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Richard P. Barth School of Social Work University of Maryland

Lessons from the U.S. National Survey of Child and Adolescent Well-Being (NSCAW): How Are the Children Faring and Did Mental Health Services Help?. Richard P. Barth School of Social Work University of Maryland.

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Richard P. Barth School of Social Work University of Maryland

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  1. Lessons from the U.S. National Survey of Child and Adolescent Well-Being (NSCAW): How Are the Children Faring and Did Mental Health Services Help? Richard P. Barth School of Social Work University of Maryland The research for this presentation was funded by the Administration on Children, Youth, and Families of the U.S. Department of Health and Human Services. Although I am grateful to the NSCAW Research Group for their work, points of view or opinions in this presentation and accompanying documents are those of the presenter and do not necessarily represent the position or policies of the U.S. DHHS or of my NSCAW colleagues. Results are preliminary and not to be quoted in print or other media. I am grateful to the Fulbright Commission for an award as a Senior Specialist Presented at ACWA Annual Conference Research Forum University of WashingtonAugust 15, 2006

  2. First National Random Sample Study Of CWS • Extended Research Team included: • Research Triangle Institute • University of North Carolina • San Diego Children’s Hospital, CASRC • CSRD, Pitt Medical Center • National Data Archive on Child Abuse and Neglect, Cornell • 92 Local Child Welfare Agencies • Federal Admin. For Children and Families • Children and Families • Taxpayers of US who have provided more than $40,000,000 in support

  3. Total 6,231 Long-term foster care 727 Enter through investigation 5,504 Other gateways 600 No services 1,725 Ongoing services 3,779 In home 2,312 Out-of-home 1467 NSCAW Cohort at Baseline

  4. Wellbeing Measures • Social Domain • Vineland Adaptive Behavior Scale Screener, Daily Living Skills domain (VABS) • Social Skills Rating System (SSRS) • Behavioral Domain • Child Behavior Checklist (CBCL) • Risky Behaviors (11+ years) • Self-Report Delinquency (SRD) • Substance Abuse • Sexual Behavior • Suicide • Infant Development (0 – 2 years) • Battelle Developmental Inventory (BDI) • Bayley Infant Neurodevelopmental Screener (BINS) • Vineland Adaptive Behavior Screener (VABS) • Cognitive Domain • Preschool Language Scale-3 (PLS-3) • Mini-Battery of Achievement (MBA)

  5. Family Cumulative Risk Score • Risk Assessment section (CW worker) • 23 items (e.g., including trouble meeting basic needs, substance abuse, past CW involvement, domestic violence, parent psychopathology) • Proportional score created • Low risk (< 22%) • Medium risk (22% to 40%) • High risk (40%) When using as predictor of child behavior (e.g., CBCL), child behavior variables are omitted from this score

  6. Risky Behavior Domain (11 to 15 at BL) Substance Abuse • Modified from Youth Risk Behavior Survey items • 14 questions: 7: Substances used past 30 days 7: Frequency of use • Scoring: Acts weighted by seriousness & multiplied by frequency Self-Report Delinquency (SRD) • Modified version of the SRD (Elliott & Ageton, 1980) used for Wave 7 (1987) of the NLSY • 72 Questions: • 36: Acts committed in previous 6 months • 36: Frequency of acts • Scoring: Acts weighted by seriousness & multiplied by frequency • Cronbach’s α = .98

  7. Risky Domain (11 to 15 at BL) Suicidal Behavior Risk Items from the Youth Self Report, and the Children’s Depression Inventory Six items ask the youth and caregiver about thoughts, plans, and suicides attempts of the child Scores range from 0 to 17 • No risk (0, No suicidal behavior reported) • Low risk (1 – 3, Suicidal thoughts in the past two weeks) • Medium/High risk (4–17, Has deliberately tried to harm self and/or has had suicidal thoughts in the past two weeks, and has a plan) Voluntary Sexual Behavior Three items ask (1) Had youth ever had intercourse; (2) Consistency of use of protection for sexual intercourse; and (3) Had youth ever been pregnant or gotten someone pregnant (0 = “No” or not applicable, 1 = “Yes”). Scores ranged from 0 to 5 • No risk (0, Never had intercourse or first experience was coerced) • Low risk (1, Has had intercourse but used protection consistently and has never been/gotten someone pregnant) • Medium/High risk (2-5, Inconsistent use of protection and possible pregnancy)

  8. Change in Developmental Well-Being of Children Involved with CWS from Baseline to 18 Months Conditional Probability of Change 2. Change scores and effect sizes 3. Assessment of Contributors to Well-Being Using General Estimating Equations

  9. Age Groups andWell-Being Measures

  10. Proportion of Developmental/Clinical Cutting Scores Per Child^ W1 Median W3 Median ^Number of possible measures per child varies from 4 to 7

  11. Baseline Mean (SE) 18 months Mean (SE) Effect Size Setting In-home at baseline and 18 months (n=881) 42.0 (.97) 42.1 (1.25) +.01 Out-of-home at baseline and 18 months (n=312)** 44.2 (2.02) 40.1 (1.83) -.32 Total (n=1493) 42.6 (.92) 42.0 (1.04) -.05 Changes in Cognitive Development Score (BDI) for 0-2 Year Old Children: Baseline to 18-Months Note: 454 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were equal for the purposes of comparison. All analyses are on weighted data. Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-of-home to in-home). ** p < .01

  12. Risk for Developmental Delay or Neurological Impairment at Baseline Risk for Developmental Delay or Neurological Impairment at 18 Months Low Moderate High Low (n=59) .02 .04 .02 Moderate (n=132) .03 .13 .15 High (n=367) .07 .20 .35 Changes in Risk for Developmental Delay or Neurological Impairment (BINS) for Children 0-2, Baseline to 18-Months All analyses are on weighted data. Red(upper) triangle shows negative change, Green (lower)shows improvement.

  13. Risk for Developmental Delay or Neurological Impairment at Baseline Risk for Developmental Delay or Neurological Impairment at 18 Months Low Moderate High Low (n=31) .01 .05 .02 Moderate (n=78) .04 .13 .16 High (n=167) .07 .15 .38 Change in (BINS) for Children 0-2, BL to 18-Months (In-Home Only) All analyses are on weighted data. Red (upper) triangle shows negative change, Green (lower)shows improvement.

  14. Risk for Developmental Delay or Neurological Impairment at Baseline Risk for Developmental Delay or Neurological Impairment at 18 Months Low Moderate High Low (n=16) .05 .02 .01 Moderate (n=21) .00 .14 .14 High (n=110) .07 .23 .34 Change in (BINS) for Children 0-2, BL to 18-Months (Out-of-Home Only) All analyses are on weighted data. p<.001 (Bowker’s test); Red (upper) triangle shows negative change,Green (lower) shows improvement.

  15. Baseline Mean (SE) 18 months Mean (SE) Effect Size Setting In-home at baseline and 18 months (n=879)* 91.3 (1.31) 87.8 (1.03) -.20 Out-of-home at baseline and 18 months (n=317) 90.0 (1.31) 86.5 (1.72) -.22 Total (n=1501)** 91.3 (1.05) 87.8 (.89) -.20 Changes in Language Skills Score (PLS-3) for 0-2 Year Old Children: Baseline to 18-Months Note: 438 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were equal for the purposes of comparison All analyses are on weighted data. Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-of-home to in-home). * p < .05; ** p < .01

  16. Baseline Mean (SE) 18 months Mean (SE) Effect Size Setting In-home at baseline and 18 months (n=252)** 88.4 (1.84) 94.6 (2.90) +.36 Out-of-home at baseline and 18 months (n=41)* 76.1 (5.87) 82.6 (6.88) +.33 Total (n=345)** 88.1 (1.67) 95.0 (2.48) +.39 Changes in Language Skills Score (PLS-3) for 3-5 Year Old Children: Baseline to 18-Months Note: 401 cases were deleted such that the number of cases with valid scores at Baseline and 18 Months were equal for the purposes of comparison All analyses are on weighted data. Total group also includes cases with mixed placement types across waves (I.e., in-home to out-of-home, and out-of-home to in-home). * p < .05; ** p < .01

  17. Age at baseline In-home at baseline and 18 months Out-of-home at baseline and 18 months + change - change + change - change 0-2 3-5 25% 19% 8% 19% 6-10 15% 11% 21% 8% Changes in Daily Living Skills (VABS) Baseline to 18-Months by Setting and Age Red shows negative change, Green shows improvement.

  18. CBCL Changes for Children (Ages 3-5): Served at Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  19. CBCL Changes for Children (Ages 3-5): Served Out-of-Home* Red (upper) triangle shows negative change, Green (lower) shows improvement.

  20. CBCL Change Over 18 months (Children Aged 3 to 5 Years at BL) Child Gender* Beta (Units Change in CBCL Score) Male* 3.25 Female Reference Group Child Race/Ethnicity* Black/Non-Hispanic* -3.45 White/Non-Hispanic Reference Group Hispanic -1.85 Other 1.74 Parent Cumulative Risk   Low Reference Group Medium 3.03 High* 3.27 Non-significant Variables: Wave, Proportion of Time of Out-of-Home Care, In-Home at Both Waves, Poverty Level *p<.05 **p<.01 ***p<.001

  21. CBCL Changes for Children (Ages 6-10): Served at Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  22. CBCL Changes for Children (Ages 6-10): Served Out-of-Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  23. CBCL Changes Over 18 Months (Children Aged 6 to 10 Years at BL) Gender* Beta Male* 2.13 Female Reference Group Child Race/Ethnicity   Black/Non-Hispanic -0.28 White/Non-Hispanic Reference Group Hispanic** -3.89 Other -1.89 Wave*** Baseline Reference Group 18 Months*** -2.56 Proportion of Time in Out-of-Home Care*   In-Home Reference Group Out-of-Home 4.74 Mixed* 4.70 Non-significant Variables: In-Home at Both Waves, Poverty Level, Parent Cumulative Risk **p<.05 **p<.01 ***p<.001

  24. CBCL Changes for Children (Ages 11+): Served at Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  25. CBCL Changes for Children (Ages 11+): Served Out-of-Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  26. CBCL Scores^ Over 18 months (Children Aged 11 to 15 Years at BL) Significant Predictor TIME (WAVE)* Beta   Baseline Reference Group 18 Months* -1.43 *p<.05 Non-significant Predictor: Gender, Child Race/Ethnicity, Proportion of Time in Out-of-Home Care, In-Home at Both Waves, Poverty Level, Parent Cumulative Risk, Substance Abuse, and Delinquency ^Measured using Child Behavior Checklist

  27. CBCL Changes for Children (Ages 2-15): Served at Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  28. CBCL Changes for Children (Ages 2-15): Served Out-of-Home Red (upper) triangle shows negative change, Green (lower) shows improvement.

  29. Age at baseline In-home at baseline and 18 months Out-of-home at baseline and 18 months + change - change + change - change 3-5 14% 16% 11% 13% 6-10 18% 9% 26% 11% 11+ 20% 13% 22% 21% Summary of Changes in CBCL Baseline to 18-Months by Setting and Age • 3-5 year olds show more negative change across settings than 6-10 year olds • 6-10 year olds show more positive change at home • 11-15 year olds show more positive change across settings Red shows greater negative change, Green shows greater improvement.

  30. CBCL Changes for All Children Since BL Child Age at Baseline***Beta 2 years*** -5.62 3-5 years*** -3.87 6-10 years*** -3.73 11+ years Reference Group Child Race/Ethnicity*   Black/Non-Hispanic -0.90 White/Non-Hispanic Reference Group Hispanic** -3.10 Other -0.24 Wave***   Baseline Reference Group 18 Months*** -1.55 Proportion of Time in Out-of-Home Care** In-Home Reference Group Out-of-Home** 4.36 Mixed 2.31 Parent Cumulative Risk***   Low Reference Group Medium** 2.59 High*** 3.42 Non-significant Variables: Gender, In-Home at Both Waves, and Poverty Level **p<.05 **p<.01 ***p<.001

  31. Self-Reported Delinquency Changes for Children (Ages 11-15) Served at Home Unweighted n=624 Red (upper) shows negative change, Green (lower) shows improvement.

  32. Self-Reported Delinquency Changes for Children (Ages 11-15) Served Out of Home Unweighted n=141 Red (upper) shows negative change, Green (lower) shows improvement.

  33. Suicide Risk Changes for Children (Ages 11-15) Served in Home Unweighted n=664 Red (upper) shows negative change, Green (lower) shows improvement.

  34. Suicide Risk Changes for Children (Ages 11-15) Served Out of Home Unweighted n=156 Red (upper) shows negative change, Green (lower) shows improvement.

  35. Substance Abuse Risk Changes for Children (Ages 11-15) Served at Home Unweighted n=605 Red (upper) shows negative change, Green (lower) shows improvement.

  36. Substance Abuse Risk Changes for Children (Ages 11-15) Served Out of Home Unweighted n=135 Red (upper) shows negative change, Green (lower) shows improvement.

  37. Risk In-home at baseline and 18 months Out-of-home at baseline and 18 months + change - change + change - change Delinquency 22% 23% 26% 23% Suicide 25% 13% 28% 11% Substance Abuse 14% 29% 15% 17% Summary of Changes in Risk Behavior to 18-Months by Setting and Age Red shows greater negative change, Green shows greater improvement.

  38. Baseline Mean (SE) 18 months Mean (SE) Effect Size Setting In-home at baseline and Wave 3 (n=536) 12.3 (1.6) 12.0 (16) .02 Out-of-home at baseline and 18 months (n=161) 21.7 (3.4) 9.4*** (3.4) .39 Total (n=848)^ CTS-PC (Child) Scores for Inappropriate Parenting, BL to 18 Months (Children 11+) 13.6 (1.4) 11.7 (1.4) .08 ^Total includes children in mixed placement settings p<.05**, p<.01***, p<.001

  39. Baseline Mean (SE) 18 months Mean (SE) Effect Size Setting In-home at baseline and Wave 3 (n=536) 2.1 (.39) 1.0* (.23) .16 Out-of-home at baseline and 18 months (n=161) 7.2 (2.2) 3.1** (1.9) .21 Total (n=848)^ CTS-PC (Child) Scores for Severe Violence, BL to 18 Months (Children 11+) 2.8 (.38) .54 1.3*** (.25) ^Total includes children in mixed placement settings p<.05**, p<.01***, p<.001

  40. Predictors of Change in Well-Being for Multivariate (GEE) Models • Age (at Baseline) • Gender • Race/Ethnicity: Black, White, Hispanic, Other • Urbanicity: Urban, Nonurban • Child Setting: In-home, Out-of-home, Mixed • Most Serious Maltreatment Type: Physical, Sexual, Failure to Provide (FTP), Failure to Supervise (FTS), Other • Parent Cumulative Risk Score: Low, Medium, High • Change in Parental Figurein 18 months (Y/N) • Prior CWS History (Y/N) • Chronic Health Problem (Y/N) • Ratio of Children to Adults in Household (continuous) • Poverty Rate (continuous) • HOME-SF Score (continuous)

  41. Infants: Other Significant Findings • BINS: victims of sexual abuse comprised the only maltreatment type subgroup at higher risk at 18-months • VABS: children in out-of-home care have a greater decline in this measure than in-home children or children in mixed settings

  42. Summary: Age 0-2 • No significant measured improvements in development for infants • In general, infants < 2 years decline in all measures, those 25-35 months improve • Children with lower HOME-SF scores see greater declines in three of the four measures • Children in nonurban PSUs see higher risk for developmental delay and neurological impairment and worsening language skills • Males decline in cognitive development and social skills

  43. Toddlers: Other Significant Findings • SSRS: children in mixed settings exhibited a large decline in social skills, significantly so compared with the relatively stable skills of in-home children • PLS-3: victims of Other abuse exhibited a decrease, while children in all other abuse type groups exhibited an increase

  44. Summary: Age 3-5 • Slight decline in social skills; improvement in language skills; stable level of problem behavior • Age in months is a significant predictor of change, but not in a consistent direction • Prior CWS history is a predictor of change for both social and language skills • Could be that they receive greater level of intervention, this time • Could be that prior involvement already raised the level of their care or treatment

  45. School-Age Children: Other Significant Findings • CBCL: Being male, living in nonurban areas, and more poverty are associated with greater decreases in problem behavior • MBA-Math: Children with low parent cumulative risk and those in mixed settings exhibited increases, in contrast to their counterparts

  46. Summary: Age 6-10 • Only age group that showed improvements, although slight, in all developmental measures examined • Only age group where age is not a significant predictor of rate of change for any domain • Maltreatment type is the only significant predictor across more than one domain, yet with varied results

  47. Maltreated Adolescents Risky and Risk-Taking Behaviors

  48. Problem Behaviors • Approximately 40% of maltreated adolescents have borderline/clinical levels of problem behavior, compared to only 5% of children in the general population (Achenbach, 1991) • Maltreated adolescents need assistance in dealing with more than the maltreatment incident (e.g., aggression, attention problems)

  49. Delinquency • Delinquency is fairly stable but 6% of youth are reporting consistently high levels of serious/violent behaviors • Confirms other research (see Loeber & Farrington, 1998) that a small proportion of youth are committing the most serious/violent offenses (e.g., gang fights, robbery, rape)

  50. Risky Sexual Behavior • Youth living in out-of-home care are reporting more risky sexual behavior. • Probably attributable to the fact that out-of-home youth are often removed from very high-risk homes (Carpenter, Clyman, Davidson, & Steiner, 2001). Are youth living in out-of-home care being monitored sufficiently? How can we assist youth in out-of-home care to engage in less unsafe sex?

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