Case Advocacy: A Study of the Interventive Process in Child Advocacy

This is an exploratory study of the practice of case advocacy on behalf of children. The objectives of the study were to identify and classify the major components of case advocacy, to generate hypotheses describing the basic dynamics of this process, and to analyze the implications of these findings for the theory and practice of advocacy. The study was carried out during 1972-1973. Data were collected from 39 practitioners of child advocacy who had varying levels of education and work experience and were employed in eight different types of agencies located throughout the country. The respondents submitted 163 incidents of case advocacy over a five-month data collection period. The critical incident technique was the primary research instrument. Respondents were asked to submit brief written questionnaires describing the first incident of case advocacy they engaged in each week. Data collected in this manner were supplemented by site visits to each of the sample agencies, background information questionnaires on the respondents, and findings from a baseline study of child advocacy. The incidents were analyzed in an inductive manner to identify the major components of case advocacy and to develop a classification scheme delineating these variables. The incidents were then coded by the conference method so that frequencies and associations among variables could be computed. Finally, these findings were analyzed to generate hypotheses describing the major dynamics of the advocacy process. Case advocacy was revealed in this study as a complex, dynamic process in which there are a number of interrelated variables. To describe this process briefly, the study identified five major modes of direct intervention in child advocacy: intercession, persuasion, negotiation, pressure, and coercion. In addition, it was noted that indirect modes of influence are employed frequently. The advocate's use of one or more of these modes of intervention is determined by his analysis of the problem, objective and sanction for the intervention; his resources; and the receptivity of the target system. These variables also influence his decision as to the level and object of his intervention. It appears, however, that there is constant interaction and feedback among these components of the advocacy process so that the change agent constantly reassesses his approach in relation to his changing understanding of these various factors. And after the initial intervention has been completed, the advocate's evaluation of the outcome influences his decision as to whether to terminate his activity, adopt a different strategy, or initiate additional advocacy. It was noted that the advocates were reluctant to employ adversarial techniques, making extensive use of collaborative and mediatory strategies. Also, the respondents tended to employ a rather limited interventive repertoire and to engage in a relatively low level of intervention. The change agent and the target system appeared to be the primary determinants of the advocacy process. However, it was noted that the stronger the sanction for a particular intervention, the more options the advocate had in regard to object, level, and method of intervention. Although there was no conclusive evidence, it seemed that the resources of the change agent and the receptivity of the target system were the primary factors related to outcome. The findings have implications for the organization and practice of child advocacy. Also, it is hoped that the conceptual framework presented here will contribute to the development of a theory of advocacy practice

Workforce Retention Issues in Voluntary Child Welfare

Unlike many studies focused on retention and turnover in public child welfare, this study examined issues of job satisfaction and retention in voluntary child welfare. Although three-fourths of the 1, 624 workers surveyed intended to remain in child welfare, 57.3% had thought about leaving their agencies during the past year. All respondents were dissatisfied with their level of pay, but those thinking of leaving were significantly less satisfied with the contingent rewards they received

Societal Factors Impacting Child Welfare: Validating the Perceptions of Child Welfare Scale

Objective: This research examines the psychometric properties of the Perceptions of Child Welfare Scale (PCWS). This instrument is designed to assess child welfare workers ’ understanding of how society views their role and their work. Methods: Confirmatory factor analysis (CFA) was utilized to analyze data on 538 child welfare workers. Results: The final model consisted of three latent variables with 14 indicators related to stigma, value, and respect (w2 362.33, p .00; root mean square error of approximation [RMSEA] .09; 90 % confidence interval [CI]: [.08,.09]; comparative fit index [CFI] .96; Tucker–Lewis Index [TLI] .95). Discussion: The way in which workers believe others view their work suggests an increasingly complex prototype for understanding workforce issues. Those wishing to examine societal factors related to child welfare workforce issues could use this validated instrument

Cross-Sectional Analysis of Late HAART Initiation in Latin America and the Caribbean: Late Testers and Late Presenters

Background: Starting HAART in a very advanced stage of disease is assumed to be the most prevalent form of initiation in HIV-infected subjects in developing countries. Data from Latin America and the Caribbean is still lacking. Our main objective was to determine the frequency, risk factors and trends in time for being late HAART initiator (LHI) in this region. Methodology: Cross-sectional analysis from 9817 HIV-infected treatment-naive patients initiating HAART at 6 sites (Argentina, Chile, Haiti, Honduras, Peru and Mexico) from October 1999 to July 2010. LHI had CD4$^+$ count $\leq$200cells/mm$^3$ prior to HAART. Late testers (LT) were those LHI who initiated HAART within 6 months of HIV diagnosis. Late presenters (LP) initiated after 6 months of diagnosis. Prevalence, risk factors and trends over time were analyzed. Principal Findings: Among subjects starting HAART (n = 9817) who had baseline CD4$^+$ available (n = 8515), 76% were LHI: Argentina (56%[95%CI:52–59]), Chile (80%[95%CI:77–82]), Haiti (76%[95%CI:74–77]), Honduras (91%[95%CI:87–94]), Mexico (79%[95%CI:75–83]), Peru (86%[95%CI:84–88]). The proportion of LHI statistically changed over time (except in Honduras) ($p\leq0.02$; Honduras p = 0.7), with a tendency towards lower rates in recent years. Males had increased risk of LHI in Chile, Haiti, Peru, and in the combined site analyses (CSA). Older patients were more likely LHI in Argentina and Peru (OR 1.21 per +10-year of age, 95%CI:1.02–1.45; OR 1.20, 95%CI:1.02–1.43; respectively), but not in CSA (OR 1.07, 95%CI:0.94–1.21). Higher education was associated with decreased risk for LHI in Chile (OR 0.92 per +1-year of education, 95%CI:0.87–0.98) (similar trends in Mexico, Peru, and CSA). LHI with date of HIV-diagnosis available, 55% were LT and 45% LP. Conclusion: LHI was highly prevalent in CCASAnet sites, mostly due to LT; the main risk factors associated were being male and older age. Earlier HIV-diagnosis and earlier treatment initiation are needed to maximize benefits from HAART in the region

Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial

Importance: Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks' or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective: To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants: A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks' or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions: Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures: The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. Results: Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks' gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, -1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance: Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness

Respect in the Workplace: A Mixed Methods Study of Retention and Turnover in the Voluntary Child Welfare Sector

A significant challenge facing the child welfare system is the recruitment and retention of a stable and qualified workforce. Several studies have identified individual and organizational factors impacting workforce turnover. The current study expands upon previous research by utilizing a mixed methods design to examine the relationship between workers\u27 perceptions of respect in the workplace and their intention to leave. Thematic analysis of the qualitative data revealed that workers perceive a lack of respect in five domains including organizational support, fair salary and benefits, fair promotion potential, adequate communication and contingent rewards. Based on the qualitative findings, researchers designed the Respect Scale, a quantitative scale measuring the concept perceived respect. Results from the logistic regression found that workers who score lower on the Respect Scale were significantly more likely to intend to leave their current job. Research and practice implications are discussed

Predicting Turnover: Validating the Intent to Leave Child Welfare Scale

A number of proxies have been used in child welfare workforce research to represent actual turnover; however, there have been no psychometric studies to validate a scale specifically designed for this purpose. The Intent to Leave Child Welfare Scale is a proxy for actual turnover that measures workers\u27 intention to leave. This scale was validated in the current study by a CFA. The resulting factors were compared to actual turnover. Nearly two in three workers who indicated that they had considered looking for a job in the past year actually left their agencies (60.0%). A confirmatory factor analysis was conducted to determine the validity of the Intent to Leave Child Welfare Scale. The best fitting model consisted of three factors with acceptable fit statistics (X2 = 28.6, p = 0.04; RMSEA = 0.05, 90% RMSEA CI = 0.01-0.08; CFI = 0.99; TLI = 0.98). Identified latent factors included thinking, which included observed variables related to workers thinking about leaving their current jobs; looking, which included observed variables related to workers searching for a new job; and acting, which included observed variables related to workers actually taking physical steps to seek a new job. Once a good fitting model was identified, binary logistic regression was conducted to determine odds ratios to predict who actually left their agencies. Each of the identified latent factors was significantly predictive of actual leaving (thinking: OR = 1.24, p = 0.00; looking: OR = 1.25, p = 0.00; acting: OR = 1.28, p = 0.01)

Differential Factors Influencing Public and Voluntary Child Welfare Workers\u27 Intention to Leave

Although several studies have explored personal and organizational factors impacting retention and turnover in public or private agencies, there are no studies comparing the similarities and differences between voluntary and public child welfare settings. The research reported here is designed to contribute to knowledge about the differential factors that may contribute to worker retention and turnover in the voluntary (private, non-profit) and public child welfare sectors. The current research expands knowledge of the child welfare workforce by comparing the difference in factors contributing to job satisfaction and turnover between the voluntary and public child welfare sectors in a large urban community. The research includes workers from 202 voluntary agencies (n=538) and from one large public child welfare agency (n=144).The bivariate analyses revealed that public agency workers were more satisfied with their opportunities for promotion, benefits, and the nature of their work, whereas the voluntary agency workers were more satisfied with their co-workers. A structural equation model (SEM) revealed that lower investment in child welfare work was associated with intent to leave for both samples, as was lower satisfaction with contingent rewards and the nature of their work. Moreover, agency auspice was strongly predictive of intent to leave. Voluntary child welfare workers had stronger intentions to leave, despite the fact they displayed higher investment in child welfare work in the bivariate analysis. The key factor predicting voluntary agency workers\u27 intention to leave was their dissatisfaction with their level of pay

Differential factors influencing public and voluntary child welfare workers' intention to leave

Although several studies have explored personal and organizational factors impacting retention and turnover in public or private agencies, there are no studies comparing the similarities and differences between voluntary and public child welfare settings. The research reported here is designed to contribute to knowledge about the differential factors that may contribute to worker retention and turnover in the voluntary (private, non-profit) and public child welfare sectors. The current research expands knowledge of the child welfare workforce by comparing the difference in factors contributing to job satisfaction and turnover between the voluntary and public child welfare sectors in a large urban community. The research includes workers from 202 voluntary agencies (n = 538) and from one large public child welfare agency (n = 144). The bivariate analyses revealed that public agency workers were more satisfied with their opportunities for promotion, benefits, and the nature of their work, whereas the voluntary agency workers were more satisfied with their co-workers. A structural equation model (SEM) revealed that lower investment in child welfare work was associated with intent to leave for both samples, as was lower satisfaction with contingent rewards and the nature of their work. Moreover, agency auspice was strongly predictive of intent to leave. Voluntary child welfare workers had stronger intentions to leave, despite the fact they displayed higher investment in child welfare work in the bivariate analysis. The key factor predicting voluntary agency workers' intention to leave was their dissatisfaction with their level of pay.Worker retention Job satisfaction Structural equation modeling Auspices