CBCL Baseline by 18-Months

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Lessons from the U.S. National Survey of Child
and Adolescent Well-Being (NSCAW): How Are
the Children Faring and Did Mental Health
Services Help?
Richard P. Barth
School of Social Work
University of Maryland
Presented at ACWA Annual Conference Research Forum
University of WashingtonAugust 15, 2006
The research for this presentation was funded by the Administration on Children, Youth, and Families of the U.S.
Department of Health and Human Services. Although I am grateful to the NSCAW Research Group for their work,
points of view or opinions in this presentation and accompanying documents are those of the presenter and do not
necessarily represent the position or policies of the U.S. DHHS or of my NSCAW colleagues. Results are
preliminary and not to be quoted in print or other media. I am grateful to the Fulbright Commission for an
award as a Senior Specialist
First National Random Sample Study Of CWS
• Extended Research Team included:
– Research Triangle Institute
– University of North Carolina
– San Diego Children’s Hospital,
CASRC
– CSRD, Pitt Medical Center
– National Data Archive on Child Abuse
and Neglect, Cornell
– 92 Local Child Welfare Agencies
– Federal Admin. For Children and
Families
– Children and Families
– Taxpayers of US who have provided
more than $40,000,000 in support
NSCAW Cohort at Baseline
Total
6,231
Long-term
foster care
727
Enter through
investigation
5,504
No services
1,725
Other gateways
600
Ongoing services
3,779
In home
2,312
Out-of-home
1467
Wellbeing Measures
• Infant Development (0 – 2
years)
– Battelle Developmental
Inventory (BDI)
– Bayley Infant
Neurodevelopmental
Screener (BINS)
– Vineland Adaptive
Behavior Screener (VABS)
•
Cognitive Domain
– Preschool Language
Scale-3 (PLS-3)
– Mini-Battery of
Achievement (MBA)
• Social Domain
– Vineland Adaptive Behavior
Scale Screener, Daily Living
Skills domain (VABS)
– Social Skills Rating System
(SSRS)
• Behavioral Domain
– Child Behavior Checklist
(CBCL)
• Risky Behaviors (11+ years)
– Self-Report Delinquency
(SRD)
– Substance Abuse
– Sexual Behavior
– Suicide
Family Cumulative Risk Score
• Risk Assessment section (CW worker)
• 23 items (e.g., including trouble meeting basic
needs, substance abuse, past CW involvement,
domestic violence, parent psychopathology)
• Proportional score created
– Low risk (< 22%)
– Medium risk (22% to 40%)
– High risk (40%)
When using as predictor of child behavior (e.g., CBCL), child behavior
variables are omitted from this score
Risky Behavior Domain (11 to 15 at BL)
Self-Report Delinquency (SRD)
• Modified version of the SRD
(Elliott & Ageton, 1980) used
for Wave 7 (1987) of the NLSY
• 72 Questions:
– 36: Acts committed in
previous 6 months
– 36: Frequency of acts
• Scoring: Acts weighted by
seriousness & multiplied by
frequency
• Cronbach’s α = .98
Substance Abuse
• Modified from Youth Risk Behavior
Survey items
• 14 questions:
7: Substances used past 30 days
7: Frequency of use
• Scoring: Acts weighted by
seriousness & multiplied by
frequency
Risky Domain (11 to 15 at BL)
Voluntary Sexual Behavior
Suicidal Behavior Risk
Three items ask (1) Had youth ever
had intercourse; (2) Consistency
of use of protection for sexual
intercourse; and (3) Had youth
ever been pregnant or gotten
someone pregnant (0 = “No” or not
applicable, 1 = “Yes”).
Scores ranged from 0 to 5
• No risk (0, Never had intercourse or
Items from the Youth Self Report,
and the Children’s Depression
Inventory
Six items ask the youth and
caregiver about thoughts, plans,
and suicides attempts of the
child
Scores range from 0 to 17
• No risk (0, No suicidal behavior
•
•
first experience was coerced)
Low risk (1, Has had intercourse but
used protection consistently and has
never been/gotten someone
pregnant)
Medium/High risk (2-5, Inconsistent
use of protection and possible
pregnancy)
reported)
•
•
Low risk (1 – 3, Suicidal thoughts
in the past two weeks)
Medium/High risk (4–17, Has
deliberately tried to harm self and/or
has had suicidal thoughts in the past
two weeks, and has a plan)
Change in Developmental Well-Being of
Children Involved with CWS from
Baseline to 18 Months
1. Conditional Probability of Change
2. Change scores and effect sizes
3. Assessment of Contributors to Well-Being
Using General Estimating Equations
Age Groups andWell-Being Measures
Domain
Measure
Age Group
0-2 3-5 6-10
Development Bayley Infant Neurodevelopmental
Screener (BINS)
x
Social
x
Vineland Adaptive Behavior Scales
Screener (VABS)
Social Skills Rating System (SSRS)
Cognitive
Battelle Developmental Inventory (BDI)
x
Preschool Language Scale-3 (PLS-3)
x
x
x
x
x
x
Mini Battery of Achievement (MBA)
Behavior
Child Behavior Checklist (CBCL)
x
x
x
Proportion of Developmental/Clinical
Cutting Scores Per Child^
40
40
35
Baseline (W1)
18 months (W3)
Percent
30
25
20
15
15
10
5
12
11
9
7 6
8 8
7
2
9
4
1 1
2
4
1 1
0 .3 1
0 .11
0 .3
2
0
0.00 0.17 0.20 0.25 0.33 0.40 0.50 0.60 0.67 0.75 0.80 0.83 1.00
Proportion of Clinical Scores
^Number of possible measures per child varies from 4 to 7
Changes in Cognitive Development Score (BDI) for
0-2 Year Old Children: Baseline to 18-Months
Baseline
Mean
(SE)
18 months
Mean
(SE)
Effect Size
In-home at baseline and 18
months (n=881)
42.0 (.97)
42.1 (1.25)
+.01
Out-of-home at baseline
and 18 months (n=312)**
44.2 (2.02)
40.1 (1.83)
-.32
Total (n=1493)
42.6 (.92)
42.0 (1.04)
-.05
Setting
Note: 454 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were
equal for the purposes of comparison.
All analyses are on weighted data.
Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-ofhome to in-home).
** p < .01
Changes in Risk for Developmental Delay or Neurological
Impairment (BINS) for Children 0-2, Baseline to 18-Months
Risk for Developmental Delay or Neurological
Impairment at 18 Months
Risk for Developmental
Delay or Neurological
Impairment at Baseline
Low
Moderate
High
Low (n=59)
.02
.04
.02
Moderate (n=132)
.03
.13
.15
.07
.20
.35
High (n=367)
All analyses are on weighted data.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
Change in (BINS) for Children 0-2, BL to 18Months (In-Home Only)
Risk for
Developmental Delay
or Neurological
Impairment at Baseline
Risk for Developmental Delay or Neurological
Impairment at 18 Months
Low
Moderate
High
Low (n=31)
.01
.05
.02
Moderate (n=78)
.04
.13
.16
.07
.15
.38
High (n=167)
All analyses are on weighted data.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
Change in (BINS) for Children 0-2, BL to 18Months (Out-of-Home Only)
Risk for Developmental Delay or Neurological
Impairment at 18 Months
Risk for Developmental
Delay or Neurological
Impairment at Baseline
Low
Moderate
High
Low (n=16)
.05
.02
.01
Moderate (n=21)
.00
.14
.14
.07
.23
.34
High (n=110)
All analyses are on weighted data.
p<.001 (Bowker’s test); Red (upper) triangle shows negative change,Green (lower) shows improvement.
Changes in Language Skills Score (PLS-3) for 0-2 Year Old
Children: Baseline to 18-Months
Baseline
Mean
(SE)
18 months
Mean
(SE)
Effect Size
In-home at baseline and 18
months (n=879)*
91.3 (1.31)
87.8 (1.03)
-.20
Out-of-home at baseline
and 18 months (n=317)
90.0 (1.31)
86.5 (1.72)
-.22
Total (n=1501)**
91.3 (1.05)
87.8 (.89)
-.20
Setting
Note: 438 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were
equal for the purposes of comparison
All analyses are on weighted data.
Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-ofhome to in-home).
* p < .05; ** p < .01
Changes in Language Skills Score (PLS-3) for 3-5 Year Old
Children: Baseline to 18-Months
Baseline
Mean
(SE)
18 months
Mean
(SE)
Effect Size
In-home at baseline and 18
months (n=252)**
88.4 (1.84)
94.6 (2.90)
+.36
Out-of-home at baseline
and 18 months (n=41)*
76.1 (5.87)
82.6 (6.88)
+.33
Total (n=345)**
88.1 (1.67)
95.0 (2.48)
+.39
Setting
Note: 401 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were
equal for the purposes of comparison
All analyses are on weighted data.
Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-ofhome to in-home).
* p < .05; ** p < .01
Changes in Daily Living Skills (VABS) Baseline to 18-Months by Setting
and Age
Age at
baseline
In-home at baseline and 18
months
Out-of-home at baseline
and 18 months
+
change
change
+
change
change
3-5
25%
19%
8%
19%
6-10
15%
11%
21%
8%
0-2
Red shows negative change,
Green shows improvement.
CBCL Changes for Children (Ages 3-5):
Served at Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.53
.07
.08
2. Borderline
.05
.01
.03
3. Clinical
.06
.03
.14
Baseline
Total unweighted n =529.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Changes for Children (Ages 3-5):
Served Out-of-Home*
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
.34
.05
.07
0
0
.01
.10
.01
.41
Baseline
1. Normal
2. Borderline
3. Clinical
Total unweighted n =74.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Change Over 18 months
(Children Aged 3 to 5 Years at BL)
Child Gender*
Male*
Female
Child Race/Ethnicity*
Black/Non-Hispanic*
White/Non-Hispanic
Hispanic
Other
Parent Cumulative Risk
Low
Medium
High*
Beta (Units Change in CBCL Score)
3.25
Reference Group
-3.45
Reference Group
-1.85
1.74
Reference Group
3.03
3.27
Non-significant Variables: Wave,
Proportion of Time of Out-of-Home Care,
In-Home at Both Waves, Poverty Level
*p<.05 **p<.01 ***p<.001
CBCL Changes for Children (Ages 6-10):
Served at Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.55
.02
.04
2. Borderline
.04
.01
.03
3. Clinical
.11
.03
.16
Baseline
Total unweighted n =877.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Changes for Children (Ages 6-10):
Served Out-of-Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.36
.04
.04
2. Borderline
.03
.01
.03
3. Clinical
.19
.04
.28
Baseline
Total unweighted n =152.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Changes Over 18 Months
(Children Aged 6 to 10 Years at BL)
Gender*
Beta
Male*
2.13
Female
Reference Group
Child Race/Ethnicity
Black/Non-Hispanic
-0.28
White/Non-Hispanic
Reference Group
Hispanic**
-3.89
Other
-1.89
Wave***
Baseline
Reference Group
18 Months***
-2.56
Proportion of Time in Out-of-Home Care*
In-Home
Reference Group
Out-of-Home
4.74
Mixed*
4.70
Non-significant Variables: In-Home at Both
Waves, Poverty Level, Parent Cumulative
Risk
**p<.05 **p<.01 ***p<.001
CBCL Changes for Children (Ages 11+):
Served at Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.38
.03
.06
2. Borderline
.06
.03
.04
3. Clinical
.10
.04
.27
Baseline
Total unweighted n =654.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Changes for Children (Ages 11+):
Served Out-of-Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.29
.07
.13
2. Borderline
.07
<.01
.01
3. Clinical
.14
.01
.28
Baseline
Total unweighted n =147.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Scores^ Over 18 months
(Children Aged 11 to 15 Years at BL)
Significant Predictor
TIME (WAVE)*
Baseline
18 Months*
Beta
Reference Group
-1.43
*p<.05
Non-significant Predictor:
Gender, Child Race/Ethnicity, Proportion of
Time in Out-of-Home Care, In-Home at
Both Waves, Poverty Level, Parent
Cumulative Risk, Substance Abuse, and
Delinquency
^Measured
using
Child Behavior
Checklist
CBCL Changes for Children (Ages 2-15):
Served at Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.51
.04
.05
2. Borderline
.05
.01
.03
3. Clinical
.09
.03
.18
Baseline
Total unweighted n =2244.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
CBCL Changes for Children (Ages 2-15):
Served Out-of-Home
CBCL Total Score 18 Months
Group
1. Normal
2. BRDL
3. Clinical
1. Normal
.33
.05
.08
2. Borderline
.03
<.01
.02
3. Clinical
.15
.02
.30
Baseline
Total unweighted n =401.
Red (upper) triangle shows negative change, Green (lower) shows improvement.
Summary of Changes in CBCL Baseline to 18-Months by
Setting and Age
Age at
baseline
In-home at baseline
and 18 months
Out-of-home at
baseline and 18
months
+
change
change
+
change
change
3-5
14%
16%
11%
13%
6-10
18%
9%
26%
11%
11+
20%
13%
22%
21%
Red shows greater negative change, Green shows greater improvement.
• 3-5 year olds
show more
negative change
across settings
than 6-10 year
olds
• 6-10 year olds
show more
positive change
at home
•11-15 year olds
show more
positive change
across settings
CBCL Changes for All Children Since BL
Non-significant
Variables:
Gender, InHome at Both
Waves, and
Poverty Level
Child Age at Baseline*** Beta
2 years***
-5.62
3-5 years***
-3.87
6-10 years***
-3.73
11+ years
Reference Group
Child Race/Ethnicity*
Black/Non-Hispanic
-0.90
White/Non-Hispanic
Reference Group
Hispanic**
-3.10
Other
-0.24
Wave***
Baseline
Reference Group
18 Months***
-1.55
Proportion of Time in Out-of-Home Care**
In-Home
Reference Group
Out-of-Home**
4.36
Mixed
2.31
Parent Cumulative Risk***
Low
Reference Group
Medium**
2.59
High***
3.42
**p<.05 **p<.01 ***p<.001
Self-Reported Delinquency Changes for Children (Ages
11-15) Served at Home
Delinquency Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.41
.09
.05
.01
Low
.08
.04
.04
.02
Medium
.04
.03
.03
.02
High
.02
.02
.03
.06
Unweighted n=624
Red (upper) shows negative change, Green (lower) shows improvement.
Self-Reported Delinquency Changes for Children (Ages
11-15) Served Out of Home
Delinquency Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.40
.07
.10
.01
Low
.04
.02
.02
.01
Medium
.07
.07
.02
.02
High
.03
.02
.03
.07
Unweighted n=141
Red (upper) shows negative change, Green (lower) shows improvement.
Suicide Risk Changes for Children
(Ages 11-15) Served in Home
Suicide Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.55
.08
.01
.02
Low
.10
.05
.01
.01
Medium
.02
.01
<.01
.00
High
.08
.03
.01
.03
Unweighted n=664
Red (upper) shows negative change, Green (lower) shows improvement.
Suicide Risk Changes for Children
(Ages 11-15) Served Out of Home
Suicide Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.57
.06
.00
.01
Low
.14
.01
.03
.01
Medium
0
0
0
0
High
.05
.08
.01
.04
Unweighted n=156
Red (upper) shows negative change, Green (lower) shows improvement.
Substance Abuse Risk Changes for Children
(Ages 11-15) Served at Home
Substance Abuse Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.48
.11
.10
.02
Low
.06
.03
.03
.01
Medium
.03
.01
.06
.02
High
.01
<.01
.02
.02
Unweighted n=605
Red (upper) shows negative change, Green (lower) shows improvement.
Substance Abuse Risk Changes for Children
(Ages 11-15) Served Out of Home
Substance Abuse Risk Level at 18 Months
Baseline
No Risk
Low
Medium
High
No Risk
.59
.09
.05
.01
Low
.02
.02
.01
.00
Medium
.06
.02
.05
.01
High
<.01
<.01
.03
.03
Unweighted n=135
Red (upper) shows negative change, Green (lower) shows improvement.
Summary of Changes in Risk Behavior to 18Months by Setting and Age
Risk
In-home at baseline and 18
months
Out-of-home at baseline and
18 months
+
change
change
+
change
change
Delinquency
22%
23%
26%
23%
Suicide
25%
13%
28%
11%
Substance
Abuse
14%
29%
15%
17%
Red shows greater negative change, Green shows greater improvement.
CTS-PC (Child) Scores for Inappropriate
Parenting, BL to 18 Months (Children 11+)
Baseline
Mean
(SE)
18 months
Mean
(SE)
Effect Size
In-home at baseline and
Wave 3 (n=536)
12.3 (1.6)
12.0 (16)
.02
Out-of-home at baseline
and 18 months (n=161)
21.7 (3.4)
9.4*** (3.4)
.39
13.6 (1.4)
11.7 (1.4)
.08
Setting
Total (n=848)^
^Total includes children in mixed placement settings
p<.05**, p<.01***, p<.001
CTS-PC (Child) Scores for Severe
Violence, BL to 18 Months (Children 11+)
Baseline
Mean
(SE)
18 months
Mean
(SE)
Effect Size
In-home at baseline and
Wave 3 (n=536)
2.1 (.39)
1.0* (.23)
.16
Out-of-home at baseline
and 18 months (n=161)
7.2 (2.2)
3.1** (1.9)
.21
2.8 (.38)
1.3*** (.25)
.54
Setting
Total (n=848)^
^Total includes children in mixed placement settings
p<.05**, p<.01***, p<.001
Predictors of Change in Well-Being
for Multivariate (GEE) Models
•
•
•
•
•
•
•
•
•
•
•
•
•
Age (at Baseline)
Gender
Race/Ethnicity: Black, White, Hispanic, Other
Urbanicity: Urban, Nonurban
Child Setting: In-home, Out-of-home, Mixed
Most Serious Maltreatment Type: Physical, Sexual,
Failure to Provide (FTP), Failure to Supervise (FTS), Other
Parent Cumulative Risk Score: Low, Medium, High
Change in Parental Figure in 18 months (Y/N)
Prior CWS History (Y/N)
Chronic Health Problem (Y/N)
Ratio of Children to Adults in Household (continuous)
Poverty Rate (continuous)
HOME-SF Score (continuous)
Infants: Other Significant Findings
• BINS: victims of sexual abuse comprised
the only maltreatment type subgroup at
higher risk at 18-months
• VABS: children in out-of-home care have
a greater decline in this measure than inhome children or children in mixed settings
Summary: Age 0-2
• No significant measured improvements in
development for infants
• In general, infants < 2 years decline in all measures,
those 25-35 months improve
• Children with lower HOME-SF scores see greater
declines in three of the four measures
• Children in nonurban PSUs see higher risk for
developmental delay and neurological impairment
and worsening language skills
• Males decline in cognitive development and social
skills
Toddlers: Other Significant Findings
• SSRS: children in mixed settings
exhibited a large decline in social skills,
significantly so compared with the
relatively stable skills of in-home children
• PLS-3: victims of Other abuse exhibited a
decrease, while children in all other abuse
type groups exhibited an increase
Summary: Age 3-5
• Slight decline in social skills; improvement in
language skills; stable level of problem
behavior
• Age in months is a significant predictor of
change, but not in a consistent direction
• Prior CWS history is a predictor of change for
both social and language skills
– Could be that they receive greater level of intervention,
this time
– Could be that prior involvement already raised the level
of their care or treatment
School-Age Children: Other
Significant Findings
• CBCL: Being male, living in nonurban
areas, and more poverty are associated
with greater decreases in problem
behavior
• MBA-Math: Children with low parent
cumulative risk and those in mixed settings
exhibited increases, in contrast to their
counterparts
Summary: Age 6-10
• Only age group that showed improvements,
although slight, in all developmental
measures examined
• Only age group where age is not a significant
predictor of rate of change for any domain
• Maltreatment type is the only significant
predictor across more than one domain, yet
with varied results
Maltreated Adolescents
Risky and Risk-Taking Behaviors
Problem Behaviors
• Approximately 40% of maltreated
adolescents have borderline/clinical levels
of problem behavior, compared to only 5%
of children in the general population
(Achenbach, 1991)
• Maltreated adolescents need assistance in
dealing with more than the maltreatment
incident (e.g., aggression, attention problems)
Delinquency
• Delinquency is fairly stable but 6% of
youth are reporting consistently high levels
of serious/violent behaviors
• Confirms other research (see Loeber & Farrington,
1998) that a small proportion of youth are
committing the most serious/violent
offenses (e.g., gang fights, robbery, rape)
Risky Sexual Behavior
• Youth living in out-of-home care are reporting
more risky sexual behavior.
• Probably attributable to the fact that out-ofhome youth are often removed from very
high-risk homes (Carpenter, Clyman, Davidson, &
Steiner, 2001).
Are youth living in out-of-home care being
monitored sufficiently?
How can we assist youth in out-of-home care to
engage in less unsafe sex?
Substance Abuse
• A small portion (4%) of youth are reporting
consistently high levels of substance abuse
and 15% report high use at 18 months.
• Higher achievement may serve as protection
against increases in substance use for
maltreated youth.
How can we explain the increase in the
probability of substance abuse that nonaggressive youth are reporting?
Suicide Risk Behavior
• Youth in a mixture of placements are
experiencing more increases in suicide risk
behavior.
– What does this finding tell us?
• Could be attributable to factors related to
placement moves over the 18 months.
• Race/ethnicity differences appear somewhat
different from national trends in suicide (CDC,
2004) but NSCAW is not measuring actual
suicides.
Summary of Well-Being Findings
NAPCWA told us that child
welfare agencies were not in
control of enough resources to
achieve gains in wellbeing…….. they were prescient.
Cognitive Well-Being over 18 Months
•
•
•
•
Worsened since BL for children 0-2 yrs
Improved for children 3-5 and 6-10 yrs
Males ≤ 5 yrs doing worse than females ≤ 5 yrs
Generally higher for White than non-White
children
• Abuse type has more effect on infants than older
children
• Poverty associated with lower cognitive wellbeing for youngest (0-2 yrs) and oldest (11-15
yrs) children
Social Well-Being over 18 Months
• Worsened since BL for children 0-2 yrs
• For children aged 3-5 and 6-10 yrs, social skills
for :
• Non-White children > White children
• Children with low family cumulative risk > for
children with higher family cumulative risk
• For children aged 6-10 yrs and 11-15 yrs, social
skills for:
• IH children > OOH children
• Above poverty > Below poverty
Behavioral Well-Being over 18 Months
• Behavior showed significant improvement over
time for 6- to 10-year-olds only
• For children aged 3-5 and 6-10 yrs, behavior
problems for :
• Males > females
• White children > non-White children
• Children with high family cumulative risk > for
children with lower family cumulative risk
• High levels of substance abuse were associated
with more problem behavior (11-15 yrs)
Risky Behavior over 18 Months
•Delinquent behavior was fairly stable over
18 months
•Substance abuse levels were fairly stable
over 18 months
•Voluntary risky sexual behavior increased
•Suicidal behavior decreased
Infant Development over 18 Months
BDI
Children at 50-99% poverty had significantly lower cognitive development
scores than children at 150-199% and 200%+ poverty.
BINS
The risk of developmental delays & neurological impairments worsened over
18 months for infants. This was particularly the case for:
•African American children compared to White children.
•Children at <50% poverty compared to children at 150-199% and 200%+
poverty.
•HOME-SF (Home environment) was used as predictor
in these models
Cognitive Well-Being over 18 Months
•
•
•
•
Worsened since BL for children 0-2 yrs
Improved for children 3-5 and 6-10 yrs
Males ≤ 5 yrs doing worse than females ≤ 5 yrs
Generally higher for White than non-White
children
• Abuse type has more effect on infants than older
children
• Poverty associated with lower cognitive wellbeing for youngest (0-2 yrs) and oldest (11-15
yrs) children
Conclusions: Re-Report
• Although the majority of re-reports are not substantiated,
about one-in-five children have at least one re-report over
the 18 months
• Children in out of home care still have some risk of
recurrent maltreatment
– Possible explanations for maltreatment include:
• occurred prior to child entering foster care
• occurred during visit with biological family
• child on child maltreatment in foster or group home
• Receipt of parenting services associated with increased
likelihood or re-report
– Possible explanations include:
• Families with greater needs selected into services
• Agency surveillance
• Services do not adequately family needs
Caregiver Report of Violent Parenting
Tactics
• Many caregivers (8%) report using severe
violence toward their child following child
welfare involvement
• A large proportion of severe violence
remains unreported. This is especially true
for infants and toddlers.
• Violence between intimate partners often
leads to an increase in the amount of
severe violence children experience
Implications
• Parenting services
– Rigorous evaluation needed
– Developmentally appropriate
• Linkages to ongoing family support services
– Assist families to address ongoing needs
– Early intervention services, as required by
CAPTA 2003
• Child welfare workers must identify and
intervene to address violence toward
caregivers
General Discussion
• We are not achieving what I had hoped—at
least in the shortterm—regarding children’s
well-being
– Out of home care has changed (see next
slide)
• Our models of out of home care may not be
working the way they once had (assuming that
prior research in NYC and San Diego was
correct that foster care is restorative)
– Services are not used or don’t help
Alternate Explanations for Findings
• PSM did not match for important unobserved
covariates
• Services may not have been used in full
• Substance abuse services may interfere with parental
adequacy
– Focus is on parent’s recovery not child’s welfare
– Time and effort for SAT can be burdensome to parent
• Services may result in greater surveillance which
results in more observed behaviors that might place
children at risk, thus more reports
– But there was also a tendency for more placements into
foster care (p < .10).
Caregiving Environments Have More
Commitment but Fewer Resources
• Many children in out-of-home care live
below the poverty line
• Many children in out-of-home care live in
large households or with single parents
(and sometimes both)
• Many children in out-of-home care live with
caregivers without a HS education
Changes in the “Foster Care” Model
Agency Resources
Agency Resources
Kinship
Family
Social
Capital
Foster
Family
Social
Capital
Commitment to
Child
Commitment to
Child
Caregiving
Caregiving
General Discussion (continued)
• Findings are consistent with other research that children
in foster care have serious developmental risks
• They receive substantial levels of service, although they
are still underserved
– Children with the most significant problems receive the most
clinical mental health services, although only between a third and
half of children with a clinical CBCL score receive specialty
mental health services.
– Young children at high risk of developmental problems are not
routinely referred for supplementary or special education—especially
if they are in kinship care.
– Children in non-kinship and group care receive high levels of
supplementary educational services.
• The services may not be what they need or be sufficient,
or both
A Needed Change in Focus
• Service Access
• Foster Family as
Resource
• Substance Abuse
Treatment as
Resource to Mothers
(it may still be
protective of children)
• More voluntary and
flexible services
• Service Quality
• Foster Family as
Recipient of
Resources
• Substance Abuse
Treatment as Risk for
Mothers (it may still be
protective of children)
• More voluntary,
flexible, and family
focused services
Summary of Findings: Top 20
1. Significant developmental needs of children receiving
CWS at home are evident across many domains and
not often addressed, especially among young children
(US DHHS, 2005, US DHHS, 2003, and Stahmer, et al,
in press)
2. The diversity in apparent reasons for entering care is
considerable and does not always include severe
maltreatment (US DHHS, 2005 and Barth et al, in
press (a))
3. There is considerable prior CWS involvement--this is
one of the best predictors of many service and
developmental outcomes (US DHHS, 2005)
4. Mental health problems of mothers are very common
(US DHHS, 2005)
Summary of Findings II
5. Substance abuse among mothers was less common
than expected (US DHHS, 2005 and Gibbons et al., in
press)
6. Domestic violence in families entering CWS is
frequent, but relatively few placements among those
cases (US DHHS, 2005, Kohl, et al. in press, Kohl et
al, in press)
7. Many foster families have incomes at 100% of the
poverty rate or lower (US DHHS, 2005, US DHHS,
2003 Report, and Barth et al., in press (b))
8. Large (5 or more children) nonkinship foster families
are common [about 1/3rd of all nonkinship homes] (US
DHHS, 2003, US DHHS, 2005, and
Summary of Findings III
9. Caregiving environments for children in out of home care
are generally not stimulating (US DHHS, 2005 and Barth et
al., in press (b))
10. Mental health services to children with behavioral problems
were fewer than expected, given prior research on the
extensive cost of mental health services to foster children
(US DHHS, 2005 and Burns, et al., in press)
11. African American children with serious mental health
problems are served at rates that are comparable to white
children but African with fewer problems get less
preventative mental health care (Leslie, et al., 2004).
12. Mental health services that are closely coordinated with
CWS appear to reduce the extent of underservice for black
children (Hurlburt, et al., in press)
Summary of Findings IV
13. Almost every relationship between case characteristics
and services vary significantly by the age of the child (US
DHHS, 2005, US DHHS, 2003, Burns et al., in press)
14. Less service use by children in kinship care—especially
among younger children (US DHHS, 2003; 2005)
15. Caregiver evaluations of CWWs are more positive than
caregiver evaluation of services (US DHHS, 2005,
Chapman et al., 2003)
16. Children in out of home care generally (>80%) report
feeling close to their caregivers (US DHHS, 2005,
Chapman, et al., 2004); children in group care are one
important exception.
Summary of Findings V
17. Substance abuse and domestic violence by caregivers (selfreport) are often not known to CWWs (US DHHS, 2005,
Gibbons & Barth., in press; Hazen, et al., in press)
18. Termination of parental rights almost always follows
reunification efforts—reunification bypasses are not common
(Barth, Wulczyn, & Crea, in press).
19. At 18-months, about one-third of children are receiving care
in multiple care sectors (i.e., special education and specialty
mental health) (Farmer et al., under review)
20. The substantiation status of sexual abuse allegations
explains service rates more so than children's exhibited
needs (McCrae, Chapman, & Christ, in press).
References I
Barth, R.P., Wildfire, J., & Green, R. L. (in press (a)). Placement into foster care and the
interplay Nof urbanicity, child behavior problems, and poverty. American Journal of
Orthopsychiatry.
Barth, R. P., Green, R., Wall, A., Webb, M. B., Gibbons, C., & Craig, C. D. (in press
(b)).Characteristics of out-of-home caregiving environments provided under child welfare
services. Child Welfare.
Barth, R.P., Wulczyn, F. & Crea, T. (in press (c)). Adoption from foster care since the Adoption
and Safe Families Act. Journal of Law and Social Policy.
Burns, B.J., Phillips, S.D., Wagner, H.R., Barth, R.P., Kolko, D.J., & Campbell, Y. (2004).
Mental health need and access to mental health services by youth involved with child
welfare. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960970.
Chapman, M. V., Wall, A., & Barth, R.P. (2004). Children's voices: The perceptions of children
in foster care. American Journal of Orthopsychiatry, 74(3), 293-304.
Chapman, M. V., Gibbons, C, B., Barth, R.P., & McCrae, J.S. (2003). Parental views of inhome services: What predicts satisfaction with child welfare workers?, Child Welfare,
82(5), 571-596.
Farmer, E.M.Z., Mustillo, S.A., Wagner, H.R., Burns, B.J., Kolko, D.J., Barth, R.P., et al. (under
review). Multi-sector service use by youth in contact with child welfare.
Gibbons, C., & Barth, R.P. (in press). Prevalence of substance abuse among in-home
caregivers in a U.S. child welfare population: Caregiver vs. child welfare worker report.
Child Abuse & Neglect.
Gibbons, C., Barth, R.P., & Martin, S. (under review (a)). Characteristics of substance-abusing
mothers involved with child welfare services.
Gibbons, C., Barth, R.P., & Martin, S. (under review (b)). Substance abusing mothers in child
welfare:Who gets treatment?
References II
Hazen, A., Connelly, C.D., Kelleher, K., Landsverk, J., & Barth, R.P. (in press). Intimate
partner violence among female caregivers of children reported for child maltreatment.
Child Abuse & Negect.
Hurlburt, M.S., Leslie, L.K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R.D., et al. (in
press). Contextual predictors of mental health services use among a cohort of children
open to child welfare services. Archives of General Psychiatry.
Kohl, P.L., Barth, R.P., Hazen, A.L., & Landsverk, J.A. (in press). Child welfare as a gateway
to domestic violence services: Findings from the National Survey of Child and Adolescent
Well-Being. Children & Youth Services Review.
Kohl, P.L., Edleson, J.L., English, D.J., & Barth, R.P. (in press). Domestic violence and
pathways into child welfare services: Findings from the National Survey of Child and
Adolescent Well-Being. Children & Youth Services Review.
Leslie, L. K., Hurlburt, M. S., Landsverk, J., Barth, R., & Slymen, D.J. (2004). Outpatient
mental health services for children in foster care: a national perspective. Child Abuse
and Neglect, 28(6), 697-712.
McCrae, J., Chapman, M. V., & Christ, S.L. (in press). Profile of children investigated for
sexual abuse, psychopathology, and services. American Journal of Orthopsychiatry.
Stahmer, A.C., Leslie, L. K., Hurlburt, M., Barth, R.P., Webb, M.B., Landsverk, J., et al. (in
press).Developmental and behavioral needs and service use for young children in child
welfare. Pediatrics.
U.S. Department of Health and Human Services Administration for Children and Families.
(2005). National Survey of Child and Adolescent Well-Being: Children involved with the
child welfare services (Baseline Report). Washington, DC, ACF, US DHHS.
U.S. Department of Health and Human Services Administration for Children and Families
(2003). National Survey of Child and Adolescent Well-Being: Children living for one year
in foster care. Washington, DC, ACF, US DHHS
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