Julie S. McCrae

Propensity Score Matching Strategies for Evaluating the Success of Child and Family Service Programs

This article presents propensity score matching as a method to implement randomized conditions to analyze service effects using nonexperimental data. Most social work research is challenged to implement randomized clinical trials, whereas administrative and survey data are often available and can provide valuable information about services received under naturalistic conditions. This article discusses the assumptions of this method and the analytic steps involved; and it presents three examples of the approach, demonstrating that it is possible to approximate the conditions of a randomized controlled trial, and when selection bias is reduced, investigators can have more confidence in their findings.

Profile of children investigated for sexual abuse : Association with psychopathology symptoms and services

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates childrens psychological symptoms and child welfare service (CWS) patterns to understand how childrens needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to childrens needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed.

Using Cumulative Risk to Screen for Mental Health Problems in Child Welfare

Objective: This study tests the hypothesis that information typically collected during a maltreatment investigation can be used to screen children for mental health problems. Method: Data are from the National Survey of Child and Adolescent Well-Being. Cumulative risk scores were created for 3,022 children and compared to reports of clinical-level problems using standardized measures. Bivariate, multivariate, and sensitivity analyses were used. Results: Cumulative risk showed 73% sensitivity to identify children with mental health concerns and 52% specificity to identify children without such concerns. Comparatively, child welfare worker indications showed 48% sensitivity and 78% specificity. Conclusions: Investigative information could serve the dual purpose of screening children for mental health problems, having the potential for benefit and cost avoidance.

Development and Initial Findings of an Implementation Process Measure for Child Welfare System Change

This article describes a new measure designed to examine the process of implementation of child welfare systems change. The measure was developed to document the status of the interventions and strategies that are being implemented and the drivers that are being installed to achieve sustainable changes in systems. The measure was used in a Childrens Bureau-supported national effort to assess the ongoing implementation of 24 systems-change projects in child welfare jurisdictions across the country. The article describes the process for measure development, method of administration and data collection, and quantitative and qualitative findings.

Complex health concerns among child welfare populations and the benefit of pediatric medical homes

Children referred to child welfare have higher-than-average rates of physical, mental, and developmental health conditions, yet coordinating medical care to address their complex needs is challenging. This study investigates complex health characteristics of child welfare-involved children to inform evolving patient-centered medical homes that incorporate multidisciplinary care and social health determinants. Study questions include: (1) To what degree do child welfare-involved children present with complex physical, behavioral, and developmental conditions? (2) How does the clustering of complex health concerns vary according to developmental stage? (3) What demographic factors relate to complex health concerns? Data are from 5873 children (birth to 18) who participated in the National Survey of Child and Adolescent Well-being II. Latent class analyses were conducted for children in four developmental groups (infants, preschool-age, elementary school-age, and adolescents), including up to 11 indicators from standardized health measures. For all developmental groups, the best fitting model indicated a complex health concern class and a class with fewer health concerns. Multivariate logistic regressions revealed that membership in the complex health concerns class was associated with: increased age, poverty, poor caregiver health, out-of-home placement, gender, and race/ethnicity; although some developmental differences in predictors were observed. Results suggest that for younger children, preventive approaches and integration of developmental specialists in primary care is needed, while school-age children and adolescents demonstrate greater need for integrated behavioral health. All developmental groups would benefit from multidisciplinary teams that address complex health issues related to environmental risks common among children involved in child welfare.

Systematic Review of Social–Emotional Screening Instruments for Young Children in Child Welfare:

Purpose: The Child Abuse Prevention and Treatment Act requires child welfare agencies to have provisions in place to refer young children to early intervention services, yet the socioemotional health needs of children are often challenging to recognize and treat effectively. This study reviews the substantive and psychometric properties of screening instruments designed for children ages 10 and younger. Methods: Major social science databases, websites of national organizations, and the Mental Measurements Yearbook were used to identify instruments for review. Results: Twenty-four instruments met review criteria, and eight show above-average measurement properties and testing, tap children’s strengths and concerns, and have evidence of validity with families similar to child welfare–involved families. Discussion: It is important to effectively screen for children showing concerns in early childhood, so that treatment and prevention can be prioritized. This study indicated several tools with adequate testing and with emerging evidence and applicability to child welfare.

Measuring Organizational Change Tactics to Improve Child Welfare Programs: Experiences in 13 Counties

This study introduces a new measure that assesses the extent of organizational change tactics usage within a human service organization. The Organizational Change Tactics Questionnaire (OCTQ) was developed based on a comprehensive review of effective organizational change tactics and adapted to the unique needs of human service organizations. This study presents the psychometric properties of the OCTQ using the tool with 13 large child welfare organizations experiencing organizational change. Respondents who saw a greater use of change tactics and those who were more involved with the change process were significantly more likely to perceive the change process as successful.

Enhancing early childhood outcomes: connecting child welfare and Head Start

Head Start is a preschool program for families with low incomes and nearly 85% of child welfare-involved families are low-income, yet little is known about Head Start and child welfare collaboration. This study uses data from 28 Head Start directors to describe collaboration facilitators and barriers, and collaborative mechanisms in place. The mixed-methods study used data from a statewide survey and focus groups. Quantitative analysis used descriptive means and proportions. Qualitative analysis used a general inductive approach. Results show that nearly all Head Start programs prioritise enrollment for child welfare-involved children and know about foster care placement, but lack memoranda of understanding (50%), co-located staff (14%) and policies concerning joint service planning (9%). Directors report that Head Start staff need more support, including making referrals to child welfare. Cross-training, shared case planning, and streamlined processes could help move the organisations further along the developmental continuum of collaboration.