Child Welfare Services Research Articles

The power of the adult attachment interview in predicting subsequent psychopathology: a tribute to Mary Main

ABSTRACT Mary Main’s conceptualization and operationalization of attachment states of mind through the Adult Attachment Interview (AAI) represent seminal contributions to the attachment field. The AAI is a semi-structured clinical interview used to assess attachment states of mind that is widely used in research and clinical settings. Unresolved state of mind regarding loss or trauma has been linked to concurrent internalizing symptoms. The current study explored the associations between unresolved classification and later depression and anxiety, above and beyond trauma history and symptoms. Participants (n = 70) were parents (98.6% female, 67.1% Black/African-American) from a follow-up of a randomized clinical trial of a parenting program for families referred to child welfare services. Parents completed the AAI, Childhood Trauma Questionnaire, and the Psychiatric Diagnostic Screening Questionnaire at timepoint 1 (T1) and the Brief Symptom Inventory approximately 12 years later, at timepoint 2 (T2). Hierarchical regressions revealed that unresolved state of mind significantly predicted depression at T2, and marginally predicted anxiety at T2, above and beyond childhood trauma, post-traumatic stress symptoms, and early internalizing symptoms. These results suggest that unresolved states of mind are clinically significant and provide unique information about later internalizing symptoms in adults with a history of trauma or loss.

Anogenital Lesions in Children: A Critical Alert for Pediatricians.

A 7-y-old girl presented to the pediatric department with a two-week history of a skin lesion in the anogenital region. She appeared well-nourished, quiet, afebrile; vitals and her systemic examination was normal. Examination revealed a greyish white wart-like perianal lesion, unusual for her age. Further history revealed the child had become withdrawn, avoiding play recently, and had oral and vaginal ulcers a month earlier without treatment. These findings raised suspicion of sexual abuse. Investigations confirmed positive VDRL (1:64 titres), positive TPHA, and negative results for her parents' TPHA and HIV. A medicolegal case was registered, involving child welfare services and police. A psychiatrist diagnosed post-traumatic stress disorder and recommended counselling. Treatment with a single dose of intramuscular Benzathine penicillin led to improvement, with VDRL titres decreasing to 1:8 and complete resolution of the lesion after 3 months. Pediatricians are pivotal in identifying and managing child sexual abuse cases promptly.

Confronting our failures: Tensions in remedying systemic discrimination in Canada

This article examines the complexities of providing remedies for systemic discrimination in light of evolving understandings of equality and justice. Despite constitutional and statutory protections affirming the right to live free from discrimination, there remains a significant gap between recognizing systemic discrimination and implementing effective remedies. The 2021 case of Canada (Attorney General) v. First Nations Child and Family Caring Society of Canada serves as a focal point to highlight the shortcomings of the current remedial framework, which often prioritizes corrective over transformative justice, reflecting a formal rather than substantive approach to equality. In this case, the Canadian Human Rights Tribunal found that Canada’s inequitable funding of First Nations child welfare services was discriminatory on the grounds of race and national or ethnic origin. It ordered Canada to compensate every child impacted, while simultaneously imposing systemic remedies such as reforming federal funding policies. By exploring the Tribunal’s decision to uphold both individual and systemic remedies, the paper argues for a more integrated approach that moves beyond the dichotomy of individual versus systemic discrimination. It advocates for co-designed remedies informed by the perspectives of affected communities, calling for a shift in how systemic discrimination is addressed within Canada’s legal framework.

Building trust with children in collaborative processes within in-home child welfare services

ABSTRACT This study explores trust-building between child welfare professionals and children aged 7–12 in Norwegian in-home support unit. Through ethnographic fieldwork with 13 professionals and 12 children, alongside interviews with eight professionals, the study reveals children’s active role in assessing trustworthiness and negotiating power dynamics through dialogue. The findings show that professionals must prioritize building trust through informal, activity-based interactions, which help bridge communication gaps and enhance children’s self-esteem. The importance of reciprocity in the trust-building process is emphasized. This study highlights the value of empathetic, child-centered practices in fostering trust and collaboration within child welfare.

The Role of Dosage and Family Profiles in a Child Welfare Home Visiting Program

Abstract Background Among the different modalities of family support, home visiting programs have proved to be one of the most effective secondary prevention models for families involved in child welfare services. Despite the promising outcomes and the extensive available literature, further research is needed to investigate target population characteristics and implementation factors that may explain the heterogeneity in the outcomes of these programs for families receiving child welfare services. Objective This longitudinal study explored the role of dosage and family characteristics related to the effectiveness of the Family Intervention Program (FIP), which is a home-based Spanish child welfare service for supporting families at psychosocial risk. Method To this end, a quasi-experimental design was followed, including a time-series evaluation of the 289 families receiving the FIP. In order to examine the impact of the FIP, the evolution of child well-being (CWB) was evaluated with Child Well-Being Scales every 6 months. Results The results showed that the highest average CWB score was observed after 39 months of intervention, observing no improvements in CWB from that point. Similarly, the results showed that the FIP was more effective for single parent families at higher socioeconomic levels. Conclusions This article provides new knowledge for the understanding of home visiting programs success, concluding that the programs are not equally effective for all family profiles, and that it is necessary to adjust each program to the specific characteristics of the target population.

“Being a Parent in Finland” - psycho-educative intervention: development and acceptability of a group programme aimed at increasing trust among migrant parents

ABSTRACT The existing literature highlights distrust among migrant parents in Nordic countries towards child welfare and other services. However, interventions to enhance parental trust are few in number, and descriptions of their development and feasibility testing in a Nordic context are lacking. This paper describes the development of ‘Being a Parent in Finland’, a psycho-educative group intervention designed for migrant parents to foster institutional trust. The intervention’s content and structure are outlined using the Six Steps for Quality Intervention Development framework (6SQuID). Additionally, the paper presents findings from a small-scale pilot study involving thematic interviews with 16 parents and a pre-post survey with 14 parents to assess programme acceptability. The pilot study indicated high acceptability and perceived benefits among parents, although no changes in institutional trust emerged in the quantitative survey. Implications for future development, practice, and research are discussed.

Youth Receiving Child Welfare Services and their Preferred Relationships With Their Service Providers

Purpose: This study explores the experiences of youth receiving Child Welfare Services (CWS) in Nova Scotia, Canada and their preferred relationships with different service providers and how these relationships may promote or hinder their resilience at different levels of risk exposure. Method: Qualitative interviews with 23 youth (aged 14–19) were analyzed using grounded theory. Results: The analysis revealed two core categories, relationship building and mentoring relationship as well as supporting themes that were modelled into a theoretical understanding of three distinct relationship patterns (parent-like, peer-like, and professional) that youth seek from their service providers. Findings discuss the category relationship building, comprising of two themes—youth mobility and multiple service providers; followed by a discussion on the three mentoring relationships. Conclusion: Implications address how salient features from these patterns of youth–worker relationships can be effectively integrated into service delivery.

“Suffering in silence”: How social workers in child welfare practice experience and manage burnout

Social workers in child welfare practice encounter dilemmas, tensions, contradictions, ambiguities, and ambivalence as they attempt to meet the competing demands of the Tri-sphere — the formal child welfare system, the professional theories and values guiding practice, and the child welfare service recipients. This study explored how these encounters result in worker burnout and how that is managed. The study used a constructivist grounded theory approach. Data were collected in St. John’s, NL, Canada, employing in-depth individual interviews with 18 frontline child welfare social workers. Findings reveal that child welfare social workers regularly experience varied feelings and emotions of burnout and utilize a variety of self-care strategies to manage. Recommendations include a call for child welfare agencies to provide opportunities for workers to feel heard and acknowledged about any negative feelings and emotions, strengthen positive peer supports, and promote essential self-care practices such as offering reduced membership cost for physical activities.

The Role of Resilience as a Mediating Factor between Adverse Childhood Experience and Mental Health in Adolescents Receiving Child Welfare Services in Nova Scotia

The Role of Resilience as a Mediating Factor between Adverse Childhood Experience and Mental Health in Adolescents Receiving Child Welfare Services in Nova Scotia

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.

Co-producing an intervention to prevent mental health problems in children and young people in contact with child welfare services

BackgroundChildren and young people (CYP) in contact with child welfare services are at high risk of developing mental health problems. There is a paucity of evidenced-based preventative interventions provided to this population.ObjectiveThis project worked in partnership with CYP, their parents/caregivers and the professionals who support them to co-produce a preventative mental health intervention for CYP in contact with child welfare services.Participants and settingWe recruited a purposive sample of CYP in contact with child welfare services (n = 23), parents/caregivers (n = 18) and practitioners working within child welfare services and mental health services (n = 25) from the North East of England and convened co-production workshops (n = 4).MethodsThis project followed the established principles for intervention development, applying the six steps to quality intervention development (6SQUID) approach. The mixed method research consisted of four work packages with continuous engagement of stakeholders throughout the project. These were: a systematic review of reviews; focus groups with practitioners; interviews with parents/caregivers and CYP; co-production workshops.ResultsWe identified that the primary risk factor affecting CYP in contact with child welfare services is the experience of childhood adversity. The quality of relationships that the CYP experiences with both their parent/caregivers and the professionals involved in their care are considered to be the main factors amenable to change.ConclusionsWe found that a trauma-informed, activity-based intervention with an embedded family-focused component provided to CYP who have experienced adversity is most likely to prevent mental health problems in those in contact with child welfare services.

Mental Health and Parenting Practices and Styles Among Parents Receiving Child Welfare Services in Norway: A Cross‐Sectional Study

Mental Health and Parenting Practices and Styles Among Parents Receiving Child Welfare Services in Norway: A Cross‐Sectional Study

Socioeconomic and psychosocial outcomes of parents with children in out-of-home care: A scoping review

Families involved with child welfare services (CWS) often diverge systematically from the general population. They are more likely to live in challenging circumstances characterised by adverse socioeconomic conditions (e.g. poverty) and psychosocial adversities (e.g. mental health problems and substance misuse). Past research has primarily focused on the development and lifelong health and social outcomes of children who have experienced out-of-home care (OHC). However, the separation could also trigger negative emotions and other changes in parents, but much less attention has been paid to the associations between children’s placement and parents’ lives.This scoping review synthesises results from quantitative studies investigating the socioeconomic and psychosocial outcomes of parents who have experienced the removal of a child into OHC. Six databases were comprehensively searched, with 15 studies selected for inclusion in the review. Studies were conducted among countries of the Organization for Economic Cooperation and Development (OECD) with substantial heterogeneity in the methods and designs, as grouped into three categories: “cross-sectional assessments” (4 studies), “longitudinal assessments” (7 studies) and “pre-post assessment” (4 studies).To a large extent, studies focus on psychosocial outcomes among mothers. The majority indicate that having a child placed in OHC is associated with the deterioration of psychosocial or socioeconomic outcomes among parents. We may conclude that parents who have experienced the removal of a child are a group that deserves tailored support and counselling. However, further quantitative research into aspects of parents’ lives after children’s OHC placement is needed, particularly with longitudinal designs and more rigorous methods to enable a better understanding of the causes and effects of these associations. This might support the development of targeted and effective interventions for these families.

CaseAIM: child welfare workers’ experiences using information and communication technology for case management services

ABSTRACT The use of information and communication technologies (ICT) to enhance child welfare services provides innovative tools and support for child welfare workers to manage caseloads effectively. This study used the Technology Acceptance Model (TAM) to understand case managers’ experiences with the CaseAIM mobile app, a tool that supports workload efficiency through documentation, case access, support, and transportation. Thematic analysis of interviews (n=11) revealed four domains of experiences with CaseAIM: time management, increased engagement with children and families, improved case management support, and challenges. Findings yield implications for agencies introducing new technologies into their workforce.

Characteristics of Transition-Age Youth Engaging in Suicidal Behavior

PurposeSuicide rates are markedly high among children with foster care involvement. Transition-age youth (TAY) who age-out of the foster care system are at particularly high risk. MethodsAnalyzing data from the California Youth Transitions to Adulthood Study (n=727), this paper explores the descriptive characteristics of TAY who engage in suicidal behavior with the goals of better identifying, understanding, and supporting those at risk. We report rates of suicidal ideation and suicide attempt at four interview waves (ages 17, 19, 21, 23) and examine differences in rates by sociodemographic characteristics, past maltreatment, and behavioral health disorders. ResultsAt age 17, 42% of California Youth Transitions to Adulthood Study participants had thought of committing suicide and 24% had attempted suicide. Across ages, sexual minority youth reported significantly higher rates of suicidal ideation and behavior than their heterosexual peers. We also found that youth with (1) maltreatment experiences (both before and during foster care); (2) major depressive disorder, anxiety disorder or post-traumatic stress disorder; and (3) alcohol/substance abuse disorders were significantly more likely than their peers without these characteristics/diagnoses to engage in suicidal behavior at certain ages. Youth with comorbid psychiatric and substance use disorders were consistently at elevated risk. DiscussionRoutine screening for suicidal behavior among TAY is important for child welfare service providers to consider. Youth at risk may benefit from more consistent assessment, mental health care, and targeted mental health intervention. Future research is needed to shed light on mechanisms linking certain sociodemographic, experiential, and behavioral health characteristics with suicidal behavior in TAY.

Examining the Complexities of Conducting Randomized Controlled Trials in Child Welfare Settings

ABSTRACT Background Randomized controlled trials (RCTs) are considered the gold standard for assessing the effectiveness of interventions. At the same time, it is challenging to evaluate interventions using experimental designs in child welfare settings. Objective This study explores the facilitators and challenges faced when carrying out a pilot RCT of a home-visitation intervention, Family Partner, that was implemented within Norwegian child welfare services. Method This study draws on 29 qualitative in-depth interviews and four focus group interviews that were carried out with child welfare workers, managers and stakeholders. Results Results revealed one facilitator and four challenges with carrying out RCTs in child welfare settings: The main facilitator was the staff’s belief in the intervention, while the challenges were 1) ethical concerns in participant recruitment and information sharing, 2) resource management challenges in randomization, 3) emotional strains in response to randomization, and 4) contamination between the intervention and control participants. Conclusion While we present possible solutions to the challenges, our results also highlight the importance of careful planning, preparation, piloting, and using mixed method research approaches when conducting RCTs within child welfare services.

Child Welfare Outcomes After Attachment and Biobehavioral Catch-Up Intervention Participation: A Quasi-Experimental Study.

Limited research is available examining distal child welfare outcomes after participation in evidence-based parenting interventions. To address this gap, this study employed a multi-tiered analytic approach to examine child welfare outcomes after participation in Attachment and Biobehavioral Catch-up (ABC). Using propensity score analytic techniques to establish a matched comparison group, logistic regressions examined subsequent maltreatment reports and substantiation, and survival analyses observed time to and likelihood of reunification for children who received one of three ABC curriculums compared to comparison group children (child welfare services as usual). In total, 205 children were included in the impact analysis (n = 66 treatment; n = 139 comparison); the majority of the children were White (53.7%), non-Hispanic (84.4%), males (59.5%) with an average age of 6 months (M [SD] = .50 [1.0]). Over half (56.1%) of the study sample was in out-of-home placement; 23.5% of the removed children experienced reunification. No statistically significant group differences were observed on the likelihood of subsequent or substantiated maltreatment reports. All three ABC curriculums were associated with a statistically significant increased likelihood of reunification, when compared to their matched counterpart. Additional research is warranted, though results indicate ABC may be a promising intervention to help enhance the likelihood of reunification.

Does attending to extremely poor clients increase the burnout of social workers?

ABSTRACT This study examines how working with extremely poor clients contributes to social worker burnout. Previous research has shown that the emotional labour social workers perform on a daily basis may have negative consequences such as job stress and burnout. Studies have also reported that clients’ poverty may increase these consequences through several mechanisms. Based on these findings, we hypothesised that social workers working with extremely poor clients will be more likely to burn out than those working with less poor clients. Data from a survey of Hungarian social workers in child and family welfare services were analysed using linear regression models. Burnout was measured using the Maslach Burnout Inventory (MBI) distinguishing three dimensions of burnout: emotional exhaustion, depersonalisation, and personal accomplishment. Results show that working with extremely poor clients is not associated with higher emotional exhaustion and higher depersonalisation, but it significantly decreases the perceived level of personal accomplishment. This finding highlights the importance of addressing the significant chronic stress experienced by those working with the extremely poor, which exposes them to various mental and physical illnesses in the long term. The study also discusses the methodological implications of our findings on the applicability of the MBI.

The practice of zero tolerance: emergency placement by child welfare services in Norway

The article discusses the emergency placement of children by the Norwegian Child Welfare Services. Nine mothers were interviewed about their experiences of the transfer of care of their children. Several of the mothers had their children removed due to an emergency decision. The article focuses on one of these stories and analyses the way in which emergency placement can be seen as a form of communication and practice. The purpose of this article is to generate knowledge about how the concept of ‘zero tolerance’ is used to legitimise emergency placements and how this practice might cause more harm than benefits for individual children. The article’s analytical perspective is grounded in the systems theory of Niklas Luhmann.

Dynamics of Social Work Approach in Childcare; An Analysis of Integration of Islamic Kafala Theory and Bowlby’s Attachment Theory and Application Thereof in Childcare in Saudi Arabia

This paper explores the dynamic integration of Islamic Kafala theory and attachment theory within the context of childcare and welfare in Saudi Arabia. Despite the growing recognition of diverse cultural and theoretical frameworks in social work practice, there is very limited research on how specific theories are integrated and applied in childcare, particularly within Islamic contexts. This study aims to fill this gap by analyzing the application of these theories in enhancing child welfare and social work practices in Saudi Arabia. Utilizing a mixed-methods approach, the research draws on qualitative data from surveys of child welfare professionals and families engaged in the Kafala system, supplemented by case study analyses in various Muslim countries. The findings reveal that the integration of Islamic Kafala theory and attachment theory offers a culturally sensitive and effective framework for improving childcare practices, promoting the emotional and psychological well-being of children in care. The study highlights practical implications for social workers, suggesting strategies for the successful incorporation of these integrated theories into child welfare practices in Saudi Arabia. It also identifies challenges and limitations within the current system, offering recommendations for policymakers to enhance child welfare services. This research contributes to the theoretical and practical knowledge of childcare and welfare, advocating for a more nuanced and culturally informed approach to social work in Saudi Arabia.