we gained insights from workers’ perspectives on how CWICE interacts with both child welfare and immigration systems. The systems map (see Appendix 2) visually represents the support systems for child welfare considerations at entry ports, highlighting CWICE's role in connecting these systems to build holistic support and safety for families and communities.</p> <p>The challenges and benefits of CWICE's involvement are explored through worker interviews. Participants acknowledged the expertise of CWICE workers in navigating the complex immigration process, while indicating that challenges like worker turnover and the lack of clarity in designated representatives can complicate circumstances for families. The report emphasizes collaboration and training as factors leading to more effective services, as well as the need for greater awareness of CWICE's services among settlement agencies to provide comprehensive support. Lastly, we recommend future research initiatives to better understand unaccompanied children's experiences in various child welfare systems across Canada. The report concludes by encouraging continued innovation and proactive collaboration in the child welfare sector to increase the safety and well-being of families and children dealing with immigration issues.</p>

Dual system youth and their pathways in Los Angeles County: A replication of the OJJDP Dual System Youth Study

Health, social and legal outcomes of individuals with diagnosed or at risk for fetal alcohol spectrum disorder: Canadian example

Disproportionality and disparities in the treatment of children of color has been a growing concern in the child welfare system. System stakeholders have begun to recognize the problem through data, which help identify discrepancies within their jurisdictions. Nationally, the primary concern is the overrepresentation of African American children within the child welfare system, where African Americans represent proportions of the foster population at a level more than twice as high as they are represented in the community at large. In some jurisdictions, however, this is only one piece of the disproportionality concern. San Jose, for example, has both an overrepresentation of African American and an overrepresentation of Hispanic children in the child welfare system. Because San Jose’s child welfare population is unique, they have had to take a unique approach to addressing these concerns. This article outlines strategies and tools used to begin reducing disproportionality within the child welfare and juvenile dependency court system, using San Jose’s experience as an example. Some of the key approaches to addressing disproportionality include ensuring a systems approach (creating a Cross Agency Systems Team that prioritizes services for parents and children in various systems, e.g., mental health, substance abuse, etc.); addressing disproportionality from multiple perspectives and examining the roles’ of caseworkers, supervisors, service providers, judges, and attorneys; gaining community and system stakeholder buy-in by maintaining momentum and providing opportunities for dialogue about the complex issues facing families of color; using a data-driven approach to inform ongoing initiatives and changes in policy and practice (e.g., closely examining policies and practices such as the frequency of recommendations to by-pass reunification services); and implementing changes in practice at multiple levels including child welfare and on the bench. The examination of San Jose’s approach reveals challenges, successes, and lessons learned.

Childhood abuse is a common experience for youth in the child welfare system, increasing their risk of bullying perpetration and victimization. Little research exists that has examined the rates of bullying perpetration and victimization for child welfare-involved adolescent girls. The study addressed the following aims: (a) to generate frequency estimates of physical, nonphysical, and relational forms of bullying perpetration and victimization; (b) to identify the frequency of bully-only, victim-only, bully-victim, and noninvolved roles; and (c) to identify risk and protective factors that correlate with these bullying role types. Participants were 236 girls (12-19 years) in the child welfare system from a Midwestern urban area. Participants were referred to the study to join a trauma-focused group program. Seventy-five percent of the total sample were youth of color, with the remaining 25% identifying as White, non-Hispanic. Data were collected through baseline surveys that assessed childhood abuse, bullying perpetration and victimization, posttraumatic stress, substance misuse, aggression-related beliefs and self-efficacy, placement type, placement instability, and mental health service use. Child welfare-involved adolescent girls were found to assume all four major role types: bully-only (6.4%, n = 15), victim-only (20.3%, n = 48), bully-victim (44.1%, n = 104), and nonvictims (29.2%, n = 69). The bully-victim rate was approximately 7 times higher than the rate found in a nationally representative sample of non-child welfare-involved youth. The current study identified posttraumatic stress disorder (PTSD) symptoms, anger self-efficacy, and alcohol use as significant correlates of bullying roles. The identification of a substantially higher rate of bully-victims has important practice implications, suggesting child welfare and school systems adopt trauma-informed systems of care. Bully-victims are very likely traumatized children who are in need of effective trauma treatment rather than punitive sanctions.

A commonly emphasized component of trauma-informed care is the practice of building cross-system collaboration (CSC). While existing research on CSC states numerous benefits and barriers associated with increasing collaboration between systems, there is limited empirical understanding on how to define and measure collaboration between county systems of care. The current study presents the psychometric evaluation of scores from the Perceptions of Overarching Cross-System Collaboration-Child Welfare and Behavioral Health Systems (POCSC-CW/BH), a 6-item self-report instrument completed by system administrative leadership and direct service providers, administered within child welfare and children's behavioral health systems in 6 California counties. Psychometric analysis demonstrated good support of internal consistency, as well as the factorial, convergent, and discriminant validity of scores produced by the tool. There was also evidence for content validity. System-level analyses showed within-county child welfare, and children's behavioral health system staff reported similar perceptions of CSC in 5 of 6 counties, whereas POCSC-CW/BH scores across counties showed variability. Exploratory results revealed CSC scores varied by staff role in each system. In general, the POCSC-CW/BH is a promising instrument that adds to a limited array of practical empirically supported measurement tools for measuring CSC between child welfare and children's behavior health systems. The study limitations and implications for CSC measurement and trauma-informed practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The role of inter-agency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

The United States is experiencing unprecedented rates of drug overdose deaths and drug-related problems. This epidemic is driven primarily by opioids. Although most responses to this opioid epidemic are focused on preventing harm to adults, there are at least 5 pathways by which opioid-related problems can spill over and affect child health and safety:Indeed, quantitative and qualitative studies suggest that increases in parental opioid misuse and overdose death have resulted in concomitant increases in these adverse childhood experiences and that many children are ending up in foster care.1–3 Three decades of evidence now make clear that this type of childhood adversity increases the risk of physical and mental health problems and many of the leading causes of adult death.4 There is, therefore, an urgent need to meet the needs of these children and their families to prevent and remediate the long-term developmental consequences of parental opioid misuse.Effective opioid use disorder treatment of parents is the first step to keeping children safe and healthy. Medication-assisted treatments (MATs) with buprenorphine or methadone have significantly improved outcomes for patients with opioid use disorder compared with treatments that do not include medication. This is true for both women who are pregnant and parents who are involved with child welfare, among whom research reveals that MAT is associated with improved birth outcomes and child safety, respectively.1,5 MAT also increases engagement in obstetric care, which may facilitate access to family planning and prevent further unwanted pregnancies. Providers should review safe storage practices with patients and may consider the presence of children in the household when determining dosage and the frequency of follow-up visits to avoid accidental ingestion by children.However, accessing treatment may be challenging because of financial barriers and a shortage of specialty programs for women who are pregnant.1 In addition, substance use treatment alone is necessary but not sufficient because the needs of families affected by opioid use disorder are complex and are often intertwined with a host of other problems. These include poverty, co-occurring mental health conditions, use of other substances, domestic violence, and homelessness. Cross systems collaboration (collaboration that moves beyond the implementation of isolated evidence-based practices to a "best systems practice" approach) is needed to ensure comprehensive, collaborative care for these parents and their children. Unfortunately, substance use treatment programs are often not well equipped to meet the needs of families,1 and child welfare systems often lack knowledge, guidance, and/or resources to adopt best practices for substance use treatment.2Since 2007, the Children's Bureau's Regional Partnership Grants (91 grants in total) have been used to explore ways in which the child welfare, behavioral health, and justice systems can collaborate more effectively to serve families. Promising approaches have emerged. Shared outcome measures, joint trainings for professionals, and formal data sharing agreements can increase coordination across these 3 systems. Expanding both parenting programs for parents in substance use treatment and peer recovery programs for parents involved with child welfare has improved substance use and child welfare outcomes. Family drug courts (specialized dockets used to divert parents who are using drugs into treatment) increase treatment retention and reduce foster care time. Adopting trauma-informed practices and addressing housing needs also improve outcomes.6Two recent changes in federal policy have major implications for the ability of states to address the pediatric impact of the opioid epidemic.First are changes in Medicaid policy. The 2014 expansion of Medicaid to more adults with low income sharply reduced the uninsured rate for adults with opioid use disorder7 and is likely helping to facilitate parents' access to MAT of opioid use disorder.2 In contrast, in 2018, states were permitted for the first time to deny Medicaid coverage to parents who neither worked nor had a disability that prevented working. Intended to incentivize workforce participation, this policy may be counterproductive for parents with opioid use disorder, who cannot legally confer eligibility for disability. Without insurance, these parents may be unable to afford the treatment they need to remain in the workforce.Second, in 2019, state child welfare agencies will, for the first time, be able to receive partial federal reimbursement for time-limited substance use, mental health, and parental training services provided to families with a child at risk for entering foster care. This could offer child welfare agencies the freedom to fund new services for families with substance use problems. In addition, these services will have to meet certain standards of evidence to qualify for reimbursement. Interventions for family substance use disorders are of mixed quality, and new reimbursement incentives and best practice guidelines should motivate child welfare agencies to increase the proportion of evidence-based practices in their existing portfolio of services for families with substance use disorders.It is urgent that states begin planning immediately to leverage new federal reimbursement for preventive services to better support families involved with the child welfare system because of opioids. A new investment in evidence-based programs that simultaneously offer MAT and evidence-based parenting interventions can help address long-term consequences of this epidemic for children. The extensive evidence provided by regional partnership grants can help inform the adoption and implementation of these and other best practices across public and private agencies.6 States should also reconsider establishing work requirements for Medicaid; these requirements will likely impede access to precisely the services that are needed to protect children and preserve families negatively affected by opioids.For researchers, there is an urgent need to consolidate evidence about both the consequences of the opioid epidemic for children and how these consequences can be prevented or ameliorated. Currently, there are not even accurate estimates of the number of children growing up in a household with a parent who has an opioid use disorder. There are no estimates of the substance use treatment or parenting services that these families are already receiving nor of the gap between the need for these services and states' capacities to provide them. There is also substantial opportunity for the refinement of existing interventions and the development of improved interventions for families affected by opioid-related problems. As states seek to meet the needs of children affected by the opioid epidemic, a better evidence base can help guide decision-making.Finally, pediatricians and other child-serving medical, social service, and research professionals must be vocal advocates for the needs of children whose families are affected by opioid-related problems. Public officials must be made aware of the imperative to act on behalf of the next generation, whose long-term health depends on our ability to meet the unique needs of children in this opioid epidemic.

Kinship caregiving as a paradigm in the United States (US) is historically linked to slavery subcultural practices. Over time, dominant US systems have vacillated in demonstrating formal acknowledgement of kinship as an acceptable family unit and in availing resources to support kinship caregiving. The patterns and practices of these variations pertaining to kinship caregiving as a paradigm has received little attention despite documentation of its increased utilization in public child welfare and welfare systems. This exploratory case study responds to the paucity of knowledge regarding the systemic shifts towards the kinship caregiving paradigm and the perspectives of kinship caregivers who interface with public child welfare and welfare systems during their relative caring episodes. Critical theory is used to explore the impact of privilege and oppression as relates to the variations of the paradigm over time within these systems, as well as to the kinship families’ interactions with the child welfare and welfare systems. Kinship caregivers’ recommendations for child welfare and welfare systems’ improvements are also included in this study. Information gained from this study may assist policy makers, trainers, educators, and practitioners involved in child welfare and welfare agencies enhance these systems towards policies and practices that are culturally responsive and improve services to sustain kinship families.