Abstract
Youth involved in the child welfare system and specifically those in foster care disproportionately experience concerns related to their psychosocial needs compared to youth who are not in care; consequently, assessment of those needs and referral to appropriate services is critical. The purpose of this study was to examine whether needs (i.e. behaviors) of youth involved in the child welfare and foster care systems and organizational culture and climate are associated with caseworkers’ recommendations for services, considering youth and caregiver report, as well as other individual and family factors. The sample came from Wave 2 of the National Survey of Child and Adolescent Well-Being II and weighted data were used for the analyses (n = 462). Logistic regression was used to analyze factors, such as youth behavior and organizational culture and climate, that predict a referral for various youth services for youth who experienced maltreatment and remained in home or were placed in foster care. Results indicate that youth behavior was most likely to predict referral services, as well as other youth characteristics, but organizational culture and climate of agencies did not influence referral recommendations. These findings highlight the need for more research examining the decision-making and assessment practices of child welfare caseworkers and use of appropriate assessments for youth involved in the child welfare system.
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Data Availability
The datasets generated during and/or analyzed during the current study are not publicly available due the owners of the National Survey of Child and Adolescent Well-being. Restricted access is available to researchers who complete the data protection plan with the owner of the data.
References
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. University of Vermont, Department of Psychiatry.
Achenbach, T. M. & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont, Department of Psychiatry.
Achenbach, T., & Rescorla, L. (2001). The Manual for the ASEBA School-Age Forms & Profiles. University of Vermont, Research Center for Children, Youth, and Families.
Alfandari, R. (2017). Systemic barriers to effective utilization of decision making tools in child protection practice. Child Abuse & Neglect, 67, 207–215. https://doi.org/10.1016/j.chiabu.2017.02.030
Allan, H., Harlaar, N., Hollinshead, D., Drury, I., & Merkel-Holguin, L. (2017). The impact of worker and agency characteristics on FGC referrals in child welfare. Children and Youth Services Review, 81, 229–237. https://doi.org/10.1016/j.childyouth.2017.08.013
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: Text revision. (4th ed.). American Psychiatric Association.
Baldwin, H., Biehal, N., Cusworth, L., Wade, J., Allgar, V., & Vostanis, P. (2019). Disentangling the effect of out-of-home care on child mental health. Child Abuse & Neglect, 88, 189–200. https://doi.org/10.1016/j.chiabu.2018.11.011
Baumann, D., Dalgleish, L., Fluke, J., & Kern, H. (2011). The decision-making ecology. American Humane Association.
Bederian-Gardner, D., Hobbs, S. D., Ogle, C. M., Goodman, G. S., Cordón, I. M., Bakanosky, S., Narr, R., Chae, Y., Chong, J. Y., & NYTD/CYTD Research Group. (2018). Instability in the lives of foster and nonfoster youth: Mental health impediments and attachment insecurities. Children and Youth Services Review, 84, 159–167. https://doi.org/10.1016/j.childyouth.2017.10.019
Bell, T., Romano, E., & Flynn, R. J. (2015). Profiles and predictors of behavioral resilience among children in child welfare. Child Abuse & Neglect, 48, 92–103. https://doi.org/10.1016/j.chiabu.2015.04.018
Bérubé, A., Lafantaisie, V., Clément, M., Coutu, S., Dubeau, D., Caron, J., & Lacharité, C. (2017). Caseworkers’ perspective on risk factors in the family environment influencing mothers’ difficulties in meeting children’s needs. Children and Youth Services Review, 82, 365–372. https://doi.org/10.1016/j.childyouth.2017.09.038
Boothby, N., & Walker, V. (2012). What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care? Child Abuse & Neglect, 36, 711–721. https://doi.org/10.1016/j.chiabu.2012.09.004
Braciszewski, J. M., & Stout, R. L. (2012). Substance use among current and former foster youth: A systematic review. Children and Youth Services Review, 34, 2337–2344. https://doi.org/10.1016/j.childyouth.2012.08.011
Brown, A., Courtney, M. E., & McMillen, J. C. (2015). Behavioral health needs and service use among those who’ve aged-out of foster care. Children and Youth Services Review, 58, 163–169. https://doi.org/10.1016/j.childyouth.2015.09.020
Center for Mental Health Services and Center for Substance Abuse Treatment (CMHS CSAT). (2013). Diagnoses and health care utilization of children who are in foster care and covered by Medicaid (HHS Publication No. (SMA) 13–4804). Substance Abuse and Mental Health Services Administration, Center for Mental Health Services and Center for Substance Abuse Treatment. https://store.samhsa.gov/system/files/sma13-4804.pdf
Chabot, M., Fallon, B., Tonmyr, L., MacLaurin, J. F., & Blackstock, C. (2013). Exploring alternate specifications to explain agency-level effects in placement decisions regarding aboriginal children: Further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part B. Child Abuse & Neglect, 37, 61–76. https://doi.org/10.1016/j.chiabu.2012.10.002
Cheng, T. C., & Lo, C. C. (2018). Racial disparities in the proportion of needed services maltreated children received. Children and Youth Services Review, 94, 72–81. https://doi.org/10.1016/j.childyouth.2018.09.036
Connell, C. M., Bory, C. T., Huang, C. Y., Genovese, M., Caron, C., & Tebes, J. K. (2019). Caseworker assessment of child risk and functioning and their relation to service use in the child welfare system. Children and Youth Services Review, 99, 81–86. https://doi.org/10.1016/j.childyouth.2019.01.027
DosReis, S., Zito, J. M., Safer, D. J., & Soeken, K. L. (2001). Mental health services for youths in foster care and disabled youths. American Journal of Public Health, 91, 1094–1099. https://doi.org/10.2105/ajph.91.7.1094
Elertson, K. M. (2017). Improving completion of the initial comprehensive health assessment for children entering foster care. Children and Youth Services Review, 81, 124–128. https://doi.org/10.1016/j.childyouth.2017.08.006
Fallon, B., Chabot, M., Fluke, J., Blackstock, C., MacLaurin, B., & Tonmyr, L. (2013). Placement decisions and disparities among Aboriginal children: Further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part A: Comparisons of the 1998 and 2003 surveys. Child Abuse & Neglect, 37, 47–60. https://doi.org/10.1016/j.chiabu.2012.10.001
Fallon, B., Chabot, M., Fluke, J., Blackstock, C., Sinha, V., Allan, K., & MacLaurin, B. (2015). Exploring alternate specifications to explain agency-level effects in placement decisions regarding Aboriginal children: Further analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part C. Child Abuse & Neglect, 49, 97–106. https://doi.org/10.1016/j.chiabu.2015.04.012
Fan, X., Miller, B. C., Park, K., Winward, B., Christensen, M., Grotevant, H. D., & Tai, R. H. (2006). An exploratory study about inaccuracy and invalidity in adolescent self-report surveys. Field Methods, 18, 223–244. https://doi.org/10.1177/152822X06289161
Fernandez, E. (2008). Unravelling emotional, behavioural and educational outcomes in a longitudinal study of children in foster-care. British Journal of Social Work, 38, 1283–1301. https://doi.org/10.1093/bjsw/bcm028
Fong, H., Alegria, M., Bair-Merritt, M. H., & Beardslee, W. (2018). Factors associated with mental health services referrals for children investigated by child welfare. Child Abuse & Neglect, 79, 401–412. https://doi.org/10.1016/j.chiabu.2018.01.020
Glisson C., & Durick M. (1988). Predictors of job satisfaction and organizational commitment in human service organizations. Administrative Science Quarterly, 33, 61–81. https://www.jstor.org/stable/2392855
Glisson, C., & Green, P. (2006). The effects of organizational culture and climate on the access to mental health care in child welfare and juvenile justice systems. Administration and Policy in Mental Health and Mental Health Services Research, 33, 433–448. https://doi.org/10.1007/s10488-005-0016-0
Glisson, C., & Green, P. (2011). Organizational climate, services, and outcomes in child welfare systems. Child Abuse & Neglect, 35, 582–591. https://doi.org/10.1016/j.chiabu.2011.04.009
Glisson, C., Green, P., & Williams, N. J. (2012). Assessing the Organizational Social Context (OSC) of child welfare systems: Implications for research and practice. Child Abuse & Neglect, 36, 621–632. https://doi.org/10.1016/j.chiabu.2012.06.002
Goemans, A., van Geel, M., & Vedder, P. (2015). Over three decades of longitudinal research on the development of foster children: A meta-analysis. Child Abuse & Neglect, 42, 121–134. https://doi.org/10.1016/j.chiabu.2015.02.003
Greeno, E. J., Lee, B. R., Tuten, M., & Harburger, D. (2019). Prevalence of substance use, housing instability, and self-perceived preparation for independence among current and former foster youth. Child and Adolescent Social Work Journal, 36, 409–418. https://doi.org/10.1007/s10560-018-0568-y
Havlicek, J., Garcia, A., & Smith, D. C. (2012). Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions. Children and Youth Services Review, 35, 194–203. https://doi.org/10.1016/2012.10.003
Heflinger, C. A., Simpkins, C. G., & Combs-Orme, T. (2000). Using the CBCL to determine the clinical status of children in state custody. Children and Youth Services Review, 22, 55–73. https://doi.org/10.1016/S0190-7409(99)00073-0
Heggdalsvik, I. K., Rød, P. A., & Heggen, K. (2018). Decision-making in child welfare services: Professional discretion versus standardized templates. Child & Family Social Work, 23, 522–529. https://doi.org/10.1111/cfs.12444
Howell, D. C. (2013). Statistical methods for psychology (8th ed.). Belmont, CA: Cengage.
Jedwab, M., Chatterjee, A., & Shaw, T. V. (2018). Caseworkers' insights and experiences with successful reunification. Children and Youth Services Review, 86, 56–63. https://doi.org/10.1016/j.childyouth.2018.01.017
Kang, H. (2013). The prevention and handling of the missing data. Korean Journal of Anesthesiology, 64, 402–406. https://doi.org/10.4097/kjae.2013.64.5.402
Kerns, S. E., Pullmann, M. D., Negrete, A., Uomoto, J. A., Berliner, L., Shogren, D., Silverman, E., & Putnam, B. (2016). Development and implementation of a child welfare workforce strategy to build a trauma-informed system of support for foster care. Child Maltreatment, 21, 135–146. https://doi.org/10.1177/1077559516633307
Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatric and Adolescent Medicine, 156, 607–614. https://doi.org/10.1001/archpedi.156.6.607
Knight, J. R., Shrier, L. A., Bravender, T. D., Farrell, M., Vanderbilt, J., & Shaffer, H. J. (1999). A new brief screen for adolescent substance abuse. Archives of Pediatric and Adolescent Medicine, 153, 591–596. https://doi.org/10.1001/archpedi.153.6.591
Kobulsky, J. M. (2019). The prevalence of substance use in child welfare and general population eighth graders in the United States. Substance Use & Misuse, 54, 1618–1626. https://doi.org/10.1080/10826084.2019.1594907
Leathers, S. J. (2002). Foster children’s behavioral disturbance and detachment from caregivers and community institutions. Children and Youth Services Review, 24, 239–268. https://doi.org/10.1016/s0190-7409(02)00175-5
Lee, T., & Morgan, W. (2017). Transitioning to adulthood from foster care. Child and Adolescent Psychiatric Clinics of North America, 26, 283–296. https://doi.org/10.1016/j.chc.2016.12.008
Leslie, L. K., James, S., Monn, A., Kauten, M. C., Zhang, J., & Aarons, G. (2010). Health-risk behaviors in young adolescents in the child welfare system. Journal of Adolescent Health, 47, 26–34. https://doi.org/10.1016/j.jadohealth.2009.12.032
Liu, D., Chu, C. H., Neo, L. H., Ang, R. P., Tan, M. Y. L., & Chu, J. (2016). Multiple trauma exposure and psychosocial functioning in Singaporean children in out-of-home care. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 431–438. https://doi.org/10.1037/tra0000098
McCrae, J. S. (2009). Emotional and behavioral problems reported in child welfare over 3 years. Journal of Emotional and Behavioral Disorders, 17, 17–28. https://doi.org/10.1177/1063426608319141
Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication - Adolescent Supplement (MCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980–989. https://doi.org/10.1016/j.jaac.2010.05.017
Miller, J. J., & Collins-Camargo, C. (2016). Success on their own terms: Youths’ perspectives on successful foster care. Journal of Public Child Welfare, 10, 59–78. https://doi.org/10.1080/15548732.2015.1089813
Munson, M. R., Katz, C. C., Okpych, N. J., & Courtney, M. E. (2020). Mental health management among older youth in foster care: Service utilization and preparedness. Journal of Adolescent Health, 67, 225–231. https://doi.org/10.1016/j.jadohealth.2020.02.017
Newton, R. R., Litrownik, A. J., & Landsverk, J. A. (2000). Children and youth in foster care: Disentangling the relationship between problem behaviors and number of placements. Child Abuse & Neglect, 24, 1363–1374. https://doi.org/10.1016/S0145-2134(00)00189-7
NSCAW (2014). NSCAW Wave 3 Report: Wave 3 Tables. RTI International. Retrieved April 29, 2019 from: https://www.acf.hhs.gov/opre/report/nscaw-ii-wave-3-report-wave-3-tables
Ogg, J., Montesino, M., Kozdras, D., Ornduff, R., Lam, G. Y. H., & Takagishi, J. (2015). Perceived mental health, behavioral, and adaptive needs for children in medical foster care. Journal of Child and Family Studies, 24, 3610–3622. https://doi.org/10.1007/s10826-015-0170-2
Pecora, P. J., Jensen, P. S., Romanelli, L. H., Jackson, L. J., & Ortiz, A. (2009). Mental health services for children placed in foster care: An overview of current challenges. Child Welfare, 88, 5–26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061347/
Perez Jolles, M., Givens, A., Lombardi, B., & Cuddeback, G. S. (2019). Welfare caseworkers’ perceived responsibility for the behavioral needs of children: A national profile. Children and Youth Services Review, 98, 80–84. https://doi.org/10.1016/j.childyouth.2018.12.023
Pilowsky, D. J., & Wu, L. (2006). Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care. Journal of Adolescent Health, 38, 351–358. https://doi.org/10.1016/j.jadohealth.2005.06.014
Proctor, L. J., Skriner, L. C., Roesch, S., & Litrownik, A. J. (2010). Trajectories of behavioral adjustment following early placement in foster care: Predicting stability and change over 8 years. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 464–473. https://doi.org/10.1016/j.jaac.2010.01.022
Pullmann, M. D., Jacobson, J., Parker, E., Cevasco, M., Uomoto, J. A., Putnam, B. J., Benshoof, T., & Kerns, S. E. U. (2018). Tracing the pathway from mental health screening to services for children and youth in foster care. Children and Youth Services Review, 89, 340–354. https://doi.org/10.1016/j.childyouth.2018.04.038
Rafeedie, J., Hudson, S. M., Deavenport-Saman, A., Rao, S., Rogers, K., & Roberts, S. (2019). Decision-making in foster care: A child-centered approach to reducing toxic stress in foster children. Children and Youth Services Review, 96, 10–16. https://doi.org/10.1016/j.childyouth.2018.11.023
Rayburn, A. D., McWey, L. M., & Cui, M. (2016). The interrelationships between trauma and internalizing symptom trajectories among adolescents in foster care. Children and Youth Services Review, 61, 332–336. https://doi.org/10.1016/j.childyouth.2016.01.006
Reid, G. J., Stewart, S. L., Barwick, M., Cunningham, C., Carter, J., Evans, B., Leschied, A., Neufeld, R. W. J., Pierre, S. T., Tobon, J., Vingilis, E., & Zaric, G. (2020). Exploring patterns of service utilization within children’s mental health agencies. Journal of Child and Family Studies, Advance online publication. https://doi.org/10.1007/s10826-020-01859-2
Rosenthal, J. A., & Curiel, H. F. (2006). Modeling behavioral problems of children in the child welfare system: Caregiver, youth, and teacher perceptions. Children and Youth Services Review, 28, 1391–1408. https://doi.org/10.1016/j.childyouth.2006.02.007
Scozzaro, C., & Janikowski, T. P. (2015). Mental health diagnosis, medication, treatment and placement milieu of children in foster care. Journal of Child and Family Studies, 24, 2560–2567. https://doi.org/10.1007/s10826-014-0058-6
Skrypek, M. M., Wells, S. J., Bauerkemper, K., Koranda, L., & Link, A. (2008). Developing a case typology for children in out-of-home care: Child welfare worker perspectives. Families in Society, 89, 302–311. https://doi.org/10.1606/1044-3894.3746
Smith, C., Fluke, J., Fallon, B., Mishna, F., & Pierce, B. D. (2018). Child welfare organizations: Do specialization and service integration impact placement decisions? Child Abuse & Neglect, 76, 573–582. https://doi.org/10.1016/j.chiabu.2017.09.032
Steenbakkers, A., van der Ellingsen, I. T., Steen, S., & Grietens, H. (2018). Do foster parents and care workers recognize the needs of youth in family foster care with a history of sexual abuse? Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 27, 811–831. https://doi.org/10.1080/10538712.2018.1520378
Swanke, J. R., Yampolskaya, S., Strozier, A., & Armstrong, M. I. (2016). Mental health service utilization and time to care: A comparison of children in traditional foster care and children in kinship care. Children and Youth Services Review, 68, 154–158. https://doi.org/10.1016/j.childyouth.2016.06.029
Tarren-Sweeney, M. (2018). The mental health of adolescents residing in court-ordered foster care: Findings from a population survey. Child Psychiatry and Human Development, 49, 443–451. https://doi.org/10.1007/s10578-017-0763-7
Trager, E., & Moss, H. (2017). Prevalence of substance use and mental illness in foster youth [poster]. Journal of the American Academy of Child and Adolescent Psychiatry, 56, s23b. https://doi.org/10.1016/j.jaac.2017.09.244
U.S. Department of Health and Human Services (USDHHS). (2016). The AFCARS report: Preliminary FY1 2015 estimates as of June 2016 - No. 23. Washington, DC: Children’s Bureau. https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport23.pdf
U.S. Department of Health and Human Services (USDHHS). (2017a). The AFCARS report: Preliminary FY1 2016 estimates as of October 20, 2017 - No. 24. Washington, DC: Children’s Bureau. https://www.acf.hhs.gov/cb/resource/afcars-report-24
U.S. Department of Health and Human Services (USDHHS). (2018). The AFCARS report: Preliminary FY1 2017 estimates as of August 10, 2089 - No. 25. Washington, DC: Children’s Bureau. https://www.acf.hhs.gov/cb/resource/afcars-report-25
U.S. Department of Health and Human Services (USDHHS). (2019). The AFCARS report: Preliminary FY1 2018 estimates as of August 22, 2019 - No. 26. Washington, DC: Children’s Bureau. https://www.acf.hhs.gov/cb/resource/afcars-report-26
U.S. Department of Health and Human Services (USDHHS). (2017b). Child Maltreatment 2017. Washington, DC: Children’s Bureau. https://www.acf.hhs.gov/sites/default/files/cb/cm2017.pdf#page=30
Vasileva, M., & Petermann, F. (2017). Mental health needs and therapeutic service utilization of young children in foster care in Germany. Children and Youth Services Review, 75, 69–76. https://doi.org/10.1016/j.childyouth.2017.02.022
Vaughn, M. G., Ollie, M. T., McMillen, J. C., Scott, L., Jr., & Munson, M. (2007). Substance use and abuse among older youth in foster care. Addictive Behaviors, 32, 1929–1935. https://doi.org/10.1016/j.addbeh.2006.12.012
Verbeke, W., Volgering, M., & Hessels, M. (1998). Exploring the conceptual expansion within the field of organizational behavior: Organizational climate and organizational culture. Journal of Management Studies, 35, 303–329. https://doi.org/10.1111/1467-6486.00095
Vig, S., Chinitz, S., & Shulman, L. (2005). Young children in foster care: Multiple vulnerabilities and complex service needs. Infants & Young Children, 18, 147–160. https://doi.org/10.1097/00001163-200504000-00007
Vis, S. A., & Fossum, S. (2015). Organizational factors and child participation in decision-making: Differences between two child welfare organizations. Child & Family Social Work, 20, 277–287. https://doi.org/10.1111/cfs.12076
Washington, T., Wrenn, A., Kaye, H., Priester, M. A., Colombo, G., Carter, K., Shadreck, I., Hargett, B. A., Williams, J. A., & Coakley, T. (2018). Psychosocial factors and behavioral health outcomes among children in foster and kinship care: A systematic review. Children and Youth Services Review, 90, 118–133. https://doi.org/10.1016/j.childyouth.2018.04.030
Web, M. B., Dowd, K., Harden, B. J., Landsverk, J., & Testa, M. F. (2010). Child welfare and child well-being: New perspectives from the national survey of child and adolescent well-being. Oxford University Press.
White, C. R., O’Brien, K., Pecora, P. J., & Buher, A. (2015). Mental health and educational outcomes for youth transitioning from foster care in Michigan. Families in Society, 96, 17–24. https://doi.org/10.1606/1044-3894.2015.96.2
William, N. J., & Glisson, C. (2013). Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare. Children and Youth Services Review, 35, 1871–1877. https://doi.org/10.1016/j.childyouth.2013.09.002
William, N. J., & Glisson, C. (2014). Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: A United States national study. Child Abuse & Neglect, 38, 757–767. https://doi.org/10.1016/j.chiabu.2013.09.003
Winokur, M. A., Holtan, A., & Batchelder, K. E. (2018). Systematic review of kinship care effects on safety, permanency, and well-being outcomes. Research on Social Work Practice, 28, 19–32. https://doi.org/10.1177/1049731515620843
Yampolskaya, S., Chuang, E., & Walker, C. (2019). Trajectories of substance use among child welfare-involved youth: Longitudinal associations with child maltreatment history and emotional/behavior problems. Substance Use & Misuse, 54, 437–448. https://doi.org/10.1080/10826084.2018.1504079
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Thompson, H.M., Colvin, M.L., Cooley, M.E. et al. Factors Predicting Service Referrals for Youth in the Child Welfare System. Child Adolesc Soc Work J 39, 261–277 (2022). https://doi.org/10.1007/s10560-021-00760-1
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DOI: https://doi.org/10.1007/s10560-021-00760-1