Child Protective Services Involvement Research Articles

23 Probing bias: Understanding the experiences of Black, Indigenous and People of Colour (BIPOC) caregivers for children with developmental disabilities and their involvement with child protection

Abstract Background In Canada and abroad, a disproportionate number of Black Indigenous and Persons of Colour (BIPOC) experience referral to child protective services (CPS). Children with developmental disabilities, including Autism Spectrum Disorders (ASD) and intellectual disabilities (IDD), are also disproportionately CPS-involved. Recent Canadian research has suggested that almost a quarter of children from a complex care paediatric program are CPS-involved, however there is no known research for ASD/IDD populations seen in a general paediatric clinic. Further, intersections of race/ethnicity and ASD/IDD and CPS involvement have not been examined. Objectives We are conducting a mixed methods study to explore the intersections of race, developmental disabilities and involvement with CPS for our paediatric population. Design/Methods Phase 1: We completed a retrospective cohort study of 349 patients (0-18 years of age) who were seen by a paediatrician and social worker at a large, hospital-based paediatric clinic in Toronto, Canada in 2019. Electronic medical record data was reviewed and the following binary variables (yes/no) coded CPS-involved or referral made, 1+ caregiver identify as BIPOC, and primary language of caregiver(s) not English. Results Preliminary analyses indicate that 11.7% of our sample is CPS-involved. Contrary to over-representation of BIPOC families in the general CPS population, we found that the proportion of families involved with CPS was lower for BIPOC than non-BIPOC families. A similar pattern was observed for primary language, with a trend towards caregivers who reported English as a second language being less likely to be CPS-involved. In our presentation, we will present analyses regarding the type and intensity of CPS involvement and include other demographic characteristics of the family. These findings will be interpreted with findings from Phase 2 (currently underway), which explores lived experiences of 40 caregivers involved with CPS drawn from Phase 1. Conclusion Within an ASD/IDD patient sample, BIPOC families were less likely to be involved with CPS than non-BIPOC families. This finding is in stark contrast to provincial rates that suggest a 2.2 times greater likelihood of CPS-involvement for Black youth. While these results on the surface suggest equity, they may still reflect bias. It is possible that the concerns of BIPOC families are being downplayed in comparison to non-BIPOC families, reducing their access to supportive services.

Disparities in child protective services involvement in pediatric traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI. Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance. Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status. We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2years.

Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: A qualitative study

BackgroundCannabis is the most commonly used federally illicit substance during pregnancy. Yet, little is known about women’s lived experiences of being screened for cannabis use during pregnancy. ObjectiveTo explore perceptions of cannabis use during pregnancy and childbirth, including experiences of being screened for cannabis use during the intrapartum period. MethodsWe conducted a phenomenological qualitative study using semi-structured, online interviews with 16 English-speaking women who gave birth at a U.S. hospital within the past three months. After transcription of interview recordings, two coders analyzed data using inductive thematic analysis. We also generated descriptive statistics for sociodemographic characteristics and cannabis use behaviors. FindingsMost participants were 25–34 years of age (75 %, n=12), Black (75.00 %. n=12), and had less than a bachelor’s degree (68.75 %, n=14). Participants reported low-risk perceptions of cannabis use during pregnancy and often used cannabis to alleviate mental health conditions and pain during pregnancy and childbirth. Women reported mixed perceptions of harm, using cannabis as a medicine and because they were addicted, being fearful of disclosing cannabis use due to potential involvement of child welfare and protective services, and perceiving negative provider communication a barrier to disclosing cannabis use. ConclusionsFindings underscore the importance of patient education about adverse maternal and neonatal health outcomes of prenatal cannabis use, regardless of whether disclosure occurs. To facilitate disclosure of use, close attention should be paid to verbal and non-verbal communication when screening and counseling women during pregnancy and childbirth. Additional studies are needed to further examine patient-provider cannabis-related communication, with a focus on identifying discriminatory behaviors and practices resulting in health inequities.

A Multilevel Analysis of Individual and Community Factors Associated With Case Dispositions Following Child Maltreatment Investigations.

Understanding service disposition pathways is critical to provide deeper insight into why certain subgroups of the population are at risk for recurrent Child Protective Services (CPS) involvement and may highlight disparities across groups or geographic areas. Using the Decision-Making Ecology Framework as a lens, the present study examines whether service disposition pathways are influenced by risk assessment, safety concerns, child age, maltreatment type, previous CPS involvement, and/or county-level structural vulnerability. We linked administrative data from New Mexico's Department of Children, Youth and Families (DCYF) to data from the American Community Survey. Multilevel models examining associations between case (N = 12,960) and county (N = 33) characteristics revealed that both case (age, maltreatment type, risk/safety assessments, previous CPS involvement) and county-level factors (transportation and housing) were associated with service disposition. Additionally, we observed considerable variation at the county level in both the provision of services and the relationship between risk assessment and service provision. By linking different factors of the decision-making process in child welfare cases to intervention strategies, the analysis reveals that the perception of risk can vary based on geographical context resulting in different outcomes for families who have similar risks but different county-level vulnerabilities.

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

IntroductionRacial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals. MethodsPeer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development. ResultsThe study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination. ConclusionPregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.

Reporting Perinatal Substance Use to Child Protective Services: Obstetric Provider Perspectives on the Impact on Care.

Objective: To understand obstetric provider perspectives on child protective services (CPS)-mandated reporting requirements and how they affect care for pregnant and postpartum patients with opioid use disorder (OUD). Methods: Key informant interviews were conducted virtually with obstetricians, nurse practitioners, and social workers caring for obstetric patients (n = 12). Providers were asked about their experience as mandated reporters working with patients with OUD. Transcripts were independently coded by two staff, and content analysis was used to identify themes. Results: Our analysis resulted in six thematic areas, including CPS-mandated strengths, concerns related to CPS reporting requirements, implementation of mandates, supporting patients after CPS report, communication between stakeholders, and the impact on care. Providers noted that the fear of CPS involvement causes some patients to delay or not engage in care. Other patients are hesitant to accept medications for OUD for fear of CPS involvement. The inconsistencies in how reporting mandates are applied and how CPS handles cases make communication about the policies challenging for providers and create anxiety for patients. Conclusions: The results of this study indicate that mandated reporting requirements and the potential for CPS involvement are perceived to have minimal positive effects on perinatal individuals with OUD and may negatively affect patients and their care. Clinicaltrials.gov number: NCT04240392.

The Relationship Between Receipt of Childcare Subsidies and Child Protective Services Involvement in [MASKED COUNTY], Colorado: A Brief Research Report

The Relationship Between Receipt of Childcare Subsidies and Child Protective Services Involvement in [MASKED COUNTY], Colorado: A Brief Research Report

Disparities in Child Protective Services Reporting Among Pregnant Patients With Positive Urine Drug Screening at Delivery Hospitalization [ID 2683555

INTRODUCTION: This study assesses predictors of Child Protective Services (CPS) reporting among patients with a positive urine drug screening (UDS) during delivery hospitalization. METHODS: Patients receiving prenatal care and delivering at any UCHealth location between 2015 and 2022 with a positive UDS at delivery were included. Patient demographics, medical history, UDS, infant toxicology, and CPS reporting were collected from medical records. T-tests or nonparametric equivalents for continuous variables and χ2 or Fisher's exact tests for categorical variables were used to compare patients with and without CPS reporting. RESULTS: We found 523 patients with a positive UDS during their delivery hospitalization, with CPS reporting for 71%. CPS reporting was more common in younger patients (26 versus 28 years; P&lt;.01), patients with prior CPS involvement (15% versus 5%; P&lt;.01), patients with an antenatal UDS positive for any substance (46% versus 29%; P&lt;.01), and any positive neonatal toxicology (87% versus 58%; P&lt;.01). Patients positive for cannabis (78% versus 57%; P&lt;.01) or amphetamines (6% versus 1%; P=.03) were more likely to be reported to CPS, while patients positive for barbiturates (12% versus 1%; P&lt;.01) and benzodiazepines (6% versus 2%; P&lt;.01) were less likely. Hospitals located in large (&gt;400k pop.) or small cities (&lt;100k pop.) were less likely to be reported to CPS than mid-sized cities (&gt;100–399k pop.) (66% and 65% versus 76%; P=.03). CONCLUSION: Differences in CPS reporting depended on the substance that tested positive, infant positivity, and delivery location. Future research should explore reasons for no CPS reporting among patients with a positive UDS during delivery hospitalization.

“Instead of just taking my baby, they could've actually given me a chance”: Experiences with plans of safe care among birth parents impacted by perinatal substance use

BackgroundFederal legislation mandates healthcare providers to notify child protective service (CPS) agencies and offer a voluntary care plan called a “plan of safe care” (POSC) for all infants born affected by prenatal substance use. While POSCs aim to provide supportive services for families impacted by substance use, little is known about birth parents' perceptions and experiences. ObjectiveTo examine birth parents' perceptions and experiences regarding POSC. Participants and settingParents offered a POSC in Philadelphia in the prior year were included. MethodsThis is a qualitative interview study. Participants were recruited from birth hospitals and community-based programs with telephone consent and interview procedures. Transcripts were analyzed using an inductive, grounded theory approach to identify content themes. ResultsTwelve birth parents were interviewed (30.7 % of eligible, contacted individuals). Fear of CPS involvement and stigma were common. Some birth parents reported that the increased scrutiny related to POSCs negatively impacted their attitudes toward healthcare providers and medications for opioid use disorder (MOUD). While parents found the consolidated resource information helpful, many did not know how to access services. Finally, parents desired more individualized plans tailored to their unique family needs. ConclusionsStigma, confusion, and fear of CPS involvement undermine the goal of POSCs to support substance-exposed infants and birth parents. Providers serving this population should be transparent regarding CPS notifications, provide compassionate, non-stigmatizing care, and offer coordination services to support engagement after discharge. Policymakers should consider separating POSCs from CPS to avoid exacerbating fear and mistrust.

Linked Child Welfare and Medicaid Data in Kentucky and Florida Highlights Racial Disparities in Access to Care.

Parents with serious mental health (MH) and substance use disorders (SUD) can face profound challenges caring for their children. MH/SUD treatment can improve outcomes for both parents and their children. This study evaluated whether parents with Medicaid with MH/SUD conditions whose children had child protective services (CPS) involvement were receiving MH/SUD treatment and whether receipt differed by race. We analyzed the 2020 Child and Caregiver Outcomes Using Linked Data (CCOULD) which contains Medicaid and child welfare records from Kentucky and Florida on 58,551 CPS-involved caregivers. Among caregivers with an MH diagnosis, White individuals were more likely than Black individuals to have received counseling (42% vs. 20%) or an MH medication (69% vs. 52%). Among caregivers with an SUD, White individuals were more likely than Black individuals to have received counseling (43% vs. 20%) or an SUD medication (43% vs. 11%). More effort is needed to connect parents with CPS involvement to MH/SUD treatment, particularly Black parents.

Parents' perspectives on the results of mandatory child protection support: A qualitative study

AbstractIn situations where parents do not accept support while their family situation is assessed as unsafe (for instance in cases of child abuse and neglect), it is sometimes necessary to offer mandatory support to families. The aim of the current study is to investigate how parents perceive the results of mandatory support from Child Protection Services (CPS) and which elements of the mandatory support parents mark as crucial for the results of the support. In‐depth semi‐structured interviews were conducted with 18 parents. Parents report mixed feelings about the results of the mandatory support. According to parents, reaching alignment with professionals about the problem definition, as well as the aims of CPS at the start of mandatory CPS, is a crucial element contributing to results of CPS. Additionally, the perceived quality of the support (both on the organizational and professional level) is simultaneous important conditions for a positive view on the support of parents. Implications for practice include the importance of multi‐directed partiality of professionals to reach an agreement about the problems definition and the aims of the mandatory CPS involvement.

Levels of Involvement with Child Protection Services Associated with Early Adolescent Police Contact as a Victim and Person of Interest.

The relationship between childhood maltreatment and subsequent offending/victimization is well established. However, the magnitude of this relationship for different levels of child protection services (CPS) involvement is poorly understood, due to measurement issues, lack of longitudinal data, and reliance on reports of substantiated maltreatment, which can underestimate the impact of maltreatment. This study examined associations between CPS involvement during childhood (ages 0 to <11 years) and police services contact (as a victim and/or a person of interest) for criminal incidents in early adolescence (11 to ~14 years), differentiated according to levels of CPS involvement (i.e., no risk of significant harm [non-ROSH], unsubstantiated ROSH, substantiated ROSH, and out-of-home care; each examined relative to no CPS contact). Data for 71,465 children were drawn from the New South Wales Child Development Study, an intergenerational, longitudinal investigation that uses administrative records from CPS and police alongside other health, justice, and education data. Multinomial regression analyses were conducted to determine associations between increasing levels of CPS involvement and police contact as a victim only, a person of interest only, and as both victim and person of interest while accounting for covariates (i.e., child's sex, Aboriginal, and/or Torres Strait Islander background, socioeconomic status, maternal age at child's birth, and parental offending history). Children exposed to any of the four levels of CPS involvement had higher odds of police contact, relative to children with no CPS involvement. Odds ratios were higher for contact with police as both a victim and a person of interest, compared to police contact as a victim or a person of interest only. These findings highlight that children with even unsubstantiated CPS reports (i.e., non-ROSH and unsubstantiated ROSH reports) are at heightened risk of police contact compared to children who are unknown to CPS, underlining the need to support all families in contact with CPS.

Extra help for extra needs: Family perspectives on New Mexico's supplemental child care subsidy program for families at risk for involvement with child protective services

This study examines the perspectives of a sample of parents and primary caregivers who received child care subsidies through New Mexico's at-risk eligibility designation, which is reserved for families who are or are at risk for becoming involved with child protective services (CPS). Qualifying families pay no copays, have limited documentation requirements, and are provided with additional enrollment supports by specialized eligibility workers with lower caseloads and training in trauma-informed practices. Families reported positive experiences with their eligibility workers and with the enrollment process, saying almost universally that they did not face administrative burdens to enrollment and that their caseworker was responsive and helpful. Despite positive experiences with the subsidy system, families reported difficulties finding child care that met their needs, mainly due to challenges related to non-traditional work hours, transportation, and children's behavioral health needs. The study findings are exploratory but suggest that enhanced supports from specialized eligibility workers are valued by families facing complex risk factors and may help them access child care subsidies. Access to subsidies, in turn, helps families afford and access care. However, the utility of child care subsidies remains limited without a supply of care that meets families' logistical needs and supports their children's development. Given previously documented administrative burdens and challenges families face in accessing child care subsidies, New Mexico's approach has potential implications for other states aiming to enhance equitable access to care for families at risk for CPS involvement—a population that disproportionately experiences systemic disadvantages and destabilizing circumstances.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Disparities in the Diagnosis and Management of Infants Hospitalized With Inadequate Weight Gain.

To evaluate the association between race and the named etiology for inadequate weight gain among hospitalized infants and assess the differences in management. This single-center retrospective cohort study of infants hospitalized for the workup and management of inadequate weight gain used infant race and neighborhood-level socioeconomic deprivation as exposures. The etiology of inadequate weight gain was categorized as nonorganic, subjective organic (ie, gastroesophageal reflux and cow's milk protein intolerance), or objective organic (eg, hypothyroidism). The management of inadequate weight gain was examined in secondary outcomes. Among 380 infants, most were white and had a nonorganic etiology of inadequate weight gain. Black infants had 2.3 times higher unadjusted odds (95% credible interval [CI] 1.17-4.76) of a nonorganic etiology of inadequate weight gain compared with white infants. After adjustment, there was no association between race and etiology (adjusted odds ratio 0.8, 95% CI [0.44-2.08]); however, each 0.1 increase in neighborhood-level deprivation was associated with 80% increased adjusted odds of a nonorganic etiology of inadequate weight gain (95% CI [1.37-2.4]). Infants with a nonorganic etiology of inadequate weight gain were more likely to have social work and child protective service involvement and less likely to have nasogastric tube placement, gastroenterology consults, and speech therapy consults. Infants from neighborhoods with greater socioeconomic deprivation were more likely to have nonorganic causes of inadequate weight gain, disproportionately affecting infants of Black race. A nonorganic etiology was associated with a higher likelihood of social interventions and a lower likelihood of medical interventions.

Transphyseal Humeral Separations: An Often-Missed Fracture.

Transphyseal humeral separations (TPHS) are rare injuries often associated with non-accidental trauma, necessitating accurate diagnosis. This study aims to assess the accuracy of diagnosis of TPHS. A retrospective review was conducted at five academic pediatric institutions to identify all surgically treated TPHS in patients up to 4 years of age over a 25-year period. Demographics, misdiagnosis rates, and reported misdiagnoses were noted. Comparative analyses were performed to analyze the effects of patient age and injury mechanism on misdiagnosis rates. Seventy-nine patients (average age: 17.4 months) were identified, with injury mechanisms including accidental trauma (n = 49), non-accidental trauma (n = 21), Cesarean-section (n = 6), and vaginal delivery (n = 3). Neither age nor injury mechanism were significantly associated with diagnostic accuracy in the emergency department (ED)/consulting physician group. ED/consulting physicians achieved an accurate diagnosis 46.7% of the time, while radiologists achieved an accurate diagnosis 26.7% of the time. Diagnostic accuracy did not correlate with Child Protective Services (CPS) involvement or with a delay in surgery of more than 24 h. However, a significant correlation (p = 0.03) was observed between injury mechanism and misdiagnosis rates. This multicenter analysis is the largest study assessing TPHS misdiagnosis rates, highlighting the need for raising awareness and considering advanced imaging or orthopedic consultation for accurate diagnosis. This also reminds orthopedic surgeons to always have vigilant assessment in treating pediatric elbow injuries. Level III-Retrospective Cohort Study.

Correlates of informant discrepancies in self-harm among youth involved in child protective services

Youth involved with child protective services (CPS) are at elevated risk for engaging in self-harm. Participation in interventions or treatments that may reduce youths’ self-harm behaviors often depends on the accurate reporting of their self-injurious behaviors. However, informants often disagree on the presence or severity of self-harm engagement, making the identification of youth in need of treatment more challenging. The current study aims to characterize discrepancies between youth and caregiver reports of children’s self-harm among a sample of youth with a history of CPS involvement, and to identify factors (e.g., demographics, youth and caregiver psychological impairments, aspects of the caregiving environment) associated with these discrepancies. Participants (N = 258) were drawn from a large, nationally representative sample of youth under the age of 18 (mean age = 13.8) and their caregivers who were investigated by CPS. Multinomial logistic regressions were used to examine correlates of discrepancies in caregiver and youth reports of youth self-harm. Results indicated that 10% of caregiver-child dyads agreed on children’s engagement in self-harm. In 33% of cases, only the child reported self-harm and in 57% of cases, only the caregiver reported youth self-harm. Being a biological caregiver, child female sex, higher levels of internalizing symptoms, greater post-traumatic stress disorder (PTSD) symptoms, and greater caregiver alcohol use was associated with a lower likelihood of caregivers reporting self-harm only. Older child age, lower externalizing symptoms, higher PTSD symptoms, and greater levels of caregiver emotional security and structure were linked to lower odds of children reporting self-harm only. These results underscore important factors to consider when assessing self-harm among youth involved with CPS and have potential implications for practice guidelines in this population.

Adolescents with substance use referred to child protective services: Does substance use treatment prevent foster care entry?

AbstractAdolescent substance use has been linked to several negative outcomes, which can be exacerbated by exposure to adversity such as child maltreatment. However, few studies have examined the intersection of adolescent substance use and child protective service (CPS) involvement. This study examined the relationship between substance use treatment and entries into foster care among adolescents referred to CPS for maltreatment. Data for this study came from the National Child Abuse and Neglect Data System (NCANDS), an annually reported database that contains information on all CPS reports screened for investigation. NCANDS was merged with county‐level data from the American Community Survey to explore the relationship between treatment and foster care entry while adjusting for contextual factors. Our sample included 2326 adolescents who were referred to CPS in fiscal year (FY) 2018 and were followed until FY 2019 to examine correlates of foster care entry. A series of multilevel logistic regressions were conducted. Approximately 1 in 20 adolescents entered foster care during the study period and 1 in 10 used treatment services prior to foster care entry. Substance use treatment increased the odds of foster care entry (adjusted odds ratios = 2.30, p &lt; 0.05), while adolescents residing in counties with higher percentages of non‐Hispanic White residents had lower odds of foster care entry (adjusted odds ratios = 0.67, p &lt; 0.05). Among adolescents with substance use referred to CPS, substance use treatment increases the likelihood of foster care entry. This may highlight the need to provide services earlier and to ensure that adolescents can access treatment without entering state custody. Future research should explore these relationships in more depth.

A critical examination of Illinois’ child welfare information systems and its utility for identifying and monitoring children and youth with special health care needs for front- and back-end users

BackgroundChildren and youth with special health care needs (CYSHCN) are at an increased risk for abuse and neglect, and they experience worse outcomes during and after child protective services involvement, as compared to typically developing peers. Identifying and monitoring these vulnerable youth is essential for reducing disparities and optimizing service delivery. However, many states, including Illinois, lack systems for efficient identification and monitoring. Objective(1) To examine existing Illinois Department of Children and Family Services (ILDCFS) data systems to determine if a source exists that would allow for identification and monitoring of CYSHCN; and (2) To understand ILDCFS personnel's experience with identifying and monitoring CYSHCN. MethodsFirst, relevant ILDCFS data sources were identified, pulled, and examined for completeness. Second, ILDCFS personnel completed a mixed-methods survey assessing how they identified and monitored CYSHCN as well as what barriers they experienced in conducting these activities. Conceptual content analysis was utilized to obtain counts of different methods used to track and monitor youth as well as to identify barriers to these processes. ResultsSix data sources were identified as being relevant through ILDCFS’ data systems, but none were complete enough for effectively tracking and identifying CYSHCN. Survey responses indicated no standardized, systemic process for identifying and monitoring CYSHCN, with many personnel relying on reports from other involved parties. ConclusionsIn order to identify CYSHCN and monitor well-being, a standardized process within ILDCFS systems is needed to provide complete, accurate, and timely data for CYSHCN, allowing for both system-wide and individual-level monitoring.

Experiences of postpartum mental health sequelae among black and biracial women during the COVID-19 pandemic

ObjectiveThe objective of this study was to qualitatively examine coping mechanisms and desired supports in pregnant and birthing Black and Biracial adolescent and young adult women during the COVID-19 pandemic.MethodsBlack and Biracial participants ages 16–23 were recruited for virtual individual semi-structured interviews. Participants (n = 25) were asked about pre- and post-natal experiences with the healthcare system, effects of the pandemic, and participants’ experiences of or desires for ideal care within the healthcare system. Interviews were transcribed verbatim and coded for qualitative analysis using nVivo. Discussions around postpartum mental health evolved organically when asked about how participants were coping postpartum.ResultsNearly half the interviewees organically reported mental health symptoms consistent with postpartum depression (PPD) during questions regarding their postpartum experience. Of the 11 interviewees who reported mental health symptoms consistent with PPD, 2 were afraid to disclose their symptoms to a healthcare provider due to fear of child protective services involvement and their belief they would be treated unfairly because of their race.ConclusionClinicians who care for Black and Biracial adolescent and young adult mothers must be particularly attuned to structural barriers for appropriate screening and treatment of postpartum depression. Expanding investigations of intersectional influences on young mothers’ perinatal health and PPD are needed.