Child Service Agencies Research Articles

The opioid epidemic

Opioid use disorder is a growing epidemic, with an alarming number of associated deaths. In 2014, in the United States, 18,893 lethal overdoses were related to prescription opioids and 10,574 due to heroin. Despite the growing number of treatment options for substance use disorders, which are chronic, relapsing-remitting conditions, relapse rates remain as high as 91%. In the United States, 7.5 million children reside with at least one patient who abuses drugs or alcohol. Mothers are twice as likely to lose custody of their children. They have higher rates of comorbid abuse and psychopathology and limited social supports. Child service agencies, commonly involved in these scenarios, are often pressured to find permanent placement for children, within an expedited timeframe, inconsistent with the need for sufficient time for recovery and goals of family inclusion and unity. We present the complicated case of a 25-year-old woman with a history of opioid use disorder and depression, who, after being in and out of treatment programs for years, had a lethal overdose. She had a significant family history of addiction and had lost custody of her children. This challenging, but common presentation draws attention to challenges in providing treatment during this opioid epidemic.

Interventions for family members of adolescents with disruptive behavior disorders.

The family members of adolescents diagnosed with disruptive behavior disorders (DBDs) experience profound stress and burden. Despite the need for empirically supported interventions that address the challenges faced by these family members, few such interventions are available. In this qualitative descriptive study, we conducted in-depth interviews with 15 families of adolescents diagnosed with DBD. We asked the family members to identify what types of mental health services they needed and to describe the "ideal" program that would best address their concerns. Family members identified several intervention modalities that would fit their needs, including multifamily groups, family therapy, individual therapy, and community-based hotlines. They indicated that programs should address the following topics: family communication, conflict resolution, education about DBD, and strategies to improve interactions with child service agencies. Clinicians should recognize that all family members may need support to manage the stressors associated with caring for or living with adolescents with DBD. When working with families, clinicians should provide information about the etiology and management of DBD, help navigate interactions with child service agencies, and employ strategies to improve family communication and functioning.

Factors Affecting Pediatricians' Reporting of Suspected Child Maltreatment

To identify factors associated with pediatricians' decision not to report suspected child maltreatment. A survey was distributed to a random sample of pediatricians in a single state. Participants were asked if they had ever suspected child abuse or neglect but did not report. In addition, all were asked to list all the considerations that pediatricians incorporate into their decisions not to report. One hundred ninety-five pediatricians completed the survey (56% of those eligible). Twenty-eight percent of respondents stated that they had considered reporting an incident of suspected child maltreatment but had chosen not to. Providers who had chosen not to report were more likely to be men (P = .006), to have been in practice longer (P = .001), to have reported more cases (P = .001), to have been deposed (P = .001) or to have testified (P = .01) in child maltreatment cases, and to have been threatened with lawsuit (P = .02) than were pediatricians who had never declined to report. Multivariate logistic regression demonstrated that male gender (odds ratio [OR] 2.18; 95% confidence interval [CI] 1.05-4.49), years in practice (OR 1.23; 95% CI 1.05-1.44), and experience reporting (OR 1.28; 95% CI 1.02-1.60) were all independently associated with decisions not to report. Respondents who had declined to report were more likely to cite lack of knowledge about reporting laws and process (P = .05) and poor experiences with child service agencies (P = .03) as reasons for not reporting than were their counterparts who had never declined to report suspected maltreatment. Many barriers exist to reporting suspected maltreatment. Specific educational interventions may be helpful in eliminating barriers to reporting.

Child Protection and Child Custody

A child'S need for safety should trump any and all other considerations in family law. Child-service agencies cannot be expected to both promote reunification and child protection simultaneously. The author asserts that legislatures need to change the laws such that it is clear to the court that children come first and that safety is paramount. Although visitation between child and parent is considered to be a fundamental right, this right can and should be abrogated when initial evidence shows that such contact poses a risk of danger to the emotional or physical health and safety of the child. A new and specially trained court dealing only with issues of family violence and abuse may need to be considered.

Applications of Multidimensional Similarity Scaling (MDS) in evaluation research

Two cases are presented to illustrate the applicability of multidimensional similarity scaling in evaluation research. In the first case, respondents were the Executive Directors of ten children's service agencies in the downtown area of a large metropolitan center. They each made paired-comparison judgements of interagency similarity which were used to produce a mapping of the agencies. Dimensions were interpreted through key informant interviews and analysis of published program descriptions. The mapping not only identified the types of services that were available but also an area of potential need for service. In the second case, students judged the similarity of required courses in a university Bachelor's degree program designed for child welfare/children's mental health practitioners. Dimensions were interpreted by correlating independently-obtained ratings of the courses with the derived similarity dimensions. The information obtained confirmed that the program was perceived to function as designed and also was useful in a required program restructuring. The implications of adopting multidimensional similarity scaling as an analytic tool in evaluation research are discussed.

Multiagency outcome evaluation of children's services: a case study.

Outcome monitoring has become a focus of accountability for public and nonprofit human service agencies. Besides providing answers to funders' questions about the services' impact, outcome monitoring helps administrators improve program effectiveness. After a three-year development period and a one-year implementation experience, SumOne for Kids represents a technically advanced outcome-monitoring system for children's mental health and/or child welfare services. Initiated, designed, and tested by 31 children's service agencies throughout Pennsylvania, and with state bureaucrats' and policy makers' encouragement, SumOne for Kids represents an effort to create a bottom-up/top-down process for implementing a statewide outcome-monitoring system. This article describes the genesis of this outcome-monitoring system, primary design principles, use of social validation for outcome selection, resolution of methodological difficulties, and reasons for selecting functional over clinical outcomes. The article reviews lessons learned through the development experience instructive to children's service managers, program evaluators, and industry leaders interested in establishing outcome-monitoring systems.

The Child Welfare Response

Drug-exposed infants are having a profound impact on the child welfare system, increasing both the number of referrals to child protective services and the demand for out-of-home care. These children have created new problems for the child welfare system and exacerbated others. In many cases, already high caseloads have grown even higher. There is also increased uncertainty about appropriate roles for the various child service agencies and how to coordinate their efforts to provide an efficient and timely response. Drug-exposed infants and their families have new types of needs, such as parents’ needs for long-term treatment for drug abuse and addiction and infants’ needs for adequate parenting in a stable environment to overcome the effects of prenatal drug exposure. Meeting the special needs of these families requires new community resources. When these are not available, the requirements of current law cannot be met. This dilemma calls into question the wisdom and practicality of this law. Finally, this article discusses the challenges and the range of in-home and out-of-home service options necessary for an effective child welfare response. T he dramatic increase in the numbers of infants born exposed to drugs and of young children endangered by parental drug and Charlotte McCullough, alcohol dependency has stressed an already overwhelmed child M.Ed., is director of the welfare system. These rising demands, combined with inadequate human Chemical Dependency and fiscal resources, have created a system under siege. Legitimate areas Initiative of Child Welof disagreement, unresolved questions, and ethical and legal dilemmas fare League of America, Inc., Washington, DC. further complicate the situation. We lack clear direction regarding effective prevention and intervention strategies. Our policies for meeting the needs of this growing population need to be examined and improved. A System Forced to Change Again The child welfare system was dramatically altered in 1980 with adoption of P. L. 96272. For the first time, agencies were mandated to focus not only on the safety needs of the child but also on the broader needs of the child within the family. Underlying the law are assumptions that children develop best in their own families and that most families are worth preserving. State child welfare agencies are mandated to make “reasonable efforts” to prevent a child’s placement in foster care and, if foster care is necessary, to make efforts to reunite the family during specified time periods. The juvenile courts are required to determine whether or not the agency has made these efforts. In addition to the federal law, many states have passed their Some material in this article has been adapted with permission of Child Welfare League of America from Crack and Other Addictions: Old Realities and New Challenges for Child Welfare. Copyright 1990 by Child Welfare League of America, Washington, DC. 62 THE FUTURE OF CHILDREN – SPRING 1991 own reasonable efforts requirements, albeit with wide variation in interpretation of the requirements. All have failed to allocate sufficient resources to meet the requirements of the law. Despite inadequate funding, child welfare agency policies and practices have advanced during the past decade. Workers acquired new skills and learned to make more accurate assessments. Families, previously thought to be hopeless, responded to a host of new family support services. The benefit from a policy preference for keeping the family intact seemed to outweigh the risk that in some cases a child would not be removed from his/her family early enough. Through intensive efforts and an attitude of empowerment, workers succeeded in maintaining at-risk children in their own homes. Courts and judges, for the most part, embraced the family focus. Policymakers applauded the results and the potential for containing costs as a result of family preservation techniques. And, most importantly, fewer children were referred unnecessarily to foster care or allowed to drift aimlessly from one placement to another without any efforts to find a permanent home. The numbers of children in the system were gradually but steadily decreasing. This trend towards fewer referrals was dramatically reversed when crack cocaine entered the scene in the late 1980s. The needs of a new generation of drug-exposed infants and of young children at risk of abuse by drug-involved parents forcefully challenged the current system and its laws. Some critics argue that it is time for re-examination and change. Impact of Drugs on the Child Welfare System The impact of drug-exposed children on the child welfare system is great. Referrals to protective services have skyrocketed. The need for out-of-home care has outpaced availability. In addition, cases involving drugs have introduced new needs for both parents and children, as well as new stresses on the child welfare system itself.

Private Social Services: Obstacles to the Welfare State?

Drawing on a field study of three established voluntary family and children's service agencies, this paper illuminates the Patterns of mutual dependence and interaction between these agencies and the welfare state and the interest of these agencies in a large and permanent welfare state.