The Master of Arts in Child Advocacy

Abstract

Recent heinous examples of child neglect and abuse in the State of New Jersey have called into question how public child welfare workers are trained. The author, in collaboration with the Division of Youth and Family Services (DYFS) and other experts in the field of child welfare, worked on the development of a new degree that would more appropriately educate these workers. This paper discusses the development of the Master of Arts of Child Advocacy and its optional Concentration in Public Child Welfare and offers its curriculum as an alternative to the Master of Arts of Social Work (MSW). Child Advocacy is also explored as a new and emerging discipline.     

A project to strengthen linkages between genetic centers and child welfare services

Genetic centers are reaching out to underserved populations. One of the most vulnerable underserved populations is children receiving child welfare services. Delivering genetic services to this group is particularly problematic because of multiple barriers. The first step in overcoming barriers is developing linkages between the genetic and adoption service systems with the goal of increasing referrals of child welfare clients to genetic services. This paper presents a model of fostering linkages that was developed under the auspices of the Mid-Atlantic Regional Human Genetics Network with support from the Maternal and Child Health Bureau, Genetic Services Branch. Although the project was regional and funded, the model can be applied at the local level.     

An Overview of Trauma-Informed Care and Practice for Eating Disorders

ABSTRACT

This article reviews concepts and principles of trauma-informed care and trauma-informed practice for those with eating disorders (EDs). EDs are not universally recognized to be associated with traumatic events, despite substantial research evidence indicating that individuals with EDs report very high rates of childhood maltreatment, other lifetime traumatic events, as well as adverse consequences from trauma. Using national representative samples, higher prevalence rates of PTSD and other trauma-related comorbidities have been reported in those with EDs, particularly those with bulimic symptoms (binge eating and/or purging). Evidence suggests that those prone to develop EDs appear to be especially sensitive to the effects of stress/adversity and have high rates of premorbid anxiety disorders, personality traits, and neuropsychological features that predispose them to PTSD and its symptoms. This article also reviews some of the important principles for treating individuals with EDs comorbid for PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments, including family therapy, cognitive behavioral therapy, dialectical behavior therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitization reprocessing are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority, yet they have several concerns about administering such a treatment. As trauma-informed care is embraced by all clinicians and treatment programs that assess and treat eating and related disorders, better outcomes are anticipated.     

The Strengths and Limitations of Case Record Reviews in Examining Family Preservation Outcome Formulation and Treatment Planning

Much debate has centered on what are reasonable outcomes of the short-term intensive family preservation services (IFPS). However, little attention has been given to how therapists actually formulate outcomes in their practices. The files of 98 families who used IFPS were reviewed to determine how therapists formulated outcomes and whether formulated outcomes varied by service sector (child welfare or mental health) and child age. It was found that formulated outcomes in mental health were more likely than those in child welfare to have a child focus and an interpersonal locus. Variation in outcome formulation in child welfare by child age was found, with outcomes of younger children more likely to be parent-focused than were outcomes of older children. The issues pointed out by these findings are discussed. Since case records are a potential data source for researchers, the paper concludes with a discussion of the strengths and limitations of case record reviews for research purposes.     

Enhancing Capacity for Trauma‐informed Care in Child Welfare: Impact of a Statewide Systems Change Initiative

Youth involved in the child welfare system (CWS) are disproportionally impacted by the negative effects of exposure to trauma. While efforts to develop trauma‐informed CWSs are accelerating, little research is available about the effects of these efforts on system capacity to respond to the needs of youth exposed to trauma. No studies evaluate longer‐term effects of these efforts. In 2011, Connecticut implemented CONCEPT, a multi‐year initiative to enhance capacity of the state's CWS to provide trauma‐informed care. CONCEPT used a multi‐component approach including workforce development, deployment of trauma screening procedures, policy change, improved access to evidence‐based trauma‐focused treatments, and focused evaluation of program effects. Changes in system capacity to deliver trauma‐informed care were assessed using statewide stratified random samples of child welfare staff at three time points (Year 1: N = 223, Year 3: N = 231, Year 5: N = 188). Significant improvements across nearly all child welfare domains were observed during the first 3 years of implementation, demonstrating system‐wide improvements in capacity to provide trauma‐informed care. These gains were maintained through the final year of implementation, with continued improvements in ratings of collaboration between child welfare and behavioral health settings on trauma‐related issues observed. Responses documented familiarity with and involvement in many of the CONCEPT activities and initiatives. Staff reported greater familiarity with efforts to increase access to specific evidence‐based services (e.g., TF‐CBT) or to enhance trauma‐related policy and practice guidelines, but less familiarity with efforts to implement new practices (e.g., trauma screening) in various sectors. Staff also reflected on the contribution of these components to enhance system capacity for trauma‐informed care.     

Children with Disabilities

Abstract

Children in out-of-home care due to abuse and neglect are at disproportionately high risk for disabling conditions. The reasons for the over-representation of children with disabilities in the child welfare system are reviewed and discussed in this chapter. Factors discussed include impact of abuse and neglect, the impact risk factors such as exposure to community and domestic violence and poverty, risk of abuse or neglect associated with disability, and child welfare system factors. In addition, the need for greater efficacy in identification of disability, identification of service needs, and linkage with and delivery of services to serve the needs of children with disabilities in out-of-home care is addressed. Recommendations for policy review at State and Federal levels are offered along with direction for future research.     

Characteristics of Adult Caretakers of Children and Youth Served by an Urban Child Welfare Agency

The child welfare system of the early 1990s was marked by the proliferation of home-based services. Research on the effectiveness of various home-based interventions indicates results have been equivocal. The need to make explicit the specific characteristics of the adults and children targeted for home-based services, particularly families from diverse cultural backgrounds, has been identified as a critically needed contribution to the literature. In this study, the characteristics and service utilization experiences of adults and families served in an urban, home-based, child welfare program was examined. The results are discussed in relation to findings on the characteristics and experiences of adults and families served in other settings. Implications for future research and service delivery are discussed.     

Implementing Trauma-Informed Care in Correctional Treatment and Supervision

ABSTRACT

This article provides a rationale for trauma-informed care (TIC) in correctional services, and challenges readers to think about offending behavior through the lens of trauma. Based on interdisciplinary research and cross-theoretical literature, TIC can help in our quest to develop relevant and successful programs, practices, and policies, and the best methods for delivering them. Using Substance Abuse and Mental Health Services Administration (SAMHSA)’s core principles of TIC, this article will make suggestions for the implementation of trauma-informed service delivery and practices across correctional settings. The authors translate trauma-informed concepts into practice behaviors through the acronym SHARE (safety, hope, autonomy, respect, empathy), which honors the principles of TIC recommended by SAMHSA and the principles of effective correctional rehabilitation. TIC in corrections may help improve the desired outcomes of successful re-entry and reduced recidivism.     

Trauma-Informed Police Responses to Rape Victims

ABSTRACT

Rape victims can benefit from trauma-informed approaches when reporting rape to police. Police interviewing skill can prevent survivor re-victimization while eliciting useful crime statements. However, rape myth acceptance and police culture may pose obstacles to a trauma-informed approach. Client empowerment, demystification, trigger reduction, and expressed concern for victim safety can be implemented by police agencies. Interdisciplinary collaboration, combating sexual harassment, gender balancing, emotional debriefing of officers, accountability to victims, new reporting methods, and advanced training protocols are elements of a trauma-informed approach.     

What Does it Mean to be Trauma-Informed? A Multi-System Perspective from Practitioners Serving the Community

The increased awareness of the detrimental consequences of trauma exposure has led researchers to focus their attention in identifying best practices on integrating trauma-informed approaches (TIAs) to child and family services. Yet, terms related to TIAs are often utilized without an adequate definition, and most importantly, without concrete and specific strategies to ensure that services are in fact trauma-informed. Using a multi-methods approach, this project examined important practice considerations that support successful implementation of TIA in school and community-based behavioral health settings. Key informant interviews and electronic surveys were conducted with child and family systems practitioners; interviews inquired about training, current practices, and barriers to service engagement. Data was analyzed, organized, and synthesized in accordance with core domains and specific components proposed by Hanson and Lang’s (2014) trauma-informed care framework. Findings suggest that practice of TIA differed by system and was largely driven by experiential and informal learning experiences. Practitioners also report challenges unique to each system hinder the utilization of screening and intervention best practices. Salient differences included those related to knowledge and accessibility to training, utilization of evidence-based practices, application of screening tools, and availability of resources within their systems. This brings to light the importance of considering both general and system-specific practice mechanism for the successful implementation and sustainability of TIA frameworks. We suggest system-specific strategies to help integrate trauma into services, including prioritizing capacity building efforts within each system by leveraging their natural supports and identifying systems-specific assets for both screening and intervention practices.

     

Evaluation of a Trauma-Informed School Intervention with Girls in a Residential Facility School: Student Perceptions of School Environment

In response to the high nationwide prevalence of psychological trauma among court-involved youth who have been exposed to abuse and neglect and the associated far-reaching adverse consequences, there are calls to develop a trauma-informed workforce across the various systems (child welfare, juvenile justice, mental health, and education) designed to serve this population. We describe a pilot test of a modified version of the Heart of Teaching and Learning (HTL) curriculum, an intervention designed to increase trauma-informed practices in education settings. This program was implemented in a public charter school that exclusively serves court-involved youth placed in residential treatment. The intervention was associated with decreases in trauma symptoms experienced by youth. Because student perceptions of teachers were high both before and after implementation of the curriculum, no statistically significant changes were observed. The article concludes with a discussion of the ways in which the curriculum can be used to help prepare a national education workforce capable of implementing trauma-informed evidence-based practices in school settings.     

Differentiating between child protection and family support in the Canadian child welfare system's response to intimate partner violence,corporal punishment,and child neglect

Rates of reported child maltreatment nearly doubled in Canada over the period 1998–2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.     

From one room to the other: a story of contamination. The relationship between child and adult analysis

Does the analyst who works with both children and adults using ostensibly the same theoretical model perform similar mental operations in these two fields? The author suggests that child analysis is rooted in a different creative process from that of adults. Comparing the analysis of children to painting and that of adults to writing, and making use of the debate between Virginia Woolf and her sister Vanessa Bell on the relative merits of words and images, the author explores the psychoanalytic debate on the role of child analysis in the development of psychoanalytic theory and practice. Child analysis, initially regarded as an application of psychoanalysis, ended up acting as a catalyst for a true epistemological revolution in the 20th century through the work of Klein and Bion. Playing is not only an alternative medium to words for representing the unconscious but a different method for giving shape to representations through a specific creative process. The reverie which is born in the child analyst’s consulting room reproduces itself through the body’s actions during play, whereas in the adults’ consulting room the analyst’s capacity to dream presupposes the suspension of action. Child analysis, deploying a distinctive creative process that makes use of the body and serves itself of action in its development, may be said to rest on a similar creative process to that of figurative art. For this reason, the child analyst’s mind relates to objects in a different way, being in a more prolonged state of fusion with these as a result of ‘concentration of the body’. The significance of the unspeakable things that take place can often only be conceptualized in après‐coup. Although this difference in the development of the process suggests a significant distinction between the two ‘arts’ of child and adult analysis, the aesthetic sensitivity acquired through child analysis can be profitably used with adults, as will be demonstrated with the help of several clinical examples.     

Preface

Abstract

Child victimization is a serious and on-going problem in the United States and throughout the world. In 2000, an estimated 900,000 children were victims of abuse and neglect in the United States. New and different responses to child maltreatment will have to be developed and implemented in response to the increasingly diverse contexts and situations within which maltreatment occurs. Emerging trends in adult-child boundary violations are explored within this volume from a cross-section of disciplines, including law, sociology, criminal justice, psychology, and health services. The selections analyze issues critical to child maltreatment and offer intriguingly different perspectives of present and future issues related to child abuse.     

Preface

Summary

Child victimization is a serious and on-going problem in the United States and throughout the world. In 2000, an estimated 900,000 children were victims of abuse and neglect in the United States. New and different responses to child maltreatment will have to be developed and implemented in response to the increasingly diverse contexts and situations within which maltreatment occurs. Emerging trends in adult-child boundary violations are explored within this volume from a cross-section of disciplines, including law, sociology, criminal justice, psychology, and health services. The selections analyze issues critical to child maltreatment and offer intriguingly different perspectives of present and future issues related to child abuse.     

The relations of child adiposity with parent-to-child and parent-to-parent hostility

Objective: Investigate (1) the association of child adiposity with parent-to-child and parent-to-parent hostility, (2) the mediation of these associations by dietary behaviours and (3) moderation by gender.

Design: One hundred thirty-five couples with 6- to 14-year-old children completed measures of emotional and physical aggression, overreactive discipline and child diet. Parent-to-parent hostility was also coded from laboratory observations.

Main Outcome Measure: Child adiposity was a combination of body mass index and waist-to-hip ratio.

Results: Mother-to-child hostility was associated with child adiposity. This association was concentrated in boys and was not significantly explained by child dietary factors. Mother-to-father hostility was not significantly associated with boys’ or girls’ adiposity. Girls’ adiposity was not significantly associated with family hostility. Fathers’ hostility was not linked to child adiposity.

Conclusion: This is the first study to take a family-level approach to understanding the relation of hostility to child adiposity by examining relations among adiposity and both mothers’ and fathers’ hostility directed toward one another and toward their children. Our findings highlight the potential role played by mothers’ emotional hostility in boys’ adiposity and suggest that, if this role is further substantiated, mother-son emotional hostility may be a promising target for the prevention of child obesity.     

Permanent Housing for Child Welfare‐Involved Families: Impact on Child Maltreatment Overview

A longitudinal randomized controlled trial tested whether access to permanent housing reduces child maltreatment among inadequately housed families under investigation for child abuse and neglect. The study followed homeless and child welfare‐involved families randomly assigned to receive a referral for housing subsidies plus housing case management (n = 75, 196 children) or housing case management alone (n = 75, 186 children). Latent growth models examined change in caregiver‐reported frequencies of psychological aggression, physical abuse, and neglect toward children at five time points across 2.5 years. Intent‐to‐treat analyses suggested treatment differences for minor assault and neglect that approached significance; families randomly assigned to permanent housing plus case management exhibited marginally greater declines compared to families referred for housing case management only. Caregiver psychological aggression remained high over time, regardless of treatment condition. No evidence indicated higher risk families benefitted more from permanent housing. Results show some promise of permanent housing and highlight the complex needs of homeless families under investigation for child maltreatment. Findings emphasize the importance of continued involvement from the child welfare system to connect families with important resources.     

Inadequate Housing Among Families Under Investigation for Child Abuse and Neglect: Prevalence from a National Probability Sample

This study aimed to estimate the prevalence of inadequate housing that threaten out-of-home placement among families under investigation by child welfare. Data came from the National Survey of Child and Adolescent Well-Being, a nationally representative longitudinal survey of child welfare-involved families. Child protective services caseworkers as well as caregivers provided information on families whose child remained in the home after initial investigation (N = 3,867). Multilevel latent class analyses tested the presence of inadequately housed subgroups using 4 housing problem indicators at baseline. Logistic regressions assessed convergent and predictive validity. A two class latent solution best fit the data. Findings indicated that inadequate housing contributed to risk for out-of-home placement in approximately 16 % of intact families under investigation by child protective services. These families were 4 times more likely to need housing services 12 months later. Federal legislation emphasizes integration of social services as necessary to end homelessness. This study demonstrates overlap across public agencies. Enhanced coordination of child welfare and housing services facilitates interventions to prevent and mitigate homelessness.     

Language development of pre‐school children born to teenage mothers

An Erratum has been published for this article in Infant and Child Development 10(4) 2001, 241. This paper compares the language development of pre‐school children born to teenage (n=22) and comparison mothers (n=20) and examines the extent to which differences in language development can be explained by social background, child and parenting factors. Mothers and children were assessed at home using a range of measures, including a structured interview, the language scales of the Child Development Inventory, the HOME Inventory, and videotaped mother‐child interaction. Results showed that children of teenage mothers perform significantly poorer than children of comparison mothers on measures of expressive language and language comprehension. Subsequent analyses showed that these differences are largely explained by differences in the parenting behaviour of teenage and comparison mothers. Specifically, maternal verbal stimulation and intrusiveness accounted for the relationship between teenage motherhood and children's poorer language comprehension, while maternal intrusiveness and involvement with the child account for the relationship between teenage motherhood and children's poorer expressive language development. These findings highlight the importance of early mother–child interaction for children's language development. Copyright © 2001 John Wiley & Sons, Ltd.     

The Interplay of Empathy and Individualism in Support for Social Welfare Policies

Public support for government welfare programs is grounded in two potentially conflicting factors: a belief in individualism which undermines support for welfare assistance and the capacity for empathy which potentially enhances support. However, empathy is an expensive psychological commodity subject to pervasive up- and down-regulation. This article examines the degree to which a belief in individualism affects the expression of compassionate support for a person in need among those with the capacity for empathy. In two online survey experiments, empathic ability powerfully increases support for a welfare recipient and social welfare policies when it does not conflict with individualism. But, empathic ability decreases compassion and support for government welfare among strong individualists. Evidence that individualists down-regulate empathy for someone in need of government assistance is consistent with the conservative view that welfare promotes dependency and undermines individual agency. In contrast, charitable assistance is not associated with long-term dependency, and we find that empathy is up-regulated by strong individualists to generate charitable support for the same individual to whom they denied government assistance. The up- and down-regulation of empathy in response to someone in need of government welfare helps illuminate the sharp divisions over social welfare policy among the American public.