the service system collaboration can reduce service disparity among different race groups

I read a research paper regarding the service use of child welfare population. 

It is : Hurlburt, M. S., Leslie, L. K., Landsverk, J., Barth, R. P., Burns, B. J., Gibbons, R. D., Slymen, D. J., & Zhang, J. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61, 1217–1224.

In this paper, the author pointed out that  race/ethnicity accounted for differentials in service use; specifically, African American children were 0.61 times as likely and Hispanic children were about half as likely to use services as white children. For example, African American and Hispanic children are less likely to receive specialty mental health services than white children. 

However, this service disparity can be attenuated if there is a strong linkage between child welfare and mental health systems. The research findings showed that in counties with stronger child welfare/mental health linkages, differentials in service use between African American children and white children diminished. As linkage levels increase, differences in rates of service use between white and African American children diminish. 

Therefore, the authors believed that the coordination of services between child welfare and mental health agencies, as it relates to the mental health needs of children, may be able to prevent disparities in mental health care use among African American children.

Changing Disparity in Child Welfare

Acknowledging Disproportionate Outcomes and Changing Service Delivery (2008), focuses on the need to address racial disparities in the United States foster care system.  The article also references the Children’s Defense Fund’s 2007 report entitled America’s Cradle to Prison Pipeline to help explain the myriad racial and economic disparities that exist among systems connected to child welfare.  Additionally, McRoy pulls evidence from the 2006 United States Government Accountability Office’s study regarding African-American children in the foster care system. 

            McRoy’s research explains how African-American children are not only more likely to be placed in foster care, but that they also stay in foster care longer than Caucasian children.  The lack of adequate family support services is a significant contributing factor that hinders African-American families.  In fact, McRoy cites that although there are not more African-American parents involved in substance abuse than Caucasian parents, more African-American children are removed from homes due to their parents abusing substances because African-American parents have limited access to treatment programs, and lack of treatment prolongs the reunification process. In addition, many African-American children come from single African-American mothers who may be parenting several children and living in neighborhoods with inadequate resources.  Complicating the issue, and impacting African-American families in the child welfare system, are the disproportionate rates of incarcerated African-American men.  McRoy writes that in 2006 there were 3,042 African-American males in prison for every 100,000 African-American men in the United States compared to 487 Caucasian males in prison for every 100,000 Caucasian men in the United States. McRoy posits that racial bias affects disparities regarding decision-making. I have to agree.

            One of the recommendations she makes is to have systems collaborate and work together in order to identify stressors and support through community analysis. Such analysis can be affective if agencies hire an ethnically diverse and culturally competent child welfare staff.  I really like McRoy’s suggestion that staff experience job training in the very neighborhoods and communities, including the churches and the schools, for which they are hired to serve.  I also like McRoy’s idea for assessment tools that address African-American culture in order to strategize how best to provide support, resources, and ideas to inspire people to look beyond bias in order to clearly see challenges.  McRoy writes about multisystems collaborating as well as state and federal policies changing such that they prioritize ending racial and economic disparities. 

            After reading the article, I decided to log onto the Children’s Defense Fund website to see if any changes have occurred since 2007.  Although I read that between 2009 and 2010, there was an eight percent decrease in the number of African-American children in foster care, I also read in the Children’s Defense Fund’s report entitled Portrait of Inequality (2012), that African-American children are more than twice as likely as Caucasian children to be placed in foster care, are over six times more likely than Caucasian children to have a parent in prison, are more than three times as likely to live only with their mother, are more than 2 ½ times more likely than Caucasian children to live with neither parent, and also have the highest rate of abuse and neglect.  At first it seemed to me as if there had not been any progress since McCroy’s article was published in 2008.  However, the Children’s Defense Fund has started a Cradle to Prison Pipeline campaign to advocate for quality, accessible, and comprehensive services, including mental health coverage, in order for children to have positive preventative supports and services.  Although the statistics still reflect overwhelming disparity, one can find change evolving through child welfare campaigns, such as the Cradle to Prison Pipeline, which emphasizes and educates society about the very strategies for which McRoy advocates in her article, and for which I strongly support.

http://web.b.ebscohost.com.proxy.lib.ohio-state.edu/ehost/detail/detail?vid=2&sid=53dfb0fc-bc8d-4519-82b1-5125bedab680%40sessionmgr198&hid=106&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=33553792

http://connection.ebscohost.com/c/articles/33553792/acknowledging-disproportionate-outcomes-changing-service-delivery

http://www.childrensdefense.org/zzz-child-research-data-publications/data/portrait-of-inequality-2012.pdf

http://www.childrensdefense.org/campaigns/cradle-to-prison-pipeline/

Foster Care and Psychotropic Drugs

http://www.santacruzsentinel.com/health/20150224/senate-panel-examines-why-california-foster-care-system-addicted-to-psychiatric-drugs

In California, 1/4 kids in out of home placement are on psychotropic drugs.  Many, if not most, of these kids are on drugs to control behavior not to mediate mental health concerns.  While this is startling, more so is the fact that most of the drugs being prescribed are anti psychotics that have incredible side effects and are not even approved for use in the child population.

There are several reasons for the over-dosage of minors in the foster system.  The most notable reasons are:

1. Money.  Drug companies offer monetary incentives including money, funding, meals, and trips to doctors who prescribe their products.  Additionally, one visit to a psychiatrist per month verses one visit to a counselor or social worker per week is cost effective for the state.

2. Lack of training.  Foster parents do not receive adequate training in order to address behavioral issues that often accompany their new foster child after leaving a traumatic situation.  Foster kids do not receive any training on how to engage in a new family and deal with their trauma.

3. Laws.  The current laws do not prevent or restrict the over-dosage of the kids, the lobbying by the drug companies, and the lack of accountability in the system.

As one former client of the system explained, these drugs are not treating trauma, they are placating kids so that they can be placed.  Hopefully, as this has again been brought to the forefront, California will address these exceptionally harmful medical practices.

Unfortunately,  these practices have continued to press on despite media coverage for the past decade.  California's system, like many others, moves excruciatingly slow leaving so many of our most vulnerable children in heinous situations that constantly re-traumatize them.

Do Dad's Matter?

Do Dads Matter? Child Welfare Outcomes for Father-Identified Families

Research indicates the benefits of father involvement in the lives of children, particularly noncustodial fathers and how father absenteeism has negative impacts on child outcomes, such as cognitive development and educational gains. Policy initiatives on the national and state levels have therefore made attempts to further engage fathers in the lives of their children. For instance, the US Department of Health and Human Services started the Fatherhood Initiative to promote fathers' involvement.This has also been true of the child welfare system. While the child welfare system has historically focused on engaging mothers as typical custodial parents and mother reunification, child welfare agencies have adopted a cocurrent goal approach of trying to reunify children with their mothers, as well as, identifying and locating fathers or other noncustodial parent. Attempts to identify and engage fathers have been shown to be successful in child welfare. One study found 62% of fathers agreed to participate in permanency planning once identified.

The above article attempts to add to available literature and information, by examining the potential importance of father involvement in child welfare cases.  The study uses secondary data analysis from the first evaluation of Family Treatment Drug Courts to examine whether cases that identify fathers have differences in time in foster care, time to permanent placement, reuinification, and use of kinship permanency. 

The study found that in child welfare cases where a father was identified, children spent more time with a parent and less time in foster care. The study found that father-identified cases result in more reunifications with a parent than cases where a father was not identified. The study found no difference in time to achieve permanancy between cases that identified a father and those that did not. The study also found no difference in kinship placement where parent's rights had been terminated between father-identified cases and cases without father identification.

What do you think of these results? What role do you think that fathers may play in child welfare cases. I will say that I was surprised that identification of the father did not increase kinship placement where parent's rights had been terminated. I would have estimated that the prescence of more kinship relatives would have increased the likelihood of this occuring.

Fostering Connections

http://www.ohiohouse.gov/cheryl-l-grossman/press/representatives-pelanda-grossman-discuss-legislation-to-improve-lives-of-ohios-foster-children-enhance-guardianship-laws

https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-HB-50

The first link above is to an article summarizing a press conference held by Representatives Grossman and Pelanda of the Ohio House on House Bill 50, which was introduced on February 10. The second link goes to the actual bill, as introduced, in case anyone wants to read the official language.

The bill is working from the federal Fostering Connections to Success and Increasing Adoptions Act which was passed in 2008, and enforces expanded support for children in foster care. HB 50 introduces two concepts to support and protect vulnerable populations in Ohio. First, the bill provides clear language on the rights and responsibilities of guardians of Ohio's wards. It mandates that every guardian be given manuals and reminds them of what power they do, and do not, have over their charges, as well as what their wards have the rights to do.

More dramatic, however, is what the bill does for children in foster care. In its barest essence, the bill effectively extends foster care to age 21, rather than the current age of 18. There are, however, stipulations and specifics. Further, as Ohio's child welfare is largely county run, managed, and operated, the effects of this bill and the form that this support takes will likely vary from county to county.

To summarize, any child who turns 18 while still in the foster system, or any child who was adopted at 16 or 17, is potentially eligible for this extended foster care. They may only receive this support, however, if they meet any one of five additional criteria. These criteria are as follows: completing secondary education or a program leading an equivalent credential; enrolled in an institution which provides post-secondary or vocational education; participating in a program designed to remove barriers to employment; is employed for at least 80 hours per month, or; is incapable of doing the previous activities because of a medical condition.

Obviously, this legislation is a long time coming and is desperately needed. Research has shown several times over that this population faces homelessness, incarceration, health risks, and poverty at a significantly higher rate than the general population following emancipation. Additionally, the fact that youth are only held to one of the five criteria, and that they are held to some criteria at all, really, is a positive. As this is bill is set up to aid youth in becoming productive and self-sufficient, it is important that the youth demonstrate some level of responsibility to gain access to the funds. The wide variation in criteria, from simply working to get rid of barriers to employment, to pursuing a higher degree, allows for foster youth in different circumstances and with different interests and skill sets to benefit equally. The only negative to this bill stems from Ohio's child welfare system. As stated above, the county run child welfare can result in a significant difference in how funds are used to the benefit of the child. While this is good, as it allows for flexibility in the specific area of services, a lack of standardization will almost absolutely result in programs that are inferior and programs that are superior. That is the primary danger that has to be watched if this bill is passed into law.

Building Trauma-Informed Systems of Care for Children In Ohio

The Building Trauma-Informed Systems of Care for Children in Ohio article published in January of 2014 describes the effects of childhood trauma. It begins by telling the story of 10 year old, Ray, a responsible young boy who takes care of his younger siblings. One day, police show up at his door to inform him that his mother was shot and killed. The next few days Ray is acting out in school and getting into fights. The school's response- suspension. With the extra free time, Ray joins a gang and as the story normally goes, he gets into trouble and ends up in the juvenile detention facility and later reoffends as an adult and never finishes high school.

The article discusses adverse childhood experiences (ACEs) such as the trauma Ray experienced, and demonstrates how these experiences influence health and well-being. ACEs lead to disrupted neurodevelopment, to social, emotional, and cognitive impairments, to adoption of health-risk behaviors, causing disease, disability, and social problems, which can lead to early death (Pyramid on Page 3). The article also shows a picture of a healthy child's brain compared to a child's brain on trauma and there are very noticeable differences. Not only do ACEs like trauma affect the individual, they also create economic costs. An estimated $80 billion is spent on direct costs of hospitalization, law enforcement, and child welfare, with indirect costs on special education, juvenile and adult criminal justice, homelessness, and lost work productivity.

Trauma-informed care can help identify these problems before they get worse. For example, in Cleveland Metropolitan School District, they have created the Humanware Program in which in-school suspensions are replaced by instructional planning centers where the children are helped "cool down" and think of positive responses to problems. In 6 years, the number of out-of-school suspensions has decreased by 58.8%!

The steps of trauma-informed care are identifying and screening, assessment, and treatment. Once a child is identified as having trauma, they can then be referred to a trained clinician for assessment and treatment. Some initiatives have already begun in Ohio to start this process. ODYS received a grant from the Ohio Attorney General for the use of a trauma screening tool and training for all detention staff. As mentioned before, the Cleveland Metropolitan School District has created the Humanware Program, and Cincinnati Public Schools have created the Community Learning Center that links them with outside agencies including counseling and after-school programs that provide trauma-informed care.

Without taking trauma into account, we are not only re-traumatizing the children, but we are also limiting their achievement levels and increasing the burden on the economy/society. I think it is great that there is now evidence to show that trauma-informed care is more beneficial when it comes to children, as well as some adults. Of course, the earlier the treatment, the better the outcomes!

Economic Outcomes for Child Welfare Development

http://m.bizjournals.com/denver/blog/broadway_17th/2015/02/viewpoint-the-business-case-for-early-childhood.html?page=all&r=full

This article doesn't exactly try to reinvent the wheel when it describes the value of investing in children at an early age. It states many well known facts that are understood to point to the value of investment in early childhood development. The fact that the brain does a tremendous amount of development by age 5 and that children who receive consideration and quality care when they are younger have increase outlooks in regards to future wellbeing. The article points to high quality preschool programming in Colorado as one of its primary examples for increased future wellbeing. Essentially, the article's main thrust could be summarized by one of the thoughts given, "investing early is key."

What makes this article compelling though it's the side of the coin the persuasion comes from. The perspective taken is from the side of persuading businesses to become increasingly involved in investing and supporting high quality childhood care as this stands to benefit their interests in the future. Not only does the provision of excellent preschools create a stronger future workforce, but as the article argues, the investment of businesses in the community creates additional incentive to attract high caliber employees and provide for the working parents. An investment towards this future fights against pragmatism in selecting convenient childcare services/preschools instead of options that have proven to possess high efficacy.

I personally found this article interesting because it takes a stance from an economic standpoint. The interest in these issues from the financial side of things can only bode positively for the future of child welfare because as we all know, money is what ultimately creates long lasting change. It's an exciting prospect to begin to witness the business community get increasingly involved in the provision of early childhood intervention that excels. This early stage of life cannot be overlooked and while not completely determining the outcome of children, plays as significant of a role as any other form of an investment.

A People-centered System

The opening statement of this article is “COLUMBUS, Ohio -- The director of the state office charged with better coordinating welfare and job programs offered a simple example to illustrate why Gov. John Kasich has proposed changing the system” (Higgs, 2015).

Higgs, the writer of the article, explains that Douglas Lumpkin, the director of the office of Human Services Innovation, believes that the challenges of most families are across multiple systems. For example, a person receiving benefits could be seeing a caseworker for multiple things such as infant mortality issues, child welfare, temporary assistance for families and children benefits, and perhaps another for mental health or addiction issues. Along with all of this, that same person might be meeting with a caseworker for a job training and placement program.

Under Kasich’s budget proposal, counties would have a point agency that would coordinate all the rescources. The benefit of a point agency is that individuals would only have to meet with one person at the point agency who could link them to the resources they need.  

This proposal would target people aged 16 to 24, and the idea of this intervention is to help individuals before they get stuck in the cycle of poverty.

Lumpkin believes that this type of intervention would be a “more person-centered approach”.

Link to article: http://www.cleveland.com/open/index.ssf/2015/02/people-centered_system_the_goa.html

Child Abuser Registry?

http://www.macombdaily.com/general-news/20150218/lawmakers-wyatts-law-should-have-support-but-will-take-time

This is an article I found in a Michigan paper:

   "An effort to set up a statewide registry of convicted child abusers under “Wyatt’s Law” has garnered an avalanche of support but won’t be approved quickly. St. Clair Shores resident Eric Hammel’s online petition to set up the network in the name of her abused son, Wyatt Rewoldt, 2, has drawn 13,000-plus supporters and the backing of many officials in three months.

A registry, similar to the Sex Offender Registry, could have alerted Hammel to the fact that her son was under the care of a convicted child abuser, Rachel Edwards, who will be sentenced Thursday for abusing Wyatt. Edward, 32, faces a prison term at her sentencing after pleading no contest in January to second-degree child abuse.

Edwards was convicted of third-degree child abuse, a felony, in 2011 and was convicted of fourth-degree child abuse on the same child, the 5-year-old son of her former boyfriend, in October 2013.

      Currently, the state Department of Human Services operates the Central Registry, which includes those who have been determined to have a confirmed case of child abuse by Child Protective Services. Employers can check if someone is on the registry but must have the subject’s permission to check, and DHS can only inform the employer if the person is not on the list. If the person is on the list, the DHS informs the inquirer that it cannot comment, said Bob Wheaton, DHS spokesman."

        Anyone want to weigh in on this? Someone who has been convicted on a child abuse misdemeanor or felony would have to register.  I think it's a no-brainer that there should be a registry like they are suggesting but I may be just reacting. Can anyone think of the down side of such a registry? Obviously we don't want it to be like the tier system in Ohio that seems to be inconsistent in it's application.

"Shame on the U.S." Report

The article that I read discussed the report by the Children's Advocacy Institute at the University of San Diego School of Law. The report is titled "Shame on the U.S." and it shows failure at each level of government to enforce federal laws at the state level and protect children. This report mirrors findings done by the Associated Press.

Data suggests that "680,000 children were victims of abuse and neglect in 2013, and an estimated 1,500 children died." Despite the failures that the report shows, "experts say that prevention efforts at the local level, combined with better data collection and tighter federal oversight could reduce the number of cases of abuse and neglect.

The article gives two examples. In Olympia, Washington, Community Youth Services is working on creating a parental education program. Mr. Shelan, the CEO says that he would like to end the cycle when it comes to kids coming out of foster care who have their own children and are unprepared and do not know how to parent. He says that this leads to more children in the foster care system. He believes that parental education programs are cost effective ways of dealing with abuse before it starts. 

The next example is Eckerd which is a nonprofit company who runs child welfare services in three large counties in Florida. They created a system to indentify children in the system who are at high risk of serious injury or death so that problems can be fixed quickly. A representative of the company reported that "in two years we have not had a child death from abuse or neglect in any of our cases."

The Children's Advocacy Institute had a few suggestions in the article:

·         make child welfare funding contingent on a state’s compliance with child welfare law requirements

·         encourage the judicial branch to take a more proactive role in bolstering lax executive branch enforcement

Article: http://news.yahoo.com/report-blasts-child-welfare-system-better-protect-us-210837618.html?soc_src=copy

The CAI's Report: http://www.caichildlaw.org/Misc/Shame%20on%20U.S._FINAL.pdf