Facilitating service access for children and families in child welfare: an ecological perspective

Background. Families involved with the child welfare system often have severe and costly unmet health and social service needs. Contextual and organizational factors that could explain variation in service delivery are under-examined in the child welfare literature. Conceptual Framework. The ecological perspective posits that child welfare agency behavior is influenced by both intra-organizational factors and the interaction of the child welfare agency with its external environment. In this dissertation project, the ecological perspective is applied to identify factors at three levels of the child welfare agency environment - micro, meso, and macro - that influence the services received by children and their families. Research Objective. This project consists of three separate studies: The first examines the extent to which a micro-level factor, caseworkers' work climate, moderates the effect of a macro-level factor, performance-based contracting, upon services for caregivers. The second study examines how a factor at the meso-level, inter-agency collaboration between local child welfare and juvenile justice agencies, influences youth behavioral health service receipt. Finally, the third study examines how the accessibility of Medicaid, another macro-level factor, and the supplementation of Medicaid with child welfare funds affects children's mental health services. Methods. Data were drawn from the National Survey of Child and Adolescent Well-Being (NSCAW) and the Caring for Children in Child Welfare study (CCCW). Multivariate regression analyses incorporating the complex survey design of the data were used to examine associations between identified factors and families' receipt of necessary behavioral health and social services. Findings. In the first study, caseworkers' work climate moderated payment structures intended to restructure service delivery. In the second study, designation of agency accountability and access to shared information systems positively influenced youth receipt of behavioral health services. In the third and final study, child welfare agencies' access to and supplementation of Medicaid funds was associated with the percentage of children receiving mental health services. Implications. Child welfare policymakers, administrators, and researchers seeking to improve service access for children and families must consider the contexts in which these services are embedded, as well as how child welfare agencies' internal and external environments may interact to influence service use

Under What Conditions Does Caseworker-Caregiver Racial/Ethnic Similarity Matter for Housing Service Provision? An Application of Representative Bureaucracy Theory

In this article, we examine child welfare caseworkers’ housing-related service strategies when they serve culturally similar versus culturally dissimilar clients. Testing hypotheses drawn from representative bureaucracy theory and using data from the second cohort of the National Survey of Child and AdolescentWell-Being, we find that when non-Caucasian caseworkers share the same racial/ethnic background as caregivers, caseworkers use more active strategies to connect caregivers to needed housing services. The relationship between racial/ethnic matching and frontline workers’ repertoire of service strategies is most pronounced when the need for housing has been registered formally via referrals and case plans and thus legitimated institutionally. These results reinforce basic tenets of representative bureaucracy theory and provide evidence of the benefits of racial and ethnic diversity in the human service workforce. Our findings also highlight the need for research identifying institutional and frontline organizational factors that enhance the quality of service provision

The role of inter-agency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of interagency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies – jurisdiction, shared information systems, and overall connectivity – and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems

Does Formal Integration Between Child Welfare And Behavioral Health Agencies Result in Improved Placement Stability For Adolescents Engaged With Both Systems?

National survey data were used to assess whether child welfare agency ties to behavioral health care providers improved placement stability for adolescents served by both systems. Adolescents initially at home who were later removed tended to have fewer moves when child welfare and behavioral health were in the same larger agency. Joint training of child welfare and behavioral health staff was negatively associated with numbers of moves as well as numbers of days out of home

Organizational Supports for Evidence use in child welfare

Despite its importance to achieving positive outcomes for vulnerable children and families, use of evidence by child welfare managers and practitioners remains limited. This study describes four types of organizational supports that child welfare agencies may use to facilitate evidence use. Data collected in 2016 from a six-state sample of private child welfare agencies are used to examine agency investment in different supports for evidence use and their association with managerial evidence use. We also identify contextual, organizational, and managerial factors associated with agency investment in these supports. Findings suggest that technical infrastructure is necessary but not sufficient for promoting managerial evidence use in the absence of other supports. Implications for policy and practice are discussed

Effectiveness of a grant program's efforts to promote synergy within its funded initiatives: perceptions of participants of the Southern Rural Access Program

Abstract Background Foundations and public agencies commonly fund focused initiatives for individual grantees. These discrete, stand-alone initiatives can risk failure by being carried out in isolation. Fostering synergy among grantees' initiatives is one strategy proposed for promoting the success and impact of grant programs. We evaluate an explicit strategy to build synergy within the Robert Wood Johnson Foundation's Southern Rural Access Program (SRAP), which awarded grants to collaboratives within eight southeastern U.S. states to strengthen basic health care services in targeted rural counties. Methods We interviewed 39 key participants of the SRAP, including the program director within each state and the principal subcontractors heading the program's funded initiatives that supported heath professionals' recruitment, retention and training, made loans to health care providers, and built networks among providers. Interews were recorded and transcribed. Two investigators independently coded the transcripts and a third investigator distilled the main points. Results Participants generally perceived that the SRAP yielded more synergies than other grant programs in which they had participated and that these synergies added to the program's impact. The synergies most often noted were achieved through relationship building among grantees and with outside agencies, sharing information and know-how, sharing resources, combining efforts to yield greater capacity, joining voices to advocate for common goals, and spotting gaps in services offered and then filling these gaps. The SRAP's strategies that participants felt fostered synergy included targeting funding to culturally and geographically similar states, supporting complementary types of initiatives, promoting opportunities to network through semi-annual meetings and regular conference calls, and the advocacy efforts of the program's leadership. Participants noted that synergies were sometimes hindered by turf issues and politics and the conflicting perspectives and cultures of participating organizations and racial groups. Inadequate funding through the SRAP, restricting program involvement to only a few needy counties, and instances of over- and under-involvement by the program's leadership were sometimes felt to inhibit synergies and/or their sustainability. Conclusion Participants of the SRAP generally perceived that the SRAP's deliberate strategies yielded synergies that added to the program's impact

Facilitating mental health service use for caregivers: Referral strategies among child welfare caseworkers

Unmet needs for mental health care are common among caregivers involved in the child welfare system. Although child welfare caseworkers are well positioned to identify service needs and refer caregivers to treatment, little is known about the types of referral strategies used in practice, or their effectiveness for promoting mental health service use. The current study examined child welfare caseworkers’ use of different referral strategies and the extent to which these strategies are associated with caregivers’ receipt of mental health services within a national sample of child welfare cases. Analyses of the second cohort of families from the National Survey of Child and Adolescent Well-Being suggest that child welfare workers more often use informational strategies for referring caregivers, including suggesting treatment or providing information about treatment options. However, social referral strategies such as providing caregivers with direct assistance in completing applications and making and attending appointments were associated with a greater likelihood of caregivers receiving mental health services. Findings support evidence from other service contexts that service use is facilitated by caseworkers’ direct support for arranging services. Implications for research and for child welfare managers and administrators are discussed

Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

IntroductionEcological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity.MethodsA total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized.ResultsRespondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community.ConclusionProject leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts