Thomas P. McDonald

Predictors of prenatal care utilization

Despite substantial evidence linking improved pregnancy outcomes with receipt of prenatal care and recent improvements in prenatal care utilization, specific subpopulations continue to receive inadequate or less than adequate care. The study reported here examined the predictive power of a set of variables describing the type of financial coverage available to the mother, attributes of the mother, father and family and characteristics of the health care system. A stratified random sample of mothers was generated from state birth certificate files and surveyed through the use of a mailed questionnaire. Stratification was designed to assure adequate representation of subgroups expected to receive less adequate prenatal care. The study findings indicate that there were deficiencies in prenatal care utilization and that these deficiencies were concentrated in specific areas and subpopulations within the state. While the majority of women in the study started prenatal care in the recommended first trimester, most did not maintain the recommended schedule of visits with their care provider. The following conditions were found to reduce the likelihood of receiving adequate care after controlling for service need: younger women (particularly adolescents); less educated (particularly those without a high school education); low income; longer travel time; Medicaid recipient; and rural resident. In addition, it was found that where one lives is a significant predictor of the adequacy of prenatal care even after controlling for all of the above variables. The authors conclude that it is important in assessing potential policy and program options for reducing differentials in prenatal care use to distinguish between economic and noneconomic barriers to utilization. Receipt of Medicaid does not assure adequate prenatal care use.(ABSTRACT TRUNCATED AT 250 WORDS)

A Review of Risk Factors Assessed in Child Protective Services

Evaluating the likelihood of future maltreatment is a critical component of decision making in the child protective service process. A relatively recent phenomenon is the use of formal risk-assessment instruments for the collection of specific, generally quantifiable, data to help in this assessment. We compare the risk variables assessed in eight instruments currently employed and include results from a literature review to determine the empirical basis for use of the identified risk factors. The instruments differ in the variables included, and there is little empirical support for most of the included variables. However, subsets of variables can be identified that are common to most instruments and that have empirical support.

Evaluating the Effects of Comprehensive Substance Abuse Intervention on Successful Reunification

Objective: This study examines permanency outcomes of families with children in foster care who participated in a comprehensive service-delivery program designed to assist families and communities in dealing with alcohol and other drug (AOD) problems. Method: Survival analysis is used to measure the impact of program participation on family reunification and re-entry of children into foster care. Results: The results of this study are that, contrary to initial expectations, participants move more slowly to reunification, although the group differences are not statistically significantly different, and re-entry rates are significantly higher among those children whose parents participate in this service. Conclusions: AOD abuse recovery is a long-term process. More intensive service interventions may not automatically produce better permanency outcomes.

Permanency for Children in Foster Care: A Competing Risks Analysis

Abstract Child welfare professionals daily face the competing risks of balancing the needs and safety of children with different permanency outcomes (i.e., reunification, adoption, guardianship). However, research on permanency has focused on a single outcome or grouped them together under the general label of permanency. The literature suggests that there are differences in time to a particular permanency outcome and also the factors predicting these permanency outcomes. After using approximately 25,000 records to support these conclusions, this research as well as practice indicates that permanency outcomes are more properly analyzed as competing risks. Recommendations for future research are suggested.

Assessing the role of agency services in reducing adoption disruptions

Abstract Successful placement of special needs children in adoptive homes presents a challenge to the child welfare worker. Identification of factors which predict placement outcomes can lead to more effective practices. The reported study examined data from six agencies for 235 placements, 27 percent of which resulted in disruptions or dissolutions. Findings indicate that disruptions are more a function of factors related to the child than family or agency variables. Age of the child is the single best predictor. While agency services appear to be targeted to the most needy children, they play a relatively minor role in predicting the placement outcome.

Characteristics of children with autism spectrum disorders who received services through community mental health centers

Despite the presence of significant psychiatric comorbidity among children with autism spectrum disorders (ASDs), little research exists on those who receive community-based mental health services. This project examined one year (2004) of data from the database maintained by 26 community mental health centers (CMHCs) in the Midwestern US state of Kansas. Children with autism were compared to children with other ASDs — Aspergers disorder, Retts disorder, and PDD-NOS. Children with autism predictably received more special education services than children with other ASDs, while the latter were more likely to have experienced prior psychiatric hospitalization. Children with ASDs other than autism were also significantly more likely to be diagnosed with attention deficit hyperactivity disorder, oppositional defiant disorder, depressive disorders, and bipolar disorder. In 2004, Kansas CMHCs served less than 15 percent of the children estimated to have an ASD. Implications of these findings are discussed.

Child welfare outcomes revisited

Abstract The use of outcome measures in child welfare has been part of agency and academic discussions for at least two decades. In 1989, McDonald, Lieberman, Poertner and Hornby contributed to the implementation of an outcome focus through the publication of “Child Welfare Standards for Success.” That paper presented the results of a comprehensive review of published and unpublished research that reported on outcomes of the major public child welfare programs: protective services, substitute care and adoption. The purpose of this paper is to revisit the field to gather additional outcome studies and to determine if broader agreement can be reached on both the definitions of outcome measures and standards for evaluating success. Discussion is included on issues of the use of outcome data for management decision-making, court monitoring, and community involvement.

Building a Model of Family Caregiving for Children with Emotional Disorders

In this article we describe the results of an ongoing effort to better understand the caregiving process in families of children with severe emotional problems. We make two assumptions. First, we assume that these families are essentially like other families but are faced with a special challenge in raising and caring for their special children while at the same time performing the multiple tasks and demands faced by all families. Second, we assume that public policy and programs must be supportive of the care of these children in their own homes and communities whenever possible. The purpose of this article is to present a model of family caregiving that draws broadly from available theory and empirical literature in multiple fields and to subject this model to empirical testing. We use structural equation modeling with latent variables to estimate an empirical model based on the theoretical model. Results of the model testing point to the importance of the childs external problem behaviors and the familys socioeconomic status and coping strategies as determinants of caregiver stress. Other findings highlight difficulties in measuring and modeling the complex mediating process, which includes formal and informal supports, perceptions, and coping behaviors. The use of structural equation modeling can benefit our efforts to support families by making explicit our theories about the important dimensions of this process and the relationship between these dimensions, which can then be subjected to measurement and validation.

The path to adoption for children of color

OBJECTIVE This article focuses on the path to adoption for children involved in the public child welfare system. METHOD Descriptive and event history analyses were conducted of 1,550 children who had been removed from their homes and placed in out of home care in the child welfare system in Kansas and have adoption as a goal. RESULTS African American children consistently took longer to reach significant milestones, including adoption placement and finalization. CONCLUSION African American children are over-represented throughout the progression from substantiated abuse to adoption. Future research in other states should focus on whether this trend is unique to Kansas or applicable in other states. Additionally, efforts should be devoted to investigating the social, psychological, cultural, and systemic factors contributing to this differential treatment. Finally, there is a dire need to develop and evaluate interventions targeted at meeting the specialized needs of African American children in this system.

Children who wait: Long term foster care or adoption?

Abstract This study focuses on children who have been freed for adoption. Researchers examined case records of 147 children in state custody in a mid-Western state in an attempt to identify child characteristics that distinguish between those children whose social service goal was long term foster care and those whose goal was adoption. Results obtained through logistic regression indicated that a model including the variables of race, age, developmental disabilities of the child, and genetic or family history that puts the child at risk for medical intervention is significantly predictive of the social service goal. Children who were not European-American, were older, and had developmental disabilities were more likely to have the case plan of long term foster care, while the presence of genetic or family risk factors increased the chances that adoption would be planned. The authors discuss the implications for child welfare policy and practice.