Child Welfare Research Articles

Time-out under scrutiny: examining the relationships among the discipline strategy time-out, child well-being and attachment and exposure to adversity.

Discipline is a crucial aspect of parenting, shaping child development and behaviour. Time-out, a widely used disciplinary strategy with a strong evidence-base, has recently come under scrutiny with concerns about potential adverse effects on children's emotional development and attachment, particularly for those with a history of adversity. To contribute critical empirical insights to the current controversy surrounding time-out by exploring the associations among time-out implementation, parent-child attachment and child mental health, and whether adversity exposure moderated these associations. This cross-sectional study utilised a nationally representative sample of 474 primary caregivers in Australia, with children aged 6-8 years, who completed an online survey. Measures included the Implementation of Time-out Scale, Adverse Life Experiences Scale, Primary Attachment Style Questionnaire, Strengths and Difficulties Questionnaire and Spence Child Anxiety Scale. Appropriately implemented time-out was associated with enhanced mental health and attachment, while inappropriate time-out correlated with adverse child outcomes. Exposure to adversity moderated the relationship between time-out implementation and child well-being, such that children exposed to adversity were most likely to experience attachment enhancement from appropriately implemented time-out. Despite recent concerns of harm caused by time-out, particularly for children with a history of adversity, findings support the beneficial impact of time-out on child well-being and attachment when implemented in accordance with evidence-based parameters. Combatting misinformation and disseminating evidence-based time-out guidelines is crucial for promoting child well-being and attachment, especially for children who have experienced adversity.

Family support among young adults: The role of childhood maltreatment

BackgroundSuccess in young adulthood marked by independence and exploration is not universal. Parentification, when young people acquire adult roles before they are developmentally ready, and family support patterns suggest potential differences based on childhood maltreatment history hence widening inequalities. ObjectiveThis study aimed to describe family-of-origin support patterns among young adults with various levels of exposure to child maltreatment and child protective services (CPS). Participants & settingThe study leveraged Year 22 data of the Future of Families and Child Wellbeing dataset; a national, longitudinal, birth-cohort study of U.S. children born in 1998–2000. MethodsWe used bivariate statistics and logistic regressions to examine maltreatment exposure, socioeconomic conditions, and family-of-origin relationships. ResultsThose with out-of-home care and CPS contact without out-of-home care had lower odds of contact and feeling “extra” close to their caregiver compared to those without reported maltreatment, and those with out-of-home care had lower odds of receiving financial support from family for bills (OR = 0.62, 95 % CI [0.42, 0.92]). Those with out-of-home care had higher odds of providing dependent care to family members (OR = 1.67, 95 % CI [1.02, 2.72]); and those with CPS contact only had higher odds of supporting family members financially (OR = 1.79, 95 % CI [1.29, 2.47]). ConclusionFindings suggest the importance of public support programs to assist those with maltreatment histories susceptible to the absence of parental support and additional demands of support provision. Understanding young adult-parent relationships within the context of childhood maltreatment is critical to promote well-being.

Dietary diversity and development among early childhood children in rural China

BackgroundEarly childhood is a critical period for cognitive development, heavily influenced by nutrition. Despite significant economic advancements, malnutrition and micronutrient deficiencies persist in many low- and middle-income countries, including China, where dietary diversity remains suboptimal. Existing research predominantly relies on correlational data, underscoring the need for more rigorous empirical evidence. This study aims to fill that gap by providing stronger empirical evidence on the relationship between dietary diversity and developmental outcomes in rural Chinese children.MethodsWe conducted a longitudinal cohort study of 1,207 children aged 6–23 months, drawn from 100 villages across 22 counties in rural China, with three follow-up rounds extending until the children reached 51–83 months of age. Cognitive and non-cognitive development, as well as key health indicators, were evaluated. Cognitive development was measured using the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition. Non-cognitive development was assessed via the Ages and Stages Questionnaire: Social-Emotional and the Strengths and Difficulties Questionnaire. Health indicators included anemia, frequency of illness in the past 2 weeks, and four key anthropometric measures (height-for-age z-scores, weight-for-age z-scores, weight-for-height z-scores, and body mass index-for-age z-scores). Multiple linear regression models were applied to analyze the relationship between dietary diversity scores (DDS) and developmental outcomes, incorporating child fixed effects and adjustments for time-variant confounders. We accounted for the hierarchical structure of the data by clustering standard errors at the village level, which also reflects the township level.ResultsThe regression analysis identified significant positive associations between DDS and cognitive (p < 0.01), as well as reduced illness incidence (p < 0.001) in children aged 6–54 months. Additionally, DDS demonstrated a strong positive effect on non-cognitive development (p < 0.001) in children 2 years and older. The associations between DDS, non-cognitive development (p < 0.01), and illnesses reduction (p < 0.001) remained robust under two-way fixed effects models.ImplicationsTo promote sustainable improvements in child development and health, policymakers should prioritize nutrition-focused interventions in rural areas. Community-based programs offering caregivers training and nutritional support, integrated within healthcare and social services infrastructures, are vital for ensuring families have the necessary resources enhance child wellbeing and long-term developmental outcomes.

“This is not why we brought our children here!”: Tensions and challenges in responding to Adverse Childhood Experiences in African-background refugee families

BackgroundRefugee-background children face increased risks of Adverse Childhood Experiences (ACEs). However, their access to support services continues to pose significant challenges. A need exists to understand how families and child welfare services respond to ACEs to inform the design of culturally responsive interventions. PurposeBased on a broader qualitative study with parents and practitioners, this article shares the findings on the tensions and challenges of addressing ACEs in African-background refugee families in New South Wales (NSW), Australia. MethodologyThe research employed a qualitative micro-ethnographic approach. The first author interviewed 12 parents and 12 clinical practitioners and conducted two focus group discussions with African community leaders: the first with six and the second with five participants. Transcripts were analysed using reflexive thematic analysis. ResultsThree central themes reflected the tensions and challenges associated with responding to ACEs: reliance on informal support, the “messy” child protection services, and gaps in the child protection system. Parents responded to ACEs through various cultural and spiritual practices and by allocating most family resources to the needs of the children directly affected by ACEs. This came at the expense of resources available for the victim's siblings, who were also experiencing ACEs directly or vicariously. Professional responses were reactive, and the experiences taking place before resettlement were overlooked. Interactions between parents and child welfare services were particularly adversarial in the case of child removal from the family. ConclusionRefugee-background families face unique challenges in accessing services, but they also have capacities that can be harnessed in collaborative interventions addressing ACEs. Culturally responsive and trauma-informed support models may assist in improving interventions addressing ACEs.

Telehealth use in the well-child health setting. A systematic review of acceptability and effectiveness for families and practitioners.

BackgroundUniversal well-child health nursing services in high-resource countries promote the health and well-being of children and families while preventing health inequities. The COVID-19 pandemic and technological advancements have led to the increased use of telehealth in this field. To enhance policies and practices, it's important to understand the acceptability and effectiveness of telehealth, as well as the barriers and enablers to its implementation, and to determine when its use is appropriate and safe. ObjectiveTo explore the global evidence on the use of telehealth in well-child health settings within high-income countries. Focussing on the effectiveness and acceptability of telehealth, along with the factors affecting its implementation and the considerations for safety from the perspectives of both providers and families. DesignA mixed methods systematic review MethodsA systematic review was conducted following PRISMA guidelines. The inclusion criteria for the review included: primary research papers written in English, conducted in high-income countries, focused on telehealth in the well-child health setting, and involving children under six years of age. The search, which was completed in July 2023, systematically explored the CINAHL, ProQuest Central, PubMed, and Web of Science bibliographic databases. Studies were critically appraised for quality, and relevant data extracted. A convergent segregated approach was employed to synthesise both quantitative and qualitative data, which is presented in a narrative format. ResultsA total of 4,354 records were identified and screened, and 169 full-text papers were assessed for eligibility, resulting in 20 papers for inclusion. Telehealth acceptability among families was reported in 13 of the 20 studies reviewed, with participants expressing high satisfaction regarding its use as a complement to standard care. Only three studies examined practitioners' acceptance, revealing mixed responses. Effectiveness was observed in 15 studies, with no significant differences found between the control and telehealth groups, suggesting that telehealth may achieve outcomes like those of standard care. Four studies identified both enablers and barriers to the implementation of telehealth, though none addressed concerns regarding safety and appropriateness. ConclusionsTelehealth shows promise for well-child health services, but there is limited evidence of its effectiveness and safety. The COVID-19 pandemic increased its use, yet risks need further exploration. To validate telehealth in this field, we must identify effective applications, tackle implementation barriers, and ensure client safety. Additional research is essential for developing evidence-based policies for future practices.

Food Consumption and Mental Health in Children and Adolescents: A Systematic Review Protocol

Mental illnesses are prevalent among children and adolescents worldwide and may be associated with food consumption and unhealthy lifestyles. This study aims to evaluate the association between food consumption and mental health in children and adolescents through a systematic review and meta-analysis. The electronic search will include keywords related to childhood, adolescence, mental health issues (e.g., anxiety, stress, depression), and eating behaviors (e.g., eating patterns, ultra-processed foods), verified using MeSH terms. The systematic review will follow the PRISMA 2020 guidelines, employing the PECOS strategy, and will include quantitative observational and mixed-methods studies. A search will be conducted in the following databases: Scopus, CINAHL, SPORTDiscus, LILACS, Web of Science, APA-PhysioNET, PubMed (Medline) and EMBASE. Identifying the association between mental health and food consumption will contribute to the development of preventive and intervention strategies aimed at improving the health and well-being of children and adolescents. The analysis of the data will provide results on how psychological factors are linked to the consumption of various food groups, implying the formulation and updating of public policies. These guidelines can assist managers and researchers in creating effective interventions to promote mental health and healthy eating behaviors, ultimately leading to long-term positive impacts on public health..

Preferences of Citizens in Peru for School Opening during a Public-Health Crisis: A Participatory Value Evaluation Study

BackgroundThe outbreak of COVID-19 was followed by an unprecedented package of measures to protect public health. Over 150 countries mandated school closures to reduce the risk of transmission. Decisions on whether to close schools involve trade-offs between important effects on public health, learning outcomes, well-being of children, productivity of parents. ObjectivesInvestigate Peruvian citizens’ preferences for schools opening during a public-health crisis such as the COVID-19 pandemic in two scenarios: (i) when the threat from COVID-19 is low and schools are open; and, (ii) when the threat from COVID-19 is high and schools are closed. MethodsWe conducted a Participatory Value Evaluation (PVE) from 22 September to 17 October, 2022, on which 2,007 respondents assessed which policy measures to implement in the two scenarios. (i) In Scenario 1 “Schools are open”, children go to school, teachers and parents go to their jobs, but children still experience learning deficits from previous school closures. (ii) In Scenario 2 “Schools are closed”, children cannot go to school and do not receive any formal teaching, leading to learning losses; many teachers must change careers; and, many parents have to stay at home to take care of their children and lose income. Respondents were shown a range of policy measures in each of the scenarios and received information about the effects of each measure on public health, children’s well-being and learning loss. ResultsWe found that most respondents in Scenario 1 preferred mandatory vaccination for teachers and quarantine measures. In Scenario 2 we found that most respondents were positive towards reopening school policies. In both Scenarios respondents prioritized mandatory vaccination and quarantine measures over other mitigation measures. In Scenario 2, most respondents from the Highland region selected opening schools with 100% on-location teaching while hybrid teaching was mostly selected in the Coast region. Most respondents (82%) evaluated PVE as a good method to involve citizens in policy decision-making. ConclusionsPolicies that focus on prevention (e.g. mandatory vaccination for teachers and quarantine measures) can count on substantial support in a scenario when schools are open. The strong preference for opening schools with a noticeable difference in the way classes are provided (e.g. teaching on location most preferred by respondents from the Highlands and hybrid teaching by respondents from the Coast) show the importance of introducing differentiated strategies among regions.

The Technical Assistance (TA) Effectiveness Logic Model: A Tool for Systematically Planning, Delivering, and Evaluating TA.

Technical assistance (TA) is a tailored approach to capacity building that has grown in use across diverse settings over the past two decades, particularly in the domains of health improvement, child welfare, youth development, and education. In practice, TA services often include a combination of activities (e.g., coaching, professional development, site visits, and resource sharing) and vary in dosage, modality, and numerous other dimensions. While tailoring to recipient needs holds significant value, the individualized nature of TA creates challenges for assessing the effectiveness of TA. The difficulty of determining what contributes to TA outcomes is amplified when TA delivery is largely reactive (rather than proactive) and unaccompanied by a systematic approach to planning, delivery, and evaluation. Logic models are a well-established tool and a straightforward way to make TA more systematic. In this article, we introduce the TA Effectiveness Logic Model as a skeletal framework to guide systematic TA planning, delivery, and evaluation. The TA Effectiveness Logic Model graphically presents the rationale and expectations for how TA works in a setting. We describe two types of TA effectiveness logic models: basic and contextual. In addition, we offer a case example from work based on a national training and TA center to illustrate both types of logic models. Lastly, we discuss practical implications of TA effectiveness logic models for TA collaborators (funders, training and TA center administrators, TA providers, TA recipients, and researchers). Routinizing the use of TA effectiveness logic models has benefits for both the science and practice of TA.

Mental disorder diagnoses and symptoms and functional impairment in school-age children in the care of child protective services

BackgroundAbout 50 % of children in the care of child protective services present at least one mental disorder, but few studies have looked at whether there are differences in mental disorders or symptoms between children placed in out-of-home care (foster care and residential care) and their community peers. ObjectiveThis study documents the mental disorder diagnoses and symptoms among children in out-of-home care and their associations with children functional impairment. It also compares out-of-home care children with those from the community. Participants and settingThe sample was composed of children aged 5 to 12 years in foster care (n = 154), in residential care (n = 111), and from the community (n = 92). MethodsCaregivers reported the children's diagnoses and completed questionnaires on the children's symptoms. Results1) Proportionally more children in out-of-home care presented a mental disorder than did children from the community. Proportions were similar for those in foster care and those in residential care; 2) Children in out-of-home care presented more symptoms than those from the community for all the mental disorders considered and the children in residential care presented more symptoms than did those in foster care for about half of the disorders considered; 3) symptoms were strongly associated with functional impairment; and 4) the symptoms of RAD, ADHD, OCD, CD, and ODD proved significant predictors of functional impairment. ConclusionsThis study provides a picture of the mental disorders and symptoms among samples of school-age children in the care of child protective services and raises questions about the proportions of some of the diagnosis that children receive.

Domestic and Family Violence Affecting Children and Young People from Culturally and Racially Marginalized Migrant Backgrounds in Australia: A Scoping Review of Child Experiences and Service Responses.

In Australia, children and families from culturally and racially marginalized (CARM) migrant backgrounds experience a range of compounding structural and interpersonal factors that limit help-seeking and exacerbate the impacts of domestic and family violence (DFV). This scoping review examines the current state of knowledge on how children and young people from CARM migrant backgrounds experience DFV, and the services that respond to DFV including child protection services. A systematic search was conducted across PsycINFO, MEDLINE, and CINAHL databases and Google Scholar, alongside a complementary grey literature search. Articles were included in the review if participants were from CARM migrant backgrounds, and the article included information related to children and young people's experiences of DFV, and the DFV service system. The review found 19 articles that met selection criteria. Due to limited research on this topic in Australia, most articles focused on children and young people's experiences shared through parental, carer or service provider perspectives. To our knowledge, this is the first scoping review to examine how children and young people from CARM migrant backgrounds experience DFV. Findings demonstrate children and young people are victim-survivors of multiple forms of DFV. Children and young people's engagement with the DFV service system is often accompanied by feelings of fear and distrust. Findings suggest that to strengthen system responses to DFV, services must build their capability to implement intersectional approaches that simultaneously support the safety and well-being of both the child and the non-violent parent or carer.

Contact person intervention in Nordic countries: A comparative integrative review

In Sweden, Finland, Norway, and Denmark, the contact person intervention (CPI) is declared for children and youth in national legislation. The CPI is based on a relationship between the child and a volunteer adult who provides support to the child in need in different life situations. In this review, we summarise how the CPI within child welfare services has been studied and defined in four Nordic countries (Finland, Sweden, Norway, and Denmark). The aim is to present an overview of research-based knowledge on the intervention in the Nordic countries. A thorough integrative literature review for the period January 2010 to September 2022 produced 16 scientific publications. There were no academic publications available for Denmark during this period. The review focused on research carried out in Sweden (10 publications), Finland (5), and Norway (1). All studies on the CPI are descriptive and explorative and mainly focus on tracing the historical background of the intervention. The practice of working with contact persons would benefit from research looking at the content and effectiveness of the service. More systematic national and cross-national research is needed to strengthen the knowledge base of the intervention.

자립준비청년의 자립 경험에 대한 국내 연구동향

This study aims to examine trends in the Korean literature on the experiences of young adults who aged out of the child welfare system. We analyzed 86 studies including 56 peer-reviewed journal articles and 30 master's theses and dissertations published up to August 2024. The first related study appeared in 2002, and about 55% of the studies were published in the past five years. The term referring to the young adults varied in the literature, but the official term “youth preparing for independence” has been used since the policy announcement in 2021. Most studies focused on leaving out of foster care facilities, followed by foster care homes and group homes. In terms of research methods, more qualitative studies were published than quantitative studies.. In-depth interviews were the most commonly used method of data collection in qualitative research, and other methods such as focus group interviews and qualitative meta-analysis were also used. In quantitative research, both primary and secondary data were commonly used. We classified the topics of research into seven themes: independent living, emotions, relationships, support services, career paths, employment, and health. We suggest that future research focus on specific topics in more depth, converge research across academic disciplines, and attempt to diversify research methods.

Association Between Unmet Needs in Health Care and Social Services and Exposure to Violence Among Parents.

Existing research has shown that parental exposure to violence has negative consequences on health outcomes, but the effect of such exposure on unmet health care and social service need is unknown. This study aims to investigate the association between unmet health care and social services and parental violence exposure among parents with children. This study used the data of 6289 parents aged 18-60 years who had at least one child under 18 years living in the same household. Parental violence exposure was measured. Unmet child and adult health care and social service need was operationalized through questions on the services needed, those that had not been received, and those that were considered inadequate. Parents who experienced any kind of violence had more unmet service need. There were more women among parents with violence experience (65.4%) than those with no violence experience (51.9%). Violence experience increased the odds of unmet need for general adult healthcare services (OR 2.02, CI 1.64-2.57), maternity and child health clinics (OR 2.52, CI 2.00-3.18), family guidance clinics and home help (OR 2.38, CI 1.60-3.54), mental health or child welfare services (OR 2.05, CI 1.52-2.75), and school health care (OR 1.99, 1.50-2.65). After adjusting for sociodemographic factors, the associations between exposure to violence experience and unmet needs for healthcare and social services remained statistically significant. Violence in close relationships profoundly impacts health and well-being. By addressing unmet health care needs and supporting parents, we can break the cycle of violence and promote better mental health outcomes. Preventive policies and early interventions are essential to mitigate the consequences of violence in families.

Perception of leadership challenges within the Norwegian child welfare services: A Gordian knot

Perception of leadership challenges within the Norwegian child welfare services: A Gordian knot

Youth engagement in permanency planning within tribal child welfare systems: a qualitative study of current practice

ABSTRACT This qualitative study utilized interviews with American Indian/Alaskan Native young adults with lived expertise in foster care, Tribal child welfare workers and court professionals to gather training ideas to prepare the workforce for their role in supporting children and youth in achieving permanency (relational, cultural, and legal). Seven themes were identified: child engagement in court, service (in)sufficiency, definition of permanency, cultural connectedness, listening/respecting youth, benefits of authentic youth engagement, and recommendations for practice. This study expands the literature on youth involvement in permanency planning through a culturally aligned lens.

The specialization/collaboration paradox: Investigating specialization within child welfare as a barrier to collaboration

Abstract Existing research highlights the trend of organizing social services into specialized units, addressing specific areas such as child welfare. Further specialization within child welfare extends to target groups (youth vs child) and work task dimensions. The literature remains inconclusive about whether specialization enhances or hinders social work practice. Potential drawbacks of specialization, like gaps between services and a lack of a holistic view, are assumed to increase the need for collaboration. However, specialization might impede collaboration due to profession-specific tensions, such as differing cultures or turf issues. Empirical findings suggest challenges in collaboration both within and between specialized organizations. This study explores how various specializations in child welfare relate to social workers’ perceptions of collaboration within their workgroup, between different social service units, and with external organizations, considering factors like work demand, time spent with clients, and work experience. Analysing survey data from 2003 to 2018 with 895 social workers in Stockholm County, the present study uses generalized estimating equations to address clustering within organizations. The findings indicate a potential positive association between target group specialization and perceived collaboration functionality within the workgroup and with external organizations, challenging assumptions that specialization hinders collaboration and suggesting that target group specialization could facilitate collaboration.

A study on the Practical Group work to Enhance the Resilience of "Quasi-Family" Children's Welfare Institutions

Orphans and disabled children are a special group of children, and the welfare of orphans and disabled children is an important part of the social security system. At present, there are mainly institutional care, foster family care, "quasi-family" care, and adoption. Among them, "quasi-family" is an innovative model that recruits loving and responsible parents from the society to form a simulated family to raise orphans and disabled children, which supplements the family support that children lack and allows them to grow up in a warm and loving life and interaction. However, in practice, it is also found that the "quasi-family" parenting model still has problems in family organization model, family belief system, family communication ability, etc. Therefore, using group work methods, guided by family resilience theory, and starting from the perspective of strengths, professional social work services are provided to quasi-family, promoting changes in quasi-family belief system, organization model and communication status, so as to improve the quality of raising orphans and disabled children.

Transgenerational association of mentalization with child mental health: A scoping review.

This scoping review provides an overview of empirical research concerning the association between parents' mentalization and child mental health (0-12 years of age). Specifically, it aims at synthesizing the evidence regarding to what extent mentalization (a) is a protective factor for child mental health, and (b) moderates the transgenerational transmission of psychopathology. A total of 73 studies were selected out of 5112 identified (duplicates excluded). The results hint at a relation between parent's mentalization and child mental health: 88% of the studies showed significant associations between predictor and outcome dimensions across a variety of samples, research procedures, and assessment measures. About the direction of the associations, almost all of them behave as expected, supporting the statement that children of parents with healthy mentalization skills tend to have better functioning and show less psychopathology. The evidence indicates that parents' healthy mentalization strengthens children's well-being and helps them cope with stressors more effectively so it is acting as a protective factor against mental health problems. Eleven studies found moderating roles of parents' mentalization in the transgenerational transmission of psychopathology. In a context where mental ill-health is mostly addressed only once there is a problem, these results suggest that fostering parents' mentalization in clinical but also in non-clinical settings could help to improve child mental health in terms of symptoms, functioning, and well-being, and stop the growing incidence of mental disorders across development.

Youths over 18 receiving support from the child welfare service: evolving motivation in the interaction between the youth and the caseworker

ABSTRACT This article focuses on the interaction between youths and caseworkers and how it influences youths’ motivation during emerging adulthood. The study is based on qualitative interviews with 10 youths aged 18–23 and six child welfare caseworkers. The interviews were analysed using a phenomenological and hermeneutic approach. In the analysis, we examine which factors motivated youths to evolve in the interaction between the youth and the caseworker. The findings interrelate and categorize into four topics: Interaction to explore youths’ desire for independence forms a base for evolving motivation. Secondly, motivation evolves in the interaction to tailor the follow-up to meet youths’ wishes and needs. The third topic shows that relationships with support allow motivation to progress. Last, interaction relies on caseworkers’ presence and competence. Evolving motivation involves balancing support and self-determination, contributing to youths coping, development and autonomy.

"If We Don't Beat It, How Long Will It Take?" Worries and Concerns of Children with Advanced Cancer and Their Parents.

Background: Navigating pediatric advanced cancer is challenging for children and parents, resulting in increased risk for psychological distress. While research has explored parent worries/concerns, few studies have included children's perspectives. Objectives: To explore worries/concerns in children with advanced cancer and their parents. Design: This was a part of a larger, mixed-methods study examining shared decision-making. Setting/Subjects: Children (of age 5-25) with advanced cancer (i.e., relapsed/refractory disease or physician estimated prognosis of <60%) and their parents in the Midwestern United States. Measurements: Children and parents completed the Response to Stress Questionnaire and individual semi-structured interviews. Coders analyzed the qualitative data via thematic analysis. Results: Parent and child worries/concerns included: (1) prognosis, (2) symptom burden and side effects of treatment, (3) emotional well-being, (4) impact on future, and (5) no concerns/uncertainty (child-only theme). Benefit-finding emerged as a minor theme. Many expressed concerns about treatment response, resulting in worries about death/dying. Others shared fear about managing current symptoms and the impact of long-term treatment side effects on the child's future. Parents reported worry about their child's emotional well-being, while children expressed worries about their families if they died. While all parents were able to identify worries/concerns, some children denied worries/concerns. Quantitatively, parents similarly identified worries about prognosis and symptom burden but also endorsed concern about being unable to help their child feel better. Conclusions: Our findings highlight similarities and differences in worries/concerns among children and parents as they navigate a child's advanced cancer journey. Early integration of palliative care may be helpful in mitigating these issues.