Search Type Title Author/Investigator Search Advanced Search

Table of Contents | Previous | Next

8. In-Home Caregiver Services

The public perception of child welfare services (CWS) usually focuses on children who are removed from their homes of origin and placed in out-of-home settings, especially foster care (Reid & Misener, 2001). Nonetheless, the majority of children who come into contact with CWS do not experience out-of-home placement, and only an estimated 21% of children designated to be “victims” of abuse and neglect enter foster care soon after the maltreatment (U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 2001). About 60% of the suspected abuse and neglect cases that are investigated by CWS are not substantiated, and most cases do not result in an open case or the ongoing delivery of services through CWS (U.S. DHHS, 2003). For cases that are substantiated (as well as some in which there is no substantiation), services are more often than not delivered to the family while the child remains in the home under CWS supervision. This allows for the preservation of the family while intending to protect the safety and well-being of the child.

Little is known, however, about the background and experiences of the in-home caregivers who, after being investigated for child maltreatment, retain custody of their children. Their levels of problems, the services they receive to address those problems, and their satisfaction with services have not been well studied. When these problems have been classified, they have typically been based on interviews with child welfare workers or case record data (U.S. DHHS, 1994). Interviews with clients have been a much less common source of information.

Chapter 6 of this report described the demographic characteristics and selected risk factors of current caregivers. The two sections in this chapter focus on the service experiences of the in-home caregivers, including caregivers receiving no formal child welfare services (i.e., their case was closed at intake) and caregivers receiving in-home child welfare services (i.e., their case was opened at intake). Section 8.1 reports in-home caregivers’ receipt of services in the months prior to and immediately following contact with CWS, including receipt of public financial assistance, inpatient and outpatient mental health services, and services for drug and alcohol problems. In-home caregivers with open child welfare cases are compared with in-home caregivers with closed cases with regard to receipt of these services. In addition, child welfare worker reports of caregiver services provision, arrangement, and referral at intake are presented, as well as the different types of services provided to, arranged for, or to which caregivers were referred, are presented.

Section 8.2 describes in-home caregivers’ reported satisfaction with CWS. Caregivers with open in-home cases report on the frequency and recentness of their contact with child welfare worker(s), the extent to which they felt understood and respected by their child welfare worker(s), and their satisfaction with services to which they were referred.

8.1 Description of Analyses

Caregivers involved with CWS have diverse service needs, requiring a range of services that are often coordinated by the child welfare agency but provided by others with specialization in mental health, substance abuse, housing, and public assistance. Analyses presented in Section 8.1 test for differences in service receipt between various subgroups of in-home caregivers including:

• caregivers of children living at home who have not received child welfare services versus caregivers of children living at home who have received child welfare services

• caregivers in various age categories

• caregivers in various race/ethnicity categories 29

• caregivers of children in various age categories.

Section 8.2 uses factor analysis to create two scales of caregiver satisfaction and multiple regressions to compare caregivers’ satisfaction by demographic and case characteristics, such as the type of child maltreatment, level of harm to the child, and number of child welfare workers with whom caregivers were in contact since the investigation.

In general, data in bivariate tables throughout this chapter are presented with breakouts by caregiver’s age and race/ethnicity, child’s age, and whether or not they received services through the child welfare agency (although exact variables and categories may vary depending on the analysis).

8.2 In-Home Caregiver Services

As described in Chapter 6, in-home caregivers experience a variety of risk factors that may influence their parenting abilities, including poverty, mental health needs, and substance abuse problems. These problems may have resulted in their family’s involvement with CWS. Even though services are typically available in the community to assist with these issues, caregivers may need help locating services or accessing care. CWS may refer families brought to their attention to the needed services and, in some cases, may coordinate the care they receive. Families may also obtain other community services.

This section examines several types of services commonly received by in-home caregivers, including Temporary Assistance to Needy Families (TANF) benefits, mental health services, and alcohol and drug abuse treatment. Information on receipt of these services was obtained from the in-home caregiver during the baseline interview and reflects the services received in the months prior to and immediately following their contact with CWS.

8.2.1 TANF

TANF is a federally funded, state-administered program that provides assistance such as cash payments, vouchers, and other forms of benefits designed to meet a family’s ongoing basic needs. TANF intends to reduce the dependency of needy parents by promoting job preparation and work experience. In 1997, TANF replaced Aid to Families with Dependent Children (AFDC), which was then commonly known as “welfare.”

The overlap in services receipt between TANF participation and placement in foster care is thought to be substantial, with about 60% of children who enter foster care having just been on TANF (U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, 2000). Less is known about the overlap between families who receive TANF and those who have been the subject of a child maltreatment investigation that does not result in the child’s placement in out-of-home care. More than three out of five in-home caregivers (61%) reported they had received TANF/AFDC benefits, either currently or at some point in the past (Table 8-1). There were no differences in the lifetime receipt of TANF/AFDC benefits by child age or receipt of services. White caregivers and those classified as other races/ethnicities were significantly less likely to report ever having received TANF or AFDC benefits than African American caregivers (p<.001); there was also a trend toward caregivers classified as other races/ethnicities being less likely than White or Hispanic caregivers to report having ever received TANF or AFDC (p< .03 for both).

Regarding current TANF receipt, slightly more than one in five in-home caregivers (21%) reported receiving TANF benefits at the time of the baseline interview (Table 8-2). About three-fourths of these had been receiving TANF benefits before the current CPS investigation began. White caregivers were less likely to be currently receiving TANF benefits than African American caregivers (p<.001 and p<.01, respectively), while caregivers from other racial/ethnic groups were less likely than African American caregivers to be currently receiving benefits (p< .01).

The logistic regression model for predicting lifetime use of TANF/AFDC supported the race/ethnicity effect, with both African American (p<.001) and Hispanic caregivers significantly more likely to report use as compared with White caregivers (Table 8-3). (This is consistent with annual data on the racial composition of TANF cases in the general population, as African American and Hispanic caregivers are more likely to be TANF recipients than White Non-Hispanics (Lower-Basch, 2000). In addition, male caregivers were significantly less likely to report use of this service as compared with female caregivers (p<.001).

8.2.2 Caregiver Mental Health, Alcohol, and Drug Services Use

Mental health and substance abuse are significant problems facing many families receiving child welfare services. Previous research indicates that children whose parents abuse alcohol or other drugs are almost three times more likely to be abused and over four times more likely to be neglected than children of parents who are not substance abusers (Kelleher et al., 1994). Children of parents with a history of psychiatric disorders are two to three times more likely to experience maltreatment than those without a parental history of mental health problems (Walsh, MacMillan, & Jamieson, 2002). In-home caregivers in the NSCAW sample responded to questions about their use of mental health and substance abuse services prior to, and immediately following, their contact with CWS. In, addition, they were asked about lifetime use of these services.

Table 8-1. In-home Caregiver Report of Ever Receiving TANF/AFDC Benefits

		No Services Percent(SE)	Services Percent (SE)	Total Percent (SE)
Caregiver Age	≤24 yrs	54.3 (4.7)	57.9 (5.1)	55.3 (3.9)
	25–34 yrs	64.4 (3.6)	69.2 (3.2)	65.6 (3.0)
	35–44 yrs	58.9 (3.9)	63.8 (3.2)	60.4 (3.0)
	45–54 yrs	49.6 (7.3)	47.5 (8.4)	49.0 (5.7)
	55+ yrs	55.0 (17.7)	34.7 (8.0)	49.0 (13.8)
Caregiver Race/ Ethnicity	African American	75.8 (3.9)	69.9 (4.1)	73.9 (3.0)
	White	52.5 (3.3)	60.0 (2.4)	54.5 a (2.6)
	Hispanic	69.9 (5.4)	63.5 (5.4)	68.3 (4.0)
	Other	38.5 (6.9)	58.8 (6.2)	42.6 b (5.6)
Child Age	0-2 yrs	55.1 (4.7)	54.5 (3.8)	55.0 (3.5)
	3-5 yrs	57.9 (3.9)	65.3 (4.1)	60.1 (3.3)
	6-10 yrs	60.8 (3.2)	69.7 (3.6)	62.8 (2.7)
	11+ yrs	63.7 (4.2)	60.2 (4.0)	62.6 (3.4)
TOTAL		59.9 (2.3)	63.3 (1.9)	60.8 (1.8)

a White caregivers are less likely than African American caregivers to have received TANF/AFDC benefits (X2=19.7 p<.001). (back) b Caregivers of other races/ethnicities are less likely than African American caregivers to have received TANF/AFDC benefits (X2=18.6, p<.001). (back)

Almost 8% of in-home caregivers report currently receiving outpatient counseling or therapy for a mental health problem (Table 8-4), with 11% reportedly having received these services in the past 12 months. Additionally, more than 1 in 10 caregivers (12%) reported having a need for these services but not receiving them. Receipt of services varied significantly by caregiver age, with younger caregivers being significantly less likely to report the current use of mental health services, as compared to caregivers aged 25–44 years, as well as the past-year use of outpatient mental health services in the past 12 months, as compared with the middle-age group of 35- to 44-year-olds. No significant differences were seen by caregiver race/ethnicity, child age, or receipt of services, although several trends are present. Caregivers receiving in-home child welfare services tend to be more likely to report current outpatient mental health service use than those not receiving services (p=.02). In addition, among those caregivers receiving in-home child welfare services, White caregivers are more likely to report current mental health service use (p=.02).

Table 8-2. In-Home Caregiver Report of Current Receipt of TANF Benefits

		No Services Percent(SE)	Services Percent(SE)	Total Percent(SE)
Caregiver Age	≤24 yrs	24.4 (4.4)	25.5 (4.1)	24.7 (3.6)
	25 – 34 yrs	19.3 (2.6)	23.8 (3.2)	20.4 (2.1)
	35 – 44 yrs	18.5 (2.9)	22.9 (4.3)	19.8 (2.7)
	45 – 54 yrs	15.9 (6.8)	19.4 (5.0)	16.8 (5.2)
	55+ yrs	0.3 (0.3)	26.3 (7.8)	8.0 (3.6)
Caregiver Race/ Ethnicity	African American	28.2 (3.9)	38.4 (4.2)	31.4 (3.2)
	White	14.4 (2.8)	15.5 (2.5)	14.7 a b (2.4)
	Hispanic	28.1 (3.6)	23.5 (6.1)	26.9 (3.1)
	Other	8.1 (2.9)	22.0 (6.2)	10.9 c (3.0)
Child Age	0-2 yrs	25.2 (3.8)	27.6 (3.4)	25.9 (3.1)
	3-5 yrs	19.5 (3.3)	24.1 (5.1)	20.8 (2.7)
	6-10 yrs	18.6 (3.4)	28.7 (3.6)	20.9 (3.0)
	11+ yrs	16.8 (2.8)	14.5 (2.6)	16.1 (2.0)
TOTAL		19.5 (2.1)	23.6 (2.4)	20.6 (1.9)

a White caregivers are less likely than African American caregivers to be receiving TANF/AFDC benefits (X2=16.9, p<.001). (back) b White caregivers are less likely than Hispanic caregivers to be receiving TANF/AFDC benefits (X2=7.48, p<.01). (back) c Caregivers of other races/ethnicities are less likely than African American caregivers to be receiving TANF/AFDC benefits (X2=13.6, p<.01). (back)

Logistic regression analyses confirm the caregiver age effect on reported use of outpatient mental health services (Tables 8-5 and 8-6). An overall trend (p=.03) observed in the bivariate relationships suggests a curvilinear relationship with age, with the youngest and oldest groups of caregivers reporting less current use of outpatient mental health services as compared with the middle groups (aged 3–44 and 44–54). Caregivers receiving in-home child welfare services were also more likely to be currently receiving mental health services (p<.01).

When the same analysis is used to understand the use of outpatient mental health services in the past 12 months, the patterns hold. The lower rates of mental health services use among younger caregivers are even more prominent, as are the lower rates for the older caregivers (although these are not significantly different from the reference group of 35- to 44-year-olds).

Table 8-3. Logistic Regression Modeling Ever Received TANF/AFDC

		OR	95% CI
Caregiver Age	≤24 yrs	0.71	.48, 1.05
	25 – 34 yrs	1.23	.79, 1.90
	35 – 44 yrs	(reference group)
	45 – 54 yrs	0.60	.32, 1.10
	55+ yrs	0.71	.14, 3.65
Caregiver Race/ Ethnicity	White	(reference group)
	African American	2.45**_i	1.70, 3.52
	Hispanic	1.72*	1.12, 2.64
	Other	0.64	.38, 1.08
Caregiver Gender	Male	0.26**_ii	.16, .43
	Female	(reference group)
Child Setting/ Services	In-home, no services	(reference group)
	In-home, services	1.11	.86, 1.42

Cox and Snell pseudo-R2 is .08 * p<.01; (back) ** p<.001 (back: **_i, **_ii)

Caregivers not receiving in-home services are less likely to have received mental health services in the past year (p<.01), while African American caregivers tend to be less likely than White caregivers to have received mental health services (p<.04). These rates of outpatient mental health service use do not closely correspond with the caregivers’ self-reported depression using the CIDI-SF (see Chapter 6). It should be noted, though, that the portion of the CIDI-SF administered only examines major depression and there may be other mental health impairments present among these caregivers.

Other evidence suggests high levels of mental health problems among the caregivers involved with CWS. About 3 out of 100 in-home caregivers report use of inpatient mental health services, defined as admission to a psychiatric hospital or a psychiatric unit in a medical hospital, in the past year (Table 8-7). Over 1 in 10 report using inpatient mental health services at some point in their relatively young lives. This figure varies with caregiver race/ethnicity, though, as Hispanic caregivers are significantly less likely to report lifetime use of inpatient mental health services as compared to White caregivers, and tend to be less likely than African American caregivers and those classified as other races/ethnicities (p<.03 for both) to use mental health services.

Two percent of the in-home caregivers are currently receiving drug or alcohol services, with those receiving child welfare services significantly more likely to report current or lifetime use (p<.001 for both), as shown in Table 8-8. Almost 1 in 10 report the use of drug or alcohol services in their lifetime. Reports of lifetime usage vary by caregiver age, with those between 35and 44 years of age significantly more likely to report lifetime use than younger or older caregivers. Of those who have ever received drug or alcohol services, the mean number of times is 2.2 per lifetime. Of those who are not currently receiving this service, only 2 of every 100 caregivers report that they currently have a need for it.

Table 8-4. In-Home Caregiver Report of Outpatient Mental Health Services

		Current Use			Received in Past 12 Months Percent (SE)	Not Receiving Service, But Have Need Percent (SE)
		No Services Percent (SE)	Services Percent (SE)	Total Percent (SE)
Caregiver Age	≤24 yrs	2.8 (1.2)	4.8 (1.5)	3.4 a b (1.0)	5.5 c (1.2)	10.4 (2.0)
	25 – 34 yrs	5.8 (1.3)	12.2 (2.4)	7.4 (1.2)	10.0 d (1.3)	10.4 (1.4)
	35 – 44 yrs	8.0 (2.0)	14.0 (3.1)	9.8 (1.7)	17.2 (2.1)	14.9 (2.7)
	45 – 54 yrs	10.1 (4.4)	13.9 (4.3)	11.1 (3.3)	13.1 (3.6)	11.4 (3.2)
	55+ yrs	6.6 (5.2)	1.7 (1.3)	4.9 (3.5)	4.9 (3.5)	5.1 (2.9)
Caregiver Race/ Ethnicity	African American	6.3 (2.6)	4.3 (1.2)	5.7 (1.8)	8.7 (2.1)	11.1 (2.0)
	White	6.5 (1.3)	16.3 (2.6)	9.2 (1.2)	14.0 (1.7)	13.4 (1.4)
	Hispanic	5.5 (2.2)	7.3 (2.3)	6.0 (1.9)	7.5 (2.1)	8.7 (3.3)
	Other	4.5 (2.2)	11.0 (3.2)	5.8 (1.9)	9.8 (3.1)	7.6 (2.6)
Child Age	0-2 yrs	7.2 (1.9)	7.8 (1.8)	7.3 (1.4)	9.3 (1.5)	10.5 (1.9)
	3-5 yrs	5.1 (1.6)	16.0 (4.7)	8.3 (1.7)	12.6 (1.8)	13.2 (1.8)
	6-10 yrs	4.7 (1.2)	9.1 (1.8)	5.7 (1.1)	9.2 (1.5)	11.9 (2.0)
	11+ yrs	8.7 (2.5)	12.0 (2.4)	9.7 (1.9)	14.9 (2.1)	10.5 (2.2)
TOTAL		6.1 (1.0)	11.2 (1.6)	7.5 (0.9)	11.3 (1.0)	11.6 (1.2)

a Caregivers aged 24 and younger are less likely than caregivers aged 25-34 years to be currently receiving outpatient mental health services (X2 = 6.8, p=.01). (back) b Caregivers aged 24 and younger are less likely than caregivers aged 35-44 years to be currently receiving outpatient mental health services (X2 = 10.65, p<.01). (back) c Caregivers aged 24 years and younger are less likely than caregivers aged 35-44 years to have received outpatient mental health services in the past 12 months (X2=19.3, p<.001). (back) d Caregivers aged 25-34 years are less likely than caregivers aged 35-44 years to have received outpatient mental health services in the past 12 months (X2=8.5, p<.01). (back)

Table 8-5. Logistic Regression Modeling Current Use of Mental Health Outpatient Services

		OR	95% CI
Caregiver Age	≤24 yrs	0.32*	.16, .64
	25 – 34 yrs	0.76	.46, 1.26
	35 – 44 yrs	(reference group)
	45 – 54 yrs	1.23	.61, 2.48
	55+ yrs	0.48	.10, 2.29
Caregiver Race/ Ethnicity	White	(reference group)
	African American	0.58	.28, 1.20
	Hispanic	0.62	.29, 1.33
	Other	0.66	.32, 1.35
Caregiver Gender	Male	0.80	.35, 1.85
	Female	(reference group)
Child Setting/Services	In-home, no services	(reference group)
	In-home, services	1.94*	1.02, 3.06

Cox and Snell pseudo-R2 is .02 * p<.01 (back)

There are no significant differences in current or lifetime receipt of drug and alcohol services by caregiver race/ethnicity or child age, although several trends are present. Caregivers receiving child welfare services report higher levels of unmet need for drug and alcohol services (p=.04), while African American caregivers and caregivers of other races/ethnicities are more likely to report unmet need (p=.02).

Logistic regression analyses confirm the bivariate findings. Caregivers receiving in-home child welfare services are almost three times more likely to report current use of alcohol or drug services as compared with those not receiving in-home services. Similar analyses predicting report of lifetime use of alcohol or drug services indicate that the youngest (less than 24 years) and the oldest (55 or more years) age groups are significantly less likely to report use as compared with the reference group aged 35–44 years.

Table 8-6. Logistic Regression Modeling Use of Mental Health Outpatient Services (Past 12 Months)

		OR	95% CI
Caregiver Age	≤ 24 yrs	0.27 **	.16, .46
	25 – 34 yrs	0.56*_i	.37, .84
	35 – 44 yrs	(reference group)
	45 – 54 yrs	0.78	.40, 1.52
	55+ yrs	0.25	.05, 1.17
Caregiver Race/Ethnicity	White	(reference group)
	African American	0.56	.32, 1.01
	Hispanic	0.50	.26, 0.99
	Other	0.72	.35, 1.47
Caregiver Gender	Male	0.63	.31, 1.29
	Female	(reference group)
Child Setting/Services	In-home, no services	(reference group)
	In-home, services	1.96*_ii	1.31, 2.94

Cox and Snell pseudo-R2 is .04 * p<.01; (back: *_i, *_ii) ** p<.001 (back)

8.2.3 Child Welfare Worker Reports of Caregiver Service Provision and Referral

When child welfare workers help families resolve problems related to child maltreatment, multiple types of services may be recommended. A large part of the child welfare worker role is to assess family needs and either to provide necessary services or to link families to other services that may help alleviate the family distress (Crosson-Tower, 2001).

Child welfare workers reported whether in-home caregivers had any services provided, arranged, or referred at the time of intake to CWS. As shown in Table 8-9, 43% of caregivers had some type of service provided or recommended to them, as reported by child welfare workers. Not surprisingly, having an open child welfare case is significantly related to caregiver service provision, arrangement, or referral across all caregiver age groups, caregiver race/ethnicities, and child age groups, with the overwhelming majority of caregivers receiving some sort of attention. Many caregivers with unopened cases also receive services, as some sort of service provision is reported for about a quarter of caregivers with unopened cases.

Results of multivariate analysis confirm the bivariate findings that child welfare workers report being active in arranging services for their clients. Caregivers with an open child welfare case are far more likely than those without a formally opened case to have services provided, arranged, or referred by the child welfare worker.

Table 8-7. In-Home Caregiver Report of Inpatient Mental Health Service Use

		Used Inpatient Mental Health Services in past 12 months Percent (SE)	Ever Used Inpatient Mental Health Services Percent (SE)	Mean Number of Inpatient Mental Health Stays (Lifetime) Percent (SE)
Caregiver Age	≤24 yrs	2.6 (0.9)	10.4 (2.6)	2.0 (0.5)
	25 – 34 yrs	1.9 (0.5)	8.9 (1.4)	2.6 (0.7)
	35 – 44 yrs	3.7 (1.0)	11.2 (2.3)	1.8 (0.3)
	45 – 54 yrs	3.2 (2.0)	12.9 (4.9)	2.0 (0.4)
	55+ yrs	0.0 (0.0)	8.8 (5.8)	1.6 (0.3)
Caregiver Race/ Ethnicity	African American	2.5 (1.0)	8.5 (2.1)	2.3 (0.5)
	White	3.1 (0.7)	12.7 (2.1)	2.1 (0.4)
	Hispanic	1.7 (1.2)	3.1 a (1.4)	1.3 (0.2)
	Other	1.5 (0.5)	13.8 (3.5)	2.6 (1.0)
Child Age	0-2 yrs	3.9 (1.2)	10.6 (1.5)	2.6 (0.5)
	3-5 yrs	2.4 (1.0)	12.0 (2.7)	2.4 (0.9)
	6-10 yrs	2.0 (0.6)	6.9 (1.4)	2.3 (0.5)
	11+ yrs	2.6 (0.8)	12.9 (2.6)	1.6 (0.2)
Child Welfare Services	Not receiving services	2.4 (0.6)	10.1 (1.6)	2.1 (0.4)
	Receiving services	3.0 (0.6)	10.0 (1.5)	2.3 (0.4)
TOTAL		2.6 (0.5)	10.1 (1.3)	2.2 (0.3)

a Hispanic caregivers are less likely than caregivers of other races/ethnicities to have ever used inpatient mental health services (X2=10.6, p<.01). (back)

Table 8-8. In-Home Caregiver Report of Alcohol and Drug Treatment Services

		Currently Receiving Alcohol or Drug Services Percent (SE)	Ever Received Alcohol or Drug Services Percent (SE)	Not Receiving Service, But Have Need Percent (SE)	Mean Number of Times Received Alcohol or Drug Services Percent (SE)
Caregiver Age	≤24 yrs	1.6 (0.5)	6.3 c (1.2)	1.1 (0.3)	2.0 (0.6)
	25 – 34 yrs	1.8 (0.4)	8.8 (1.2)	2.2 (0.6)	2.4 (0.5)
	35 – 44 yrs	2.8 (0.9)	13.4 (2.3)	2.5 (0.9)	2.2 (0.4)
	45 – 54 yrs	1.0 (0.5)	8.3 (2.4)	3.1 (1.9)	1.4 (0.2)
	55+ yrs	1.1 (1.1)	1.1 d e f (1.1)	2.0 (1.5)	1.0 (0.0)
Caregiver Race/Ethnicity	African American	1.6 (0.6)	10.9 (1.9)	4.5 h (1.2)	3.3 (0.6)
	White	2.4 (0.6)	10.0 (1.4)	1.3 (0.4)	1.6 (0.2)
	Hispanic	1.5 (0.5)	6.2 (2.2)	0.8 (0.5)	1.8 (0.6)
	Other	1.1 (0.4)	8.8 (2.5)	3.6 (1.4)	2.9 (1.1)
Child Age	0-2 yrs	2.6 a (0.5)	9.5 (1.4)	2.1 (0.8)	2.3 (0.4)
	3-5 yrs	3.6 (1.2)	11.0 (1.8)	2.0 (0.6)	1.5 (0.1)
	6-10 yrs	1.0 (0.3)	8.2 (1.4)	2.0 (0.7)	2.4 (0.5)
	11+ yrs	1.5 (0.6)	10.1 (1.7)	2.7 (1.0)	2.6 (0.8)
Child Welfare Services	Not receiving services	0.9 (0.3)	7.2 (1.1)	1.8 (0.5)	2.0 (0.4)
	Receiving services	4.8 b (0.9)	15.5 g (1.8)	3.2 (0.6)	2.4 (0.4)
TOTAL		2.0 (0.3)	9.5 (1.0)	2.1 (0.4)	2.2 (0.3)

a Caregivers of children aged 0-2 years are more likely than caregivers of children aged 6-10 to be currently receiving drug or alcohol services (X2 = 7.2, p<.01). (back) b Caregivers receiving services are more likely than caregivers not receiving services to be currently receiving drug or alcohol services (X2 = 14.0, p<.001). (back) c Caregivers aged 24 years and younger are less likely than caregivers aged 35-44 years to have ever received drug or alcohol services (X2 =6.9, p=.01). (back) d Caregivers aged 55 years and older are less likely than caregivers aged 24 years and younger to have ever received drug or alcohol services (X2 =7.3, p<.01). (back) e Caregivers aged 55 years and older are less likely than caregivers aged 25-34 years to have ever received drug or alcohol services (X2 =8.7, p<.01). (back) f Caregivers aged 55 years and older are less likely than caregivers aged 35-44 years to have ever received drug or alcohol services (X2 = 11.0, p<.01). (back) g Caregivers receiving services are more likely than caregivers not receiving services to have ever received drug or alcohol services (X2 =13.5, p<.001). (back) h African American caregivers are more likely than Hispanic caregivers to report higher levels of unmet need for drug and alcohol services (X2 =7.8, p<.01). (back)

Child welfare workers reported on the types of services that they provided to caregivers, arranged for caregivers, or to which caregivers were referred. The most frequently cited type of service provided, arranged, or referred is counseling or mental health treatment (Table 8-10).

Child welfare workers report that over 50% of caregivers were either referred to mental health treatment, or had this service arranged for them or provided to them by the CWS at intake. This percentage is far higher than the proportion of caregivers who reported receiving this type

of service in Table 8-4, wherein just 12% of caregivers reported receiving mental health services in the past 12 months. The discrepancy between child welfare worker reports of mental health service provision, referral, or arrangement at intake and caregiver reports of mental health services receipt at intake could be explained in a variety of ways and will be addressed in future analyses.

Parenting classes are frequently provided, arranged, or referred by child welfare workers. Child welfare workers report that 30% of caregivers were referred to parenting services, had parenting services provided to them, or had parenting services arranged for them at intake. Child welfare workers also report providing, arranging, or referring caregivers to “other” types of services—24% of caregivers were reportedly referred to other types of services or had other services provided to them or arranged for them by the child welfare agency. Caregivers of younger children are more likely to have other types of services provided or recommended, as are White caregivers. Although we lack specific knowledge about what these other services might be, these data do argue that responsive child welfare services appear to require access to a wide variety of services.

Bivariate analyses show there are significant differences in the types of services provided, arranged, or referred by caregiver race/ethnicity and by the age of the child. Caregivers with young children (aged 0–2) are significantly more likely to be identified by child welfare workers as needing assistance related to basic necessities such as housing, transportation, and food (concrete services). Caregivers of young children are also more likely to have substance abuse services provided, arranged, or referred. In regard to caregiver race/ethnicity, White caregivers are more likely than African American caregivers to have other types of services provided, arranged, or referred.

Table 8-9. Any Services Provided, Arranged, or Referred
This table contains several footnotes, with several data cells referencing the same footnote. When finished reading a footnote, use the browser <Back> button to return to the last data cell you were reading.

		No Services Percent Yes (SE)	Services Percent Yes (SE)	Total Percent Yes (SE)
Caregiver Age	≤24 yrs	23.0 (3.7)	94.2 a (1.7)	42.6 (3.3)
	25 – 34 yrs	22.8 (3.5)	91.5 a (1.9)	39.5 (2.8)
	35 – 44 yrs	29.0 (3.7)	93.1 a (1.6)	48.3 (3.1)
	45 – 54 yrs	27.5 (9.9)	96.2 a (1.6)	45.0 (7.5)
	55+ yrs	–	83.2 a (7.6)	41.3 (9.6)
Caregiver Race/ Ethnicity	African American	21.6 (4.6)	92.0 a (2.4)	42.2 (2.8)
	White	23.0 (2.5)	92.2 a (1.6)	41.9 (2.3)
	Hispanic	33.3 (9.4)	96.3 a (1.4)	49.1 (6.3)
	Other	27.0 (6.5)	90.3 a (3.1)	38.2 (5.9)
Child Age	0-2 yrs	24.2 (4.1)	93.4 a (2.1)	43.6 (3.4)
	3-5 yrs	21.4 (4.0)	89.0 a (2.8)	41.1 (3.4)
	6-10 yrs	24.9 (4.1)	95.5 a (1.1)	41.3 (3.6)
	11+ yrs	28.0 (4.2)	92.0 a (2.1)	46.7 (3.3)
TOTAL		24.8 (2.9)	92.7 a (1.4)	42.9 (2.1)

a Caregivers with an open child welfare case are more likely to have services provided, arranged, or referred (p<.001).

Some variation in the service types provided, arranged, or referred exists by service setting, but the types of services provided, arranged, or referred are quite similar, whether caregivers have opened cases or not (Table 8-11). Caregivers with an open child welfare case are more likely than caregivers with closed cases to have concrete services and income support services provided, arranged, or referred. No other significant differences were found in types of services provided, arranged, or referred according to service setting.

Table 8-10. Types of Caregiver Services Provided, Arranged, or Referred

		Type of Service Percent Yes (SE)
		Counseling/ Mental Health	Concrete Services	Income Support	Substance Abuse	Parenting Classes	Family Support Center	Domestic Violence	Legal	Other
Caregiver Age	≤24	47.8 (5.2)	25.1 (5.3)	13.7 (3.7)	10.8 (1.7)	38.7 (4.4)	23.0 (4.4)	11.2 (2.0)	6.5 (1.5)	35.7 (4.6)
	25 – 34	52.3 (4.2)	19.7 (3.3)	9.8 (2.1)	11.3 (1.6)	31.1 (3.8)	21.2 (3.3)	12.4 (1.9)	7.3 (1.5)	21.6 (2.5)
	35 – 44	59.0 (6.0)	12.7 (2.5)	8.9 (2.5)	17.7 (3.3)	21.8 (3.8)	18.2 (3.0)	14.3 (4.5)	13.7 (3.1)	21.7 (2.4)
	45 – 54	58.3 (7.9)	9.5 (3.4)	7.4 (3.4)	18.2 (4.1)	36.8 (8.4)	15.1 (5.0)	7.6 (2.9)	6.4 (2.1)	18.4 (7.4)
	55+	41.2 (11.1)	15.2 (6.8)	19.0 (8.0)	29.6 (10.8)	23.9 (9.1)	15.4 (6.1)	---	32.5 (10.0)	16.3 (7.1)
Caregiver Race/ Ethnicity	African American	44.8 (4.8)	22.4 (3.9)	17.1 (3.6)	16.5 (3.2)	26.2 (4.4)	19.0 (3.3)	7.3 (2.0)	6.0 (1.1)	11.7 (1.8)
	White	51.2 (3.2)	16.9 (2.8)	7.8 (1.2)	13.9 (2.2)	27.7 (3.1)	19.7 (2.7)	12.8 (2.4)	13.1 (2.9)	31.5 c (2.5)
	Hispanic	69.2 (6.0)	14.0 (5.1)	6.0 (2.6)	12.2 (3.7)	38.1 (5.9)	20.0 (4.1)	17.1 (3.5)	5.3 (1.6)	20.0 (5.9)
	Other	59.6 (8.3)	17.6 (5.0)	15.8 (7.6)	10.1 (2.9)	37.1 (8.1)	27.3 (8.2)	11.7 (4.5)	6.5 (1.8)	24.6 (6.2)
Child Age	0-2	48.4 (4.1)	24.9 a (3.8)	14.8 (3.7)	21.0 b (2.2)	42.9 (3.9)	25.3 (4.1)	13.2 (1.8)	10.6 (1.7)	32.0 d (2.7)
	3-5	52.8 (5.8)	22.2 (4.7)	14.5 (3.9)	12.5 (3.1)	26.1 (4.5)	19.4 (4.4)	12.6 (3.1)	6.8 (2.3)	28.4 (5.4)
	6-10	53.2 (5.0)	17.1 (4.9)	6.3 (1.5)	13.8 (2.6)	29.9 (3.5)	17.3 (2.5)	14.7 (4.4)	8.9 (2.7)