A New Narrative for Child WelfarePROMOTING SOCIAL AND EMOTIONAL WELL-BEING FOR CHILDREN OF COLOR
Bryan Samuels, CommissionerAdministration on Children, Youth and Families
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Data Source: Adoption and Foster Care Reporting and Analysis System, Reports 10-18 (19998-2010). Children’s Bureau, Administration on Children, Youth, and Families (USDHHS, ACF)
What happened to the child welfare population in the last decade?
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
100,000
200,000
300,000
400,000
500,000
600,000
127,821
167,235
86,581
41,588
TOTALBlack Non-HispanicWhite Non-HispanicHispanicOther
Num
ber
of C
hild
ren 408,425
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29
41
21
9
41.1
109.91.7
12.7
24.6ReunificationAdoptionRelativeReached Major-ityOtherStill in Care
43
35
15
7
Black Non-HispanicWhite Non-HispanicHispanicOther
<1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 170
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Foster Care Entries and Exits, 2002-2010
Racial Makeup of Foster Care Population, 1998 and 2010
Exits from Foster Care among 2000-2005 Entrants
Age Distribution of Entries into Foster Care, 2010
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2002 2003 2004 2005 2006 2007 2008 2009 2010200,000
220,000
240,000
260,000
280,000
300,000
320,000
340,000
En-tries
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Changes in child welfare populations have been unevenly distributedState Changes in Number of Children in Foster Care on September 30, 2006-2009
Black White Hispanic OtherNUMBER OF STATES WITH POPULATION INCREASES
Increase by less than 25% 13 14 28 30
Increase by 25-50% 0 0 8 5
Increase by 50-100% 3 0 5 5
Increase by 100% or more 1 0 1 4
NUMBER OF STATES WITH POPULATION DECREASES
Decrease by less than 25% 31 37 10 7
Decrease by 25-50% 3 1 0 1
Decrease by 50-100% 1 0 0 0
Decrease by 100% or more 0 0 0 0Data Source: Adoption and Foster Care Reporting and Analysis System, accessed via Child Welfare Outcomes Report Builder, http://cwoutcomes.acf.hhs.gov/
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Writing a New NarrativeREQUIRES ASKING KEY QUESTIONS:
• Where and how does abuse happen within communities with different ethnic/racial compositions?
• How does the experience of maltreatment impact the social and emotional well-being of children?
• What works to promote healing and recovery among children who have experienced maltreatment and what does not?
• What are the gaps? How do we fill them?November 11, 2011
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The Impact of Maltreatment• The developmental stage of the child at the onset of traumatic exposure will
influence the type and severity of the consequences.1
• The experience of maltreatment is complex and not categorical. A child’s response is a function of environment, the nature of the traumatic experience, the neurochemical cascade following the event, and subsequent changes in functioning. These changes can be cognitive, emotional, physical, and/or behavioral.2
• Heightened stress has been shown to impair the development of the prefrontal cortex, the brain region that, in humans, is critical for the emergence of executive functions—a cluster of abilities such as making, following, and altering plans; controlling and focusing attention; inhibiting impulsive behaviors; and developing the ability to hold and incorporate new information in decision-making.3
• The effects of maltreatment can influence relationships across a person's lifetime,4 and they are particularly salient when a maltreated child attempts to form a new relationship with a primary caregiver or later romantic or marital partner.5
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1. Frederico, MM; Jackson, AL; & Black, CM. (2005). Reflections on Complexity: The 2004 Summary Evaluation of Take Two. Bundoora, Victoria: School of Social Work and Social Policy, La Trobe University.
2. Wilson, KR; Hansen, DJ & Li, M. (2011). The traumatic stress response in child maltreatment and resultant neuropsychological effects. Aggression and Violent Behavior. 16:87.
3. National Scientific Council on the Developing Child (2010). Persistent Fear and Anxiety Can Affect Young Children’s Learning and Development: Working Paper No. 9. Retrieved from www.developingchild.harvard.edu
4. Mikulincer, Ml Shaver, PR. (2007). Attachment in Adulthood: Structure, Dynamics and Change. New York, NY: The Guilford Press.5. Cook, A, Blaustein; M, Spinazzola, J; & van der Kolk, B. (Eds.). (2003). Complex Trauma in Children and Adolescents: White Paper from the National
Child Traumatic Stress Network Complex Trauma Task Force.
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NSCAW – National Survey of Child and Adolescent Well-being• Nationally representative, longitudinal study of children and families
reported to child protective services• Child-level data• N = 5,501
WAVE ONE WAVE TWO WAVE THREE WAVE FOUR
•Baseline •12 Months •18 Months •36 Months
RESPONDENTS
• Children• Assessments (younger
children)• Interviews (older children)
• Teachers• Survey completed via mail
or web
• Current Caregivers• Interviews
• Caseworkers• Interviews
• Agency Directors• Interviews
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Caseworkers’ Perceptions of Risk
None Mild Moderate Severe0%
10%
20%
30%
40%
50%
60%
39%
32%
20%
9%
40%
31%
21%
8%
34% 34%
23%
9%
19%
48%
22%
11%
Level of Risk Perceived by Caseworker, by Caregiver Race/Ethnicity
Black White HispanicOther
Risk level
Data Source: National Survey of Child and Adolescent Well-Being II
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One third of reports are substantiated
Black White Hispanic Other0%
10%20%30%40%50%60%70%80%90%
100%
67% 73% 68% 74%
33% 27% 32% 26%
Substantiation Status by Caseworker Report, by Race/Ethnicity Substantiated or
Indicated
Children were classified as hav-ing a substantiated maltreatment case on the basis of casework-ers’ response at baseline to the following question: “What was the outcome of the investiga-tion 1) substantiated, 2) indi-cated, or 3) neither substanti-ated or indicated, or unfounded or ruled out?” In so-called three-tier states, indicated is a classification option that means some evidence of maltreatment exists, but not enough for sub-stantiation.
Data Source: National Survey of Child and Adolescent Well-Being II
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Neglect and physical abuse are the most common maltreatment types for all groupsMALTREATMENT TYPE Black White Hispanic OtherPhysical 24.8% 26.4% 26.7% 41.3%
Sexual 6.0% 11.8% 6.3% 5.6%
Emotional 3.3% 8.4% 9.8% 17.1%
Physical Neglect 17.5% 14.1% 15.0% 13.0%
Neglect 35.3% 35.0% 43.9% 25.6%
Substance Exposure 3.4% 2.6% 3.8% 1.0%
Domestic Violence 12.0% 8.0% 14.1% 11.0%
Substance-Abusing Parent 16.0% 17.6% 16.3% 9.7%
Other 20.4% 19.3% 14.8% 16.2%Data Source: National Survey of Child and Adolescent Well-Being II
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Maltreatment impacts children’s ability to form and maintain relationships
Black White Hispanic Other0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
27.5%
34.3%
41.6%
24.4%
Fewer Social Skills among Children 3-17 Years Old by Caregiver Report
Total Sample: 34.3%
Data Source: National Survey of Child and Adolescent Well-Being IIInstrument used was the Social Skills Rating System (SSRS; Gresham & Elliot, 1990).
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All groups of children known to child welfare have high rates of behavioral problems
CBCL Total Score in Clinical Range
CBCL Internalizing Score in Clinical
Range
CBCL Externalizing Score in Clinical
Range
0%
5%
10%
15%
20%
25%
30%
24%
17%
20%
24%
17%
23%
19%18%
19%
26%24%
27%
Behavioral Problems among Children 1.5-17 Years Old with Maltreatment Report by Caregiver Report
Black White Hispanic Other
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Comparable Norm: 8%
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Black Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms
0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
58%
36%19% 18%
4%
8%
3% 3%
27%
19%
29% 26%
11%
37%48% 53%
Trauma and Emotional/Behavioral Symptomatology among Children Entering Foster Care
Both Trauma and Emotional/Behav-ioral Symptoms
Emotional/Behav-ioral Health Symptoms Only
Trauma Symptoms Only
Neither
Data Source: Northwestern University, Illinois Department of Children and Family Services database of Integrated Assessments – Child and Adolescent Needs and Strengths. N=13,897.
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White Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms
0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
61%
41%
19% 17%
5%
8%
5% 4%
24%
20%
30%22%
10%
31%46%
58%
Trauma and Emotional/Behavioral Symptomatology among Children Entering Foster Care
Both Trauma and Emotional/Behav-ioral Symptoms
Emotional/Behav-ioral Health Symptoms Only
Trauma Symptoms Only
Neither
Data Source: Northwestern University, Illinois Department of Children and Family Services database of Integrated Assessments – Child and Adolescent Needs and Strengths. N=13,897.
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Hispanic Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms
0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
50%34%
22% 15%
6%
10%
7%12%
25%
13%
22% 27%
18%
43% 49% 46%
Trauma and Emotional/Behavioral Symptomatology among Children Entering Foster Care
Both Trauma and Emotional/Behav-ioral Symptoms
Emotional/Behav-ioral Health Symptoms Only
Trauma Symptoms Only
Neither
Data Source: Northwestern University, Illinois Department of Children and Family Services database of Integrated Assessments – Child and Adolescent Needs and Strengths. N=13,897.
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Other Children: Overlap of Trauma and Emotional/Behavioral Health Symptoms
0 - 6yo 7 - 12yo 13 - 16yo 17+ yo0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
53%
27% 21%
50%
15%
18%
11%
23%
9%
11%
9%
45%58%
50%
Trauma and Emotional/Behavioral Symptomatology among Children Entering Foster Care
Both Trauma and Emotional/Behav-ioral Symptoms
Emotional/Behav-ioral Health Symptoms Only
Trauma Symptoms Only
Neither
Data Source: Northwestern University, Illinois Department of Children and Family Services database of Integrated Assessments – Child and Adolescent Needs and Strengths. N=13,897.
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White children are prescribed psychotropic medications at higher rates than other groups
Black White Hispanic Other0%2%4%6%8%
10%12%14%16%18%
10%
17%
6%
8%
Current use of Psychotropic Medication(s) among Chil-dren 1.5-17 Years Old Reported to CPS by Caregiver
Report
Data Source: National Survey of Child and Adolescent Well-Being II
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18
Most common risk factors among caregivers
0%20%40%60%80%
100%
28% 26%
83%
41% 32%
70%
31%44%
75%
41% 32%
77%Black WhiteHispanic Other
Data Source: National Survey of Child and Adolescent Well-Being II(1) Parents were deemed in need of mental health services if they met any one of four criteria spanning caseworker report of mental health disorder, caregiver score on screening instrument, or self-reported high need of services within past year. (2) Mothers were deemed in need of domestic violence services if they met three criteria spanning caseworker report of active domestic violence, mother’s score on screening instrument, or self-reported need for domestic violence services within past year. (3) Includes receipt of TANF, WIC, food stamps, SSI, or housing support.
November 11, 2011 Fauri Memorial Lecture (MI)
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Groups show different patterns in lengths of stay
2000 2001 2002 2003 2004 200556789
101112131415
Median Duration (in months) of First Placement Spell by Year of Entry for Race/Ethnicity
BlackWhiteHispanicOther
Entry Year
Mon
ths
Wulczyn, F; Chen, L; & Hislop, KB. (2007). Foster Care Dynamics 2000-2005: A report from the Multistate Foster Care Data Archive. Chicago, IL: Chapin Hall Center for Children at the University of Chicago.Note: At the time of analysis, a median duration of placement could not be calculated for Black children entering in 2005, meaning that fewer than 50% of these children had exited when this report was published.
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Across groups, most children exit care to reunification
Black White Hispanic Other0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
36%44% 42% 42%
10%10% 8% 9%
11%10%
8% 9%
Exit Destinations as Percent of All Entries
Still in Care
Other
Runaway
Emancipation
Guardianship or Relatives
Adoption
Reunification
Perc
ent
of C
hild
ren
Wulczyn, F; Chen, L; & Hislop, KB. (2007). Foster Care Dynamics 2000-2005: A report from the Multistate Foster Care Data Archive. Chicago, IL: Chapin Hall Center for Children at the University of Chicago..
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Most Common Diagnosis for Maltreated Children and Youth and Evidence of Effective PracticeDiagnosis/Concern/Activity Evidence of EffectivenessScreening ActivitiesIdentification of Mental Health and Behavioral Health Issues
SCREENING
TOOLS
• Strengths and Difficulties Questionnaire• Pediatric Symptom Checklist• Child Behavior Checklist Behavior Assessment for Children• Etc.
Most Common Clinical-Level Social and Emotional ConcernsCHILD BEHAVIOR CHECKLIST
INTERNALIZING:WithdrawnAnxiety/Depression
• Brief Strategic Family Therapy• Child Parent Psychotherapy• Functional Family Therapy• Nurturing Parenting Programs (NPP)• Parenting Wisely• Triple P• Etc.
EXTERNALIZINGAggressive BehaviorDelinquentAttention Problems
Most Common Mental Health Diagnoses for Children in Foster CareAttention Deficit Hyperactivity Disorder
• Children’s Summer Treatment Program
Posttraumatic Stress Disorder • Cognitive Behavioral Intervention for Trauma in Schools (CBITS)• Combined Parent-Child Cognitive Behavioral Therapy for Families at Risk for
Child Physical Abuse• Prolonged Exposure Therapy• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Major Depression • Adolescents Coping with Depression• Alternative for Families-Cognitive Behavioral Therapy (AF-CBT, formerly known
as Abuse-Focused-Cognitive Behavioral Therapy)• Etc.
Conduct Disorder/Oppositional Defiant Disorder
• Brief Strategic Family Therapy (BSFT)• Familias Unidas• Parent-Child Interaction Therapy (PCIT)• Strengthening Families Program (SFP)
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Soci
al a
nd E
mot
iona
l W
ell-B
eing
: Wha
t do
es it
look
like
?
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SELF-MANAGEMENTAge-appropriate autonomy, emotional self-regulation, persistence, constructive time useAGENCYPlanfulness, resourcefulness, positive risk-taking, realistic goal-setting, motivation
SENSE OF PURPOSEBelieving one’s life is meaningfully connected to a larger pictureCONFIDENCEPositive identity and self-worth
SOCIAL INTELLIGENCECommunication, cooperation, conflict-resolution skills, trust, intimacy
ENVIRONMENTAL AWARENESS & BEHAVIORKnowledge, positive behaviorsRISK MANAGEMENT SKILLSSkills and knowledge to avoid drug and alcohol use and risky sexCRITICAL THINKINGEvaluation/analytical/problem-solving skills
KNOWLEDGE OF ESSENTIAL LIFE SKILLSFinancial management, decision-making skills, home maintenance, etc.
POSITIVE RELATIONSHIPS WITH PEERS, SIBLINGS, FAMILY, ETC.Warmth, closeness, communication, support, positive advice
Adapted from: Lippman, LH; Moore, KA & McIntosh, H. (2011). Positive indicators of child well-being: A conceptual framework, measures, and methodological issues. Applied Research in Quality of Life. Accessed on August 16, 2011. http://www.springerlink.com.proxy.uchicago.edu/content/tr32721263478297/.
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Understanding
Experiences
Developmental Tasks
Coping Strategies
Environmental
Buffers
Protective mechanisms can serve in multiple functions; what is important is how they contribute to healing and recovery
Dimensions through which experiences of trauma and violence
impact children in the short- and long-terms
Locus of interventions to promote social and emotional functioning to facilitate healing and recovery
Protective Mechanisms
Protective Mechanisms
Social and
Emotional Well-Being
Faci
litat
ing
Wel
l-Bei
ng fo
r C
hild
ren
and
Yout
h in
C
hild
Wel
fare
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Child and Family Services Improvement and Innovation Act of 2011 (P.L. 112-34)Reauthorization of Promoting Safe and Stable Families (PSSF) includes new language addressing trauma and vulnerable populations:• State plans shall include an outline of “how health
needs identified through screenings will be monitored and treated, including emotional trauma associated with a child’s maltreatment and removal from home.”– Plans must include a description of “the oversight of
prescription medicines, including protocols for the appropriate use and monitoring of psychotropic medications.”
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Changing Policy
Fauri Memorial Lecture (MI) 25
Aligning Funding• Integrating Trauma-Informed and Trauma-
Focused Practice in Child Protective Service Delivery ($3.2 million, 5 grantees)
• Child Welfare-Early Education Partnerships to Expand Protective Factors for Children with Child Welfare Involvement & Child Welfare-Education System Collaborations to Increase Educational Stability ($4.3 million, 18 grantees)
• Improving Service Delivery to Youth in the Child Welfare System ($1.4 million, 4 grantees)
• Family Connections Grants: Using Family Group Decision-Making to Build Protective Factors for Children and Families ($3.4 million, 7 grantees)
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Aligning Funding, cont’d• Permanency Innovations Initiative,
Year 2 ($15.3 million, 6 grantees)– AZ Dept. of Economic Security: Native American and African
American Adolescents– CA Dept. of Social Services: African American Youth– IL Dept. of Children and Family Services: Youth 9-12 at High Risk
of Long-Term Foster Care– LA Gay and Lesbian Community Services Center: LGBTQ Children
and Youth– Univ. of KS Center for Research, Inc.: Children with Severe
Emotional Disturbances– Washoe Co. (NV) Dept. of Social Services: Children with Serious
Barriers to Permanency
• President’s Budget Proposal ($250 million each year for 10 years)
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Fauri Memorial Lecture (MI) 27
Communicating the New Narrative
• IM 11-03: Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Foster Care
• IM 11-01: Child Welfare-Head Start Partnerships: Partnering with Families involved in Head Start and Early Head Start Programs; OCC IM (4-11): Child Welfare and Child Care Partnerships: Partnering with Families Involved in Child Care Subsidy Programs
• Joint letter on educational provisions of Fostering Connections
• Over 80 speaking engagements between October 2010 and October 2011
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The New NarrativeChild welfare interventions will focus on the repair or establishment of protective, supportive, and emotionally responsive adult relationships. Through these emotionally positive and strong, fundamental relationships, children and youth will thrive socially, emotionally, and developmentally in safe, permanent homes. They will have access to the physical health, mental health, and educational resources necessary for long-term well-being.
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Variation in Change African American Children in Foster Care across States
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Orego
n
New H
amps
hire
Kentu
cky
West V
irgini
a
Minnes
ota
India
na
Tenn
esse
e
Missou
ri
New M
exico
Califor
nia
Alabam
a
South
Car
olina
Distric
t of C
olumbia
Massa
chus
etts
Maryla
nd
Penn
sylva
nia
Wiscon
sin
Puer
to Rico
New Yo
rkTe
xas
Iowa
Nevad
a
Colora
do
Arizon
aId
aho
Hawaii
-100%
-50%
0%
50%
100%
150%
Percent Change in Population of African American Children in Foster Care, by State (2006-2009)