The Long View: Has Anything Really Improved for Children and Families Involved with Child Welfare over 3 Decades?

The overall poor health status and outcomes of children and youth in foster care have been documented in multiple studies over the last 3 decades. During this time, knowledge about brain development, positive parenting, resilience, traumatic stress, and epigenetics has exploded, resulting in demands for child welfare to become trauma-informed, child-centered, and developmentally focused. This special issue affords us the opportunity to reflect on: what’s better or not after 30 years; whether legislation and financing are aligned with child welfare’s goals of safety, permanency and well-being; and what remains to be done to improve the outcomes of children and youth in foster care or otherwise involved with child welfare

Childhood adversity and parent perceptions of child resilience

Abstract Background Adverse childhood experiences (ACEs) negatively impact health throughout the life course. For children exposed to ACEs, resilience may be particularly important. However, the literature regarding resilience, particularly the self-regulation aspect of resilience, is not often described in children with ACEs. Additionally, family and community factors that might help promote resilience in childhood may be further elucidated. We aimed to describe the relationship between ACEs and parent-perceived resilience in children and examine the child, family, and community-level factors associated with child resilience. Methods Using the US-based, 2011–2012 National Survey of Children’s Health, we examined adverse childhood experiences (NSCH-ACEs) as the main exposure. Affirmative answers to adverse experiences generated a total parent-reported NSCH-ACE score. Bivariate and multivariable logistic regression models were constructed for parent-perceived child resilience and its association with ACEs, controlling for child, family, and neighborhood-level factors. Results Among 62,200 US children 6–17 years old, 47% had 0 ACEs, 26% had 1 ACE, 19% had 2–3 ACEs, and 8% had 4 or more ACEs. Child resilience was associated with ACEs in a dose-dependent relationship: as ACEs increased, the probability of resilience decreased. This relationship persisted after controlling for child, family, and community factors. Specific community factors, such as neighborhood safety (p < .001), neighborhood amenities (e.g., libraries, parks) (p < .01) and mentorship (p < .05), were associated with significantly higher adjusted probabilities of resilience, when compared to peers without these specific community factors. Conclusions While ACEs are common and may be difficult to prevent, there may be opportunities for health care providers, child welfare professionals, and policymakers to strengthen children and families by supporting community-based activities, programs, and policies that promote resilience in vulnerable children and communities in which they live.https://deepblue.lib.umich.edu/bitstream/2027.42/144527/1/12887_2018_Article_1170.pd

Adverse Childhood Experience and Social Risk: Pediatric Practice and Potential

In a landmark study, Felitti et al found 10 Adverse Childhood Experiences (ACEs) to be associated, in a dose-dependent manner, with the leading causes of illness and death in adults decades later. Over the subsequent 20 years, research has confirmed that trauma in early childhood, in the absence of sufficient protective caregiving, causes a frequent or prolonged stress response that is the physiological link between childhood trauma and poor adult outcomes. Schonkoff and Garner termed this “toxic stress.”ACEs harm a child\u27s still-developing immunological system and brain explaining the findings of poor physical, emotional, and developmental health down the road. For pediatric researchers and practitioners, these data have created a 2-fold challenge: How to mitigate exposure to adversity and, critically, how to ameliorate the impacts of adversity on those exposed. In practice, this requires identification of those at risk and responses and tools to impact the trajectory

Translating Developmental Science to Address Childhood Adversity

Demystifying child development is a defining element of pediatric care, and pediatricians have long appreciated the profound influences that families and communities have on both child development and life course trajectories. Dramatic advances in the basic sciences of development are beginning to reveal the biologic mechanisms underlying well-established associations between a spectrum of childhood adversities and less than optimal outcomes in health, education and economic productivity. Pediatricians are well positioned to translate this new knowledge into both practice and policy, but doing so will require unprecedented levels of collaboration with educators, social service providers, and policy makers. Pediatricians might recognize the negative impact of family-level adversities on child development, but developing an effective response will likely require the engagement of community partners. By developing collaborative, innovative ways to promote the safe, stable, and nurturing relationships that are biologic prerequisites for health, academic success, and economic productivity, family-centered pediatric medical homes will remain relevant in an era that increasingly values wellness and population health

Timely identification of mental health problems in two foster care medical homes

Despite known high rates of mental health problems among children in foster care, these problems are often not identified promptly by primary care or other systems. A novel delivery system is a centralized primary care practice for foster care. The purpose of this study was to examine the identification of mental health within two pediatric medical homes for foster care. We conducted a retrospective medical chart review of all children, aged 6-18 years, newly entering foster care, in two foster care clinics serving two county-wide populations. Our sample of 242 children describes demographics, rates for mental health problem identification, and length of time after entering foster care that mental health needs were identified. We used logistic regression analyses to examine variables associated with identification of mental health needs. Both centralized foster care medical homes had high rates for identification of mental health problems (> 70% in both sites), timely identification (the majority identified within two months after entry into care), and high mental health referral rates for children entering foster care (> 70%). Our findings suggest that attention to mental health needs for children in foster care within their primary care setting can impact identification rates and management of mental health.Mental health Foster care Medical homes

Trends in Child Protection and Out-of-Home Care

BackgroundOver the past decades, increased knowledge about childhood abuse and trauma have prompted changes in child welfare policy, and practice that may have affected the out-of-home (OOH) care population. However, little is known about recent national trends in child maltreatment, OOH placement, or characteristics of children in OOH care. The objective of this study was to examine trends in child maltreatment and characteristics of children in OOH care.MethodsWe analyzed 2 federal administrative databases to identify and characterize US children who were maltreated (National Child Abuse and Neglect Data System) or in OOH care (Adoption and Foster Care Analysis and Reporting System). We assessed trends between 2000 and 2010.ResultsThe number of suspected maltreatment cases increased 17% from 2000 to 2010, yet the number of substantiated cases decreased 7% and the number of children in OOH care decreased 25%. Despite the decrease in OOH placements, we found a 19% increase in the number of children who entered OOH care because of maltreatment (vs other causes), a 36% increase in the number of children with multiple (vs single) types of maltreatment, and a 60% increase in the number of children in OOH care identified as emotionally disturbed.ConclusionsFrom 2000 to 2010, fewer suspected cases of maltreatment were substantiated, despite increased investigations, and fewer maltreated children were placed in OOH care. These changes may have led to a smaller but more complex OOH care population with substantial previous trauma and emotional problems

Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children: The Racial and Cultural Appropriateness of a Commonly Used Parenting Measure.

ObjectiveThe objective of this study was to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children's socioemotional outcomes, comparing children from Mexican-American and African American families with children from their White counterparts.MethodsThe Early Childhood Longitudinal Study Birth Cohort data were used to examine 6 global parenting styles with socioemotional outcomes at 48 months of age while controlling for both time-independent and time-depending sociodemographic, maternal mental health, and child characteristics. Data were stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed.ResultsThe 6 global parenting scores from the Two-Bag Task measures differed across White, African American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, whereas Mexican-American and African American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children but were nearly nonexistent for Mexican-American and African American children when adjusting for covariates.ConclusionOur results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important to optimally support child development for non-White children. Furthermore, a critical lens is important to mitigate the perpetuation of inaccurate research findings for Mexican-American and African American children

Additional file 1: of Childhood adversity and parent perceptions of child resilience

Table S1. Questions from the National Survey of Children’s Health 2011–2012†. †Please see 2012 NSCH: Child Health Indicator and Subgroups SPSS Codebook, Version 1.0 for more information on coding used regarding these questions. Questions from the National Survey of Children’s Health used in the study. (DOCX 20 kb