ACF OPRE: National Survey of Child and Adolescent Well-Being (NSCAW)

6. Service Needs and Receipt

Child welfare services are intended to address the safety and permanency needs of children by providing direct services and coordinating services needed to assist families and children. The determination of need occurs in a variety of ways, including observation, interviewing, and assessment by third-party evaluators. The precise configuration of services provided or orchestrated by CWS will vary according to the conditions that brought the child and family to the attention of child welfare services and to the services that they are already receiving. Although there is no precise legal standard for the time that addressing these needs will take, the expectation of the Adoption and Safe Families Act is that most families whose children are placed in foster care will have had ample chance to benefit from services that are provided before their 12-month permanency hearing. In keeping with these principles, we also expect that most children who have been in foster care for about one year will have received an assessment for their service needs and referral to needed services. This chapter addresses the child welfare and other human services needs and services for the children in foster care for one year and for their families (as reported by the child welfare worker).

6.1 Risk Factors and Initial Services

Child welfare services are initiated in response to specific risks to the safety of children. Although the exact parameters of such risk assessments vary considerably across settings and individuals, an expected result of all risk assessment systems is to generate a case plan that fairly and effectively addresses extant risks. Although assessing effectiveness of service plans is beyond the scope of this chapter, the evidence does have bearing on our understanding of fairness by addressing whether families with different levels of risk appear to get different kinds of services and whether children with differing needs receive differing levels of service.

What family risk factors were present at the time of placement?

Although information about the reasons children in this sample originally entered foster care is sparse, some data are available about the risk factors that brought children into care. Child welfare workers were asked to identify risk factors that the family might have experienced prior to the placement, including active domestic violence, low social support, caregiver as victim of abuse, monetary problems, no second supportive caregiver present, lack of cooperation with authorities, and prior reports of maltreatment. Not having a second supportive caregiver present was the most common risk factor present at the time of placement. (It should be noted that caseworkers were not asked to identify all of the risk factors for OYFC as they were for CPS, because during pilot testing child welfare workers indicated that they would not have knowledge of some categories, such as substance abuse and incarceration, for children and families at the time of placement. However, information about the broad use of substance abuse services suggests that the use of drugs and alcohol was a contributor to placement.)

Do these family risk factors vary by child’s race, type of abuse, age, or placement type?

We examined the presence of risk factors by race of the child and the results appear in Figure 6-1. The number of risk factors varies from 0 (7% had none on this list) to 7 (2% had all risk factors), with about 60% of the parents having between 3 and 5 risk factors. The likelihood of the presence of risk factors at the time of placement did not vary significantly by race of the child.

Figure 6-1. Risk Factors at Time of Placement, by Race of Child
[D]

In addition, the likelihood of risk factors does not vary by the type of abuse of the child. Four types of abuse were included in this analysis—physical maltreatment, sexual maltreatment, failure to provide and failure to supervise. None of the risk factors was significantly related the type of abuse (Figure 6-2).

Figure 6-2. Risk Factors at Time of Placement, by Most Serious Type of Abuse
[D]

Low social support (Chi-square=9.08, p<0.05), a history of abuse of the primary caregiver (Chi-square=8.70, p<0.05), and prior reports of maltreatment (Chi-square=12.32, p<0.01) are significantly related to child age. Families with children 1 to 2 years old appear more likely to have had low social support at the time the child was removed (Chi-square= 9.08, p <.05). Young children (1 to 5 years old) also appear more likely than older children to have come from families with caregivers with a history of abuse (Chi-square= 8.70, p <.05). Families with older children, however, had more often experienced previous reports of maltreatment (Chi-square= 12.32, p<.01) (Figure 6-3).

Figure 6-3. Risk Factors at Time of Placement, by Age of Child
[D]

Risks were no different for children placed in kinship care, non-kinship foster care and group care (Figure 6-4). Apparently the removal reason and the placement resource that the child was in one year later are largely independent.

All of these findings about the risk factors at the time a child was placed should be interpreted as preliminary and with some caution because of the length of time that has elapsed since the placement and because the collection of risk data was not as comprehensive as it will be in the NSCAW CPS sample component data analyses.

Figure 6-4. Risk Factors at Time of Placement, by Placement Type
[D]

6.2 Caregiver Services

What are child welfare workers’ assessments of general human services that are needed by and provided to parents?

Child welfare workers were asked what types of general services were needed by and provided to the caregivers (primarily, biological parents) from whom the children were removed. Overall, child welfare workers indicated that 78% of caregivers needed income assistance, 70% needed employment services, 77% needed substance abuse services, 78% needed mental health services, 73% needed legal services; 62% needed domestic violence services; and 90% needed Medicaid. Housing services were needed by 71% of caregivers and health care services were needed by 49% of the families (Table 6-1).

Table 6-1. Caregiver Need for General Human Services in the past 12 Months
Type of Service	Proportion Needing Service % (95% CI)
Housing	71 (66, 75)
Income Assistance	78 (74, 81)
Legal	73 (68, 77)
Medicaid	90 (87, 93)
Domestic Violence	62 (56, 67)
Employment	70 (66, 74)
Mental Health	78 (74, 81)
Health	49 (46, 53)
Alcohol or Drug	77 (75, 82)
Day Care	78 (73, 82)

To more fully address the questions about types of service needed by primary caregivers, a need classification was developed. For this, we identified all caregivers who had an unaddressed need for a service, as identified by the child welfare worker. This classification of need excluded (1) caregivers who were not identified as having a service need and were not referred to that service, (2) caregivers who were already receiving the service at the time of the interview, (3) caregivers who received the service after they had been referred, and (4) caregivers who were referred for assessment but determined not to need the service. Tables 6-2 through 6-11 show the distribution of need by the type of service.

Over two-thirds of caregivers had a need for housing services at the time of the interview (Table 6-2). Just over half of all caregivers did not receive housing services (38%) or did not receive services although they were referred to services (13%). Twelve percent of caregivers received housing services after they were referred.

Over three-quarters of caregivers needed income assistance at the time of the interview (Table 6-3). Although 13% of caregivers received income assistance once they were referred, 42% did not have their need addressed and another 8% did not receive income assistance even though they were referred by the child welfare worker.

Table 6-2. Caregiver Need for Housing Services
Housing Services Not Received (57%)
	%
Need unaddressed	38
Did not receive service though referred	13
Missing	7
Housing Services Received (14%)
Already receiving service	2
Received service after referral	12
Referral made and service determined not to be needed	0.2
TOTAL HOUSING SERVICE NEED	71

Table 6-3. Caregiver Need for Income Assistance
Income Assistance Still Needed (57%)
	%
Need unaddressed	42
Did not receive service though referred	8
Missing	7
Income Assistance Not Needed (20%)
Already receiving service	7
Received service after referral	13
Referral made and service determined not to be needed	0
TOTAL INCOME ASSISTANCE NEED	78

The majority of caregivers had a need for legal services (Table 6-4). Some caregivers received legal services once they were referred by a child welfare worker (17%), but many caregivers did not have their need addressed (36%).

Table 6-4. Caregiver Need for Legal Services
Legal Services Still Needed (45%)
	%
Need unaddressed	36
Did not receive service though referred	2
Missing	7
Legal Services Not Needed (27%)
Already receiving service	10
Received service after referral	17
Referral made and service determined not to be needed	0.2
TOTAL LEGAL SERVICE NEED	73

Many caregivers needed Medicaid services (Table 6-5). Though some caregivers did receive Medicaid after they were referred to the program by a child welfare worker (14%), many caregivers did not have their need met (58%).

Table 6-5. Caregiver Need for Medicaid
Medicaid Still Needed (58%)
	%
Need unaddressed	N/A
Did not receive service though referred	1
Missing	57
Medicaid Not Needed (32%)
Already receiving service	18
Received service after referral	14
Referral made and service determined not to be needed	0
TOTAL MEDICAID NEED	90

Many caregivers needed domestic violence services (Table 6-6). Just under half did not have their need for domestic violence services met even though a child welfare worker knew that a need existed. A small proportion of the caregivers did receive help once they were referred (13%).

Table 6-6. Caregiver Need for Domestic Violence Services
Domestic Violence Services Still Needed (47%)
	%
Need unaddressed	25
Did not receive service though referred	7
Missing	16
Domestic Violence Services Not Needed (15%)
Already receiving service	2
Received service after referral	13
Referral made and service determined not to be needed	0
TOTAL DOMESTIC VIOLENCE SERVICES NEED	62

Over two-thirds of all caregivers needed employment services at the time of the interview (Table 6-7). Although 10% of the caregivers did have their need met after they were referred to employment services, 58% did not have their need for services met.

Almost 80% of the caregivers needed mental health services (Table 6-8). Just over half (52%) did not have their need for mental health services met, though 11% of the caregivers did receive mental health services after they were referred by a child welfare worker.

Table 6-7. Caregiver Need for Employment Services
Employment Services Still Needed (58%)
	%
Need unaddressed	38
Did not receive service though referred	7
Missing	13
Employment Services Not Needed (14%)
Already receiving service	3
Received service after referral	10
Referral made and service determined not to be needed	1
TOTAL EMPLOYMENT SERVICES NEED	72

Table 6-8. Caregiver Need for Mental Health Services
Mental Health Services Still Needed (52%)
	%
Need unaddressed	36
Did not receive service though referred	11
Missing	5
Mental Health Services Not Needed (26%)
Already receiving service	2
Received service after referral	11
Referral made and service determined not to be needed	0
TOTAL MENTAL HEALTH SERVICES NEED	78

Just under one-half of the caregivers had a need for health services (Table 6-9). Most caregivers did not have their need for health services met (41%).

Table 6-8. Caregiver Need for Mental Health Services
Health Services Still Needed (41%)
	%
Need unaddressed	12
Did not receive service though referred	1
Missing	28
Health Services Not Needed (8%)
Already receiving service	4
Received service after referral	4
Referral made and service determined not to be needed	0.1
TOTAL HEALTH SERVICES NEED	49

Over three-quarters of all caregivers needed alcohol or drug services at the time of the interview (Table 6-10). Just over one-quarter (27%) of the caregivers had their need met, though most of the caregivers did not have their need met (49%).

Table 6-10. Caregiver Need for Alcohol or Drug Services
Alcohol or Drug Services Still Needed (49%)
	%
Need unaddressed for alcohol problem^	49
Need unaddressed for drug problem	85
Did not receive service though referred	28
Missing	0
Alcohol or Drug Services Not Needed (27%)
Already receiving service	42
Received service after referral	14
Referral made and service determined not to be needed	0
TOTAL ALCOHOL OR DRUG SERVICES NEED	77

^ Sums to more than 100% because some caregivers need both alcohol and drug services.

The majority of caregivers had a need for day care services (78%), although about one-fifth (22%) did have their need met after they were referred to services (Table 6-11).

Table 6-11. Caregiver Need for Day Care Services
	%
Day Care Services Still Needed (66%)
Need unaddressed	N/A
Did not receive service though referred	3
Missing	63
Day Care Services Not Needed (34%)
Already receiving service	12
Received service after referral	22
Referral made and service determined not to be needed	0.3
TOTAL DAY CARE SERVICES NEED	78

The description of the service needs of the biological parents at the time the child entered out-of-home care suggests that the most common needs (all 77% or higher) were for Medicaid, income assistance, day care services, mental health services, and alcohol and drug treatment services. In addition, alcohol and drug treatment were the two services most likely to continue to be needed following a referral for them.

Among those who did not receive services despite a referral, refusal to attend was cited as the reason the service was not received for 70% of those who needed and were referred to alcohol or drug services and 77% of those who needed and were referred to mental health services. Another 20% of people who needed and were referred to these services did not receive the service for some reason other than the above. Transportation and child care difficulties were attributed as reasons for not receiving mental health and drug treatment services in less than 20% of the cases. Three percent of the people who needed alcohol or drug services did not receive them because the service was not available in their area. No individual failed to receive either drug or alcohol services or mental health services due to ineligibility, lack of financing, scheduling problems, being wait-listed or because the service was inappropriate.

What proportion of primary caregivers needed and used alcohol or drug services?

Because of the high prevalence of substance abuse problems among child welfare clients, additional detail was gathered about the pathways to and use of substance abuse services. Child welfare workers were asked to report on the need for and use of alcohol and drug services by the primary caregivers of the selected children. The data are displayed in Table 6-12. According to the child welfare workers, about one-third of the primary caregivers needed services for an alcohol problem, and almost two-thirds needed services for a drug problem. The majority of those perceived to have a drug or alcohol problem did obtain a formal assessment. Among these, 83% were found to have a serious or moderate impairment, according to these data.

Table 6-12. Substance Abuse Service Needs, Assessment, and Assessment Findings in Past 12 Months, According to Child Welfare Workers
	A. Needed services (% of total cases)	B. Obtained a formal assessment (% of A)	C. Serious or moderate impairment found (% of B)
Alcohol	33	63	83
Drugs	58	73	83

In all, 91% needed services for a substance abuse (alchohol or drug) problem, 53% (of the total sample) were referred for services, and 29% actually received services. Many received more than one type of service. Of those who received substance abuse services,

61% received outpatient services,
53% were part of a 12-step program,
45% received inpatient services,
26% received intensive day-treatment services,
9% received detoxification services,
1% received methadone treatment, and
16% received a different type of substance abuse service.

6.3 Child Welfare Services

What types of child welfare services did families receive?

Child welfare workers reported on the services received by the families of origin of OYFC children. The analysis of these services begins with some general aggregation into three primary types of services that are often provided to families involved with the child welfare system and summarized in Figure 6-5. About 15% of families received intensive family preservation services; 16% received other home or community-based services; and 52% received non-intensive home-based services, which essentially consists of monitoring by the child welfare worker. Of those families receiving non-intensive home-based services, 88% received these services at least monthly, while the remainder of families typically received services less than once each month.

Figure 6-5. Proportion of Families That Received 3 Primary Types of Child Welfare Services
[D]

Additional details in Tables 6-13 and 6-14 address the use of child welfare services provided by the child welfare worker indicating whether services were provided, for how long they were provided, and whether they were still being provided at the time of the interview.

Table 6-13. Receipt and Duration of Child Welfare Services
Service	Ever received? (%)	Still receiving service? (% of ever received)	Average duration of receipt (if service closed) (weeks)
Intensive Family Preservation	15	43	35
Intensive Home-Based Services	16	54	33
Non-Intensive Home-Based Services	52	61	44

Table 6-14. Receipt of Child Welfare Services
Service	Ever received? (%)	Average number of times received	Average number of weeks received
Home Management	18	35	22
Parent Training	40	19	17
Parent Aide	13	^	24
Respite Care	15	^	^
House Cleaning & Repairs	4	^	26
Individual Counseling at Home	48	10	31
Family Counseling		^	22
Foster Children Counseled	30	^	30
Child Care	31	^	19

^ Omitted because 6 or fewer responses.

Child welfare workers indicated that about half of respondents were still receiving one or more of these services, which is consistent with the long length of services provided in those cases where the services had closed. It is surprising that intensive family preservation services would have lasted so long (given the definition of a brief service provided during the interview). Table 6-14 breaks out the home-based services and provides more detail about what these services included. (These service durations are reported to be shorter than those in Table 6-13, in part because Table 6-14 includes cases that remain open.)

To what extent were reunification plans and efforts in place?

Child welfare workers were asked if there was currently or had ever been a plan to reunify the children who were then in an out-of-home placement. At the time of the interviews, 25% of children had already left care—child welfare workers were not asked about reunification plans for them. Although some of these children may have left care without a reunification plan (i.e., they ran away to home), it is a reasonable assumption that most of them were planfully reunified.

Among the 75% who had not been reunified, 10% never had a reunification plan. A current reunification plan existed for about one-quarter (25%) of OYFC children still in care, as shown in Table 6-15. For those children still in care with no current reunification plan, child welfare workers were asked if reunification efforts had ever been made with anyone in the child’s family. Such efforts had been made for 84% of the children for whom there is not a current reunification plan; 8% of all OYFC children never had a reunification plan. In all, about half of all the children have been reunified or have a reunification plan with the remaining half of all children being unlikely to be reunified (i.e., they have never had a reunification plan or no longer have one).

Table 6-15. Reunification Status and Activity
	% by Reunification Status	% by Reunification Activity	% of all children
Reunification Accomplished^	25
With Mother		80	20
With Father		10	2.5
With Other Person		10	2.5
Reunification Not Accomplished (child still in care)	75
Ever Had Reunification Plans		90
Currently Has Reunification Plan			25
Currently Has No Reunification Plan			42
Never Had Reunification Plan		10	8

^ Some of these children may not have been formally reunified (they may have run away to home), but their case data include an interview on record with their biological parent, so we are treating them as reunified.

Table 6-16 presents the breakdown of selected child and case characteristics for each category of reunification status. To identify characteristics associated with reunification status, bivariate tests of association were run for each child and case variable against the variable indicating reunification status. In these analyses, only race was significant, with white children being less likely than expected to be in the “returned home” category and black children being most likely to be returned home (p<.001).

With whom are the children to be reunified?

Child welfare workers identified with whom the children would be reunified. For 87% of those children still in care with a reunification plan, that plan targeted their mother; for 11% of these children the reunification plan targeted the father (Table 6-17). At this point in the case, few other reunification resources (e.g., the aunt, uncle, siblings) were involved.

Of the children who did not have a current reunification plan, had such efforts ever been made and, if so, with whom?

Child welfare workers were asked, with regard to children who were still in care but did not have a current reunification plan, to whom the previous reunification efforts, if any, had been directed; workers were permitted to identify as many family members as applied. For half (50%) of these children, reunification plans or efforts had been made with just one family member, and for 43% reunification efforts had been made with two family members. For 7% of these children, reunification efforts had been made with three or more family members.

Table 6-16. Reunification Status of OYFC Children by Select Child and Case Characteristics
	Returned home	Current reunification plan	Previous reunification efforts	No previous reunification efforts
	Reunification status Percent (95% CI)
			No current reunification plan
Age
1-2	15 (9, 24)	23 (17, 31)	29 (22, 37)	33 (17, 54)
3-5	24 (17, 34)	19 (8, 39)	13 (8, 19)	19 (7, 43)
6-10	32 (25, 40)	32 (20, 47)	31 (26, 37)	20 (10, 35)
11+	29 (21, 39)	26 (17, 38)	27 (22, 33)	28 (14, 48)
Gender
Male	47 (39, 55)	58 (49, 66)	46 (37, 56)	48 (29, 68)
Female	53 (45, 61)	42 (34, 51)	54 (44, 63)	52 (32, 71)
Race/Ethnicity^
Black	52 (40, 64)	39 (27, 52)	45 (35, 55)	43 (20, 69)
White	19 (12, 28)	37 (29, 45)	37 (28, 48)	24 (12, 42)
Hispanic	24 (18, 31)	13 (8, 22)	14 (9, 20)	29 (14, 52)
Other	6 (1, 22)	11 (5, 23)	4 (2, 9)	4 (1, 17)
Placement Type
Foster home		55 (38, 72)	59 (53, 65)	70 (46, 87)
Kin care	N/A	29 (16, 48)	34 (29, 39)	23 (10, 47)
Group home		15 (8, 28)	7 (5, 12)	6 (2, 17)
Most Serious Abuse Type
Physical	18 (10, 31)	7 (4, 13)	9 (6, 15)	3 (1, 9)
Sexual	7 (3, 14)	8 (4, 16)	9 (4, 22)	10 (2, 37)
Failure to Provide	23 (15, 34)	44 (32, 57)	39 (31, 47)	39 (25, 54)
Failure to Supervise	46 (38, 54)	37 (26, 49)	32 (26, 38)	29 (13, 53)
Other	6 (3, 11)	4 (2, 10)	11 (7, 17)	18 (4, 52)
Proportion of Clinical Scores
0	41 (25, 60)	28 (20, 39)	35 (28, 42)	24 (13, 41)
.17 to .25	32 (22, 43)	32 (18, 49)	29 (21, 37)	22 (11, 40)
.33 to .50	18 (13, 25)	21 (15, 28)	24 (17, 34)	32 (20, 48)
.60 to 1	9 (4, 21)	19 (11, 31)	12 (9, 16)	21 (10, 39)

^ Significant differences among reunification status categories at p<.001.

Table 6-17. Object of Current Reunification Plan
Family member	Percent (95%CI)
Mother	87 (78, 92)
Father	11 (6, 18)
Grandmother	0.4 (0, 3)
Aunt	0.3 (0, 2)
Other	2 (1, 7)

Table 6-18 describes the distribution of reunification efforts that had ended by the person’s relationship to the selected child. For 87% of the children for whom reunification efforts had been made, the mother was a part of these efforts, and in 40% the father was included in such efforts. Other reunification resources had been part of the effort to return the child from out-of-home care as well—the child’s aunt was the next most frequently included family member (12%), followed by a grandmother (8%), grandfather and uncle (4% each), and sister and brother (1% each).

Are child’s characteristics related to reunification?

Fifty-one percent of OYFC children had been reunified or had a current reunification plan. The remainder never had a reunification plan or did not currently have a reunification plan. Table 6-19 indicates the proportion of children, by selected child and case characteristics, who had a current reunification plan or for whom reunification had been completed.

A regression model was developed to try to understand which children had a current reunification plan (or had gone home) and to contrast them with those who had never had a reunification plan or no longer had a reunification plan. The model (R(2) = .06), which controlled for severity of abuse and proportion of clinical scores, in addition to age, race, and most serious type of abuse, indicates that differences by age are not significant, overall. Yet the youngest children tend to have fewer reunification plans than the children in the three older age groups, which would be consistent with the foster care caseload dynamics research, indicating that younger children are much more likely to have reunification plans changed to adoption (Barth, 1996). (Please note that questions about adoption plans were not asked in the baseline but will be asked in subsequent waves.) The only variable in the model that exhibited significant differences between categories with regard to current or completed reunification plans was most serious type of abuse (F=3.00, p<.05). Specifically, children with a most serious abuse type of failure to supervise are significantly more likely than children with a most serious abuse type of failure to provide to have a current reunification plan or completed reunification.

Table 6-18. Object of Ceased Reunification Efforts
Family member	Percent^ (95% CI)
Mother	87 (82, 91)
Father	40 (32, 50)
Grandmother	8 (4, 15)
Grandfather	4 (2, 8)
Aunt	12 (7, 17)
Uncle	4 (2, 8)
Brother	1 (0, 4)
Sister	1 (0, 4)
Other	4 (2, 7)

^ More than one response permitted.

Table 6-19. Current Reunification Plan (or Completed Reunification), by Selected Child Characteristics
Child characteristic	Percent yes	95% CI
Age
1-2 years	39	32, 45
3-5 years	62	40, 81
6-10 years	52	44, 61
11+ years	51	42, 59
Race/Hispanicity
Black/non-Hispanic	50	43, 58
White/non-Hispanic	44	34, 55
Hispanic	55	40, 68
Other	67	41, 85
Most serious type of abuse/neglect
Physical abuse	62	42, 78
Sexual abuse	44	29, 61
Failure to provide	46	35, 58
Failure to supervise	57	46, 68

The model was computed a second time, excluding the children with a completed reunification plan, in order to contrast those with a current reunification plan against those who never or no longer had a reunification plan. In this model (R2 = .06), out-of-home placement type was added to the list of independent variables. Results show that out-of-home placement type is significantly associated with whether a child still in care has a reunification plan or not (F=3.46, p<.05). Specifically, children in group homes are significantly more likely to have a current reunification plan than children in kin care settings. Children in non-kin foster homes and kin care settings are not significantly different with regard to their likelihood of having a current reunification plan. In addition, although race did not exhibit a significant effect overall (F=1.67, p=.18), comparisons within this characteristic indicate that children in the “other” group are significantly more likely than black children to have a current reunification plan (p<.05). Similarities in the presence of reunification plans for black, white, and Hispanic children are consistent with recent evidence that black children are beginning to have more equal access to reunification (Wulczyn, 2001). Presence of a reunification plan does not differ significantly based on any of the other variables in the model.

Were family risks at time of placement related to the likelihood of the child having a current reunification plan or completed reunification?

We examined the risks present in the child’s home at the time of placement to see if these appear to be related to whether the child currently had a reunification plan or had completed reunification. This analysis was limited, because risk assessment items completed at the baseline for the children in foster care were limited and excluded indicators of such key parental characteristics as substance abuse. The risk categories were not mutually exclusive; child welfare workers could select all risks that applied for each child. As can be seen in Table 6-20, the percentage of children with a current reunification plan or completed reunification does not appear to vary depending on the risks present, as the proportion of each risk group with a current reunification plan or completed reunification plan is similar to the proportion of all children in foster care for one year with a current or completed reunification plan. Possible exceptions are for those children whose caregivers did not cooperate with the authorities (Chi-square = 5.82, p <.05) and those children whose permanent caregiver was a victim of abuse (Chi-square= 4.58, p <.05).

Table 6-20. Current Reunification Plan or Completed Reunification by Risks Present at Time of Placement
Risks	Percent yes	95% CI
Prior reports of maltreatment	49	38, 60
Caregiver was victim of abuse	45	35, 55
Low social support	48	41, 54
Monetary problems	52	43, 60
Active domestic violence	43	30, 57
Did not cooperate with authorities	40	28, 53
No second supportive caregiver present	50	42, 58

What did foster parents of OYFC children think and feel about adopting them?

Foster parents were asked if they had legally adopted the child and, if not, if they have ever considered adopting the child if he/she could not return to his/her family. Although virtually no OYFC children (2%) had been legally adopted by their current foster parents, about two-thirds (68%) of the foster parents would consider adopting the child if that became an option in the future. Foster parents who had legally adopted the child or considered doing so in the future were asked what factors contributed to wanting to adopt the child. These responses are summarized in Table 6-21. About three-quarters (74%) of foster parents who had adopted or considered adopting the child in their care identify their feelings of love and affection for the child as one of the contributing factors. A similar proportion (72%) reported feeling that the child is part of their family as a contributing factor. Over half of these foster parents indicated that their desire for the child to grow up in a safe environment (62%) and their feeling that the child’s biological parents could not adequately care for the child (54%) were contributing factors. For over one-quarter (28%) of the foster parents, the fact that the child is related to them or someone in their family contributed to their desire to adopt. Six percent of the foster parents had already adopted one or more of the child’s siblings, which served as a factor contributing to their adopting or desire to do so.

Foster parents who had legally adopted the child or considered doing so in the future were also asked what factors discouraged them from wanting to adopt the child. These responses are summarized in Table 6-22. The most common factor discouraging foster parents from adopting is that the biological parents’ rights had not been relinquished or terminated (25%). For almost one-fifth of the foster parents (18%), there were no factors discouraging them from adopting the child. No foster parents indicated that the child’s race or ethnicity being different from their own or their family’s was a factor discouraging them from adopting.

Table 6-21. Factors Contributing to Foster Parent Wanting to Adopt Child
Factor	Percent^ (95% CI)
Feelings of love/affection for child	74 (65, 81)
Feeling that child is part of caregiver's family	72 (63, 80)
Desire for child to grow up in safe environment	62 (51, 72)
Feeling that child's biological parents cannot adequately care for child	54 (44, 64)
Concerned that child would otherwise be placed with another family	36 (27, 46)
Child is related to caregiver or caregiver's family	28 (21, 36)
Child's race/ethnicity is same as caregiver's family	15 (11, 21)
Not concerned that child's race/ethnicity differs from that of caregiver or caregiver's family	12 (8, 18)
Having already adopted child's sibling(s)	6 (4, 9)

^ Interviewers coded as many responses as the respondent indicated were applicable.

Table 6-22. Factors Discouraging Foster Parent from Wanting to Adopt Child
Factor	Percent ^ (95% CI)
Biological parent has not relinquished rights, or rights have not been terminated by court	25 (18, 34)
No discouraging factors	18 (13, 24)
Financial concerns	11 (8, 16)
Child has disabilities that caregiver may not be able to handle in a long-term situation	7 (4, 12)
Problems between child and other members of caregiver's family	5 (3, 8)
Child's race/ethnicity differs from that of caregiver's family	0

^ Interviewers coded as many responses as the respondent indicated were applicable.

Finally, foster parents were asked if they had talked with their child welfare worker about the possibility of adopting the child—85% of those foster parents who had considered adoption indicated that they had. Those foster parents who indicated they had spoken with their child welfare worker about this and those who had already adopted the child were asked how the child welfare worker responded to the caregiver’s willingness to adopt the child. Over half (52%) of the foster parents indicated that the child welfare worker was strongly encouraging. Another 37% indicated the child welfare worker was encouraging. Only 7% and 4% described their child welfare worker’s response as discouraging or strongly discouraging. (Note that questions about adoption plans were not asked of child welfare workers in the baseline but are asked in subsequent waves.)

6.4 Services for Children

When children are in out-of-home care, the child welfare agency can be expected to assess their well-being and endeavor to enhance it. Although many of those efforts to assist children in out-of-home care are provided directly by caregivers, specialized services may also be needed and provided. This section uses a variety of information sources to assess the underlying needs of children and to determine whether or not they are being addressed.

What specialty mental health services have OYFC children received and which children are receiving them?

To assess the mental health services that children in out-of-home care were receiving, we examined five questions that were asked of the child’s caregiver. Data were collected from the caregiver regarding whether the child had been to any of the following for emotional, behavioral, learning, attention, or substance abuse problems in the twelve months prior to the interview:

a mental health or community health center,
a therapeutic nursery,
day treatment
a psychiatric hospital or psychiatric unit in a medical hospital, or
private professional help from a psychiatrist, psychologist, social worker, or psychiatric nurse since the investigation date.

The results are presented in Table 6-23. Overall, 23 percent of OYFC children currently in out-of-home care had received at least one specialty mental health service in the past twelve months. OYFC children most often received private professional help (13%) for emotional, behavioral, learning, attention, or substance abuse problems, while day treatment was the second most common (12%) service used to address those issues. OYFC children had been to mental health or community health centers, therapeutic nurseries, or psychiatric hospitals or units less frequently (4% each). Of the OYFC children who had received at least one specialty mental health service in the past twelve months, the proportion receiving private professional help was 58%, day treatment 30%, mental health or community health center 18%, psychiatric hospital or unit 15%, and therapeutic nursery 8%.

Table 6-23 also indicates the proportion of children receiving specialty mental health services by various child and case characteristics. Not surprisingly, age appears to be a significant factor with regard to whether a child had received private professional help or been to a psychiatric hospital or unit. Specifically, significantly fewer 1- to 2-year-olds (2%) had received private professional help than 3- to 5-year-olds (13%), 6- to 10-year-olds (17%), and children 11 years of age and older (20%) (p<.001). Similarly, no 1- to 2-year-olds were reported to have been to a psychiatric hospital or unit, which is significantly different than the 3% of 6- to 10-year-olds and 9% of children 11 years of age and older (p<.01). No 3- to 5-year-olds were reported to have been to a psychiatric hospital or unit, which is also significantly different than children 11 years of age and older (p<.01). One- to two-year-olds were also less likely (p<.01) to have received at least one specialty mental health service (8%) than were 6- to 10-year-olds (28%) and children 11 years of age and older (34%).

Table 6-23. Specialty Mental Health Services Received by OYFC Children Currently in Out-of-Home Care
	MH or community health center	Private professional help	Therapeutic nursery	Day treatment	Psychiatric hospital or unit (inpatient)	Any Specialty MH Service
	Specialty mental health service Percent (95% CI)
TOTAL	4 (3, 7)	13 (10, 18)	4 (2, 8)	12 (7, 20)	4 (2, 7)	23 (19, 27)
Age
1-2	3 (1, 14)	2 (1, 5)	3 (1, 8)	N/A	0	8 (3, 18)
3-5	2 (0, 7)	13 (8, 21)	6 (2, 21)	N/A	0 (0, 3)	20 (10, 36)
6-10	6 (2, 14)	17 (10, 26)	N/A	12 (6, 24)	3 (1, 8)	28 (20, 37)
11+	5 (2, 14)	20 (13, 29)	N/A	12 (6, 23)	9 (5, 17)	34 (25, 44)
Gender
Male	5 (3, 9)	15 (10, 23)	2 (1, 9)	9 (5, 16)	4 (2, 8)	23 (17, 31)
Female	3 (1, 8)	11 (7, 17)	6 (2, 15)	15 (7, 29)	4 (2, 10)	22 (17, 30)
Race/Ethnicity
Black	1 (0, 3)	7 (4, 14)	2 (1, 6)	14 (7, 26)	2 (1, 6)	15 (11, 20)
White	4 (2, 9)	22 (16, 31)	4 (1, 15)	12 (5, 24)	5 (2, 12)	29 (22, 38)
Hispanic	11 (5, 24)	10 (3, 26)	1 (0, 4)	0	0 (0, 1)	21 (12, 34)
Other	10 (2, 41)	12 (5, 28)	32 (14, 58)	34 (7, 78)	15 (4, 41)	47 (25, 70)
Placement Type
Foster home	4 (2, 8)	12 (9, 18)	6 (2, 14)	12 (7, 22)	3 (1, 7)	24 (20, 28)
Kin care	3 (1, 10)	8 (3, 22)	0 (0, 3)	4 (1, 18)	0 (0, 1)	12 (6, 21)
Group home	11 (4, 29)	38 (28, 49)	0	32 (13, 60)	21 (12, 34)	59 (42, 75)
Most Serious Abuse Type
Physical	2 (0, 15)	21 (11, 37)	0	4 (1, 14)	1 (0, 6)	26 (15, 41)
Sexual	14 (5, 35)	22 (8, 48)	0	17 (7, 37)	6 (2, 20)	46 (26, 68)
Failure to Provide	2 (1, 5)	10 (6, 18)	8 (3, 22)	2 (1, 5)	2 (1, 7)	17 (10, 28)
Failure to Supervise	1 (0, 4)	16 (9, 26)	1 (0, 6)	17 (8, 33)	2 (1, 7)	25 (15, 39)
Other	12 (3, 34)	2 (0, 11)	0	3 (0, 20)	3 (1, 11)	16 (6, 35)
CBCL Score
Non-clinical score	3 (1, 7)	11 (7, 16)	6 (2, 18)	6 (1, 27)	1 (0, 3)	18 (12, 26)
Borderline/Clin. score	8 (4, 14)	20 (14, 28)	2 (1, 8)	17 (11, 25)	8 (4, 14)	35 (28, 43)
Proportion of Clinical Scores
0	0 (0, 2)	8 (4, 17)	3 (1, 11)	0 (0, 3)	0 (0, 2)	10 (5, 18)
0 .17 to 0.25	3 (1, 6)	11 (5, 22)	1 (0, 5)	6 (1, 21)	5 (2, 12)	18 (10, 30)
0.33 to 0.50	8 (3, 19)	20 (12, 30)	18 (4, 55)	7 (2, 18)	4 (2, 8)	33 (24, 45)
0.60 to 1.0	10 (4, 25)	18 (9, 33)	3 (1, 10)	50 (34, 66)	10 (3, 26)	42 (33, 51)

With regard to race, significantly more white children (5%) than Hispanic children (0%) had been to a psychiatric hospital or unit (p<.05), and significantly more white children (22%) then black children (7%) had received private professional help (p<.05). Children in group homes (21%) were significantly more likely than those in both foster homes (3%) and kin care settings (0%) to have been to a psychiatric hospital or unit (p<.01). Similarly, children in group homes (59%) were significantly more likely than those in both foster homes (24%) and kin care settings (12%) to have received at least one specialty mental health service (p<.01).

The proportion of clinical scores (see Chapter 3) appears to be associated with whether OYFC children received several of the specialty mental health services. It was most significant for day treatment, as 50% of children with a “clinical” score on between 60% and 100% of the measures administered to them received this service—significantly different than those with 33% to 50% clinical scores (7%), 17% to 25% clinical scores (6%), or no clinical scores (0%) (p<.01). In addition, children with no clinical scores had been to a mental health or community health center in significantly lower proportions (0%) than those with between 33% and 50% clinical scores (8%) and 60% to 100% clinical scores (10%) (p<.05). Similarly, no children without a clinical score had been to a psychiatric hospital or unit, whereas 10% of children with 60% clinical scores or higher, had been hospitalized (p<.01). Finally, children with between 60% and 100% clinical scores (42%) were significantly more likely to have received at least one specialty mental health service than those with no clinical scores (10%) and those with between 17% and 25% clinical scores (18%) (p<.01). All of these relationships indicate that children with greater levels of social and cognitive problems on standardized measures are more likely to receive mental health services.

Our results indicate that between one-third and one-half of all the children who have very high proportions of clinical scores are receiving some kind of specialty mental health service. However, this could be because the proportion of “clinical scores” is a bit of a misnomer, since some of the scores were generated from measures of academic achievement rather than social or mental health problems. Among the children with a clinical CBCL score, 35% were receiving specialty mental health services—significantly different (at the p<.01 level) than the 18% of children with a non-clinical CBCL score who are receiving specialty mental health services.

We also examined the relationship between a child’s having a clinical CBCL score and receipt of specific specialty mental health services and found significant differences with regard to admission to a psychiatric hospital or unit and receipt of private professional help. Specifically, children with clinical CBCL scores were much more likely than children with non-clinical CBCL scores to have been admitted to a psychiatric hospital or unit (8% vs. 1%, p<.01) or to have received private professional help (20% vs. 11%, p<.05).

To further examine the relationship between various child and case characteristics on the OYFC child’s receipt of specialty mental health services, a logistic regression was performed that modeled receipt of any of the five specialty mental health services since the investigation date as reported by the current caregivers. The results are summarized in Table 6-24. Comparisons within the variables of placement type, most serious abuse type, child race/ethnicity, and the proportion of clinical scores were significant. Specifically, the model indicates children in both foster homes and kin care settings are significantly less likely than those in group homes to have received a specialty mental health service (p<.05). In addition, children with a most serious abuse type of other are less likely than those with a most serious abuse type of sexual maltreatment to have received a specialty mental health service (p<.05).

Table 6-24. Results of Logistic Regression Modeling on Receipt of Any Specialty MH Service by OYFC Children Currently in Out-of-Home Care
	OR	95% CI
	Any specialty mental health service
Age
2^	0.54	0.12, 2.46
3-5	0.67	0.22, 2.05
6-10	0.86	0.30, 2.45
11+	(reference group)
Gender
Male	1.07	0.54, 2.10
Female	(reference group)
Race/Ethnicity
Black	(reference group)
White	2.57**	1.35, 4.88
Hispanic	2.76	0.90, 8.41
Other	3.13	0.94, 10.37
Placement Type
Foster home	0.23*	0.06, 0.98
Kin care	0.13*	0.02, 0.76
Group home	(reference group)
Most Serious Abuse Type
Physical	0.68	0.19, 2.45
Sexual	(reference group)
Failure to Provide	0.54	0.21, 1.40
Failure to Supervise	1.00	0.33, 3.02
Other	0.23*	0.07, 0.81
CBCL Scores
Non-clinical score	(reference group)
Borderline or Clinical Score	1.07	0.33, 3.48
Proportion of Clinical Scores
0	0.17**	0.05, 0.57
.17 to .25	0.26*	0.08, 0.83
.33 to .50	0.48	0.19, 1.24
.60 to 1	(reference group)

^ One-year-olds are not included because they do not have a CBCL score.

* p<.05; ** p<.01; Cox and Snell pseudo-R-square is .17.

Child race/ethnicity and the proportion of clinical scores were also significantly related to receipt of specialty mental health services. White children were significantly more likely than black children to have received a specialty mental health service (p<.01). In addition, children with between 60% and 100% clinical scores were significantly more likely to have received a specialty mental health service than those with no clinical scores (p<.01) and those with between 17% and 25% clinical scores (p<.05). This belies the arguments that mental health services are given to all children in foster care as a routine part of their service package or that they are provided based on availability rather than the needs of the child. At the same time, there appear to be many children with mental health problems who are not receiving specialty mental health care.

What supplementary or special education services did OYFC children need and receive?

In Chapter 3 of this report, and in previous research, children who have been in foster care have been shown to have poor educational attainment (Cook, 1997) and elevated receipt of special education services (Goerge et al., 1992). Our understanding of the types of educational services received by foster children is, however, quite limited and does not provide any basis for determining the relationship between a child’s needs and his/her receipt of educational services. Although a few estimates of the penetration rates of foster children into special education services exist, there is less information available about the receipt of other supplementary educational services to try to improve a foster child’s educational progress. We distinguish between special education and supplementary educational services for two reasons. First, the use of nonroutine, supplementary educational services (like tutoring) may be important to preventing students from needing special education services or otherwise falling behind. Their existence for foster children deserves documentation. Second, the survey did not always ask for the source of the services—i.e., whether or not they were provided by special education resources and under the auspices of an Individual Family Service Plan (IFSP) or Individual Education Plan (IEP) is not known. In these cases we treat them as “supplementary or special education” services. Children in this category could have been receiving either type or both types of services.

In this section, we look at several ways to estimate the need for and receipt of educational services. Child welfare workers were asked if the children under their supervision needed a variety of services and whether those services were provided to the child. Caregivers and teachers also indicated whether there was receipt of supplementary or special education services. In addition, we used information from the developmental assessments of