a new narrative for child welfare promoting social and emotional well-being for children of color...

A New Narrative for Child WelfarePROMOTING SOCIAL AND EMOTIONAL WELL-BEING FOR CHILDREN OF COLOR

Bryan Samuels, CommissionerAdministration on Children, Youth and Families

Fauri Memorial Lecture (MI) 2

Data Source: Adoption and Foster Care Reporting and Analysis System, Reports 10-18 (19998-2010). Children’s Bureau, Administration on Children, Youth, and Families (USDHHS, ACF)

What happened to the child welfare population in the last decade?

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

100,000

200,000

300,000

400,000

500,000

600,000

127,821

167,235

86,581

41,588

TOTALBlack Non-HispanicWhite Non-HispanicHispanicOther

Nu

mber

of

Ch

ildre

n

408,425

November 11, 2011


29

41

21

9

41.1

109.91.7

12.7

24.6

Reunification

Adoption

Relative

Reached Major-ity

Other

Still in Care

43

35

15

7

Black Non-HispanicWhite Non-HispanicHispanicOther

<1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Foster Care Entries and Exits, 2002-2010

Racial Makeup of Foster Care Population, 1998 and 2010

Exits from Foster Care among 2000-2005 Entrants

Age Distribution of Entries into Foster Care, 2010

November 11, 2011

2002 2003 2004 2005 2006 2007 2008 2009 2010200,000

220,000

240,000

260,000

280,000

300,000

320,000

340,000

En-tries


Changes in child welfare populations have been unevenly distributedState Changes in Number of Children in Foster Care on September 30, 2006-2009

Black White Hispanic Other

NUMBER OF STATES WITH POPULATION INCREASES

Increase by less than 25% 13 14 28 30

Increase by 25-50% 0 0 8 5

Increase by 50-100% 3 0 5 5

Increase by 100% or more 1 0 1 4

NUMBER OF STATES WITH POPULATION DECREASES

Decrease by less than 25% 31 37 10 7

Decrease by 25-50% 3 1 0 1

Decrease by 50-100% 1 0 0 0

Decrease by 100% or more 0 0 0 0

Data Source: Adoption and Foster Care Reporting and Analysis System, accessed via Child Welfare Outcomes Report Builder, http://cwoutcomes.acf.hhs.gov/

November 11, 2011


Writing a New NarrativeREQUIRES ASKING KEY QUESTIONS:

• Where and how does abuse happen within communities with different ethnic/racial compositions?

• How does the experience of maltreatment impact the social and emotional well-being of children?

• What works to promote healing and recovery among children who have experienced maltreatment and what does not?

• What are the gaps? How do we fill them?November 11, 2011


The Impact of Maltreatment• The developmental stage of the child at the onset of traumatic exposure will

influence the type and severity of the consequences.1

• The experience of maltreatment is complex and not categorical. A child’s response is a function of environment, the nature of the traumatic experience, the neurochemical cascade following the event, and subsequent changes in functioning. These changes can be cognitive, emotional, physical, and/or behavioral.2

• Heightened stress has been shown to impair the development of the prefrontal cortex, the brain region that, in humans, is critical for the emergence of executive functions—a cluster of abilities such as making, following, and altering plans; controlling and focusing attention; inhibiting impulsive behaviors; and developing the ability to hold and incorporate new information in decision-making.3

• The effects of maltreatment can influence relationships across a person's lifetime,4 and they are particularly salient when a maltreated child attempts to form a new relationship with a primary caregiver or later romantic or marital partner.5

November 11, 2011

1. Frederico, MM; Jackson, AL; & Black, CM. (2005). Reflections on Complexity: The 2004 Summary Evaluation of Take Two. Bundoora, Victoria: School of Social Work and Social Policy, La Trobe University.

2. Wilson, KR; Hansen, DJ & Li, M. (2011). The traumatic stress response in child maltreatment and resultant neuropsychological effects. Aggression and Violent Behavior. 16:87.

3. National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved from www.developingchild.harvard.edu

4. Mikulincer, Ml Shaver, PR. (2007). Attachment in Adulthood: Structure, Dynamics and Change. New York, NY: The Guilford Press.5. Cook, A, Blaustein; M, Spinazzola, J; & van der Kolk, B. (Eds.). (2003). Complex Trauma in Children and Adolescents: White Paper from the National

Child Traumatic Stress Network Complex Trauma Task Force.


NSCAW – National Survey of Child and Adolescent Well-being

• Nationally representative, longitudinal study of children and families reported to child protective services

• Child-level data• N = 5,501

WAVE ONE WAVE TWO WAVE THREE WAVE FOUR

•Baseline •12 Months •18 Months •36 Months

RESPONDENTS

• Children• Assessments (younger

children)• Interviews (older children)

• Teachers• Survey completed via mail

or web

• Current Caregivers• Interviews

• Caseworkers• Interviews

• Agency Directors• Interviews

November 11, 2011


Caseworkers’ Perceptions of Risk

None Mild Moderate Severe0%

10%

20%

30%

40%

50%

60%

39%

32%

20%

9%

40%

31%

21%

8%

34% 34%

23%

9%

19%

48%

22%

11%

Level of Risk Perceived by Caseworker, by Caregiver Race/Ethnicity

Black White Hispanic

Other

Risk level

Data Source: National Survey of Child and Adolescent Well-Being II

November 11, 2011


One third of reports are substantiated

Black White Hispanic Other0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

67% 73% 68%74%

33% 27% 32%26%

Substantiation Status by Caseworker Report, by Race/Ethnicity

Substantiated or Indicated

Children were classified as hav-ing a substantiated maltreatment case on the basis of casework-ers’ response at baseline to the following question: “What was the outcome of the investiga-tion 1) substantiated, 2) indi-cated, or 3) neither substanti-ated or indicated, or unfounded or ruled out?” In so-called three-tier states, indicated is a classification option that means some evidence of maltreatment exists, but not enough for sub-stantiation.


November 11, 2011


Neglect and physical abuse are the most common maltreatment types for all groupsMALTREATMENT TYPE Black White Hispanic Other

Physical 24.8% 26.4% 26.7% 41.3%

Sexual 6.0% 11.8% 6.3% 5.6%

Emotional 3.3% 8.4% 9.8% 17.1%

Physical Neglect 17.5% 14.1% 15.0% 13.0%

Neglect 35.3% 35.0% 43.9% 25.6%

Substance Exposure 3.4% 2.6% 3.8% 1.0%

Domestic Violence 12.0% 8.0% 14.1% 11.0%

Substance-Abusing Parent 16.0% 17.6% 16.3% 9.7%

Other 20.4% 19.3% 14.8% 16.2%Data Source: National Survey of Child and Adolescent Well-Being II

November 11, 2011


Maltreatment impacts children’s ability to form and maintain relationships


5%

10%

15%

20%

25%

30%

35%

40%

45%

27.5%

34.3%

41.6%

24.4%

Fewer Social Skills among Children 3-17 Years Old by Caregiver Report

Total Sample: 34.3%

Data Source: National Survey of Child and Adolescent Well-Being IIInstrument used was the Social Skills Rating System (SSRS; Gresham & Elliot, 1990).

November 11, 2011


All groups of children known to child welfare have high rates of behavioral problems

CBCL Total Score in Clinical Range

CBCL Internalizing Score in Clinical

Range

CBCL Externalizing Score in Clinical

Range

0%

5%

10%

15%

20%

25%

30%

24%

17%

20%

24%

17%

23%

19%18%

19%

26%

24%

27%

Behavioral Problems among Children 1.5-17 Years Old with Maltreatment Report by Caregiver Report

Black White Hispanic Other

November 11, 2011

Comparable Norm: 8%


Black Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms

0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

58%

36%

19% 18%

4%

8%

3% 3%

27%

19%

29% 26%

11%

37%48% 53%

Trauma and Emotional/Behavioral Symptomatology among Children Entering Foster Care

Both Trauma and Emotional/Behav-ioral Symptoms

Emotional/Behav-ioral Health Symptoms Only

Trauma Symptoms Only

Neither

Data Source: Northwestern University, Illinois Department of Children and Family Services database of Integrated Assessments – Child and Adolescent Needs and Strengths. N=13,897.

November 11, 2011


White Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms

0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

61%

41%

19% 17%

5%

8%

5%4%

24%

20%

30%

22%

10%

31%

46%58%





Neither


November 11, 2011


Hispanic Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms

0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

50%

34%22%

15%

6%

10%

7%12%

25%

13%

22% 27%

18%

43%49% 46%





Neither


November 11, 2011


Other Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms

0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

53%

27%21%

50%

15%

18%

11%

23%

9%

11%

9%

45%58%

50%





Neither


November 11, 2011


White children are prescribed psychotropic medications at higher rates than other groups


2%

4%

6%

8%

10%

12%

14%

16%

18%

10%

17%

6%

8%

Current use of Psychotropic Medication(s) among Chil-dren 1.5-17 Years Old Reported to CPS by Caregiver

Report


November 11, 2011

18

Most common risk factors among caregivers

0%

20%

40%

60%

80%

100%

28% 26%

83%

41%32%

70%

31%44%

75%

41%32%

77%Black White

Hispanic Other

Data Source: National Survey of Child and Adolescent Well-Being II(1) Parents were deemed in need of mental health services if they met any one of four criteria spanning caseworker report of mental health disorder, caregiver score on screening instrument, or self-reported high need of services within past year. (2) Mothers were deemed in need of domestic violence services if they met three criteria spanning caseworker report of active domestic violence, mother’s score on screening instrument, or self-reported need for domestic violence services within past year. (3) Includes receipt of TANF, WIC, food stamps, SSI, or housing support.

November 11, 2011 Fauri Memorial Lecture (MI)


Groups show different patterns in lengths of stay

2000 2001 2002 2003 2004 200556789

101112131415

Median Duration (in months) of First Placement Spell by Year of Entry for Race/Ethnicity

BlackWhiteHispanicOther

Entry Year

Mo

nth

s

Wulczyn, F; Chen, L; & Hislop, KB. (2007). Foster Care Dynamics 2000-2005: A report from the Multistate Foster Care Data Archive. Chicago, IL: Chapin Hall Center for Children at the University of Chicago.Note: At the time of analysis, a median duration of placement could not be calculated for Black children entering in 2005, meaning that fewer than 50% of these children had exited when this report was published.

November 11, 2011


Across groups, most children exit care to reunification


10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

36%44% 42% 42%

10%

10%8% 9%

11%

10%8% 9%

Exit Destinations as Percent of All Entries

Still in Care

Other

Runaway

Emancipation

Guardianship or Relatives

Adoption

Reunification

Perc

en

t o

f C

hil

dre

n

Wulczyn, F; Chen, L; & Hislop, KB. (2007). Foster Care Dynamics 2000-2005: A report from the Multistate Foster Care Data Archive. Chicago, IL: Chapin Hall Center for Children at the University of Chicago..

November 11, 2011


Most Common Diagnosis for Maltreated Children and Youth and Evidence of Effective PracticeDiagnosis/Concern/Activity Evidence of Effectiveness

Screening Activities

Identification of Mental Health and Behavioral Health Issues

SCREENING

TOOLS

• Strengths and Difficulties Questionnaire• Pediatric Symptom Checklist• Child Behavior Checklist Behavior Assessment for Children• Etc.

Most Common Clinical-Level Social and Emotional Concerns

CHILD BEHAVIOR CHECKLIST

INTERNALIZING:WithdrawnAnxiety/Depression

• Brief Strategic Family Therapy• Child Parent Psychotherapy• Functional Family Therapy• Nurturing Parenting Programs (NPP)• Parenting Wisely• Triple P• Etc.

EXTERNALIZINGAggressive BehaviorDelinquentAttention Problems

Most Common Mental Health Diagnoses for Children in Foster Care

Attention Deficit Hyperactivity Disorder

• Children’s Summer Treatment Program

Posttraumatic Stress Disorder • Cognitive Behavioral Intervention for Trauma in Schools (CBITS)• Combined Parent-Child Cognitive Behavioral Therapy for Families at Risk for

Child Physical Abuse• Prolonged Exposure Therapy• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Major Depression • Adolescents Coping with Depression• Alternative for Families-Cognitive Behavioral Therapy (AF-CBT, formerly known

as Abuse-Focused-Cognitive Behavioral Therapy)• Etc.

Conduct Disorder/Oppositional Defiant Disorder

• Brief Strategic Family Therapy (BSFT)• Familias Unidas• Parent-Child Interaction Therapy (PCIT)• Strengthening Families Program (SFP)

November 11, 2011

So

cial

an

d E

mo

tio

nal

W

ell-

Bei

ng

: W

hat

d

oes

it l

oo

k li

ke?

November 11, 2011 Fauri Memorial Lecture (MI) 22

SELF-MANAGEMENTAge-appropriate autonomy, emotional self-regulation, persistence, constructive time use

AGENCYPlanfulness, resourcefulness, positive risk-taking, realistic goal-setting, motivation

SENSE OF PURPOSEBelieving one’s life is meaningfully connected to a larger picture

CONFIDENCEPositive identity and self-worth

SOCIAL INTELLIGENCECommunication, cooperation, conflict-resolution skills, trust, intimacy

ENVIRONMENTAL AWARENESS & BEHAVIORKnowledge, positive behaviorsRISK MANAGEMENT SKILLSSkills and knowledge to avoid drug and alcohol use and risky sexCRITICAL THINKINGEvaluation/analytical/problem-solving skills

KNOWLEDGE OF ESSENTIAL LIFE SKILLSFinancial management, decision-making skills, home maintenance, etc.

POSITIVE RELATIONSHIPS WITH PEERS, SIBLINGS, FAMILY, ETC.Warmth, closeness, communication, support, positive advice

Adapted from: Lippman, LH; Moore, KA & McIntosh, H. (2011). Positive indicators of child well-being: A conceptual framework, measures, and methodological issues. Applied Research in Quality of Life. Accessed on August 16, 2011. http://www.springerlink.com.proxy.uchicago.edu/content/tr32721263478297/.


Understanding

Experiences

Developmental Tasks

Coping Strategies

Environmental

Buffers

Protective mechanisms can serve in multiple functions; what is important is how they contribute to healing and recovery

Dimensions through which experiences of trauma and violence

impact children in the short- and long-terms

Locus of interventions to promote social and emotional functioning to facilitate healing and recovery

Protective Mechanisms

Protective Mechanisms

Social and

Emotional Well-Being

Fac

ilita

tin

g W

ell-

Bei

ng

fo

r C

hild

ren

an

d Y

ou

th in

C

hild

Wel

fare

November 11, 2011


Child and Family Services Improvement and Innovation Act of 2011 (P.L. 112-34)

Reauthorization of Promoting Safe and Stable Families (PSSF) includes new language addressing trauma and vulnerable populations:

• State plans shall include an outline of “how health needs identified through screenings will be monitored and treated, including emotional trauma associated with a child’s maltreatment and removal from home.”

– Plans must include a description of “the oversight of prescription medicines, including protocols for the appropriate use and monitoring of psychotropic medications.”

November 11, 2011

Changing Policy


Aligning Funding• Integrating Trauma-Informed and Trauma-

Focused Practice in Child Protective Service Delivery ($3.2 million, 5 grantees)

• Child Welfare-Early Education Partnerships to Expand Protective Factors for Children with Child Welfare Involvement & Child Welfare-Education System Collaborations to Increase Educational Stability ($4.3 million, 18 grantees)

• Improving Service Delivery to Youth in the Child Welfare System ($1.4 million, 4 grantees)

• Family Connections Grants: Using Family Group Decision-Making to Build Protective Factors for Children and Families ($3.4 million, 7 grantees)

November 11, 2011


Aligning Funding, cont’d

• Permanency Innovations Initiative, Year 2 ($15.3 million, 6 grantees)– AZ Dept. of Economic Security: Native American and African

American Adolescents

– CA Dept. of Social Services: African American Youth

– IL Dept. of Children and Family Services: Youth 9-12 at High Risk of Long-Term Foster Care

– LA Gay and Lesbian Community Services Center: LGBTQ Children and Youth

– Univ. of KS Center for Research, Inc.: Children with Severe Emotional Disturbances

– Washoe Co. (NV) Dept. of Social Services: Children with Serious Barriers to Permanency

• President’s Budget Proposal ($250 million each year for 10 years)

November 11, 2011


Communicating the New Narrative

• IM 11-03: Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Foster Care

• IM 11-01: Child Welfare-Head Start Partnerships: Partnering with Families involved in Head Start and Early Head Start Programs; OCC IM (4-11): Child Welfare and Child Care Partnerships: Partnering with Families Involved in Child Care Subsidy Programs

• Joint letter on educational provisions of Fostering Connections

• Over 80 speaking engagements between October 2010 and October 2011

November 11, 2011


The New Narrative

Child welfare interventions will focus on the repair or establishment of protective, supportive, and emotionally responsive adult relationships.

Through these emotionally positive and strong, fundamental relationships, children and youth will thrive socially, emotionally, and developmentally in safe, permanent homes. They will have access to the physical health, mental health, and educational resources necessary for long-term well-being.

November 11, 2011

Fauri Memorial Lecture (MI) 29November 11, 2011


Variation in Change African American Children in Foster Care across States

November 11, 2011

Orego

n

New

Ham

pshi

re

Kentu

cky

Wes

t Virg

inia

Min

neso

ta

Indi

ana

Tenn

esse

e

Miss

ouri

New

Mex

ico

Califo

rnia

Alaba

ma

South

Car

olin

a

Distric

t of C

olum

bia

Mas

sach

uset

ts

Mar

ylan

d

Penn

sylvan

ia

Wisc

onsin

Puer

to R

ico

New

Yor

k

Texa

sIo

wa

Nev

ada

Color

ado

Arizon

a

Idah

o

Haw

aii

-100%

-50%

0%

50%

100%

150%

Percent Change in Population of African American Children in Foster Care, by State (2006-2009)

a new narrative for child welfare promoting social and emotional well-being for children of color...

Documents

child maltreatment

developing child

foster care reporting

foster care entries

experience of maltreatment

child welfare populations

impact of maltreatment

effects of maltreatment