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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.
| 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) |
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).
| 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) |
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).
| 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 |
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.
| 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) |
| 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 |
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.
| 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 |
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.
| 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) |
|
| 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) |
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.
| 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.
| 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) |
24.0 (3.6) |
|
| 11+ | 59.3 (6.2) |
10.1 (1.9) |
8.9 (2.5) |
10.5 (2.6) |
24.4 (5.7) |
20.8 (3.3) |
8.2 (1.7) |
11.4 (2.8) |
14.9 (2.9) |
|
| TOTAL | 53.8 (3.5) |
17.7 (2.2) |
10.2 (1.5) |
14.0 (1.4) |
30.0 (2.6) |
20.1 (2.1) |
12.3 (1.7) |
9.4 (1.3) |
24.0 (2.1) |
|
|
a Caregivers of children aged 0-2 years are more likely than caregivers of children aged 11+ years to have concrete services provided or arranged (X2=11.5, p<.001). (back) b Caregivers of children aged 0-2 years are more likely than caregivers of children aged 11+ years to have substance abuse services provided or arranged (X2=10.1, p<.01). (back) c White caregivers are more likely than African American caregivers to have other services provided or arranged (X2=17.8, p<.001). (back) |
| Type of Service | No Services Percent Yes (SE) |
Services Percent Yes (SE) |
Total Percent Yes (SE) |
|---|---|---|---|
| Counseling or Mental Health Treatment | 48.0 (6.2) |
58.1 (3.1) |
53.8 (3.5) |
| Concrete Services (Food, Clothing, Shelter, Transportation) | 10.4 (3.0) |
23.1 a (2.1) |
17.7 (2.2) |
| Income Support | 6.1 (2.3) |
13.2 b (1.4) |
10.2 (1.5) |
| Substance Abuse Treatment | 9.8 (2.5) |
17.0 (2.4) |
14.0 (1.4) |
| Parenting Classes | 28.3 (5.1) |
31.2 (2.3) |
30.0 (2.6) |
| Family Support Center or Services | 19.2 (2.9) |
20.8 (2.2) |
20.1 (2.1) |
| Domestic Violence Services | 13.8 (4.0) |
11.3 (1.3) |
12.3 (1.7) |
| Legal Services | 8.8 (2.5) |
9.9 (1.5) |
9.4 (1.3) |
| Other Service | 23.0 (4.6) |
24.8 (2.4) |
24.0 (2.1) |
|
a Caregivers with open, in-home child welfare cases are more likely than caregivers with closed, in-home cases to have concrete services provided, arranged, or referred (X2=13.48, p<.001). (back) |
8.2.4 Discussion of In-Home Caregiver Services
Receipt of TANF/AFDC services among in-home caregivers is high, with 61% having received these services in their lifetime. African American and Hispanic caregivers are more likely than White caregivers to have received these services, while male caregivers are less likely than female caregivers to have received TANF/AFDC. Currently, 21% of in-home caregivers are receiving TANF, a rate much higher than that seen in the U.S. population as a whole (U.S. Department of Health and Human Services, 2002). (These data were not collected about the parent[s] of children in out-of-home care.)
About 1 in 12 caregivers (8%) report currently receiving mental health services, while 12% have received these services in the past year, much higher than the annual rate of 6% reported for the U.S. adult population as a whole (U.S. Department of Health and Human Services, 1999). Younger caregivers are less likely to have used mental health services in the past 12 months, a noteworthy finding given the high rates of mental health need reported by these caregivers. Inpatient mental health services have been used by 3% of in-home caregivers in the past year, whereas 10% report having ever used inpatient services. Hispanic caregivers are significantly less likely to report lifetime use of inpatient mental health services.
Two percent of in-home caregivers are currently receiving alcohol and drug treatment services, slightly higher than the rates reported by the 2001 National Survey on Drug Use and Health (NSDUH), formerly known as the National Household Survey on Drug Abuse (SAMHSA, 2002); 10% report ever having received these services. Caregivers receiving child welfare services are almost three times more likely to report current use of alcohol and drug services than those in-home caregivers not receiving child welfare services, although fewer than 4% of caregivers receiving in-home services are also currently receiving alcohol and drug services. The youngest (less than age 24) and oldest (aged 55 and over) age groups are less likely to indicate having ever received drug and alcohol services in their lifetime.
According to child welfare worker reports, a large proportion of in-home caregivers with an open child welfare case are provided services, have services arranged for them by the child welfare worker, or are referred to necessary services. Clearly, having an open child welfare case is related to service provision or recommendation. Child welfare workers, however, also assess families with closed child welfare cases and recommend that about one in four of these families receive services (25%).
The high proportion of caregivers for whom services have been provided, arranged, or referred indicates that child welfare workers are assessing a broad range of family needs and taking steps toward having these needs addressed. Yet there is a discrepancy between service receipt information provided by caregivers and service provision, arrangement, and referral reported by child welfare workers. In some cases, characteristics of the service environment play a role in caregiver access to services. For example, difficulty finding childcare or transportation to get to services may impede caregiver service receipt. Alternatively, caregivers may not see the need or value in following through with recommended service plans.
8.3 Relationship Between In-Home Service Recipients and Child Welfare Workers
The goals of in-home child welfare interventions are to preserve and strengthen families and to protect the children in the home. A child welfare worker’s ability to work constructively with caregivers, generally biological parents, should contribute to achieving these goals (DePanfilis, 2000). A relationship characterized by mutual respect, shared decision-making, and understanding is a goal child welfare workers are encouraged to achieve when working with families (Stehno, 1986).
Many different strategies are employed by child welfare agencies to monitor children’s safety and encourage family change, including the use of homemakers, contracted services from family preservation agencies, and direct services provided by the child welfare worker. Some of these functions may be designated to other agencies that provide in-home services, but the child welfare worker typically coordinates the service plan. Meetings with the family to obtain information about child and family functioning, service needs, and the family’s progress toward goals is very often part of in-home child welfare interventions. Although families may receive many types of services and work with several different helping professionals, the common assumption is that the relationship between the child welfare worker and the caregiver is central to the process (DePanfilis, 2000).
However, child welfare workers and in-home caregivers must negotiate a relationship that is often complicated by the competing responsibilities inherent in a child welfare worker’s role. The child welfare worker is continually assessing whether a child’s current living environment is adequately safe, whether changes can be made within the home to ensure a child’s safety, or whether one or more family members should live elsewhere if children are to remain in the home. The child welfare worker must work with the in-home caregiver as well as the courts to determine how the case should proceed, how long services will be provided, and which services may be required (Rooney, 2000). Decisions such as these may be mutual between the caregiver and the child welfare worker, or there may be disagreement and, quite possibly, tension.
Little is known empirically about how caregivers perceive their relationship with child welfare workers. Still less is known about how this relationship affects children’s safety and well-being. Most theories of helping emphasize relationship-building as the cornerstone of successful intervention (Kadushin, 1990; Perlman, 1984; Shulman, 1992), yet the relationship between child welfare workers and caregivers who are reported to CPS is unique. Parents generally do not voluntarily seek assistance from social service or child protection agencies (Keller & McDade, 2000). The typically involuntary nature of the relationship raises the question of whether a caregiver can view a child welfare worker as an ally: someone who understands a caregiver’s life circumstances and who can join with him/her to make needed changes. The literature on relationships between child welfare workers and clients is mixed and characterized by small, unrepresentative samples. Existing studies that document caregivers’ perceptions of their experiences with CWS highlight extreme views, ranging from highly negative caregiver experiences to positive and even life-changing relationships with child welfare workers (Akin & Gregoire, 1997; Fryer et al., 1990).
To learn more about caregiver perceptions of child welfare workers, NSCAW asked in-home caregivers receiving CWS a series of questions about their satisfaction with their child welfare workers. Caregivers reported their frequency of contact with the child welfare worker, their beliefs about whether the child welfare worker understood their family’s needs, and whether or not they felt the child welfare worker treated them respectfully. In addition, caregivers were asked how well the services to which they were referred met their needs.
8.3.1 Contact between Caregivers and Child Welfare Workers
Caregivers of children remaining in the home and receiving CWS were first asked by NSCAW interviewers whether or not they had talked with a child welfare worker since the start of the investigation. Most caregivers (72%) reported they had spoken with a child welfare worker since the start of the investigation, but a sizable proportion (28%) of clients classified as having open child welfare cases reported they had not spoken with a child welfare worker since the investigation. (See Section 3.3 for a detailed discussion of how the classification of having an open case was determined.) Because this was an unexpected finding, several analyses were undertaken to investigate what might account for almost one-third of caregivers with open cases reporting no contact with a child welfare worker. Bivariate and multivariate analyses of this phenomenon constitute the initial analysis of caregivers’ satisfaction with child welfare services.
Table 8-12 summarizes demographic and case characteristics of caregivers with open in-home cases regarding reported verbal contact with a child welfare worker since the investigation. Bivariate tests for differences between caregivers reporting no verbal contact and those reporting verbal contact are presented. Case characteristics such as the outcome of the investigation, report of child harm, and risk severity are included in these analyses to test the hypothesis that child welfare workers prioritize cases by these factors, which would, in turn, relate to contact with a given caregiver. Table 8-13 presents the results of multivariate analyses testing the likelihood of caregiver and child welfare worker verbal contact by caregiver demographic characteristics and selected case characteristics, again, with the hypothesis that these factors may be related to likelihood of contact. Discussion of the results of these inquiries concludes this initial section of caregivers’ satisfaction with child welfare services.
| Caregivers’ Verbal Contact with a Child Welfare Worker Percent Yes (SE) |
||
|---|---|---|
| Total | 72.3 (3.7) |
|
| Caregiver Age | <25 | 71.9 (6.8) |
| 25 – 34 | 75.6 (3.8) |
|
| 35 – 44 | 70.8 (6.2) |
|
| 45 – 54 | 61.6 (8.9) |
|
| >54 | 69.9 (7.4) |
|
| Caregiver Race/ Ethnicity | White | 80.3 (3.5) |
| African American | 63.4 a (5.7) |
|
| Hispanic | 59.1 (10.2) |
|
| Other | 81.5 (5.3) |
|
| Child Age | 0-2 | 80.8 (2.6) |
| 3-5 | 70.0 (6.1) |
|
| 6-10 | 71.3 (5.2) |
|
| 11+ | 69.8 (7.0) |
|
| Investigation Outcome | Substantiated/High Risk | 79.2 (3.6) |
| Indicated/Medium Risk | 68.3 (11.7) |
|
| Neither/Low Risk | 68.6 (5.7) |
|
| Child Harm | None | 72.9 (5.4) |
| Mild | 71.0 (4.8) |
|
| Moderate | 74.6 (7.3) |
|
| Severe | 79.6 (5.3) |
|
| Risk Severity | None | 78.6 (6.3) |
| Mild | 71.2 (6.5) |
|
| Moderate | 76.3 (4.9) |
|
| Severe | 82.7 (3.0) |
|
| Type of Maltreatment | Physical Abuse | 71.5 (5.6) |
| Sexual Abuse | 62.8 (9.0) |
|
| Failure to Provide | 77.3 (7.2) |
|
| Failure to Supervise | 79.5 (4.2) |
|
| Other | 73.4 (6.5) |
|
Descriptive differences in the proportion of in-home caregivers who indicated that they had contact with a child welfare worker by caregiver age, race/ethnicity, investigation outcome, risk, child harm, and maltreatment type are summarized in Table 8-12.
Bivariate comparisons show a significant difference by caregiver race/ethnicity, with fewer African American caregivers reporting they had spoken with a child welfare worker since the investigation compared with White caregivers. There are no other significant bivariate differences in caregiver reports of verbal contact with regard to caregiver age, child age, investigation outcome, risk severity, child harm, and most serious type of maltreatment.
To further examine the factors that might account for differences in caregiver-child welfare worker verbal contact among open, in-home cases, we expanded these analyses to include a multivariate model, adding additional variables such as agency and service characteristics. The following possibilities were assessed in the multivariate model:
-
case characteristics, such as the severity of risk or the child’s age, are associated with the likelihood of contact with a child welfare worker
-
agency characteristics, such as differences in agency resources, may influence the extent to which child welfare workers are in contact with caregivers
-
service types and decisions, such as referring a family to additional services, when compared with child welfare agency provision of services, will relate to the likelihood a caregiver has spoken with a child welfare worker.
| OR | 95% CI | ||
|---|---|---|---|
| Caregiver Race/ Ethnicity | White | (reference group) | |
| African American | .43 | .22, .87 | |
| Hispanic | .44 | .19, 1.05 | |
| Other | 1.19 | .46, 3.05 | |
| Child Age | 0 – 2 | 1.57 | .66, 3.73 |
| 3 – 5 | .88 | .39, 1.99 | |
| 6 – 10 | .95 | .48, 1.88 | |
| 11+ | (reference group) | ||
| Maltreatment Type | Physical | .68 | .39, 1.18 |
| Sexual | .43a b | .24, .76 | |
| Failure to Provide | .66 | .30, 1.45 | |
| Failure to Supervise | (reference group) | ||
| Other | .73 | .29, 1.83 | |
| Risk Severity^ | None | (reference group) | |
| Mild or moderate | .47 | .16, 1.37 | |
| Severe | .42 | .13, 1.35 | |
| Investigation Outcome | Neither/Low Risk | (reference group) | |
| Indicated/Medium Risk | 1.35 | .58, 3.14 | |
| Substantiated/High Risk | 2.25c | 1.33, 3.80 | |
| Urbanicity | Urban | (reference group) | |
| Non-urban | 1.28 | .51, 3.23 | |
| County Poverty Level | Non-Poor | (reference group) | |
| Poor | .55 | .27, 1.11 | |
| Child Welfare Service Status | At least one service provided | 2.01 | 1.12, 3.60 |
| All services arranged or referred | (reference group) | ||
|
^ Child welfare workers are asked to describe the level of severity of risk on a 4-point Likert scale. Cox and Snell pseudo-R2 is .12; n=1740 (back) a Caregivers of children with sexual abuse as the most serious maltreatment type have less odds of verbal contact with a child welfare worker than caregivers of children with neglect-failure to supervise as the most serious maltreatment type (p≤.01). (back) b Caregivers of children with sexual abuse as the most serious maltreatment type have less odds of verbal contact with a child welfare worker than caregivers of children with neglect-failure to provide as the most serious maltreatment type (p≤.01). (back) |
Several significant differences emerge in multivariate analyses. The odds of verbal contact with a child welfare worker vary by maltreatment type, investigation outcome, child welfare service status, and caregiver race/ethnicity (Table 8-13). A most serious maltreatment type of sexual abuse is associated with less odds of caregiver-child welfare worker verbal contact, as reported by caregivers, compared with cases wherein neglect—failure to provide and failure to supervise—is the most serious maltreatment type (p<.01 for both). Caregivers with substantiated or high-risk cases, when compared with unsubstantiated or low-risk cases, are significantly more likely to report verbal contact with a child welfare worker (p<.01). African American caregivers have a tendency to report no verbal contact with a child welfare worker, compared with White caregivers (p<.05). Finally, caregivers whose child welfare worker reports providing at least one service (e.g., parenting training, individual counseling) tend (p < .05) to report verbal contact with a child welfare worker compared with caregivers whose child welfare worker reports that all services were arranged or referred to another agency. Risk severity, child age, agency urbanicity, and county poverty level are not significantly associated with caregiver and child welfare worker verbal contact. 30
The logistic regression presented in Table 8-13 supports and extends the bivariate findings related to caregiver race/ethnicity and verbal contact. African American caregivers with open, in-home cases have a tendency toward lesser odds than White caregivers of reporting verbal contact with a child welfare worker (p ≤.05). In addition, the finding that caregivers of children with neglect as the most serious maltreatment type are more likely to report verbal contact with a child welfare worker compared with caregivers of children with sexual maltreatment as the most serious maltreatment type is intriguing. One possible explanation is that for children remaining in a home wherein sexual abuse was investigated, the abusive individual may have left the home either because of law enforcement intervention or because the non-offending caregiver has separated from the abusive party, thus requiring less immediate child welfare worker response. (This possibility cannot be tested with available data.)
We conducted one additional analysis regarding the finding that a substantial proportion of caregivers with open, in-home cases report no contact with a child welfare worker since the investigation. We explored the possibility that the timing of data collection influenced these findings. This does not appear to be the case. On average, the caregiver interview was completed within 6 months of caregivers’ first contact with a child welfare worker following the report of abuse or neglect. The elapsed time between the investigation and the research interview for caregivers indicating no contact with a child welfare worker does not differ significantly from the elapsed time among caregivers indicating that they had not spoken with a child welfare worker.
In addition, the possibility that NSCAW data collection and analysis decisions play a role in the findings must also be considered. Children and caregivers may be underserved in some unsystematic way that the data are not detecting. Some caregivers could also have been misclassified in regard to in-home services during study sampling or in subsequent analyses to determine service classifications. (Chapter 3 describes this protocol.) Measurement error is a possibility; the interview question may not have been uniformly understood by caregivers, there could be confusion among caregivers as to whom the question is referring, or caregivers might call their child welfare worker 31 by another title (such as social worker).
In all, the findings indicate that there are likely to be systematic reasons why caregivers with cases classified as “open” report that they have had no contact with a child welfare worker. The most likely caregivers to report no contact were those who did not have substantiated or high-risk cases and who had sexual abuse cases (and not those with neglect cases). Caregivers with referred or arranged services (with the exception of substance abuse and legal services) and African American caregivers (compared with White caregivers) have a tendency to receive less contact.
Nevertheless, the fact that over one-quarter of caregivers with open in-home child welfare cases reported no verbal contact with a child welfare worker since the investigation remains a puzzle for which the NSCAW research team, unfortunately, does not have definitive answers. This finding leaves open the possibility that many families are receiving little or no timely services from the agency entrusted to help them provide safe and continuous care for their children. Caregiver report of no verbal contact among open, in-home cases, on the contrary, may not necessarily indicate that caregivers were in need of such contact and did not receive it. Of the caregivers reporting no verbal contact, 47% were identified as “low risk” and 17% were judged as “indicated” or “medium risk” cases by the child welfare worker. As tested above, a substantial proportion of caregivers (28%) reporting no verbal contact received contracted CWS (referred or arranged services), and about 1% were indicated as abandoned in-home cases, presumably because children were left in the care of family members already living in the home. When these cases are unduplicated, the cases that have at least one of these reasons account for 89% of the caregivers who report no verbal contact with a child welfare worker. Even so, further examination of which families do not have timely ongoing contact with CWS and the factors associated with less contact ought to be priorities in future research.
8.3.2 Recentness of Caregiver and Child Welfare Worker Contact and Number of Child Welfare Workers
Those in-home caregivers who indicated they had spoken with a child welfare worker since the investigation were asked questions about this relationship. Bivariate and multivariate analyses were conducted to explore relationships between caregiver characteristics and (1) recentness of child welfare worker contact and (2) number of child welfare workers with whom caregivers had contact since the investigation. The recentness of caregiver-child welfare worker contact was analyzed using two additional variables—investigation outcome and maltreatment type—because the researchers hypothesized that these variables are related to child welfare worker response. Since a large majority of caregivers had met with two or fewer workers since the investigation, the analyses of this item (Table 8-14) included only caregiver demographic variables.
| Caregivers’ Last Verbal Contact with a Child Welfare Worker | |||||
|---|---|---|---|---|---|
| Within Past Week | 2-4 Weeks Ago | 1-3 Months Ago | 4-6 Months Ago | ||
| Percent / (SE) | |||||
| Total | 35.1 (2.4) |
32.5 (2.5) |
20.5 (2.2) |
11.9 (1.7) |
|
| Caregiver Age | <25 | 33.0 (4.0) |
35.8 (4.1) |
19.7 (4.0) |
11.5 (3.0) |
| 25 – 34 | 37.0 (4.4) |
30.0 (3.4) |
20.3 (2.2) |
12.7 (2.4) |
|
| 35 – 44 | 34.0 (5.6) |
32.5 (6.3) |
21.0 (5.8) |
12.5 (2.4) |
|
| 45 – 54 | 29.6 (6.0) |
41.1 (5.7) |
25.5 (7.0) |
–– | |
| >54 | 49.1 (11.8) |
26.2 (8.2) |
–– | –– | |
| Caregiver Race/ Ethnicity | White | 32.2 (3.2) |
32.5 (3.6) |
21.3 (2.8) |
13.9 (2.8) |
| African American | 41.5 (4.0) |
34.4 (3.7) |
16.1 (2.3) |
8.1 (2.0) |
|
| Hispanic | 33.1 (10.9) |
28.7 (6.1) |
26.3 (6.4) |
12.0 (3.5) |
|
| Other | 39.4 (6.0) |
32.5 (6.2) |
18.6 (6.8) |
9.6 (2.7) |
|
| Child Age | 0 – 2 | 38.4 (3.8) |
27.9 (3.7) |
21.9 (3.3) |
11.8 (2.8) |
| 3 – 5 | 34.0 (5.4) |
36.1 (5.5) |
18.6 (3.9) |
11.3 (2.7) |
|
| 6 – 10 | 35.3 (4.6) |
32.7 (3.9) |
19.1 (2.8) |
12.9 (2.6) |
|
| 11+ | 33.2 (4.7) |
32.6 (5.5) |
22.8 (4.4) |
11.4 (2.6) |
|
| Investigation Outcome | Substantiated/High risk | 32.6 (3.3) |
39.6 (3.2) |
17.3 (2.3) |
10.5 (2.3) |
| Indicated/Medium risk | 36.1 (3.8) |
30.8 (4.5) |
22.9 (4.6) |
10.1 (2.7) |
|
| Neither/Low risk | 38.7 (4.3) |
24.4 (3.7) |
25.0 (3.5) |
11.9 (2.3) |
|
| Type of Maltreatment | Physical abuse | 32.8 (4.3) |
29.4 (4.8) |
28.7 (4.9) |
9.1 (2.0) |
| Sexual abuse | 20.8 (5.7) |
47.1 (11.3) |
16.2 (4.3) |
16.0 (5.3) |
|
| Failure to provide | 38.0 (4.4) |
29.3 (4.1) |
16.1 (3.1) |
16.6 (4.5) |
|
| Failure to supervise | 39.2 (4.4) |
32.7 (3.7) |
20.3 (3.4) |
7.9 (2.3) |
|
| Other | 34.1 (7.4) |
38.8 (7.0) |
19.8 (4.2) |
7.3 (3.2) |
|
Caregivers of children remaining in the home and receiving child welfare services were asked when they last spoke with a child welfare worker. The majority of caregivers (66%) reported speaking with a child welfare worker within the past month. A full fifth of the caregivers (20%) had last spoken with a child welfare worker 2 to 3 months ago, and 13% of the caregivers last spoke with a child welfare worker 4 months ago or longer. Table 8-14 presents differences in last verbal contact by caregiver age and race/ethnicity. In bivariate analyses, neither race/ethnicity nor caregiver age was significantly related to the recentness of contact between caregivers and child welfare workers.
Bivariate analyses indicate a trend by investigation outcome: caregivers whose maltreatment was judged substantiated or high risk are different from caregivers whose maltreatment was considered neither substantiated nor indicated or low risk (p=.03). The high-risk group reported more recent contact with a child welfare worker than did the lower-risk group. No other notable between-group differences were found in these analyses.
A regression analysis was performed to further understand the bivariate findings. Table 8-15 presents the results of this analysis. In the multivariate analysis, race/ethnicity is significant, as African American caregivers appear to have had more recent contact with a child welfare worker than White caregivers (p£.001). Caregivers of other race/ethnicity have spoken with a child welfare worker more recently than have White caregivers (p£.05). These findings stand in contrast to the previous analysis that includes all in-home cases, which indicated that African American and Hispanic caregivers were significantly less likely to report any verbal contact with a child welfare worker. Future analyses will hopefully shed light on factors that may influence the recentness of contact between caregivers and child welfare workers by caregiver race/ethnicity. A trend is present by maltreatment type, with caregivers of children with a most serious maltreatment type of sexual abuse reporting less recent contact with a child welfare worker compared with caregivers of children with a most serious maltreatment type of physical abuse (p =.06).
Caregivers of children remaining in the home and receiving CWS also reported how many different child welfare workers they had met or talked with since the maltreatment investigation. Responses show that most caregivers (73%) interacted with a low number of child welfare workers (i.e., two or fewer). Table 8-16 presents percentages and standard errors for the number of different child welfare workers with whom caregivers have spoken by caregiver age and race/ethnicity. Bivariate analyses showed no significant differences in the number of child welfare workers these caregivers met or talked with by age or race/ethnicity of the caregiver.
8.3.3 Caregivers’ Perceived Quality of the Relationship with their Child Welfare Worker(s)
Families have described the worker-client relationship as a strong contributor to service effectiveness (Walton & Dodini, 1999). In a study of family preservation services, clients reported that a worker’s most helpful activity was “sincerely caring and being a good friend” (Walton & Dodini, 1999); in another, clients reported that “listening and being heard” was the most highly valued quality in an in-home therapist (Coleman & Collins, 1997). NSCAW asked caregivers receiving in-home child welfare services and indicating verbal contact with a child welfare worker nine questions about specific aspects of their interactions with their child welfare worker(s). The mean responses for each item are shown in Table 8-17. Using factor analysis, a scale depicting caregivers’ perceived quality of the relationship they have with their child welfare worker(s) was created using eight of the nine items. Results of bivariate analyses associating caregivers’ perceived satisfaction with caregiver demographics and selected case characteristics are presented. Finally, multivariate analyses presented in Table 8-18 indicate the relationship between caregivers’ satisfaction with services and caregiver age and race/ethnicity, caregiver-child welfare worker racial match, recentness of verbal contact, number of different child welfare workers, and investigation outcome.
| Beta Coefficient (SE) | ||
|---|---|---|
| Caregiver Age | <25 | -5.45 (9.6) |
| 25 – 34 | 7.26 (8.7) | |
| 35 – 44 | (reference group) | |
| 45 – 54 | 4.59 (10.6) | |
| >54 | 3.77 (13.6) | |
| Caregiver Race/ Ethnicity | White | (reference group) |
| African American | -21.15 (5.3) a | |
| Hispanic | -3.8 (9.3) | |
| Other | -17.02 (7.2) | |
| Child Age | 0 – 2 | 7.43 (11.4) |
| 3 – 5 | -5.39 (7.5) | |
| 6 – 10 | -5.80 (6.2) | |
| 11+ | (reference group) | |
| Investigation Outcome | Substantiated/High Risk | -6.08 (6.0) |
| Indicated/Medium Risk | -0.16 (8.4) | |
| Unsubstantiated/Low Risk | (reference group) | |
| Maltreatment Type | Physical abuse | (reference group) |
| Sexual abuse | 18.71 (9.7) | |
| Failure to provide | 8.77 (6.4) | |
| Failure to supervise | 4.20 (6.6) | |
| Other | -2.99 (6.4) | |
|
Multiple R2 is .02; n=1592 |
| Number of Different Child Welfare Workers | |||
|---|---|---|---|
| 1 or 2 Percent (SE) |
3 or more Percent (SE) |
||
| Total | 73.3 (2.6) |
26.7 (2.6) |
|
| Age | <25 | 77.2 (3.9) |
22.8 (3.9) |
| 25 – 34 | 77.6 (2.7) |
22.4 (2.7) |
|
| 35 – 44 | 64.7 (5.9) |
35.3 (5.9) |
|
| 45 – 54 | 69.6 (5.6) |
30.4 (5.6) |
|
| >54 | 92.5 (3.8) |
7.5 (3.8) |
|
| Race/ Ethnicity | White | 72.0 (3.7) |
28.0 (3.7) |
| African American | 78.4 (3.8) |
21.6 (3.8) |
|
| Hispanic | 70.3 (6.0) |
29.7 (6.0) |
|
| Other | 69.7 (5.3) |
30.3 (5.3) |
|
| Mean Score | |
|---|---|
| Child welfare worker listened to them | 5.12 |
| Child welfare worker understood their situation | 3.50 |
| Child welfare worker treated them with respect | 5.36 |
| Child welfare worker treated them fairly | 5.12 |
| Child welfare worker explained problems, treatment, and/or services to them | 3.78 |
| Child welfare worker maintained contact with them | 4.63 |
| Child welfare worker invited them to relevant meetings about their child | 4.74 |
| Child welfare worker involved them in decision-making about their child | 4.79 |
Caregivers were asked how often their child welfare worker(s) (1) listened to their concerns, (2) understood their situation, (3) treated them with respect, (4) treated them fairly, (5) explained treatment and service options to them, and (6) met with them to develop an action plan to address their needs and concerns. Additional questions addressed the extent to which caregivers have been satisfied with the amount of contact they have with their child welfare worker(s), their involvement in relevant meetings, and participation in decision-making. Table 8-17 presents caregivers’ mean satisfaction scores on these items (the items were derived by summing caregivers’ responses and dividing by the total number of questions answered by each respondent).
Factor analysis confirmed that eight of these nine items were related and a scale was created to depict caregivers’ perceived quality of the relationship they have with their child welfare worker(s). The resulting scale has a possible range of 1 to 8, with higher scores indicating higher relationship quality. The construct shows high internal consistency (a=.89). The mean score for the sample was 4.59, indicating that caregivers report a middle level of perceived relationship quality.
Table 8-18 presents a comparison of mean relationship quality by caregiver age, race/ethnicity, last verbal contact with a child welfare worker, number of different child welfare workers, and the racial match between child welfare worker and caregiver. Consistent with the helping literature, case characteristics that promoted relationship building were chosen for the analysis; specifically, recentness of child welfare worker visits and the number of child welfare workers with whom the caregiver had interacted were included. The investigation outcome was included because of concerns in previous studies that caregivers judge their child welfare workers solely based on the outcome of the case (English et al., 2002). Racial matching was determined by creating a variable using self-reported child welfare worker race and self-reported caregiver race. The created variable is a dichotomous yes or no variable. It refers to the child welfare worker who completed the NSCAW caseworker interview.
The recentness of contact, a lower number of child welfare workers that a caregiver had worked with, and an investigation outcome that was neither substantiated nor indicated or considered low risk were significantly associated with higher perceived relationship quality. A regression analysis was performed to further test these associations and to predict a caregivers’ perceived relationship with the child welfare worker (Table 8-19). The predictors were age, race/ethnicity, caregiver-child welfare worker racial match, last verbal contact with a child welfare worker, the number of different child welfare workers, and investigation outcome. Three of the bivariate findings were confirmed. As expected, caregivers who had contact with child
welfare workers more recently had more positive feelings about the relationship. In addition, caregivers who had had three or more child welfare workers expressed lower levels of perceived relationship quality than those caregivers who had worked with only one or two child welfare workers. Finally, caregivers whose maltreatment investigation was judged as indicated or of medium risk were significantly less positive about their relationship with their child welfare worker(s) than caregivers whose maltreatment was considered neither substantiated nor indicated or judged low risk.
In summary, in-home caregivers receiving child welfare services report relationships with their child welfare worker(s) that are of moderate quality. Caregivers report the highest satisfaction, on average, with the following aspects of their relationship with their child welfare worker(s): feeling listened to, feeling respected, and feeling as though they were treated fairly. Caregivers report the least satisfaction in regard to believing their child welfare worker(s) understood their situation and explained their problems and treatment or service options to them. Differences in caregivers’ perceived relationship quality, according to multivariate analyses, appear related to child welfare worker actions and case characteristics as opposed to caregiver demographics.
| Mean Satisfaction with Child Welfare Worker Relationship (SE) | ||
|---|---|---|
| Total | 4.6 (0.1) | |
| Caregiver Age | <25 | 4.4 (0.2) |
| 25-34 | 4.7 (0.1) | |
| 35-44 | 4.4 (0.2) | |
| 45-54 | 5.0 (0.3) | |
| >54 | 5.1 (0.3) | |
| Caregiver Race/Ethnicity | White | 4.5 (0.1) |
| African American | 4.8 (0.2) | |
| Hispanic | 4.8 (0.4) | |
| Other | 4.5 (0.3) | |
| Caregiver-Caseworker Racial Match | Yes, race matches | 4.7 (0.1) |
| No, race does not match | 4.5 (0.2) | |
| Last Verbal Contact with Child Welfare Worker | Within the past week | 4.7 (0.2) a |
| 2-4 weeks ago | 4.7 (0.2) b | |
| 2-3 months ago | 4.6 (0.2) c | |
| 4-6 months ago | 3.8 (0.3) d | |
| Over 6 months ago | 5.3 (0.3) | |
| Number of Different Child Welfare Workers | 1 or 2 | 4.7 (0.1) e |
| 3 or more | 4.3 (0.1) | |
| Investigation Outcome | Substantiated/high risk | 4.3 (0.2) f |
| Indicated/medium risk | 4.2 (0.2) g | |
| Neither/low risk | 5.0 (0.2) | |
|
a Caregivers whose last verbal contact with a child welfare worker was within the last week had higher perceived relationship quality than caregivers whose last verbal contact was 4 to 6 months ago (t=2.6, p<.01). (back) b Caregivers whose last verbal contact with a child welfare worker was between 2 to 4 weeks ago had higher perceived relationship quality than caregivers whose last verbal contact was 4 to 6 months ago (t=2.9, p<.01). (back) c Caregivers whose last verbal contact with a child welfare worker was 2 to 3 months ago had higher perceived relationship quality than caregivers whose last verbal contact was 4 to 6 months ago (t=2.5, p≤.01). (back) d Caregivers whose last verbal contact with a child welfare worker was over 6 months ago had higher perceived relationship quality than caregivers whose last verbal contact with a child welfare worker was 4 to 6 months ago (t=-3.4, p≤.001). (back) e Caregivers meeting or speaking with 1 or 2 different child welfare workers had higher perceived relationship quality than caregivers meeting or speaking with 3 or more different child welfare workers (t=3.2, p≤.001). (back) f Caregivers whose maltreatment was substantiated or high risk had lower perceived relationship quality than caregivers whose maltreatment was neither substantiated nor indicated and considered low risk (t=-2.6, p≤.01) (back) |
| Beta Coefficient (SE) | ||
|---|---|---|
| Caregiver Age | <25 | -.05 (.22) |
| 25 – 34 | .26 (.20) | |
| 35 – 44 | (reference group) | |
| 45 – 54 | .60 (.30) | |
| >54 | .52 (.41) | |
| Caregiver Race/Ethnicity | White | (reference group) |
| African American | .38 (.17) | |
| Hispanic | .45 (.30) | |
| Other | 0 | |
| Caregiver-Caseworker Racial Match | Yes, race matches | (reference group) |
| No, race does not match | -.36 (.19) | |
| Last Verbal Contact with Child Welfare Worker | Within the past week | .01 (.18) |
| 2 – 4 weeks ago | (reference group) | |
| 2 – 3 months ago | -.26 (.23) | |
| 4 – 6 months ago | -.96 (.34)a b | |
| Number of Different Child Welfare Workers | 1 or 2 | (reference group) |
| 3 or more | -.58 (.13)c | |
| Investigation Outcome | Substantiated/high risk | -.65 (.27) |
| Indicated/medium risk | -.78 (.31) d | |
| Neither/low risk | (reference group) | |
|
Multiple R2 is .13 ^ Caregivers whose last verbal contact with a caseworker was over 6 months ago were excluded from the regression analyses due to low numbers. (back) a Caregivers whose last verbal contact with a child welfare worker was 4 to 6 months ago had lower perceived relationship quality than caregivers whose last verbal contact was 2 to 4 weeks ago (p≤.01). (back) b Caregivers whose last verbal contact with a child welfare worker was 4 to 6 months ago had lower perceived relationship quality than caregivers whose last verbal contact was within the past week (p≤.01). (back) c Caregivers meeting or speaking with 3 or more different child welfare workers had lower perceived relationship quality than caregivers meeting or speaking with 1 or 2 different child welfare workers (p<.001). (back) |
8.3.4 Caregiver Perceptions of Service Adequacy
Caregivers receiving in-home child welfare services and indicating verbal contact with a child welfare worker were asked a final series of questions about their relationship with their child welfare worker. Items addressed the extent to which caregivers agreed that their child welfare worker(s) offered them necessary help, had given them enough time to make changes, and offered them enough services. Two additional questions addressed issues related to services to which the caregiver was referred: whether these services were helpful and whether services were delivered promptly. Following factor analysis to establish that all five items were associated with a single underlying construct, these items were summed and the score divided by the number of questions answered to create a scale depicting caregivers’ perception of service adequacy. The scale ranges from one to five, with higher scores indicating more positive perceptions of service adequacy. The scale shows satisfactory internal consistency (a=.74).
Table 8-20 presents comparisons of caregivers’ satisfaction with services by caregiver age, race/ethnicity, caregiver and child welfare worker racial match, recentness of contact, and number of child welfare workers with whom the caregiver had worked. No significant bivariate differences were found in caregivers’ levels of satisfaction with services by any of the comparison variables, although two comparisons by age suggested a trend. Caregivers over age 54 reported a tendency toward higher levels of satisfaction with service adequacy than 25- to 34-year-old caregivers (p=.04) and 35- to 44-year-old caregivers (p=.05). Multivariate analyses confirmed the bivariate findings. No significant differences were found between categories of caregivers’ age, race/ethnicity, caregiver–child welfare worker racial match, last verbal contact with a child welfare worker, or number of different child welfare workers with regard to caregivers’ satisfaction with service adequacy.
Overall, caregivers report a low level of satisfaction with service adequacy. Caregivers generally express greater dissatisfaction with help offered by the child welfare worker compared with the personal interactions they have with their child welfare worker, as presented in the previous analyses. Caregivers report low levels of satisfaction with aspects of service adequacy, such as receiving necessary services, receiving services that were helpful, and receiving services promptly.
8.3.5 Discussion of the Relationship Between In-Home Service Recipients and Child Welfare Workers
These findings answer some questions and raise new issues to be explored in the future. First, it remains unclear why some caregivers report that they had had no contact with their child welfare worker since the investigation. At this point, there is no definitive explanation for this finding. Of the hypotheses explored, none satisfactorily explains the lack of contact between caregivers and their child welfare worker(s) in 28% of in-home open cases, although many of the cases did have a possible explanation. The evidence that the likelihood of contact varies significantly by maltreatment type, types of services provided or recommended, and level of risk suggests that child welfare workers, even when working with families judged in need of child welfare services, may be unable to meet the demands of their caseload. Families judged by child welfare workers as lower risk (64% of the reported no-contact cases) appear to have the greatest risk of substantially delayed contact with their child welfare worker and related access to services. Yet findings presented earlier (see Chapter 4) indicate that many of the cases that are eventually identified as in need of more intensive child welfare services had prior contact with CWS. These lower-risk families appear to have substantial unmet needs for preventive child welfare services; they do not even get much surveillance. These findings argue for continued innovation in the way that CWS responds to families (National Study of Child Protective Services Systems and Reform Efforts, 2003) for whom traditional child welfare services are not offering much assistance.
More positively, caregivers report that they generally perceive their relationships with their child welfare workers to be of moderate quality. This would indicate that caregivers believe that their child welfare worker understands their circumstances and is sensitive to their needs.
| Mean Satisfaction with Service Adequacy (SE) | ||
|---|---|---|
| Total | 2.0 (0.11) | |
| Caregiver Age | <25 | 3.0 (0.07) |
| 25-34 | 2.9 (0.07) | |
| 35-44 | 2.9 (0.07) | |
| 45-54 | 3.0 (0.14) | |
| >54 | 3.2 (0.13) | |
| Caregiver Race/ Ethnicity | White | 3.0 (0.06) |
| African American | 2.9 (0.11) | |
| Hispanic | 2.7 (0.13 | |
| Other | 3.0 (0.14) | |
| Caregiver and Child Welfare Worker Racial Match | Yes, race matches | 3.0 (0.06) |
| No, race does not match | 2.8 (0.10) | |
| Last Verbal Contact with Child Welfare Worker | Within the past week | 2.9 (0.09) |
| 2-4 weeks ago | 3.0 (0.07) | |
| 2-3 months ago | 3.0 (0.07) | |
| 4-6 months ago | 2.8 (0.09) | |
| Number of Different Child Welfare Workers | 1 or 2 | 3.0 (0.05) |
| 3 or more | 2.9 (0.07) | |
Caregivers appear less satisfied with the adequacy of services that have been provided to them. Taken together, these two findings suggest that child welfare workers may be forming positive relationships with in-home caregivers but are not as able to identify service needs adequately and connect caregivers with appropriate services.
Finally, these findings support two hypotheses about helping relationships. Consistency of the child welfare worker and frequent contact enhance caregivers’ perceptions of the child welfare worker’s understanding of their life circumstances and the perception of service. In addition, caregiver race/ethnicity, caregiver age, and racial match between child welfare worker and caregiver do not seem to have an effect on caregivers’ perceptions, suggesting that effective working relationships can be formed regardless of such differences between child welfare worker and caregiver.
8.4 Summary and Conclusions
This chapter provides an overview of services received by in-home caregivers and presents caregiver reports of satisfaction with their child welfare worker and the services they receive. The high proportion of caregivers who report receiving public financial assistance is certainly related to the extent to which caregivers involved with CWS have difficulty meeting their family’s basic needs. This relationship between poverty and child welfare involvement is expected, but as noted in Chapter 3, about two-thirds of families involved with CWS are not assessed by child welfare workers as having trouble paying for the basic necessities in life, even though nearly 40% of these families are living below the poverty line (Barth, Wildfire, & Green, 2003). Thus, the relationship between poverty and the need for child welfare services is most often mediated by other factors.
At some odds with previous research, caregivers involved with CWS do not report extraordinarily high levels of involvement in substance abuse services. They do report substantial elevated rates of mental health service need, receipt, and unmet need. Although caregivers might be inclined to underreport their use and dependence on drugs and alcohol, even child welfare workers report rates of substance abuse that are considerably lower than the higher end estimates. This finding, coupled with the unmet mental health needs of younger caregivers, suggests that more attention needs to be paid to the links between child maltreatment and mental health. In addition, the importance of well-formed relationships between service providers—substance abuse, mental health, and child welfare—is evident. Child welfare workers are in an optimal position to facilitate these relationships and to forge relationships with caregivers that encourage necessary service participation. A respectful and productive relationship between a child welfare worker and caregiver serves to aid the helping process. Although the relationship between caregivers and child welfare workers were often judged to be positive, the same was not true of ratings of services provided to caregivers.
The key findings for in-home caregiver services are as follows:
-
The majority of in-home caregivers (61%) report ever having received TANF or AFDC.
-
African American caregivers are more likely to report receiving TANF/AFDC benefits, both currently and in the past, compared with White caregivers and caregivers of other race/ethnicities.
-
Rates of mental health service use among caregivers involved with CWS are much higher than in the general population; yet an additional 12% of in-home caregivers report needing mental health services but not receiving them.
-
A very small proportion of in-home caregivers report currently receiving substance abuse services (2%), and an equally small proportion of caregivers report needing substance abuse services but not receiving them (2%).
-
Some evidence suggests that having an open child welfare case increases the likelihood that caregivers receive mental health and substance abuse services.
-
Almost all caregivers with an open child welfare case (93%) have some type of service provided, arranged, or referred by their child welfare worker.
-
Mental health services are the most frequently provided, arranged, or referred caregiver service (54%), followed by parenting classes (30%).
-
Caregivers of young children (aged 0-2 years) are more likely to have services provided, arranged, or referred.
-
There is incongruence between the proportion of caregivers indicating they received mental health services in the past year and the proportion of caregivers whose child welfare workers reported providing, arranging, or referring mental health services.
The caregiver and child welfare worker relationship:
-
A sizable proportion of caregivers classified as having open, in-home child welfare cases (28%) report having no contact with their child welfare worker since the investigation, a concern that was thoroughly investigated but for which the NSCAW research team does not have definitive conclusions.
-
The majority of caregivers who had contact with a child welfare worker last had contact within the past month (66%).
-
Most in-home caregivers who had contact with a child welfare worker since the investigation met with a small number of different child welfare workers—two or fewer (73%).
-
In-home caregivers report the highest average satisfaction with the following aspects of the relationship: feeling listened to, feeling respected, and feeling as though they were treated fairly.
-
In-home caregivers report the least satisfaction in regard to believing their child welfare worker(s) understood their situation and explained their problems and treatment/service options to them.
-
More recent contact with a child welfare worker and a low number of different child welfare worker(s) are associated with higher reported relationship satisfaction, as reported by in-home caregivers.
-
In-home caregivers report less satisfaction with help offered by the child welfare worker than with personal interactions they have with their child welfare worker; caregivers report lower levels of satisfaction concerning receiving necessary services, receiving services that were helpful, and receiving services promptly.
More than twice as many children, and their families, receive child welfare services in their homes than receive them in out-of-home care. Then, again, about twice as many children receive no ongoing child welfare services following any given investigation. Yet considerably more research has been done on out-of-home care than on in-home services. These findings add significantly to the portrait of the services received by in-home caregivers and how they view themselves, their child welfare workers, and the services they receive.
Caregivers view themselves as troubled by mental health problems more often than by substance use or dependency. This view that mental health problems are a more common occurrence than substance abuse is not the same view that is generated from the risk assessment profiles completed by child welfare workers. Child welfare workers view the occurrence of substance abuse and mental health to be roughly equivalent among in-home caregivers. Despite the indications that mental health problems are impairing the functioning of many young parents, relatively few are receiving mental health services. Having an open child welfare case seems to encourage mental health service use—a potentially positive result of child welfare services case management that deserves more exploration.
The services received by in-home clients are often of a very low intensity, judging by the average recentness of contact between child welfare workers and caregivers and the proportion of caregivers reportedly receiving mental health and substance abuse services. Child welfare clients do not, on the whole, indicate that services are very helpful. Other studies suggest that more intensive services are often more highly valued than conventional services (e.g., Schuerman, Rzepnicki, & Littell, 1994), yet there is little evidence to rely on to make decisions about the most beneficial intensity or package of services. Future longitudinal analyses should contribute to the knowledge base.
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