Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Hoffman, Jill A.; Bunger, Alicia C.; Robertson, Hillary A.; Cao, Yiwen; West, Kristopher Y.

doi:10.1016/j.childyouth.2016.04.003

Cited by 30 publications

(16 citation statements)

References 32 publications

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“…Supervisors engaged in mediating activities that translated top management implementation plans to frontline professionals and diffused and synthesized information. Supervisors also “sold” implementation, although they engaged in this role less than other roles perhaps because of competing demands (e.g., “initiative fatigue”) [42] or they felt that the intervention detracts from their focus on child safety (a common issue when implementing behavioral health-focused interventions in child welfare settings) [43, 44]. Nonetheless, these results provide support for the middle managers’ roles specified by theory and the application of this theory to supervisors’ behaviors within child welfare contexts.…”

Section: Discussionmentioning

confidence: 99%

Elucidating the influence of supervisors’ roles on implementation climate

et al. 2019

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BackgroundSupervisors play an essential role in implementation by diffusing and synthesizing information, selling implementation, and translating top management’s project plans to frontline workers. Theory and emerging evidence suggest that through these roles, supervisors shape implementation climate—i.e., the degree to which innovations are expected, supported, and rewarded. However, it is unclear exactly how supervisors carry out each of these roles in ways that contribute to implementation climate—this represents a gap in the understanding of the causal mechanisms that link supervisors’ behavior with implementation climate. This study examined how supervisors’ performance of each of these roles influences three core implementation climate domains (expectations, supports, and rewards).Materials and methodsA sequenced behavioral health screening, assessment, and referral intervention was implemented within a county-based child welfare agency. We conducted 6 focus groups with supervisors and frontline workers from implementing work units 6 months post-implementation (n = 51) and 1 year later (n = 40) (12 groups total). Participants were asked about implementation determinants, including supervision and implementation context. We audio-recorded, transcribed, and analyzed focus groups using an open coding process during which the importance of the supervisors’ roles emerged as a major theme. We further analyzed this code using concepts and definitions related to middle managers’ roles and implementation climate.ResultsIn this work setting, supervisors (1) diffused information about the intervention proactively, and in response to workers’ questions, (2) synthesized information by tailoring it to workers’ individual needs, (3) translated top managements’ project plans into day-to-day tasks through close monitoring and reminders, and (4) justified implementation. All four of these roles appeared to shape the implementation climate by conveying strong expectations for implementation. Three roles (diffusing, synthesizing, and mediating) influenced climate by supporting workers during implementation. Only one role (diffusing) influenced climate by conveying rewards.ConclusionsSupervisors shaped implementation climate by carrying out four roles (diffusing, synthesizing, mediating, and selling). Findings suggest that the interaction of these roles convey expectations and support for implementation (two implementation climate domains). Our study advances the causal theory explaining how supervisors’ behavior shapes the implementation climate, which can inform implementation practice.

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Section: Discussionmentioning

confidence: 99%

Elucidating the influence of supervisors’ roles on implementation climate

et al. 2019

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“…When screening identifies mental health needs, multiple factors potentially inhibit provision of services and result in unmet needs for many children (Mersky et al, 2020; Petrenko et al, 2011). Demands on a caseworker’s time may limit caseworkers’ ability to address children’s needs beyond basic safety and protection (Hoffman et al, 2016). Caseworkers also frequently lack the training needed to identify the youth’s specific mental health needs and then assist foster families and youth in navigating complex systems of care (Hoffman et al, 2016; Kerns et al, 2014).…”

Section: Provision Of Mental Health Services In Out-of-home Carementioning

confidence: 99%

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Leathers

Voort

Melka-Kaffer

2021

Developmental Child Welfare

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Children at risk for placement instability are subpopulation in out-of-home care with a critical need for enhanced mental health services, but little is known about the types and adequacy of the mental services they receive. This descriptive study sought to identify the types of mental health services and psychotropic medications provided to children with a risk for moves, foster parents’ perceptions of their adequacy, consistency of therapy services with evidence-based models, and racial and gender differences in service provision. Foster parents completed telephone surveys for a randomly selected sample of 144 children aged 8–14 in specialized or traditional family foster care with a history of placement moves or hospitalizations in a large state in the US. Over two-thirds of children were reported to have mental health diagnoses, with ADHD most frequent (52%). Most children with a diagnosis received psychotherapy (75%) and psychotropic medications (90%). The majority did not receive additional services. A quarter received therapy supporting use of behavioral interventions in foster homes, with 40% of foster parents reporting this was inadequate. Additionally, half reported inadequate initial training. No racial differences in services were reported. However, girls were more likely to receive therapy described as trauma-focused than boys (30.9% and 5.6%, respectively); more boys received treatment for anger (17%) and psychotropic medication (60%). Findings indicate that children at risk for multiple moves receive a high level of services, but questions are raised about the content and adequacy of these services. Evidence-based psychosocial interventions are needed to support positive outcomes and potentially reduce psychotropic medication use.

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“…Child welfare workers have been described as service brokers and gateway providers to services for children and youth (e.g., [ 15 , 31 , 32 ]). A referral made by a child welfare worker for support services is a critical step to match services to needs [ 33 ]. The importance of understanding and addressing the needs of infants and young children who come into contact with the child welfare system is underscored by the accumulating evidence of their developmental vulnerabilities, unmet needs, and the underutilization of services [ 14 , 15 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Infants Investigated by the Child Welfare System: Exploring a Distinct Profile of Risks, Service Needs, and Referrals for Support in Ontario

et al. 2017

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The science of early childhood development underscores that maltreatment and other adversities experienced during infancy heightens the risk for poor developmental and socio-emotional outcomes. Referrals to supportive services by the child welfare system are particularly critical during infancy given the rapidity of brain development and infants’ sensitivity to their environment. The main objectives of the current study are to: (1) examine age-specific differences in clinical and case characteristics; (2) determine the factors associated with the service referral decision involving infants; and (3) explore the types of services families have been referred to at the conclusion of a maltreatment-related investigation. Using data from the Ontario Incidence Study of Reported Child Abuse and Neglect for 2013, descriptive analyses were conducted, as was a logistic regression to identify factors associated with the decision to refer families of infants to supportive services. Overall, the findings reveal that the profile of infants and their families differs distinctly from those of older children with respect to risks, service needs, and service referrals, although this is rarely reflected in child welfare practice and policy. Investigations involving infants were most likely to have a referral made to supportive services, least likely to have an infant functioning concern identified; most likely to have a primary caregiver risk factor identified; and, the greatest likelihood of experiencing economic hardship. Multiple risks, identified for the primary caregiver of the infant are correlated to referral decisions for infants. However, the needs of the infant are likely under-identified and require cross-sectorial collaboration.

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Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Cited by 30 publications

References 32 publications

Elucidating the influence of supervisors’ roles on implementation climate

Elucidating the influence of supervisors’ roles on implementation climate

Mental health services and psychotropic medications provided to children at risk for placement instability in foster care

Infants Investigated by the Child Welfare System: Exploring a Distinct Profile of Risks, Service Needs, and Referrals for Support in Ontario

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