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Infants entering foster care compared to other infants using birth status indicators
Abstract
Objective: Infants comprise nearly one fourth of all entries to foster care. Linkage of administrative birth and placement data can provide information about these infants that may otherwise be unavailable or difficult to obtain. Method: Statewide birth records and foster care placement histories were linked via probability matching. Legit regression was used to compare 26,460 maltreated infants who entered foster care between 1989 and 1994 with a random sample of 68,401 other infants born during that time frame. Results: Infants in care were more than twice as likely to have single parents and be born with low birthweight, and twice as likely to have been horn with a birth abnormality as other infants, controlling for other factors. The largest difference was in the eightfold increased likelihood for mothers of infants in care to have had no prenatal care. Infants in care were nearly three times as likely to be born into larger families (third or greater live births to the mother). Mothers of infants in care were more than twice as likely to be African American compared to White than mothers of other infants, while Hispanic and Other ethnic groups were underrepresented in the group of infants in care. Foreign born mothers, especially Hispanic women, were much less likely to have infants in care than they were to have children in the other group. Conclusions: Administrative datasets, while often limited in the number of variables they include and scope of their information, can be a valuable tool when used to understand demographics and frame questions for future research. Infants who enter foster care differ in substantial ways from other children. These findings have important implications for future research aimed toward targeting of child welfare services and supports. (C) 1998 Elsevier Science Ltd.
... Prior studies have examined the relationship between birth indicator variables and a verified or substantiated case of infant maltreatment (Wu et al., 2003), maltreatment among children who received home visiting services (Murphey & Braner, 2000), as well as infant entries to foster care following a maltreatment substantiation (Needell & Barth, 1998). A body of literature linking child welfare and birth records also arises from Europe, where linkages between administrative data sources are more common (Murphy, Jenkins, Newcombe, & Sibert, 1981; Sidebotham & Heron, 2006; Spencer, Wallace, Sundrum, Bacchus, & Logan, 2006). ...
... From these separate empirical streams, a stable list of child and family characteristics at birth has emerged for their association with subsequent maltreatment. Pregnancy variables with prior predictive value include low birth weight (Murphy et al., 1981; Needell & Barth, 1998; Spencer et al., 2006; Wu et al., 2003), a birth abnormality (Murphy et al., 1981; Needell & Barth, 1998), late or an absence of prenatal care (Murphey & Braner, 2000; Murphy et al., 1981; Needell & Barth, 1998; Wu et al., 2003; Zhou et al., 2006), and a prior pregnancy termination (Parrish & Gessner, 2010; Wu et al., 2003). ...
... From these separate empirical streams, a stable list of child and family characteristics at birth has emerged for their association with subsequent maltreatment. Pregnancy variables with prior predictive value include low birth weight (Murphy et al., 1981; Needell & Barth, 1998; Spencer et al., 2006; Wu et al., 2003), a birth abnormality (Murphy et al., 1981; Needell & Barth, 1998), late or an absence of prenatal care (Murphey & Braner, 2000; Murphy et al., 1981; Needell & Barth, 1998; Wu et al., 2003; Zhou et al., 2006), and a prior pregnancy termination (Parrish & Gessner, 2010; Wu et al., 2003). ...
This study utilizes population-level birth data to describe those children who may be at greatest risk of maltreatment during the first five years of life. Based on a unique dataset constructed by linking California's administrative child welfare data to statewide vital birth records, a cohort study design was employed to track reports of maltreatment involving children born in 2002. Twelve variables captured in the birth record were selected for analysis. Generalized Linear Models were used to estimate adjusted risk ratios (RR) for each independent variable. Predicted probabilities of CPS contact were computed based on the count of risk factors present at birth. Results suggest that many of the associations previously observed between birth variables and subsequent maltreatment have sustained value in foretelling which children will be reported to CPS beyond infancy. Of the 531,035 children born in California in 2002, 14% (74,182) were reported for possible maltreatment before the age of five. Eleven of the twelve birth variables examined presented as significant predictors of contact with child protective services.
... Children from families involved in the child welfare system have elevated rates of family risk factors such as poverty (Drake & Pandey, 1996), substance abuse (Gibbons, Barth, & Martin, in press;Magura & Laudet, 1996;Wollock & Magura, 1996), and mental illness (Mullick, Miller, & Jacobsen, 2001). Children in these families also have higher rates of premature birth, low birth weight (McGuinness & Schneider, 2007;Needell & Barth, 1998) and prenatal exposure to substances (Astley, Stachowiah, Clarren, & Clausen, 2002;McGuinness & Schneider, 2007;Semidei, Radel, & Nolan, 2001). Children in foster care also typically have a history of maltreatment, neglect, domestic violence, and/or physical or sexual abuse (Bruce, Fisher, Pears, & Levine, 2009;Chernoff, Combs-Orme, Risley-Curtiss, & Heisler, 1994;Dicker, Gordon, & Knitzer, 2001;Hazen, Connelly, Kelleher, Landsverk, & Barth, 2004;Pears, Kim, & Fisher, 2008;Vig, Chinitz, & Shulman, 2005). ...
... A number of explanations are possible, including the higher income for out-of-home caregivers; however, research shows that foster families are often low-income (e.g. Needell & Barth, 1998;Park & Helton, 2010). Income data for the full sample of families involved in child welfare were not available. ...
... The middle stratum is a relatively wide stratum, which includes representatives of social groups well adapted to the new socio-economic conditions -medium and small entrepreneurs, managers, highly qualified specialists, heads of local authorities, as well as officers. The main (basic) stratum, which constitutes a large part of society, includes the intelligentsia (engineers, teachers, doctors, etc.), employees (semi-intelligentsia), trade and service workers (Needell & Barth, 1998;Muharam et al., 2014). Representatives of this stratum have sufficient professional qualities and labor potential and try not to change the current social situation, but, on the contrary, consider the best solution to adapt to it and maintain their social status. ...
The stratification processes taking place in the newly independent states of the post-Soviet space have both common starting principles and special tendencies. Under the conditions of market reforms, stratification processes are deepening. Based on a comparative analysis of various approaches, the author identified nine types of stratification systems and their general historical nature. A summary description of the specifics of each of them is provided. As a special feature, the article shows the division of Uzbek society into various social strata and strata according to their status indicators.
... Wulczyn et al.'s analysis found that 18-20 % of children placed in foster care were infants under the age of one, while no other single age constituted more than 7 % of the sample ). Among infants, low birth weight and birth abnormalities predict placement (Needell and Barth 1998 ). Children over the age of 12 are much less likely to be placed out of home, perhaps because of workers' views that they were more likely to have a greater capacity to protect themselves; when older children were placed, it was primarily because of emotional or behavioral problems and not for protective purpose (Jones 1993 ). ...
Individuals reporting suspected child abuse or neglect will naturally wonder what will happen to the child once they report. Any consideration of policy and practice on reporting should also be informed by knowledge of the outcomes of reporting. These outcomes vary enormously, from screening the referral out with no further action on one end of a continuum to placing a child outside the home against the child and family's will at the other end, with a range of possible outcomes in between. The difference in impact on children and families is substantial. For the most part, these outcomes result from decisions made by child protective services about (a) the extent and continuing risk of child maltreatment and (b) what services if any to deliver. Through a review of empirical and practice literature, this chapter discusses this range of possible outcomes. We describe each outcome and report on the factors affecting each, including differences by type of abuse and neglect. We then use US national data to estimate the proportion of reports with each outcome. Finally we discuss the implications for understanding and positively infl uencing the reporting situation. We make use of two US national data sets extensively, in some circumstances citing already published results from these data sets and in other circumstances doing our own data analysis. One data set is the National Child Abuse and Neglect Data System (NCANDS), an annual federal compilation of data from state CPS client information systems. NCANDS includes both data on individual cases (e.g., on substantiation and child placement) and aggregate data in which states simply report
... Young children who are removed from their parent's care due to maltreatment typically face risks that began in the prenatal period and potentially extend through early childhood, including low birth weight, birth abnormalities, lack of prenatal care, and exposure to drugs, alcohol, and other teratogens (Needell & Barth, 1998;Rosenfeld, Wasserman, & Pilowsky, 1998;Wulczyn, 1994). The resulting complex interaction between genetic and environmental factors (Tomalski & Johnson, 2010) compromises the infants' regulatory capacities, which can lead to problems in mood regulation, sensory integration, motor control, sleep, and behavioral control (Degangi, Breinbauer, Doussard, Porges, & Greenspan, 2000), and to adverse health and mental health outcomes through the life course (McEwen & Gianaros, 2010;Shonkoff et al., 2012). ...
... Department of Health and Human Services, 2008). Children in foster care often face an extensive array of adverse circumstances that span socioeconomic, biological, and familial factors, such as poverty (Needell & Barth, 1998), prenatal exposure to toxins (Astley, Stachowaik, Clarren, & Clausen, 2002), abuse and neglect (Chernoff, Combs-Orm, Risley-Curtiss, & Heisler, 1994), and unstable environments (Rubin, O'Reilly, Hafner, Luan, & Localio, 2007). As a consequence of such early adversity, children in foster care may exhibit a range of neurobiological, cognitive, academic, and psychosocial difficulties (e.g., McMillen et al., 2005; Pears & Fisher, 2005; Pears, Kim, & Fisher, 2008; Pears, Heywood, Kim, & Fisher, 2011; Ringeisen, Casanueva, Urato, & Cross, 2008). ...
Patterns and predictors of center-based early care and education (ECE) of children in foster care were examined. Participants included 192 pre-Kindergarten age children in foster care. Foster parents reported demographics, ECE and other service use. Foster care history data was abstracted from case files. High rates of attendance in ECE prior to Kindergarten, including Head Start, other center-based ECE, or both were found. Children who attended Head Start were younger when first placed in foster care. Children who attended other center-based ECE services were more likely to live with kinship foster parents and foster families with higher incomes. Latent class analysis of ECE quantity, quality, type, and duration revealed three patterns: part-time Head Start, part-time other ECE, and full-time mixed ECE. Child and foster family characteristics predicted these patterns, illustrating distinct groups with potential implications for the development of children in foster care.
... Also, theory and empirical evidence suggest that children's phenotypes other than conduct problems, including health, disruptive behaviors, and developmental difficulties, may evoke maltreatment (Belsky 1993; Steele 1980; Vasta 1982; Needell and Barth 1998; Sidebotham et al. 2003; Spencer et al. 2006). Assessing the direction of causality of the relationship between these other phenotypes and maltreatment may further elucidate the etiology of maltreatment. ...
It is often assumed that childhood maltreatment causes conduct problems via an environmentally mediated process. However, the association may be due alternatively to either a nonpassive gene-environment correlation, in which parents react to children's genetically-influenced conduct problems by maltreating them, or a passive gene-environment correlation, in which parents' tendency to engage in maltreatment and children's conduct problems are both influenced by a hereditary vulnerability to antisocial behavior (i.e. genetic mediation). The present study estimated the contribution of these processes to the association between maltreatment and conduct problems. Bivariate behavior genetic analyses were conducted on approximately 1,650 twin and sibling pairs drawn from a large longitudinal study of adolescent health (Add Health). The correlation between maltreatment and conduct problems was small; much of the association between maltreatment and conduct problems was due to a nonpassive gene-environment correlation. Results were more consistent with the hypothesis that parents respond to children's genetically-influenced conduct problems by maltreating them than the hypothesis that maltreatment causes conduct problems.
Foster care placements for infants can be consequential. Research suggests that infants’ path through and beyond the care system is different than the experience for children of other age groups. Studying infants is important because of their unique needs for developmentally-sensitive care; because of the underpinnings of attachment theory; and because the long-term impacts of quality care can be pronounced. Prior research examining infants in care has typically focused on their first episode and the outcomes of that episode. This study offers a longitudinal examination of a population-based cohort of infants (n = 5789) born in 2001 who entered care during the first year of life and who were followed through multiple care episodes until age 18. Findings suggest that using single, first episode data overstates the proportion of children who successfully reunify and understates the proportion of children who are adopted, return to care, or live with guardians. This research also suggests that the experience of infants who enter care as neonates is different from that of infants who enter care after the first four weeks of life. The long-term outcome for neonates is much more likely to be adoption. Long-term foster care for all infants is an especially unlikely outcome.
Despite younger maternal age being a risk factor for child welfare involvement, the literature on decision making once young mothers are investigated for child protection concerns is limited. This article examines characteristics and decision making related to investigating workers’ determinations that young children of adolescent and young adult mothers are at risk of future maltreatment. Using a provincially representative data set, this study found that children of young mothers were more likely to be deemed at risk of future maltreatment than those of adult mothers, and this assessment was also related to more intensive child welfare involvement. Among young mothers, a risk determination was strongly associated with maternal mental health concerns and socioeconomic circumstances. Practice and policy shifts should address the need for timely and effective material and emotional supports.
Introduction:
Measuring and comparing the incidence of child maltreatment is challenging. Linkage of statewide birth cohorts with Child Protective Services reports to study incident child maltreatment over the life course are becoming more common. This study compares the reported incidence between 2 states derived from population-based administrative data linkages.
Methods:
Linked births (2009-2011) with Child Protective Services records (2009-2015) and deaths in each state were used to compare the cumulative incidence of a Child Protective Services report before age 7 years. Given differences in population race structure and documented disparities of race groups in Child Protective Services data, variation was adjusted for using direct standardization. Unadjusted cumulative incidence, race cumulative incidence, and race-adjusted cumulative incidence were compared. Analyses were completed in 2018.
Results:
Before age 7 years, 26.0% of Alaskan children and 19.0% of Californian children were reported to Child Protective Services (RR=1.37, p<0.001). Aside from Asian/Pacific Islanders, the cumulative incidence between states was similar for each race. The race-adjusted cumulative incidence indicated that children born in Alaska were 1.10 times as likely to experience a report before age 7 years compared with children in California.
Conclusions:
Much of the difference in risk for child maltreatment observed between Alaska and California is most likely due to variation in the population structure by race as opposed to modifiable factors. Standardization is a simple method to adjust for population structure differences. This study contributes to the growing body of knowledge regarding the use of linked administrative data to study maltreatment and provides insights into considerations for making comparisons or conducting cross-jurisdictional analyses based on commonly aligned data sets.
This exploratory study used administrative data from the 2015 foster care file of the Adoption and Foster Care Reporting System to examine the experiences and outcomes of infants who had substance abuse indicated as their reason for removal. Logistic regression was used to explore the relationship between removal for substance abuse and race/ethnicity, placement setting, case plan goal, and discharge manner. T-tests were used to compare infants groups with respect to average placement duration. Separate analyses were conducted to compare outcomes for infants with substance abuse as their sole removal reason and for infants with substance abuse included as at least one removal reason amongst others. Nearly 17% of infants had substance abuse indicated as their sole removal reason and over 50% of infants had substance abuse included among multiple removal reasons. Infants removed due to substance abuse differed on a number of key outcomes compared to infants whose cases did not include substance abuse as a removal reason. Findings suggest that local child welfare systems would benefit from ongoing assessment of trends in substance abuse removals and that more attention to the long-term child welfare outcomes of children who were removed due to substance abuse as infants is warranted.
Background and objectives:
Children in state care ('looked after children') have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population-based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population-based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.
Study design and methods:
National demonstration project testing the feasibility of linking routinely collected looked after children, education and health data.
Participants:
All children in publicly funded school in Scotland in 2011/12.
Results:
Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the National Health Service Scotland master patient index demonstrated that a safe link to the child's unique health service (Community Health Index) number could be obtained for a very high proportion of children in each group (94%, 95% and 95% of children classified as currently, previously, and non-looked after, respectively). In general, linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.
Conclusions:
This novel data linkage demonstrates the feasibility of monitoring population-based health outcomes of school-aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are preschool or postschool, home schooled or in independent schooling).
Rigorous research on the efficacy of family group conferencing is rare. This randomized control trial study used an intent-to-treat approach to examine whether a referral to a family group conference (FGC) was associated with re-referrals, substantiated re-referrals, or out-of-home placements among child welfare-involved families receiving in-home services. We found no significant associations between treatment and control group assignment and the three outcomes for the sample as a whole. However, families with more children had higher odds of a re-referral and a substantiated re-referral, families with more than one parent had higher odds of re-referral, and families where a substance abuse services referral was noted had higher odds of out-of-home placement. In interaction models with race, we found that families with African American mothers who were referred for an FGC were more likely to be re-referred compared to other families, but no differences were identified with respect to their rates of substantiated re-referrals or out-of-home placements. Implications are discussed.
Background and objectives:
Children with disabilities are at an increased risk for maltreatment. However, the risk of maltreatment is unknown for children with specific types of birth defects. This study was conducted to determine whether the risk and predictors of maltreatment differ between children with and without 3 birth defects: Down syndrome, cleft lip with/without cleft palate, and spina bifida.
Methods:
This population-based study of substantiated childhood maltreatment was conducted in Texas from 2002 to 2011. Linked data were used to describe the risk and types of maltreatment that occurred before age 2 years in children with and without specific birth defects. Poisson regression was used to identify predictors of maltreatment and assess differences in those predictors between children with and without these specific birth defects.
Results:
The risk of maltreatment (any type) in children with cleft lip with/without cleft palate and spina bifida was increased by 40% and 58%, respectively, compared with children with no birth defects. The risk of any maltreatment was similar between children with Down syndrome and unaffected children. Across birth defect groups, the risk of medical neglect was 3 to 6 times higher than in the unaffected group. Child-, family-, and neighborhood-level factors predicted maltreatment in children with and without birth defects.
Conclusions:
The overall risk of substantiated maltreatment was significantly higher for some but not all birth defect groups. The factors associated with increased risk were similar across groups. Enhancement of existing maltreatment prevention and early intervention programs may be effective mechanisms to provide at-risk families additional support.
This study provided a comprehensive investigation of sociodemographic background characteristics of Norwegian families involved in child welfare services (CWS) during either of the two periods 1993–1999 or 2001–2007 and examined how the strong client growth over this period was accompanied by changes in client characteristics. Child welfare clients in two distinct age groups were considered: 0–5 and 13–18 years. Data were drawn from Norwegian longitudinal population registers, and records of CWS involvement for the period 1993–2007. Each birth cohort was evaluated for differences in sociodemographic background through the use of bivariate cross-tab analyses. The unique contribution of each background factor to the odds of CWS involvement was estimated through logistic regression. Separate regression models were constructed for child welfare involvement during pre-school years (0–5) and adolescence (13–18). The results indicated distinct sociodemographic differences between child welfare clients and the general child population throughout the sample and revealed that CWS involvement risk increased with single parent status, number of children born of the mother, low parental educational level, non-Western ethnic background, household income below the poverty line, low maternal age at first birth and age. The findings also indicated a distinct decrease in the statistical influence of most parental risk factors with increasing age and increasing, although relatively moderate differences between CWS clients and the general population from the first to the second period - above all in parental education and ethnic origin.
Youth entering into the foster care system face many challenges, not the least of which is finding an appropriate placement in which their behavioral and emotional needs can be addressed. This secondary data analysis of foster youth placed in residential care and treatment foster care will study the connection between youths scores on a functional assessment and level of placement in the child welfare system using a multilevel model analysis. Data were obtained from an online case management system operated by a state child serving system. The dataset included information for 9,893 youth within 295 residential and foster care provider agencies, with 23,853 functional assessments at multiple time points. Initial findings show a linear relationship between scores on a functional assessment and a placements level of restrictiveness; all of the level 2 program variables were significantly associated with the total CANS score for a youth at intake. These findings support prior literature and least restrictive placement policies.
Through a review of empirical and practice literature, this chapter describes the different outcomes that result from reporting child maltreatment—screen outs, substantiation, ongoing child protective service, child placement, and referral to differential response—and examines their frequency and predictors. Most reports receive a modest response (screen out or no ongoing protective services). Limitations in information often hamper decision making. Outcomes vary by case characteristics such as child age and by available resources, but there is also enormous unexplained variation across states and communities. More research is needed, including enhanced program evaluations with greater focus on these outcomes.
Objective: Placing a child in out-of-home care is one of the most radical measures a child protection system can decide to take. There is an essential interest in understanding the probability of entering care and what circumstances are related to the decision to place a child in out-of-home care. This study investigates the temporal stability of rates and predictors for entry into care. Method: Data were obtained by linking several registration systems. The study population was defined as all children entering care before their third birthday from birth cohorts 1981-2008 (N = 11,034). Furthermore, a control population consisting of a randomly assigned quarter of the Danish child population from the same birth cohorts was used (N = 515,773). Rates of entry and Cox regression models from six periods from 1981 to 2008 were used to model co-variates associated with entry into out-of-home care. Results: The overall likelihood for entering care is found to be decreasing over time. Furthermore, results reveal two trends: relative rates of entry are significantly decreasing for children whose mother has a psychiatric history prior to the child's birth; relative rates are significantly increasing for children whose mother or father was unemployed in the year prior to the child's birth. (c) 2013 Elsevier Ltd. All rights reserved.
Objective: This register-based study describes the transition from in home-based care to placements in out-of-home care. It also describes whether children who enter care directly differ from children who enter care after episodes of in home-based care. Method: The study includes all children who entered the child protection system of a larger regional social service system in Denmark from 1993 to 2006 (N = 9961). Graphs of cumulative incidences were used to describe transitions into out-of-home care within two years after in home-based care started. Cox regression models are used to estimate the impacts of child and parental characteristics. In addition, Chi(2) tests are used to identify differences between children who enter care directly and children who receive in home-based care. Results: Results indicate that the majority of children do not enter out-of-home care but that risks differ among age groups. Covariates did not predict transitions into out-of-home care for those who entered in-home care after becoming teenagers. Especially for those who entered in-home care before entering their teens, the psychiatric histories of the mothers and the children predicted the transitions into out-of-home care. Immigration background was a protective factor for those who entered in-home care as pre-scholars. Depending on the age group, low birth weight, children's fathers' and mothers' psychiatric histories, and single parentship were all characteristics more likely to be associated with children who entered care directly. Children who entered care directly differed from children who entered care within two years after an in home-based service had been initiated on covariates that described psychiatric history. (c) 2013 Elsevier Ltd. All rights reserved.
Procedures to identify and serve high-risk infants in three jurisdictions (New York City, Maryland, and Michigan) are explored. Utilizing existing technology, these procedures, referred to as birth match, offer a timely, low-cost, intervention squarely based on current legal premises to increase the protection of newborns and very young children who were born to a parent with a prior termination of parental rights or has a child currently in out of home care. This procedure demonstrates the real time use of administrative data to influence child welfare decisions.
Social scientists have long been concerned about how the fortunes of parents affect their children, with acute interest in the most marginalized children. Yet little sociological research considers children in foster care. In this review, we take a three-pronged approach to show why this inattention is problematic. First, we provide overviews of the history of the foster care system and how children end up in foster care, as well as an estimate of how many children ever enter foster care. Second, we review research on the factors that shape the risk of foster care placement and foster care caseloads and how foster care affects children. We close by discussing how a sociological perspective and methodological orientation-ranging from ethnographic observation to longitudinal mixed methods research, demographic methods, and experimental studies-can foster new knowledge around the foster care system and the families it affects.
Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectiveness of FDTCs in North Carolina on child welfare outcomes. Data come from North Carolina records from child protection services, court system, and birth records. Three types of parental participation in a FDTC are considered: referral, enrolling, and completing an FDTC. The sample includes 566 children who were placed into foster care and whose parents participated in a FDTC program. Findings indicate that children of parents who were referred but did not enroll or who enrolled but did not complete had longer stays in foster care than children of completers. Reunification rates for children of completers were also higher. Outcomes for children in the referred and enrolled groups did not differ in the multivariate analyses. While effective substance use treatment services for parents may help preserve families, future research should examine factors for improving participation and completion rates as well as factors involved in scaling programs so that more families are served.
Data from the National Survey of Children’s Health, 2011–12 were used to compare children in foster care with children adopted from foster care with respect to health, health care and well-being. Children living with both biological parents and children living with never-married biological mothers were included as comparison groups. The findings suggest that adoption confers socioeconomic advantages for children, relative to children who remain in foster care. However, these advantages do not tend to translate into better developmental, academic, or other well-being outcomes. The evidence suggests that children in foster care who are adopted tend to cost the public less than children who remain in foster care or are reunited with their biological families.
Objectives: This study seeks to examine the relationship between foster care and outcomes using multiple comparison methods to account for factors that put foster youth at risk independent of care. Methods: Using the National Longitudinal Survey of Youth 1997, matching, propensity scoring, and comparisons to the general population are used to examine whether results differ depending on the matching strategy. Results: Propensity scoring produces a better model and more closely matched groups than traditional matching. No group differences emerge in outcomes using propensity scoring; however, differences emerge in other schemes. Conclusions: When examining outcomes for foster youth, it is important to consider multiple matching strategies, as this may affect results. Propensity scoring may be one approach to inform child welfare practice.
Placing a child in out-of-home care is one of the most important decisions made by professionals in the child care system, with substantial social, psychological, educational, medical and economic consequences. This paper considers the challenges and difficulties of building statistical models of this decision by reviewing the available international evidence. Despite the large number of empirical investigations over a 50 year period, a consensus on the variables associated with this decision is hard to identify. In addition, the individual models have low explanatory and predictive power and should not be relied on to make placement decisions. A number of reasons for this poor performance are offered, and some ways forwards suggested. This paper also aims to facilitate the emergence of a coherent and integrated international literature from the disconnected and fragmented empirical studies. Rather than one placement problem, there are many slightly different problems, and therefore it is expected that a number of related sub-literatures will emerge, each concentrating on a particular definition of the placement problem.
This article is part of a UCLA Law Review symposium, “Overpoliced and Underprotected: Women, Race, and Criminalization.” It analyzes how the U.S. prison and foster care systems work together to punish black mothers in a way that helps to preserve race, gender, and class inequalities in a neoliberal age. The intersection of these systems is only one example of many forms of overpolicing that overlap and converge in the lives of poor women of color. I examine the statistical overlap between the prison and foster care populations, the simultaneous explosion of both systems in recent decades, the injuries that each system inflicts on black communities, and the way in which their intersection in the lives of black mothers helps to make social inequities seem natural. I hope to elucidate how state mechanisms of surveillance and punishment function jointly to penalize the most marginalized women in our society while blaming them for their own disadvantaged positions.
In the fifty years from 1956 to 2006 the field of human genetics will have moved from the numbering of the 46 human chromosomes
to the expected mapping of the approximately 35,000 human genes. This explosion of knowledge about genetic aspects of human
health has been coupled with similar strides in reproductive technologies to overcome infertility or other barriers to the
birth of healthy children. The need for the medical community to communicate this information in a useful way to those who
may benefit from it has led to the growth of the profession of genetic counseling.
When compared with the general United States child population, children entering foster care have elevated rates of mental health problems. This study examines: (1) state approaches to mental health evaluations for children entering foster care for the first time, (2) the consistency of these approaches with professional guidelines, and (3) whether the specific instruments endorsed are supported by available evidence. Semi-structured qualitative interviews and a document review of available protocols/policies were conducted for 47 states and the District of Columbia. All states endorsed mental health evaluations; variation existed between states in approach, timeframe, administrator, and specific instruments endorsed.
Objective:
Data from the United States indicate pronounced and persistent racial/ethnic differences in the rates at which children are referred and substantiated as victims of child abuse and neglect. In this study, we examined the extent to which aggregate racial differences are attributable to variations in the distribution of individual and family-level risk factors.
Methods:
This study was based on the full population of children born in California in 2002. Birth records were linked to child protective service (CPS) records to identify all children referred for maltreatment by age 5. Generalized linear models were used to compute crude and adjusted racial/ethnic differences in children's risk of referral, substantiation, and entry to foster care.
Results:
As expected, stark differences between Black and White children emerged in the rates of contact with CPS. Black children were more than twice as likely as White children to be referred for maltreatment, substantiated as victims, and enter foster care before age 5. Yet, there were also significant differences across racial/ethnic groups in the distribution of socioeconomic and health factors strongly correlated with child maltreatment and CPS involvement. After adjusting for these differences, low socioeconomic Black children had a lower risk of referral, substantiation, and entry to foster care than their socioeconomically similar White counterparts. Among Latinos, before adjusting for other factors, children of U.S.-born mothers were significantly more likely than White children to experience system contact, while children of foreign-born mothers were less likely to be involved with CPS. After adjusting for socioeconomic and health indicators, the relative risk of referral, substantiation, and foster care entry was significantly lower for Latino children (regardless of maternal nativity) compared to White children.
Conclusions:
Race and ethnicity is a marker for a complex interaction of economic, social, political, and environmental factors that influence the health of individuals and communities. This analysis indicates that adjusting for child and family-level risk factors is necessary to distinguish race-specific effects (which may reflect system, worker, or resource biases) from socioeconomic and health indicators associated with maltreatment risk. Identifying the independent effects of these factors is critical to developing effective strategies for reducing racial disparities.
In this article, we argue for expanded efforts to integrate administrative data systems as a "practical strategy" for developing a richer understanding of child abuse and neglect. Although the study of child maltreatment is often critiqued for being atheoretical, we believe that a more pressing concern is the absence of population-based and prospective epidemiological data that can be used to better understand the distribution and interacting nature of risk and protective factors for maltreatment. We begin by briefly addressing the relevance of empirical observations to etiological theories of child maltreatment. Although the latter is widely cited as critical to the development of effective prevention and intervention responses, less attention has been paid to the role of population-based data in the development of theories relevant to highly applied research questions such as those pertaining to child abuse and neglect. We then discuss how child protection data, in isolation, translates into a relatively narrow range of questions that can be asked and answered, with an inherently pathology-focused construction of risks and little attention paid to strengths or protective factors. We next turn to examples of recent findings-spanning multiple countries-emerging from information integrated across data systems, concluding by calling for expanded administrative data linkages in an effort to better understand and prevent child maltreatment.
Children who enter public care are among the most vulnerable in society. In addition to services for their medical needs, a focus on identifying and intervening with families in need where children are at high risk of entering public care is a public health priority. This paper aims to identify the characteristics of children, their parents or their social circumstances which are associated with children entering public care. The databases searched were CSA Illumina, British Education Index, ChildData, CINAHL, Excerpta Medica, MEDLINE, the Campbell and Cochrane Collaborations, NHS Centre for Reviews and Dissemination, NHS Evidence, Social Care Online and TRIP; from start dates to 7 February 2011. A total of 6417 titles were reviewed. After review, 10 papers with cohort or case-control methodologies met the inclusion criteria and the included papers were appraised using questions from the Critical Appraisal Skills Programme to guide the critique of case-control and cohort studies. A narrative synthesis is used to describe the research identified. Socio-economic status, maternal age at birth, health risk factors and other factors including learning difficulties, membership of an ethnic minority group and single parenthood are described as risk factors associated with children entering public care. Health risk factors have been explored using databases developed for other purposes such as health insurance or hospital discharge. A number of risk factors for children entering public care are identified from the literature, some were culturally specific and may not generalize. The interaction between different risk factors needs testing in longitudinal data sets.
The extent of symptomatology related to attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) was examined in a statewide sample of adopted youth, aged 4-18 years (n = 808). The use of normed questionnaires in a nonclinical sample decreased biases associated with past research on adopted children. According to parental report, a striking number of the youth qualified as manifesting significant symptom levels of externalizing behavior problems: 21% met symptom cutoffs for ADHD (with or without ODD) and 20% met criteria for ODD (with or without ADHD), for a combined total of 29% of the sample. A number of parent-reported, preadoptive risk factors distinguished these groups from one another and from the nonexternalizing youth. The clearest associated factors included histories of preadoption abuse/neglect, later age of adoption, prenatal drug exposure, and placement in multiple foster homes prior to adoption. We discuss implications regarding both etiology and current controversies surrounding the disproportionate levels of behavioral difficulties in adopted youth.
Despite growing concern in the United States about the number of children who are entering child welfare care as infants, little empirical attention has been given to the sizable group of these children who are not reunified with their biological families and who then remain in care for long periods. This study examined length of stay and permanency outcomes for 458 legally free children who initially entered out-of-home care as infants. Using a Cox proportional-hazards event history model, the study also explored the effects of race/ethnicity and gender on the likelihood of these children achieving a permanent placement (legalized adoption or guardianship) within a reasonable period of time. African–American children and boys were found to be significantly less likely to achieve permanence than Caucasian children or girls. Across all groups of children in the sample, however, long stays in care were the norm. These findings suggest the need for flexible approaches to permanency, for efforts to better differentiate among infants in care, and for attention to children’s long-term developmental needs as well as to strategies that better assure placement stability.
Historically, data concerning children reported for abuse or neglect in the US have been compiled by child protective service agencies and analysed independently from other sources of information. Yet these data suffer from the notable limitations of being both narrow in scope (i.e. containing a limited set of variables) and narrow in coverage (i.e. capturing data for only those children who are reported). In order to extend an understanding of children reported for maltreatment, the California Department of Social Services, in partnership with the University of California at Berkeley, is pursuing a ‘public health’ oriented approach to the surveillance of child maltreatment through linkages between child protective service records and population-based sources of data. As an example of the information that can be generated through linked records, this article reports results from child-level matches completed between the state's child protective service records and vital birth records. The cumulative percentage of children reported for abuse or neglect before the age of five is examined based on maternal and child characteristics at birth. This is followed by a discussion of record linkages as a means of furthering a public health approach to child maltreatment. Copyright © 2011 John Wiley & Sons, Ltd.
‘Data suffer from the notable limitations of being both narrow in scope and narrow in coverage’
‘This article reports results from child-level matches completed between the state's child protective service records and vital birth records’
Major federal legislation since the mid-90s has embodied a philosophical shift away from trying to salvage grossly unfit parents and toward ensuring children good families before they incur permanently damaging abuse, neglect, or foster care drift. That legislation has created a widespread perception that the state is now more proactive in preventing child maltreatment. This Article explains why that perception is false and what further reforms are needed to give children the protection they deserve from unfit parents, beginning at birth. This Article integrates moral and political theory, extensive social science research, and a canvassing of state and federal child protection law in order to mount a compelling and novel indictment of the current child protection system and to advance bold proposals for making child protection a reality rather than a pretense.
This study examines the relationship between child and family characteristics, child abuse and neglect reporting histories, and placement outcomes for a sample of 1,357 infants and toddlers who were placed in foster care prior to the implementation of the Adoption and Safe Families Act of 1997 (P.L. 105-89). A cohort of children entering foster care in six California counties were followed for an average of four years, using data drawn from two management information systems (child protective services and foster care). Among the findings: children with documented prenatal drug and/or alcohol exposure were among those more likely to remain in care during the entire study period, and if they did reunify with their families, were more likely to subsequently reenter care. All children who remained in care were placed after a single report to child protective services. These child welfare outcomes are considered in light of existing child welfare policy and research about developmental risk, yielding practice, policy, and research implications. ©2002 Michigan Association for Infant Mental Health.
The purpose of the present study was to investigate the prevalence of types of child maltreatment and co-occurring risks in an entire county population of children in public education and to examine the unique relations of the child maltreatment types and timing on children's early academic success while accounting for the children's multiple-risk context. A cohort of 11,835 second grade students who were born in the county and attended the public school district served as participants. Information on first reported experiences of substantiated physical abuse, neglect, unsubstantiated child maltreatment reports, health, maternal, and social risks, and academic and behavioral outcomes was obtained and linked through a county-wide integrated data system. Results indicated that after controlling for demographics and the set of other risks, substantiated child neglect and unsubstantiated reports were associated with poorer outcomes than physical abuse. Also, first substantiated child maltreatment and unsubstantiated reports prior to kindergarten were related to a more comprehensive set of poor outcomes than post-kindergarten first reports. The differential patterns that emerged for the association between age of first reported maltreatment by type and educational outcomes were discussed with implications for future research and policy.
This study examined factors associated with decisions in favour of out-of-home placement following investigations involving
infants at risk of maltreatment. We used data from a sample of children less than 1year of age (n = 763) investigated by child welfare services across Canada in 2003. We tested unadjusted relationships with placement using
Pearson’s chi-square statistic. Multivariate logistic regression analyses identified parental substance abuse, mental health
problems and few social supports as being associated with an increased likelihood of placement. Child’s toxicology at birth,
abandonment, physical harm and number of previous family openings also increased the likelihood of placement. Several variables
that have been associated with increased placement in previous studies, such as single motherhood and young maternal age,
did not show a statistically significant association in our analysis. Among those infants that were placed, there was insufficient
power to compare kinship and non-kinship care. This analysis demonstrates the need for the implementation of established prevention
programs, such as the Nurse-Family Partnership and substance abuse programs for caregivers.
KeywordsChild abuse–Child neglect–Infant maltreatment–Placement–Foster care–Kinship care–Nonkinship care
The impact of the developmental and health problems of young children on child welfare outcomes is studied using 1999 AFCARS data that reports on children in foster care throughout the United States. Study findings indicate that developmental and health problems are associated with higher numbers of out-of-home placements, longer stays in foster care, decreased likelihood of return to parental care, and higher foster care costs. Study findings are interpreted as indicating a need for more research on how young children with developmental and medical conditions are managed within the child welfare system.
Data from the Milwaukee TANF Applicant Study were used to identify parent, family, and child-specific predictors of child welfare services involvement among 1075 families that applied for TANF assistance in 1999. Child-specific measures related to a randomly selected focal child from each applicant family were collected. Thirty-eight percent of the families were investigated for child maltreatment and 11% of the focal children were placed in out-of-home care between the 1999 TANF applications and the end of 2005. Prior child welfare services involvement and economic hardships were significant predictors of both child maltreatment investigations and out-of-home care placements. However, neither outcome was related to child-specific attributes nor behaviors once parent and family characteristics were taken into account. These findings suggest that TANF agencies are serving a population that needs help balancing family and work responsibilities.
At least 3% of children spend some of their childhood in public care and, as a group, have poor outcomes across a range of education, employment, health and social care outcomes. Research, using social care or government datasets, has identified a number of risk factors associated with children entering public care but the utility of risk factors in clinical practice is not established. This paper uses routine primary health care data to see if risk factors for children entering public care can be identified in clinical practice.
A nested case control methodology using routine primary care data from the United Kingdom. Health service use data were extracted for the 12 months before the case child entered public care and compared with 12 months of data for four control mother child pairs per case pair, matched on the age and sex of the child and the general practice. Exposures of interest were developed from a systematic review of the literature on risk factors associated with children entering public care.
Conditional logistic regression was used to investigate the combined effect of more than one exposure of interest. Maternal mental illness (OR 2.51, 95% CI 1.55-4.05), maternal age at birth of the child, socio-economic status (5(th) quintile vs. 1(st) quintile OR 7.14, 95% CI 2.92-17.4), maternal drug use (OR 28.8, 95% CI 2.29-363), non attendance at appointments (OR 2.42, 95% CI 1.42-4.14), child mental illness (OR 2.65, 95% CI 1.42-4.96) and child admission to hospital (OR 3.31, 95% CI 1.21-9.02) were all significantly associated with children entering public care. Maternal use of primary care contraception services was negatively associated with children entering public care (OR 0.52, 95% CI 0.31-0.87).
Differences in health service use can be identified from routine primary care data in mother child pairs where children enter public care after controlling for maternal age and socio-economic status. The interaction between different risk factors needs testing in a cumulative risk model using longitudinal datasets.
A recognized goal of family reunification programs is preventing the reentry of children into foster care. Using data from the National Survey of Child and Adolescent Well-Being, this study examined reentry for 273 children between the ages of 5 and 12 years. In multivariate models, reentry into foster care was associated with higher Child Behavior Checklist (CBCL) scores and higher numbers of children in the household when the child is living at home. Although these are not the only risk factors that should be considered in deciding whether to reunify a child, these characteristics appear to be high valence problems for families and their children who are reunified. Future research on reentry and on placement disruptions from foster care should routinely include information about the number of children in the family and behavior problems when endeavoring to explain caseload dynamics.
Children in out-of-home care (OOHC) present with high levels of physical, developmental and emotional and behavioural difficulties, yet often fail to receive appropriate services. This article describes a joint health and welfare service specifically developed to provide comprehensive physical, developmental and mental health assessments to a cohort of children entering long-term care in one region of Sydney, New South Wales (NSW), Australia. Paediatric, allied health, dental and psychosocial assessments were co-ordinated from a single referral from the child's welfare case manager. Follow-up appointments were held 6-12 months later to assess the outcomes of recommendations. Physical, mental health and developmental difficulties in the children are reported, the implications for service requirements are presented and process blocks described. There is a need for a specific co-ordinating service to overcome the inherent fragmentation of this group (related both to transience and change in the welfare sector, and levels of comorbidity and chronicity in health presentations). Health and Welfare services must operate together, with an awareness of the processes and resource constraints in each sector, if they are to deliver sustainable and reliable health care to this vulnerable group.
Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history.
A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009.
The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found.
Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.
Poor birth outcomes increase the risk of infant mortality and morbidity, developmental delays, and child maltreatment. This study assessed the effectiveness of a prenatal home-visitation program in reducing adverse birth outcomes among socially disadvantaged pregnant women and adolescents.
As part of a larger RCT, this study examined the effects of home-visitation services on low birth weight (LBW) deliveries.
Pregnant women and adolescents eligible for Healthy Families New York (HFNY) were recruited in three communities. Eligibility was based on socioeconomic factors such as poverty, teen pregnancy, and the risk of child maltreatment. Two thirds of the participants were black or Hispanic, and 90% were unmarried.
Pregnant women and adolescents were randomized to either an intervention group that received bi-weekly home-visitation services (n=236) or to a control group (n=265). Home visitors encouraged healthy prenatal behavior, offered social support, and provided a linkage to medical and other community services. Services were tailored to individual needs.
An LBW of <2500 grams on birth certificate files. Baseline and birth interviews were conducted from 2000 to 2002, and birth records were collected in 2007. Analyses were done from 2007 to 2008.
The risk of delivering an LBW baby was significantly lower for the HFNY group (5.1%) than for the control group (9.8%; AOR=0.43; 95% CI=0.21, 0.89). The risk was further reduced for mothers who were exposed to HFNY at a gestational age of <or=24 weeks (AOR=0.32; 95% CI=0.14, 0.74).
A prenatal home-visitation program with focus on social support, health education, and access to services holds promise for reducing LBW deliveries among at-risk women and adolescents.
To examine the roles of public policy and poverty on the rising number of children in family foster care, and to examine the impact of different types of family foster care on children's well-being.
Recent changes in welfare legislation increase the likelihood of family poverty, with a subsequent increase in the number of children in out-of-home care. Greater emphasis needs to be placed on preventing entry into out-of-home care, improving the quality of foster care, and giving children a voice in care decisions.
Nurses have important roles to play in the prevention of family dissolution, the design of healthcare delivery systems for children in foster care, in evaluating and educating all types of foster families, and as advocates in legal and legislative proceedings.
In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care.
Although the inverse relationship between the number of siblings and children's educational performance has been well established, explanations for this relationship remain primitive. One explanation, resource dilution, posits that parents have finite levels of resources (time, energy, money, etc.) and that these resources are diluted among children as sibship size increases. I provide a more rigorous investigation of the dilution model than previous studies, testing its implications with a sample of 24,599 eighth graders from the 1988 National Education Longitudinal Study. My analyses support the resource dilution model in three ways. First, the availability of parental resources decreases as the number of siblings increases, net of controls. The functional form of this relationship is not always linear, however, and depends on whether the resource is interpersonal or economic. Second, parental resources explain most or all of the inverse relationship between sibship size and educational outcomes. Finally, interactions between sibship size and parental resources support the dilution model as children benefit less from certain parental resources when they have many versus few siblings.
The foster home care system is the most commonly used alternative for the care of dependent children in the United States. However, it often fails to achieve its objective of returning the child to his home or providing a permanent substitute family. Children entering foster care have frequently suffered social, emotional, and medical neglect, and physical abuse. They have a high rate of chronic medical problems, educational handicaps, and severe emotional impairment. In many cases the health care that foster children receive fails to recognize and/or adequately address their disabilities. In order for the pediatric practitioner to work successfully with a foster child, he must not only provide comprehensive health care, but also must be familiar with the social welfare system within which the child lives.
Objective.
—To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights.
Design.
—Inception cohort.
Setting/Participants.
—Participants were selected from two previously studied multisite cohorts: very low—birth-weight (≤1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible.
Main Outcome Measures.
—The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores.
Results.
—Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight.
Conclusions.
—Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.(JAMA. 1992;267:2204-2208)
We used data from the National Survey of Families and Households to investigate economic resources and parental behavior explanations for family structure effects on children. The economic explanation received considerable support in terms of singlemother disadvantage and accounted for a smaller proportion of disadvantage associated with mother-partner families. Parental behaviors, particularly maternal and paternal support, accounted for much smaller proportions of disadvantages found in motherstepfather as well as mother-partner families. Parental behaviors did not appear to mediate any of the economic resource effects on children.
Integrating ideas from child development with sociological models of educational attainment, we examine the relationship between family structure--whether both parents are present in the household--and children's achievement in high school. Using data from the High School and Beyond study, sophomore cohort, 1986, we ask whether differences in achievement are accounted for by differences in parents' educational aspirations and parenting styles. Children who live with single parents or stepparents during adolescence receive less encouragement and less help with school work than children who live with both natural parents, and parental involvement has positive effects on children's school achievement. Differences in parental behavior, however, account for little of the difference in educational attainment between children from intact and nonintact families.
Examines the prevalence, contributions, and cumulative effects of 13 biological, economic, maternal, family-structural, and parenting-belief risk factors in poor and nonpoor families separately on low-birthweight premature children's 36-month ZQ scores and behavior problems (N = 704). Children were part of the Infant Health and Development Program (ZHDP), a multisite, randomized clinical trial providing early pediatric follow-up and educational and family support services. Risk factors occurred more frequently in poor families than in nonpoor families. Different sets of risk factors were associated with children's ZQ scores and behavior problem scores. As the number of risk factors increased, child ZQ decreased. Behavior problems did not change as a function of risk factors. Early intervention had a beneficial effect on ZQ scores regardless of the number of risks experienced.
To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights.
Inception cohort.
Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible.
The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores.
Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight.
Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.
The prevalence of psychological disorder, the topology of symptom syndromes manifested, and relative risks for disordered status and individual syndromes were determined for an entire population of 4- to 18-year-olds in foster care. Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) ratings by foster parents were employed to determine clinical status. Nearly half the population manifested evidence of psychological disorder. The full spectrum of syndromes tapped by the CBCL was represented. Relative risks associated with foster status were almost 2 to over 32 times greater than for home-reared children. Regional cultural phenomena and sociohistorical events were hypothesized to explain discrepancies with lower rates reported previously. The need to make foster care a therapeutic intervention in addition to a temporary caregiving arrangement is discussed.
Designed to provide a basis for sound child welfare policy decisions, this book presents current state and national data, as well as data from many cities and counties, on child maltreatment. The six chapters in the book present statistics on: (1) child abuse and neglect, including child abuse fatalities; (2) out-of-home care; (3) adoption; (4) finance and administration of child welfare organizations; (5) risk factors; and (6) possibilities for prevention. Chapter one draws attention to the use of different definitions of neglect and abuse, and investigation procedures by states. Chapter two describes various forms of out-of-home care. Chapter three discusses different types of adoption, all of which provide permanence for children. Chapter four illustrates the expenditures incurred by different states to safeguard and maintain child well-being. The fifth chapter focuses on the condition of poverty as a factor in child maltreatment. The last chapter considers current strategies that are used to prevent child abuse and neglect, as well as the issue of corporal punishment. Most of the data are presented in graphic formats and tables, which are meant to illustrate the wide variations in how states are addressing child abuse and neglect, not to judge the effectiveness of one state compared to another. (BA)
Research on adoption can benefit from more analysis of the relationship between family structure and size and adoption outcomes. This manuscript reviews the findings of prior adoption outcome research related to family structure and size and considers findings from related studies of family size and structure. Data from a follow-up study of international and domestic adoptions suggest that families who adopt children and have birth children as well may have less success than families comprised only of adopted children. Various explanations and recommendations for future research practices are discussed.
focus on what it means for a child to be born and spend his or her earliest years in poverty / focus is on those families that experience chronic poverty—in part because they represent a growing proportion of all poor families with young children, in part because the meaning of poverty is more coherent and predictable for such families (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Perinatal drug exposures pose a significant health hazard for women and imperil normal fetal and neonatal development. Little is known about patterns of drug exposure among pregnant immigrant and native-born Latinas in the United States. We present multivariate risk factor analyses for alcohol and illicit drug use from the California Perinatal Substance Exposure Study using a statistical probability sample (N = 11,002) of Latinas who were tested anonymously using urine toxicology screening techniques. Alcohol use during pregnancy was pervasive among both immigrant and United States-born Latinas (7%) with little variation on risk factors. Illicit drug use was found primarily in a high risk group of United States-born Latinas between 25 and 34 years of age who received no prenatal care (prevalence 50%, odds ratio of 185). Increased general awareness of perinatal alcohol risk by medical providers and public health practitioners serving this population is needed. The potential isolation of United States-born Latinas who are at risk for using illicit drugs during pregnancy requires effective communication and outreach.
Examined the impact of welfare reform on foster care in relation to children's mental health. Information on the physical and mental development status of 125 foster children, aged from birth to 3 yrs old, was obtained. Ss had been randomly assigned to a special Foster Care Program. Ss were tested using the Bayley Scales of Infant Development; Ss' foster parents were tested using the Maternal Social Support Index and the Parenting Stress Index. Results show that half of the Ss rated below normal on mental and psychomotor development, with two-thirds below normal on emotional regulation and motor quality. Results on foster parents indicate that they receive average amounts of support. Implications for social policy and program planning are discussed.
This study examined the prevalence and specific types of substance abuse in a sample of 206 cases of serious child abuse or neglect brought before a metropolitan juvenile court on care and protection petitions. In 43% of the cases, at least one of the parents had a documented problem with either alcohol or drugs, a figure which rose to 50% when alleged instances of substance abuse were included. Alcohol, cocaine, and heroin were the three most frequently mentioned abused substances. Parents with documented substance abuse were significantly more likely than nonsubstance-abusing parents to have been referred previously to child protective agencies, to be rated by court investigators as presenting high risk to their children, to reject court-ordered services, and to have their children permanently removed. When the two factors of court investigator high risk ratings and presence of parental substance abuse were combined, it was possible to obtain even higher levels of prediction of which parents would reject services and have their children permanently removed. Results suggest (1) the importance of increased screening, evaluation, and treatment of parental substance abuse in cases of serious child mistreatment; and (2) the possibility of adopting a predictive approach as to which families will be able to respond to court-ordered treatment requests and have their children returned.
Self reports from 1,645 Latino mothers of Mexican descent who participated in the Hispanic Health and Nutrition Examination Survey (HHANES) were used to relate the birthweight of their infants to the HHANES acculturation index. After controlling for parity, a one point increase on the acculturation scale was found to be associated with a 1.19 (95% CI = 1.05, 1.34) increase in risk of maternal low birthweight (LBW) (1.98 risk increase for four points). The estimated relative risk increased to 1.34 (1.12, 1.60) with controls for age at interview, wealth, city size, and years of education; controlling for current smoking status reduced the relative risk to 1.31. US-born respondents were also at increased risk relative to Mexican-born, but this relation was explained by acculturation. The effect of education was found to depend on level of acculturation. Years of education was unrelated to risk among the Mexican-oriented, while increased education was associated with reduced risk in the US-oriented. These results suggest that factors associated with a Mexican cultural orientation may be protective against the risk of LBW.
The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population, require significant amounts of medical sub-specialty care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.
The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high- and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.
A particularly interesting and consistent finding regarding the health of the Latino population is that Mexican American women, despite their relatively lower socioeconomic status, deliver significantly fewer low birth weight babies and lose fewer babies to all causes during infancy than do women of other ethnic groups. A central thesis of this discussion is that the religiosity and spirituality of many of these Latinas, a key factor in their culture, may protect them and their infants through the pre- and antenatal phases of life. We also suggest that lack of research, related to cultural similarities and differences in Hispanic/Latino subgroups, can lead to faulty or simplistic understanding regarding their health behavior and health status.
Very low birthweight and preterm delivery explain two thirds of the excess deaths experienced by African-American infants. Although comprehensive, good quality services for all African-American women will help to reduce the twofold higher rate of infant mortality experienced by African-American infants compared with white infants, the infant mortality gap will not be closed until prevention research is conducted that incorporates the social, cultural, and political context of life for African-American women; the environmental stressors and the physiologic responses associated with stress; and the protective mechanisms available in the community for responding to stress. Discrimination may be an important stressor that influences a woman's susceptibility to a poor pregnancy outcome. Strategies already exist in the community to cope with discrimination and other environmental stressors. To capture the effects of discrimination and other environmental factors and the protective factors important for prevention, the research approach must involve African-American women and their communities as collaborators in the research. Such collaboration will help to avoid problems with scientific racism.
This study examines the extent to which the Adequacy of Prenatal Care Utilization Index explains the racial disparity in infant birthweight. A stratified analysis was performed on all African-American, Mexican-American, and non-Latino white singleton infants born in Chicago, Illinois between 1982 and 1983. This older cohort was chosen to avoid the confounding effect of cocaine associated with its increased local availability after 1985. The adequacy of prenatal care utilization varied by race and place of residence. However, in moderate-income areas (median family annual income of $20,001 to $30,000), the African-American birthweight disadvantage persisted among infants born to mothers who received adequate and adequate-plus prenatal care. Similarly, although race-specific term (gestational age > 37 weeks) low birthweight rates declined as prenatal care usage rose, the position of African Americans relative to Mexican Americans and whites was essentially unchanged. These findings indicate that maternal race or some factor closely related to it affects pregnancy outcome regardless of the adequacy of prenatal care utilization.
The growth of nonmarital childbearing among women who are beyond their teenage years is well documented. Very little is known, however, about the economic status of these women. Data for 1991 from the nationally representative Panel Study of Income Dynamics indicate that the socioeconomic status of women who have had a nonmarital birth as an adult is similar to that of women who had a birth as an adolescent: They have similar median income-to-needs ratios (2.29 vs. 2.17), and similar rates of poverty (20% vs. 23%) and welfare receipt (22% vs. 19%). Women who have had both teenage and postteenage nonmarital births fare particularly poorly: Their median family income is $11,280; nearly half receive welfare; and 55% are officially poor. However, women who first gave birth as adolescents but have not had subsequent nonmarital births do reasonably well: Fewer than 10% receive welfare, and their median income-to-needs ratio is 2.6.
This study examined the health status and hospital use of women after the birth of a premature, low-birthweight infant.
The subjects were women with infants who participated in a multisite, randomized trial of an early intervention program. The outcomes examined were (1) a maternal health rating of poor or fair (i.e., poorer health) 5 years following delivery and (2) hospital use for a non-pregnancy-related condition.
By the fifth year after delivery, 29.7% of the women had been hospitalized for a non-pregnancy-related condition. Women who reported poorer health status (adjusted relative risk [RR] = 2.39; 95% confidence interval [CI] = 1.86, 3.07) or who had asthma (RR = 2.24; CI = 1.31, 3.80) were at greatest risk. After 5 years, 16.9% of the women said they were in poorer health. The number of intervening years in poorer health (1 year, RR = 3.17; CI = 2.04, 4.94; > 1 year, RR = 8.42; CI = 2.20, 12.88), more than 1 year of poverty (RR = 3.28; CI = 1.90, 5.66), obesity (RR = 3.30; CI = 1.44, 7.55), and more than 1 year of employment (RR = 0.55; CI = 0.36, 0.86) were all significantly associated with poorer health.
The continued, substantial morbidity and hospital use of women with a premature, low-birthweight infant has not previously been reported. This observation needs to be verified.
Performance indicators for child welfare services in California: 1995. Unpublished report
- B Needell
- B Webster
- R P Barth
- M Armijo
Needell, B., Webster, B., Barth, R. P., & Armijo, M. (1996). Performance indicators for child welfare services in California: 1995. Unpublished report. Berkeley, CA: Child Welfare Research Center.
SAS for Unix (Release 6.11) [Computer software] The foster care system and health status of foster children
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SAS Institute. (1996). SAS for Unix (Release 6.11) [Computer software]. Cary, NC: Author. Schor, E. L. (1982). The foster care system and health status of foster children. Pediatrics, 69, 521-528.
Third national incidence study of child abuse and neglect: Final report
- A J Sedlak
- D D Broadhurst
Sedlak, A. J., & Broadhurst, D. D. (1996). Third national incidence study of child abuse and neglect: Final report. Washington, DC: US Department of Health and Human Services.
A report form the multistate foster care data archive: Foster care dynamics
- R M Goerge
- F H Wulczyn
- A W Harden
Goerge, R. M., Wulczyn, F. H., & Harden, A. W. (1994). A report form the multistate foster care data archive: Foster care dynamics 1983–1992.
Two-generation programs: A new intervention strategy and directions for future research Escape from poverty: What makes a difference for children?
- S Smith
Smith, S. (1995). Two-generation programs: A new intervention strategy and directions for future research. In P. L. Chase-Lansdale, & J. Brooks-Gunn (Eds.), Escape from poverty: What makes a difference for children? (pp. 299 –314).
The role of prenatal care services in assisting families affected by drugs, alcohol, and AIDS Foster care: Parental drug abuse has alarming impact on young children
- H Ewing
- M Foran
Ewing, H., & Foran, M. (1993). The role of prenatal care services in assisting families affected by drugs, alcohol, and AIDS. In R. P. Barth, J. Pietrzak, & M. Ramler (Eds.), Families living with drugs and HIV: Intervention and treatment strategies (pp. 82–115). New York: Guilford. General Accounting Office. (1994). Foster care: Parental drug abuse has alarming impact on young children. Washington, DC: United States General Accounting Office.
Child abuse and neglect: A look at the states—The CWLA Stat Book DC: Child Welfare League of America. Department of Health Services General limitations of vital statistics data When bigger is not better: Family size, parental resources, and children's educational performance
- P A Curtis
- J D Boyd
- M Liepold
- M Petit
- D B Downey
Curtis, P. A., Boyd, J. D., Liepold, M., & Petit, M. (1995). Child abuse and neglect: A look at the states—The CWLA Stat Book. Washington, DC: Child Welfare League of America. Department of Health Services. (1998). General limitations of vital statistics data. Online: http://www/dhs.cahwnet/gov/ stats/chs/vdata.htm. Downey, D. B. (1995). When bigger is not better: Family size, parental resources, and children's educational performance. American Sociological Review, 60, 746 –761.
Status at birth and infant placements in New York City
- Wulczyn
Wulczyn, F. (1994). Status at birth and infant placements in New York City. In R. P. Barth, J. D. Berrick, & N. Gilbert
(Eds.), Child welfare research review (Vol. 1, pp.146 –184). New York: Columbia University Press.
SAS for Unix (Release 6.11) [Computer software
- Sas Institute
SAS Institute. (1996). SAS for Unix (Release 6.11) [Computer software]. Cary, NC: Author.
Foster care’s youngest
- Klee
Two-generation programs
- Smith
When bigger is not better
- Downey
Substance abuse and serious child mistreatment
- Murphy
The role of prenatal care services in assisting families affected by drugs, alcohol, and AIDS
- Ewing
Family structure and child well-being
- Thomson