Child Welfare-involved Youth Research Articles

Risk Prediction Model for Child Sex Trafficking Among Female Child Welfare-Involved Youth: Welfare-Involved Female Sexual Exploitation Risk Assessment Tool.

Background: Female child welfare-involved youths who are removed from the home are at risk of commercial sexual exploitation of children (CSEC). The aim of this study was to develop a prediction model to identify those at greatest risk of trafficking. Methods: Data were from the Florida Department of Children and Families' Florida Safe Families Network Database. A Cox proportional hazard regression of 60 cases and 3857 controls generated the proposed risk model. Results: Factors found to be associated with a higher risk of trafficking were quantified into point scores, generating the Welfare-Involved Female Sexual Exploitation Risk Assessment (WISER) tool with a cutoff of 20 points: first out-of-home placement at ≥15 years of age (11 points); run away from home in past year and age <15 years (40 points) or ≥15 years (16 points); English spoken as other language (14 points); on a psychotropic drug (17 points); congregate first placement (14 points); runaway/abducted status first "placement" (16 points); psychiatric facility experience (9 points); residential facility experience (7 points); and no time in temporary shelter (9 points). Of those who experienced CSEC, 92% had a WISER score above 20. Discussion: The WISER tool achieved good discrimination and calibration ability with a receiver operating characteristic for the validation data set of 0.923. The WISER tool can (1) inform risk assessment for CSEC among child welfare-involved females and (2) identify youths at greatest risk before they are harmed by trafficking.

According to their own accounts: former child welfare involved youth recalling their participation in child protective services interviews that occurred at school

ABSTRACT This qualitative study collected the first-known responses from former child welfare-involved youth detailing their experiences of participating in child welfare interviews at school. Ten participants answered semi-structured interview questions about their school interview experiences in this phenomenological qualitative study. Five themes provided a shared understanding of participants having child welfare interactions introduced into their school life. The themes were not knowing how to prepare, difficulties interacting with the child welfare worker, expectations for support from school staff, dealing with the cognitive impact, and suggestions for improving child welfare interviews at school.

Social Network Enhancement: Bridging and Bonding the Social Networks of Child Welfare Involved Youth

ABSTRACTA supportive social network is crucial for the well‐being of child welfare involved youth; however, their social networks are often small and/or unable to provide necessary support. Child welfare workers can play an important role in strengthening and expanding the social networks of youth. In this Norwegian study, 15 child welfare workers' experiences with social network enhancement were examined using semi‐structured interviews. Data analysis applied a social capital lens to identify whether and how this framework could enhance our understanding of this issue. Study findings highlight three main objectives, implemented to (a) strengthening the youth's existing network, (b) supporting the youth to take part in (new) social arenas and (c) cultivating the youth's social skills and relationship building. Findings suggest that this approach can contribute to the development of bonding and bridging social capital. Within all objectives and associated strategies, trusting relationships between youth and child welfare workers were considered a prerequisite for success. Several barriers and impeding factors were also identified, such as the limited size of the social networks or lack of social skills. These barriers show how social network enhancement can be complicated, in actual practice.

Exploring dimensions of childhood adversity as predictors of psychological adjustment among adolescents involved in the child welfare system: A latent profile analysis

Child welfare-involved youth experience elevated rates of psychological maladjustment. Few studies have examined whether there are latent subgroups of youth who experience similar patterns of psychological adjustment. Toadvance understanding of the promotion of adjustment among this marginalized population, the current study addressed this gap by conducting a latent profile analysis of psychological symptoms. Once the identified latent profiles were identified, we examined relations between sociodemographic characteristics and adversity experiences among a nationally representative sample of 1,048 child welfare-involved adolescents (11–17 years). We used a 3-step approach to examine whether dimensions of adversity predict profile membership. We identified two distinct subgroups: “comorbid internalizing and externalizing symptoms” (18%) and “non-clinical symptoms” (82%). The comorbid subgroup was characterized by scores within the clinically significant or borderline range for all indicators. Results of the logistic regression suggested that for every additional threat adversity experienced (e.g., exposure to violence, such as physical abuse), youth were 1.7 times more likely to be in the comorbid subgroup than the non-clinical subgroup. However, deprivation (e.g., unfulfilled physical, emotional, or social needs, such as physical neglect) was not a significant predictor of profile membership. Our findings highlight the importance of preventing exposure to threat-related adversity and building our understanding of psychological adjustment among child welfare-involved adolescents to promote positive psychological outcomes in this population.

The intersection of adverse childhood experiences and mental health concerns for youth involved in the child welfare system.

The present study sought to identify if there is distinct mental health symptomology among child welfare-involved youth depending on the category of adverse childhood experiences (ACEs) endorsed. A chart review of child welfare-involved youth (N = 129, ages 8-16) and caregiver reported ACEs and mental health/trauma symptoms was conducted. A K-means cluster analysis used ACE scores to identify groups of youth along two dimensions: household dysfunction and child abuse/neglect. The first cluster identified had low ACE scores outside of their system involvement (n = 62), the second predominantly endorsed household dysfunctions (n = 37), and the third predominantly endorsed abuse/neglect (n = 30). One-way analysis of variance tests revealed that youth in the systems-only cluster differed from youth in the other groups, while the two high ACE category groups did not differ from each other on mental health/trauma symptoms. These results have important implications for the screening and treatment referral processes in the child welfare system.

Prevalence and Predictors of Prescription of Family-Focused Treatment in Child Welfare

Engaging families in the behavioral health assessment process for child welfare-involved youth is a best practice standard in obtaining vital information about the context affecting their safety, permanency, and wellbeing. As family functioning plays a role in successful reunification for youth out-of-home care (OOHC), family engagement may also increase the likelihood of buy-in, clinical treatment participation and outcomes. The purpose of this study is to explore the relationship between standardized assessment domains of child and family needs and the prescription of family-focused treatment. Results suggest that there were overall low rates of prescription of family-focused treatment. There were significant differences in the prescription of family-focused treatment based on youth identified trauma, behavioral, emotional and family needs. Despite the impact of family functioning on placement, the low rate of prescribed family-focused treatment may reflect barriers such as communication and collaboration between providers, distance between family and placement, or a siloed approach to treating children in OOHC separate from their families. Approaches to address these barriers are discussed.

Promoting Resiliency and Eliminating Disparities-Best Practices when Working with Child Welfare Involved Youth of Color.

The US child welfare system has a long history of racial disproportionality and subsequent disparities. These disparities have been perpetuated by discriminatory laws and policies in our federal and state governments, coupled with a system of care that is fraught with the risk of biases in child welfare practices and procedures. Child psychiatrists should have a knowledge base of these inequities to help ensure culturally and trauma-informed care for child welfare involved youth and families. As physician leaders with knowledge of child development, child psychiatrists can also help inform inclusive legislation, policies, and programs.

Mapping the progress of the process: Codevelopment of the therapeutic alliance with maltreated adolescents.

We used a longitudinal actor-partner interdependence model to examine the codeveloping alliance in alliance empowerment therapy (AET; Escudero, 2013), a manualized team-based approach developed in Spain specifically for child welfare-involved youth. In this first evaluation of AET, we sampled 102 adolescents, 83% of whom had been removed from their homes due to abuse or neglect, and 40% of whom were in crisis at the time of referral. Before each session, clients rated their improvement-so-far; after each session, both clients and therapists completed a brief alliance measure, an adaptation of the System for Observing Family Therapy Alliances (SOFTA-s; Friedlander et al., 2006) for individual therapy. In terms of outcome, clients' improvement ratings were significantly associated with posttreatment changes in overall functioning and personal goal attainment. With respect to the change process, growth was observed in both clients' and therapists' ratings of the alliance over 12 sessions, and an increased similarity in alliance ratings was due to more rapid growth in the therapists' ratings than the clients' ratings. Dynamic structural equation modeling indicated that at higher levels of adolescent goal attainment, a stronger association was observed between increased therapist-rated alliance and goal attainment. In other words, in the most effective cases, therapists were more responsive to how the adolescents seemed to have experienced the alliance in the previous session. The cocreated alliance perceptions were due to therapist (rather than client) responsiveness, as well as to unspecified aspects of sharing a therapy environment over time, such as familiarity with the process, regular meetings, and so on. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Leveraging Technology to Increase Behavioral Health Services Access for Youth in the Juvenile Justice and Child Welfare Systems: a Cross-systems Collaboration Model

Behavioral health services access for justice- and child welfare-involved youth is limited despite significant need. Structural interventions to address limited access are nascent. Technology can advance access, but few interventions focus on system-impacted youth and their mental health needs and challenges. This article describes the development, process, and initial outcomes of the Youth Justice and Family Well-Being Technology Collaborative (JTC) that was formed to leverage technology within and across public health and justice-related systems to promote increased behavioral health services access. Cross-system considerations are identified for public health, court, and other key stakeholders to successfully integrate technology into practice to expand access to these critical services.

Gender differences in the PTSD symptoms of polytraumatized youth during isolated phases of trauma-focused cognitive behavioral therapy.

Gender differences in the development and severity of PTSD have long been observed, but much less is known about gender differences within the context of trauma-focused treatment. This study investigated gender differences in the PTSD symptoms of polytraumatized youth during Trauma-focused Cognitive Behavioral Therapy (TF-CBT). The sample included child welfare-involved youth ages 7-18 (N = 138) who experienced a mean of 4.78 types of trauma and received TF-CBT at a trauma treatment clinic. Mixed ANOVA analyses assessed gender differences in PTSD symptoms from baseline to termination of treatment. PTSD symptoms were then mapped according to the phase of treatment, and factorial ANOVAs examined gender differences during isolated phases of TF-CBT. Potential interactions with sexual violence history were considered. Significant reductions in overall PTSD, intrusive, avoidance and arousal symptoms were found from baseline to termination of TF-CBT for the entire sample, although females reported higher symptom levels across all PTSD symptom domains. Significant gender differences were also revealed during some, but not all, phases of treatment, with variations among PTSD symptom domains noted. Findings suggest TF-CBT is effective in reducing PTSD in youth with poly-trauma exposure, irrespective of gender. Gender differences in symptom severity were revealed, however, and indicate the need to attend to gender within the context of treatment. Findings also suggest the use of measurement-based care, and specifically attending to symptom fluctuation in PTSD symptom domains during treatment, can help inform clinical decision making and individualize treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Child Maltreatment and the Child Welfare System as Environmental Factors in the International Classification of Functioning.

The WHO defines child maltreatment as any form of neglect, exploitation, and physical, emotional, or sexual abuse, committed against children under the age of 18. Youth involved in the child welfare system report more maltreatment experiences and environmental turbulence (e.g., number of moves, caseworkers), placing them at greater risk for poorer physical and mental health. The International Classification of Functioning, Disability, and Health (ICF) provides a framework to describe health conditions and severity of disabilities for an individual and/or group in the context of environmental factors. The Maltreatment and Adolescent Pathways (MAP) study is a longitudinal study, assessing self-reports on variables (e.g., child maltreatment history, trauma symptoms, dating violence, and substance use) of youth in an urban child protection service system. This study focuses on 11 of the 24 MAP publications that pertain to health and functioning, which can be considered applicable to the ICF framework, following established linking rules. The purpose of this study is to analyze these MAP sub-studies, with maltreatment and involvement in the child welfare system as environmental factors that impact the functioning of child welfare-involved youth. Findings indicate significant relationships across environmental factors (i.e., child maltreatment histories, child welfare system involvement), health conditions (i.e., trauma symptomatology, psychological distress, intellectual disabilities), and functioning problems (i.e., substance use, adolescent dating violence, sexual risk-taking, coping motives, sleep problems). The interrelated nature of these factors in the MAP sub-studies suggests the value of the ICF model to a holistic health view of use to practitioners supporting system-involved youth, clarifying unattended environmental factors in guiding service provision for foster care and/or maltreated youth.

Longitudinal examination of resilience among child welfare-involved adolescents: The roles of caregiver-child relationships and deviant peer affiliation.

Despite growing attention to resilience following childhood maltreatment, it remains unclear how the development of resilience unfolds over time among child welfare-involved adolescents. Further, little is known about the immediate and enduring effects of two important attachments in children's lives, namely caregiver-child relationship and deviant peer affiliation, on resilience development over time. This study sought to examine the ways in which caregiver-child relationships and deviant peer affiliation shape developmental trajectories of resilience among child welfare-involved youth. Data were drawn from the National Survey of Child and Adolescent Well-Being. Latent growth curve modeling was conducted on a sample of 711 adolescents. The results revealed that adolescents' resilience increased across a 36-month period since initial contact with Child Protective Services. Better caregiver-child relationships were associated with a higher initial level of resilience among adolescents, whereas higher deviant peer affiliation was associated with a lower initial level of resilience. Significant lagged effects were also found; caregiver-child relationship quality and deviant peer affiliation at baseline were associated with resilience at 18 months after. The findings suggest that interventions that aim to promote positive caregiver-child relationships and prevent deviant peer relationships may help foster resilience among adolescents who have experienced child maltreatment.

Patterns of Violence Exposure and Substance Use among Child Welfare Involved Youth.

Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW) system. However, this has only been recently and tentatively explored. This study examined the associations among various forms of indirect violence exposure and substance use among subgroups of youth involved in the CW system. The analytic sample consisted of participants (aged 11 years or older) in the baseline year of the second National Survey of Child and Adolescent Well-Being (2008-2012), including youth and their caregivers. Latent class analysis was used to examine associations among distinct forms of indirect violence exposure and substance use and the potential identification of unique at-risk groups. Models for the overall sample suggested two classes of at-risk youth, with the higher-risk class having higher probabilities of alcohol, marijuana, and hard drug use, which coincided with higher probabilities of exposure to arrests, stealing, drug deals, and weapon use. However, stratified models suggested unique results for youth aged 13-14 and 15-17, suggesting that the confluence of these risks appears to differ developmentally. Prevention and intervention services for CW-involved youth should assess and address violence exposure types among youth as a potential opportunity to mitigate substance use and subsequent high-risk behavior.

Understanding dissociation in relation to child trauma, mental health needs, and intensity of services in child welfare: A possible missing link

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N = 27,737) and in residential treatment (N = 5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.

Predictors of special education receipt among child welfare-involved youth

Although the cognitive, physical and psychosocial consequences of maltreatment can heighten maltreated children’s risk for special education, we know less about how a broader set of socio-ecological factors relate to their receipt of special education. This quantitative study investigated how selected attributes of children (e.g., gender) and their microsystems (e.g., caregiving settings) related to the receipt of special education among a sample of 1855 child welfare-involved youth (48% male, 52% female, Mage = 11 years) from the National Survey of Child and Adolescent Well-Being II. Results from logistic regression models show that children with cognitive challenges had higher odds of receiving special education (odds ratio [OR] = 3.13; p < .001). Regarding children’s microsystems, youth in foster care had odds of receiving special education that was approximately 2.7 times higher relative to children in biological or adoptive care (OR = 2.72; p < .05). The association between foster care and special education receipt underscores the importance of supports that foster families may need to promote the educational well-being of children with disabilities under their care.

Religiosity and Outcomes Among Child Welfare-Involved Youth

Religiosity is understudied among child welfare-involved adolescents. This study examined the effects religiosity on seven outcomes [substance use disorder (SUD), positive future expectations, delinquency, depression, loneliness, school disengagement, and early sexual activity] in order to understand and support child welfare-involved youth and minimize the effects of trauma. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I & II), which uses a representative sample of children and adolescents with a child maltreatment report, we used logistic regression to predict each of the seven outcomes longitudinally. Youth (n = 474) who reported that religiosity was very important in Wave I were 53% less likely (OR .47, CI .24–.90, p < .05) to have SUD in Wave II than youth who reported that it was not important or only a little important. In addition, youth (n = 552) who reported that religiosity was very important in Wave I were 2.27 times as likely (CI 1.11–4.65, p < .05) to have positive future expectations in Wave II (e.g., graduate from high school; get a good job). Religiosity did not predict other outcomes nor did attendance to faith-based organizations. In order to help prevent SUD and promote positive future expectations, professionals or caregivers can: (1) assess levels of/religiosity and desire to grow accordingly; and (2) suggest use of resources in the community that foster religiosity.

Victimization and Adversity in Child Welfare Involved Youth: The Cumulative Influence on Child and Caregiver Reported Behavioral Health Symptoms.

Exposure to childhood victimization and adversity (CVA) is pervasive for child welfare (CW) involved youth. However, most research with CW samples has focused on types of maltreatment and fails to recognize the additive influence of exposure to CVA beyond maltreatment. A subsample aged 8 to 17 (n = 1,887) was drawn from the National Survey of Child and Adolescent Well-Being (NSCAW) II. CVA included six domains. Behavioral health was assessed using the Child Depression Inventory, Trauma Symptom Checklist, and the internalizing and externalizing subscales of the Child Behavior Checklist. Logistic regression was used to explore the association between the number of CVA reported and the risk of clinical-range behavioral health symptoms. Analyses were adjusted for the cluster-based sampling design and sampling weights were applied to provide nationally representative estimates. More than 60% of the sample experienced three or more CVA domains. The number of CVAs reported was associated with all four behavioral health outcomes (p < .001). Children exposed to five or more domains were more likely to report high depressive symptoms (odds ratio [OR] = 5.0), high trauma symptoms (OR = 7.0), and to have internalizing or externalizing symptoms reported by caregivers (OR = 18.0), as compared with children reporting one or less CVAs. Youth involved with CW are exposed to staggeringly high rates of CVA beyond maltreatment. For children who are already at great risk for behavioral health challenges, research to understand screening and interventions for CVA is needed to inform policy and practice initiatives to prevent and mitigate harm.

Trajectories of Substance Use among Child Welfare-Involved Youth: Longitudinal Associations with Child Maltreatment History and Emotional/Behavior Problems

Background: Maltreated children experience a variety of adverse outcomes including substance use problems. Although previous research indicated that there may be distinct trajectories of substance use among these youth, studies have examined them as if they were a single homogeneous group. Objectives: The goals of this study were to explore substance use trajectories among child welfare-involved youth and to identify characteristics that distinguish substance use trajectories. Methods: Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Multilevel latent growth mixture modeling (MLGMM) was performed using a subsample of 625 youth from ages 11–17 years investigated for maltreatment in 2008–2009. Measures included self-reported use of substance use during the previous 30 days, demographic characteristics, maltreatment history, placement in out-of-home care, and behavioral health problems. Results: MLGMM identified two distinct substance use trajectory classes including High Stable Substance Use and Rapid Progression Use. Findings suggest that the experience of physical abuse is the key factor that distinguishes the two groups. When the effects of class-specific covariates were examined, results suggest that involvement in substance use behavior and its escalation vary between groups and are affected by youth’s different previous experiences. Conclusions/Importance: The results have important implications for understanding individual differences in substance use behavior over time and how these differences were shaped by youth’s experiences of family adversity. Study findings may be helpful for developing and enhancing the effectiveness of interventions targeted at decreasing substance use behaviors in child welfare-involved youth.

Risk and protective factors for alcohol, marijuana, and cocaine use among child welfare-involved youth

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19–1.68); cocaine OR = 1.26 (1.07–1.50)] but not binge alcohol use [OR = 1.44 (0.95–2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Risk and Resilience Factors for Psychobehavioral Symptom Trajectories Among Child Welfare-Involved Youth.

The primary aim of the study was to investigate the development of psychobehavioral symptoms (internalizing, externalizing, and posttraumatic stress [PTS]) of child welfare-involved adolescents over a 3-year period and to identify predictors of the trajectories. Using three waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW-II), latent growth curve modeling was conducted on a sample of 350 adolescents who were between 11 and 13 years of age at baseline. Findings indicated that adolescents' internalizing symptoms decreased over time, whereas externalizing symptoms remained stable over time. PTS symptoms decreased over time in girls, but not boys. Physical abuse predicted higher levels of externalizing behaviors and sexual abuse predicted a slower decrease in PTS symptoms. Greater child prosocial skills and higher quality of caregiver-child relationship were associated with lower initial levels of externalizing symptoms. In addition, a higher quality caregiver-child relationship and greater satisfaction with peer relationships were associated with lower initial levels of internalizing and PTS symptoms. Findings suggest that intervention strategies should consider gender, maltreatment type, and interpersonal and social skills to effectively prevent the development of psychobehavioral symptoms among child welfare-involved youth.