Child Welfare Issues and Perspectives

CHILD WELFARE ISSUES AND PERSPECTIVES No part of this digital document may be reproduced, stored in a retrieval system ...

Author: Steven J. Quintero

45 downloads 2034 Views 2MB Size Report

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!
Report copyright / DMCA form

DOWNLOAD PDF

CHILD WELFARE ISSUES AND PERSPECTIVES No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services.

CHILD WELFARE ISSUES AND PERSPECTIVES

STEVEN J. QUINTERO EDITOR

Nova Science Publishers, Inc. New York

Copyright © 2009 by Nova Science Publishers, Inc.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Child welfare issues and perspectives / editor, Steven J. Quintero. p. cm. Includes index. ISBN 978-1-60741-409-4 (E-Book) 1. Child welfare. I. Quintero, Steven J. HV713.C38285 2009 362.7--dc22 2008051260 Published by Nova Science Publishers, Inc.  New York

CONTENTS Preface

vii

Research and Review Studies Chapter 1

Kinship Care with Hispanic Children: Barriers and Obstacles to Policy and Practice Implementation Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson

Chapter 2

Children of Color in the Child Welfare System Jillian Jimenez and Ruth M. Chambers

Chapter 3

Ethical Issues in Child Welfare: An Overview for Mental Health Professionals Jeffrey H. Sieracki, Jessica A. Snowden, Amy M. Lyons and Scott C. Leon

Chapter 4

Chapter 5

Chapter 6

17

33

The Role of Parent-Adolescent Connection in Child Welfare: A Study of High School Students in Transylvania, Romania Laszlo Brassai and Bettina F. Piko

55

Is it Better to Live in Rural or Urban Areas? A Worldwide Study on Child Health Aravinda Guntupalli and Daniel Schwekendiek

77

Child Welfare Revised: The Case of the Communist Development Country North Korea Daniel Schwekendiek

97

Chapter 7

Using Private Contracts to Create Adoptions from Foster Care Mary Eschelbach Hansen

Chapter 8

Child Custody Proceedings under the Indian Child Welfare Act: An Overview Kamilah M. Holder

Chapter 9

1

State and Family and Medical Leave Laws Jon O. Shimabukuro, Cassandra LaNel Foley and Tara Alexandra Rainson

113

127 135

vi Short Comm.

Index

Steven J. Quintero Psychopathic Personality Features and the Child Welfare System: Implications for Prevention of Problems over the Life-Course Michael G. Vaughn, Matt DeLisi, Kevin M. Beaver and John Paul Wright

151

157

PREFACE Research suggests that placement in kinship care is directly linked to a decrease in the total number of displacement disruptions for children in the child welfare system. However, Hispanic children appear at a higher risk for non-kinship care placement. This book addresses such problems and policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Child welfare is also closely related to parent-child connections. Thus, the parent-child connection is discussed as well as the authoritative/supportive parenting styles of the mother and father, which seem to protect adolescents against substance abuse. The rural-urban malnutrition rates of children living in up to 93 countries were examined and discussed. Political stability and how it affects the rural-urban malnutrition ratio, especially in democratic systems were also looked at. In addition, the human welfare system in North Korea was examined, for example, by looking at the heights of their children. Stature can assumed to be an appropriate indicator in many situations. Other such advantages and disadvantage indicators are discussed in this book. Finally, the organization of the delivery of social services to waiting children and the prospective adoptive families, which influence adoption creation are reviewed. Cross-section time-series estimates are supplemented with a new augmented fixed effects procedure to demonstrate that the use of contracts with private agencies bolsters adoption creation. Chapter 1 - Research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system. Kinship care also results in improved stability and outcomes for children post-placement. In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic. Forty-six percent of all Hispanic children are placed in non-kinship foster care settings. Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community. Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants. Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states

viii

Steven J. Quintero

with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements. Immigrant children and children growing up in mixed status families (those comprised of one or more foreign-born parents and one or more U.S. citizen children) have limited access to kinship care within the child welfare system. With the growing number of foreign born Hispanic children, the current research suggests that the rate of Hispanic immigrants and children in mixed-status families in the child welfare system will continue to increase. The lack of effective policies and practices with this population is a risk factor for disproportional service delivery in the future. To address this area of concern, this analysis addresses current policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Psychological, developmental, and social consequences of kinship placement are explored. Due to the high concentration of foreign born populations, and its close proximity to the Mexican border, Texas served as a case example for this analysis. Chapter 2 - The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices. This chapter will also discuss disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It will also highlight the major causes of this problem and provide a critique of relevant policies. Chapter 3 - What are the ethical considerations that psychologists, psychiatrists, social workers, and other mental health professionals must take into account when working with the child welfare population? How does a child welfare professional juggle the demands of the child, biological parent(s), foster parent(s), and the courts while remaining responsible to the ethics of his or her profession? This chapter addresses ethical conflicts that might arise when psychologists and other mental health professionals assess, treat, or research children and adolescents in the child welfare system. This chapter reviews the child welfare system and the role of various professionals in child welfare, and a summary is presented of ethical guidelines from the American Psychological Association (APA), the American Psychiatric Association (APA), the National Association of Social Workers (NASW), and other ethics documents from related professions that pertain to this population. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to working with the child welfare population. Chapter 4 - Child welfare is closely related to parent-child connection. Adolescence is particularly a difficult transition period influencing child welfare. Problems between adolescents and their parents may be detected by indicators of child welfare, among others, adolescent substance us. This study presents the results of a research with a sample of Transylvanian youth (in Saint George, Romania). Data collection was going on in a sample of high school students and the study included items measuring frequencies of smoking, alcohol use and illicit drug use as well as aspects of familial influences of youth’s substance use (such

Preface

ix

as family structure, the quality of the relationship with parents, parental conflicts and the ways of coping with them). Based on a comparison of prevalence rates and frequency distributions, we may conclude that the initiation of substance use may be dated at around 1516 years of age. Regarding frequencies of smoking and alcohol use, most students have already tried or used them regularly. Gender, family structure, and conflicts with parents proved to be risk factors for all types of substance use. Based on the analysis of parent-child connection, authoritative/supportive parenting style of mother and authoritarian/hard parenting style of father seem to be protective against adolescent substance use. These results may highlight the role of cultural variations in child welfare since parenting efficacy may depend on the special cultural context. Chapter 5 - Several studies have emphasized and reemphasized the rural-urban divide in living standards. Yet, these studies focused on specific countries or sub-regions of the world. Conducting a worldwide comparison, we investigate rural-urban malnutrition rates of children living in up to 93 countries at the end of the millennium (1995-2001). An interesting comparative finding is that in 97% of the countries examined, more rural than urban children were stunted. On average, rural malnutrition rates are 10% points higher than urban ones. These differences become pronounced in Latin-America; while by far, the greatest disparity of a single country is found in China. Analyzing the causes, we find that political stability per se as well as political stability in specifically democratic systems significantly decreases the rural-urban malnutrition ratio. However, we could not establish a significant relation between disease environment and rural-urban divide in the standard of living. Chapter 6 - This article assesses human welfare in North Korea. Very little information is generally available on the North Korea, a country which has drastically sealed itself off from the rest of the world since its political formation, and can largely be described as a statistical terra incognita. Thus, when it comes to typical human welfare indicators like GDP per capita, life expectancy, infant mortality, literacy rates or the human development index of the United Nations, we here argue that they are either statistically unavailable, politically manipulated, full of measurement errors, or fail completely to capture human development as a consequence of communist market distortions in North Korea. Considering a totalitarian regime, we can receive a unique glimpse at nation’s human welfare state by looking at the heights of their children. Stature can assumed to be an appropriate indicator in many situations. As distinct from conventional performance indicators, anthropometric measurements are politically incorruptible and quite sensitive to human development. Moreover, as distinct from demographic and economic indicators, in order to obtain anthropometric variables, one is not dependent on theoretical assumptions or underlying data on the population and the economy. This is because as body height is measured physically, measurement errors become in fact negligible. Most importantly, in a Maslowian sense, height and weight account for physiological human needs, which can be supposed to play a primary role for the people living in a developing country like North Korea. Given these advantages (and the discussed disadvantages of conventional indicators), we here argue that stature seem to be the first-best indicator for child welfare in North Korea. In the year 2002, we find a gap of 13 cm between North and South Korean boys – largely reflecting socioeconomic disparities between the two Koreas. Chapter 7 Creating adoptions for children waiting in foster care is a good investment, but the number of adoptions created each year meets only a fraction of the need. This paper explores how the organization of the delivery of social services to waiting children and

x

Steven J. Quintero

prospective adoptive families influences adoption creation. Cross-section time-series estimates are supplemented with a new augmented fixed effects procedure to demonstrate that the use of contracts with private agencies bolsters adoption creation. Contracts for recruitment and orientation of prospective adoptive parents are particularly effective. Chapter 8 - In 1978, Congress enacted the Indian Child Welfare Act (ICWA) in response to legislative findings of harm caused to Indian children, their families, and tribes by the high separation rate of Indian children from their homes and cultural environments. Congress addressed this situation by granting Indian tribes and Indian parents an enhanced role in determining when to remove Indian children from their homes and cultural environments. Specifically, the ICWA enumerates provisions for tribal jurisdiction and tribal intervention in state court proceedings concerning the custody, adoption, foster care placement, and termination of parental rights of Indian children. No bills amending the ICWA were introduced in the 109th Congress. Still, the debate over provisions of the ICWA remains an issue of concern. This CRS report provides an overview of some of the goals and provisions of the Indian Child Welfare Act. Chapter 9 - In 1993, Congress passed the Family and Medical Leave Act (“FMLA”) to “balance the demands of the workplace with the needs of families.” When the FMLA was enacted, it supplemented approximately 30 state statutes that provided some form of family and medical leave to employees who worked in those states. Although the FMLA and state family and medical leave laws are generally similar with regard to the availability of leave, they differ both in terms of coverage and scope. This article includes summaries of the family and medical leave laws of forty-five states and the District of Columbia. Laws pertaining to family and medical leave and maternity leave were not found in the codes of all 50 states. Summaries of the relevant leave statutes and regulations are organized in alphabetical order. Short Communication - The past ten years have witnessed a remarkable surge of research on psychopathy (i.e., psychopathic personality) in children and adolescents. Although possessing a long history in the psychological and psychiatric sciences (Vaughn & Howard, 2005), the downward extension of psychopathy to youth is fraught with numerous problems and prospects. One benefit may be the potential ability to identify and intervene with children who manifest behaviors and thoughts characteristic of psychopathy such as lack of empathy for others, a diminished capacity for self-control, and manipulative behavior. This is important given the robust criminological literature based on birth-cohort and longitudinal investigations that has established that approximately 5 to 10% of persons account for the majority of offending (DeLisi, 2005). Individuals with psychopathic personality features are responsible for a large share of not only crime but also drug abuse, family burden, and medical and judicial costs associated with this deleterious mix of personality traits. Thus, forestalling these life-course problems are of tremendous benefit to society at large, as well as to the children afflicted with these traits. This commentary will focus on the available research on psychopathic personality traits and children in the child welfare system. Salient issues and several new avenues for future research and early intervention are proffered.

In: Child Welfare Issues and Perspectives Editor: Steven J. Quintero

ISBN 978-1-60692-659-8© 2009 Nova Science Publishers, Inc.

Chapter 1

KINSHIP CARE WITH HISPANIC CHILDREN: BARRIERS AND OBSTACLES TO POLICY AND PRACTICE IMPLEMENTATION Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson University of Texas at Austin, TX

ABSTRACT Research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system. Kinship care also results in improved stability and outcomes for children post-placement (Berrick, Barth, & Needell, 1994). In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic (U.S. Department of Health and Human Services, 2006). Forty-six percent of all Hispanic children are placed in non-kinship foster care settings (Wulczyn et al., 2007). Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community (Bissell and Miller, 2003). Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants (Vericker, et al., 2007). Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements (Vericker, et al., 2007). Immigrant children and children growing up in mixed status families (those comprised of one or more foreign-born parents and one or more U.S. citizen children) have limited access to kinship care within the child welfare system. With the growing number of foreign born Hispanic children, the current research suggests that the rate of Hispanic immigrants and children in mixed-status families in the child welfare system

2

Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson will continue to increase. The lack of effective policies and practices with this population is a risk factor for disproportional service delivery in the future. To address this area of concern, this analysis addresses current policies on kinship care and barriers to implementation of child welfare policies with immigrant and mixed-status children. Psychological, developmental, and social consequences of kinship placement are explored. Due to the high concentration of foreign born populations, and its close proximity to the Mexican border, Texas served as a case example for this analysis.

INTRODUCTION Historically, families and communities have found ways to support and care for neglected and maltreated children. Extended families, such as grandparents, have been especially valuable in providing care for these children and have become an essential safety net for children whose parents struggle to care for them. This tradition of kinship care has been particularly significant in communities of color who have historically placed an emphasis on the involvement of extended family as a primary source of support to parents (Casey Family Programs, 2004). Foramalized kinship care is a fairly new method of caring for the nation’s children. Beginning in the 1980’s, public child welfare agencies began to formally utilize extended families to care for children entering the child welfare system (Casey Family Programs, 2004). Since its inception, utilization of kinship care as a placement option by child welfare agencies has grown significantly (Geen, 2003). Although actual rates for private/informal kinship care arrangements are difficult to determine and monitor as state reporting varies by the accepted definition of kinship foster care, placement rates for children in kinship care vary widely across the United States. While studies indicate an increase in the number of kinship care placements, traditional non-kinship care placements remain about four times more frequent than kinship care placements (Urban Institute, 2008). Kinship care involves the placement of children in out-of-home care with relatives by informal and formal means. Children reside with and receive care from relatives or family friends in lieu of birth parents. Kinship care typically refers to biological relatives, but the definition of kin also encompasses adults with whom the child has a strong pre-existing bond, such as godparents or other close family relations and friends (Berrick & Barth, 1994; Dubowitz et al., 1994). Agencies and state systems, who are mandated to organize care for and protect children, give preference to relatives when it is necessary to place children away from their own biological parents (Hegar, 1993). State child welfare agencies vary in their definition of individuals who are designated as kin. Twenty-four states define kin as those related by blood, marriage, or adoption; twentytwo states provide a broader definition that includes individuals who have significant relationships with the child(ren) and may include neighbors and close family friends. Five states have no definition for the individuals designated as kin (Geen, 2003). Kinship care arrangements can take place under various structures, including informal, voluntary, and formal care. Informal or private kinship care occurs without involvement of formal child welfare agencies as arrangements are made unofficially by biological parents for the care of the child(ren) by a relative or close family friend. The biological parent retains legal custody of the child and maintains control concerning their child’s reunification to their

Kinship Care with Hispanic Children

3

care. Without formal or legal support, this type of care creates difficulties for the kinship caregivers when attempting to carry out activities associated with formal institutions, such as enrolling the child in school or seeking medical treatment. Voluntary kinship care refers to placement of the child with relatives through the involvement of formal child welfare agencies, but without the state agency taking legal custody of the child. In these situations, the parent is typically unable or unwilling to care for the child, but the child does not formally enter state custody. These types of placements typically occur when child welfare agencies give parents the choice to voluntary place their child in the care of other family members in lieu of legally removing the child and placing them in traditional foster care. If it is determined by the child protective service worker that the parent has temporary or permanent inability to care for their child, but does not require the forcible removal of the child from the home, the child is removed for his/her own safety and a relative or family member is sought to care for the child. Formal kinship care involves legal removal of the child from the biological parents and the court places the child with family caregivers. Formal kinship care is a unique form of foster care that does not exclude relatives from the definition of foster parents. Kinship caregivers are granted physical custody of the child; however, the state retains legal custody and responsibility for the appropriateness of the placement. The child welfare agencies report to the court concerning the child’s well-being and are responsible for ensuring that foster care involved children are assessed for service needs, receive the services required to meet those needs, and facilitate parental visitation and reunification activities as ordered by the court.

KINSHIP CARE Policies in Kinship Care Federal policies have increased kinship care placements by providing financial support of caregivers. The 1950 amendment to the Social Security Act allowed eligible relatives to receive aid for themselves and the children under their care as part of the Aid to Families with Dependent Children (AFDC) program (Social Security Act, 1950). The current Temporary Assistance to Needy Families (TANF) program allows for grants to relatives caring for a child in a kinship placement, regardless of the relative’s income (Personal Responsibility and Work Opportunity Act, 1996). Title IV of the Social Security Act of 1962 established reimbursements to licensed foster parents but excluded kinship caregivers (Social Security Act, 1962). Although these programs have provided some financial assistance to relatives providing care for a family member’s child(ren), payment rates for these families are significantly less than those povided to licensed foster care providers (Geen, 2003). The courts also have been influential in increasing the number of kinship placements. In the 1979 court case, Miller v. Yuokim, the United States Supreme court ruled that relatives caring for children were entitled to federal foster care payments if they met the same licensing standards as non-relative foster care placements (Miller v. Youakim, 1979). The court, however, failed to provide similar financial support for relatives who did not meet state licensing requirements or children who were not eligible for federal foster care funds (e.g. non- citizen children).

4

Rebecca Gomez, Jodi Berger Cardoso and Sanna J. Thompson

The Indian Child Welfare Act of 1978 and the Adoption Assistance and Child Welfare Act of 1980 (Adoption Assistance and Child Welfare Act of 1980) gave preference to relative caregivers as sources for foster care placements (Indian Child Welfare Act, 1978; Adoption Assistance and Child Welfare Act of 1980). These acts mandated that relatives receive priority over non-relative caregivers when a child is being placed. The Indian Child Welfare Act specifically stated that Native American children in foster care must be placed with extended family whenever possible and in placements that were nearest their home (Indian Child Welfare Act, 1978). The Adoption Assistance and Child Welfare Act of 1980 required that state child protective service agencies place children in substitute care settings that were the least restrictive possible (Adoption Assistance and Child Welfare Act of 1980). Prior to the passage of this Act, relatives and kin were rarely used as foster placements (United States General Accounting Office, 1999). Following the implementation of this Act, however, child welfare agencies identified kinship care as the least restrictive placement possible. This increased the numbers of children placed with relatives or kin (United States General Accounting Office, 1999). In addition, the Personal Responsibility and Work Opportunity Reconciliation Act required that states give priority to family members when placing children in out-of-home care (Personal Responsibility and Work Opportunity Reconciliation Act, 1996). Therefore, by 1996 almost all states had implemented specific policies giving preference to family members when placing children in out-of-home settings (Boot and Geen, 1999). In 1997, The Adoption and Safe Families Act was passed (Adoption and Safe Families Act, 1997). The purpose of the act was to increase permanency for children by implementing strict guidelines regarding the length of time children could remain in foster care. This Act gave special preference to kinship caregivers and allowed states to extend the time frame for termination in cases where the child was being cared for by a relative (Adoption and Safe Families Act, 1997). In addition, this Act acknowledged the possibility of kinship care as a permanent placement for a child and allowed federal reimbursement of states for payments to kinship caregivers when those caregivers met the same licensing standards as traditional foster placements (Adoption and Safe Families Act, 1997). On October 7, 2008 the Fostering Connections to Success and Increasing Adoptions Act of 2008 was signed into law (Fostering Connections to Success and Increasing Adoptions Act, 2008). This Act is expected to impact kinship placement in two ways. First, the Act changes policies for notifying potential relatives. The Act requires that states must exercise due diligence in attempting to notify all adult relatives within 30 days of removing a child from their parents custody (Fostering Connections to Success and Increasing Adoptions Act, 2008). Second, the Act provide additional federal funding for kinship guardianship programs. This means that if a state provides payments to relatives who are the legal guardianship of a child the federal government will partially reimburse the state for this expense (Fostering Connections to Success and Increasing Adoptions Act, 2008). To qualify for payments the relative must be a licensed foster parent and the child must qualify for foster care payments. Although this change in standards for reimbursement is a step toward assisting kinship care providers, many kinship care providers are prohibited from receiving reimbursements because they cannot meet specific foster care licensing criteria, such as space requirements, income guidelines, and background checks. In addition, some immigrant children do not qualify for foster care payments.


5

History and Rationale for Kinship Care The number of children in state custody placed with kinship caregivers grew from 18% in 1986 to 31% in 1990 (United States Census Bureau, 2006). According to the U.S. Census, 2.5million children resided with family members other than their birth parents in 2005 (United States Census Bureau, 2006). This was a 55% increase from 1990 (United States Census Bureau, 2006). The Urban Institute estimates 1,760,000 children were in private kinship care, 140,000 were in voluntary foster care and 400,000 were in formal kinship care in 2002 (Urban Institute, 2006). Approximately half of children in kinship care are between the ages of 11 and 16; 59% live with grandparents, 19% live with aunts/uncles and 22% live with other relatives (Urban Institute, 2008). The growth in rates of children in kinship care can be attributed to several factors. First, federal mandates require that the least restrictive environment must be sought for out-of-home placements. Children must be placed in settings that do not limit their developmental needs and continued interaction with social and emotional supports. Utilizing family members as care givers often results in children remaining in the same school and neighborhood postremoval (United States General Accounting Office, 1999). Another reason for the increase in the growing prevalence of kinship care is related to the shortage of licensed foster parents and available foster homes, as well as the increases in the number of children requiring placement (Center for the Study of Social Policy, 1990a). It has become increasingly difficult for child protective agencies to maintain the number of foster parents needed to meet the demand for out-of-home placements. In addition, there is growing evidence of the value of kinship care placements in providing stability and permanency to children in foster care. Research has shown that nearly two-thirds of children in kinship care with family members were in stable settings three years after placement compared to only one-third of children in foster care who achieved this level of stability (Rubin, Downes, O'Reilly, Mekonnen, Luan, and Localio, 2008). Other research suggests that placement in kinship care is directly linked to a decrease in the total number of placement disruptions for children in the child welfare system (Berrick, Barth, & Needell, 1994; Jones & Chipungu, 2003; Prohn, 1994; United States General Accounting Office, 1999). Kin providers are more likely to live in the same communities as the child(ren), resulting in less disruption to the child’s life and improved stability and outcomes for children post-placement (United States General Accounting Agency, 1999). Thus, greater emphasis is being placed on identifying relatives rather than formal foster parents to provide temporary care for these children. Kinship care placements are now considered the most desirable placement option for children when they must be separated from their biological parents.

Kinship and Child Outcomes Child welfare agencies and case managers aim to maintain consistency in children’s lives after they have been removed from parental homes. Kinship placements appear to improve these outcomes as it has been well documented that children in kinship care experience fewer changes in placement than children in non-kinship care (Berrick et al., 1994; Jones & Chipungu, 2003; Prohn, 1994; United States General Accounting Office, 1999). They are also more likely to be placed with siblings, continue contact with biological parents (Jones &

6


Chipungu, 2003), and eventually reunify with their parent(s) (Conway & Hutson, 2007). Moreover, research indicates that children in kinship placements feel more connected, loved, and supported by their caregivers, report higher levels of self-esteem, have stronger ties to extended social networks, and are more engaged in extracurricular activities than are children in formal foster care (Jones & Chipungu, 2003). Previous studies indicate that since children traditionally have an established relationship with family caregivers with whom they are placed, trauma and psychological harm are minimized (Gleeson and Craig 1994; National Commission on Family Foster Care, 1991). Kinship care may be less disruptive to the child’s life and may assist in building and improving existing family bonds and relationships (Iglehart, 1994). These children experience less separation anxiety or adjustment, greater attachment, and fewer conduct problems than children in traditional foster care. They are also more accepting of guidance from caretakers (relatives, godparents, friends, neighbors), which results in fewer behavior and psychological problems (Crumley and Little, 1997). Several differences between children placed in kinship care and those placed in traditional foster care settings have been identified. Children in kinship care are younger than those in traditional foster care (Berrick, Needell, and Barth 1995; Chipungu et al. 1998). Kinship care placement occurs more frequently in the Southern regions of the United States than in other regions (Harden et al. 1997) and African American children are more frequently placed in foster care than other racial and ethnic groups (Chipungu, 1994).

Profiles of Kinship Caregivers There are also significant differences between kinship caregivers and traditional foster families. Kinship caregivers tend to be poorer and face greater economic hardships; a higher proportion of these caregivers have incomes that are below the federal poverty level (Brooks and Barth 1998, Ehrle and Geen 2002, Zimmerman et al. 1998). Moreover, kinship caregivers are often less likely to have a high school diploma than traditional foster parents (Chipungu et al. 1998; Ehrle and Geen 2002; Zimmerman et al. 1998). Kim caregivers are typically single parents; only about 40% of these caregivers are married (Pecura, LeProh, and Nasuti 1999). In contrast, approximately 75%-90% of non-relative foster care parents are married (Dubowitz et al., 1994). Relatives who provide temporary or permanent care for family member’s child(ren) are as varied as the situations into which children are placed. They include grandparents, aunts, uncles, older siblings, and cousins. Some have found that 50-70% of children placed with relatives live with grandparents, usually the maternal grandmother (Dubowitz et al., 1994). Since many kinship care providers are grandparents, they are also older than traditional foster parents (Brooks and Barth 1998; Ehrle and Geen 2002, Testa 1999) and care for large sibling groups (Berrick et al. 1994). Kinship caregivers are more likely to view themselves as responsible for encouraging contact between the child and their parents; as a result, children in kinship placements have more contact with their biological parents (LeProhn and Pecora, 1994). These caregivers often feel more positive about the children in their care; however, they also report feeling a lack of support from the child welfare agencies in terms of material goods and support services (Davidson, 1997). With this limited support, kinship caregivers report greater


7

psychological problems than do other caregivers, suggesting greater need for enhanced support services, such as respite and transportation services (Fuller-Thomson and Minkler 2000; Robinson, Kropf and Myers 2000). Despite the greater economic hardship often experienced by families who take on the responsibility of caring for another relative’s child(ren), placement in kinship care is often encouraged due to the psychological and social benefits to the child. Although placement with kinship caregivers appears to minimize adjustment problems and maintain family ties, these caregivers often receive limited support to mediate the economic difficulties exacerbated by the placement.

Supports for Kinship Caregivers Kinship caregivers experience different needs than traditional foster families in several key areas. As previously stated, they are more likely to be poor, older, have less education, and care for large sibling groups (Berrick et. al, 1994; Geen, 2003). Thus, the most salient issue for kinship caregivers is financial need. Contrary to traditional foster parents who must meet income requirements before being licensed, kinship caregivers have often experienced financial problems prior to placement and the addition of children requiring care only exacerbates these financial difficulties (Bissell and Miller, 2004). Kinship caregivers have needs for child care assistance (Geen, 2003). As these caregivers often must accept the placement of their relative’s child with limited advance notice and often have little time to organize their resources to meet the immediate needs of the child, locating and financing appropriate child care becomes a primary financial concern (Geen, 2003). Because caregivers often accept the placement of a relative’s child(ren) with little advanced notice, they typically do not have the necessary child care items, such as cribs, toys, clothing, etc. Moreover, they may not have adequate space to meet licensing requirements which disqualify them from receiving foster care assistance and reimbursements (Geen, 2003). Although kinship caregivers have significant needs, they are offered fewer services and supports than traditional foster families. A review of case records in New York City indicated a deficit in the supervision of kinship foster homes. Kinship care homes are perceived by many workers as needing less supervision than other non-relative foster care homes (Task Force on Permanency Planning for Foster Children Inc., 1990). Others have suggested that the lack of attention and support for kinship caregivers is due to an overloaded system that cannot monitor all foster placements (Geen, 2003). Caseworkers recognize that the emotional bond among kinship caregivers is more likely to result in appropriate care of a relative’s child, despite a lack of services. Therefore, caseworkers may be less likely to offer support services to these kinship care providers. On the other hand, it is possible that kinship care providers resent agency intrusion in their parenting and therefore, seek and receive fewer supports and services in an effort to remain autonomous (Iglehart, 1994). Many states utilize private foster care agencies to license and support traditional foster families; kinship caregivers do not have a role in these private agencies and are excluded from utilizing this support (Testa et al., 2001). Also, kinship caregivers may be less aware of available services and less likely to request services (Metzger, 2004). Some kinship caregivers also attempt to keep their difficulties from caseworkers because they are fearful of agency involvement. Some believe that the agency may infer that their needs mean they are not capable of caring for the child and will remove the child from their home.

8


Even when needs are identified, few services are available to kinship caregivers. Traditional foster parents qualify for most services through the licensing process. These services vary by state but include monthly foster care payments, health coverage, clothing stipends, respite care, school supplies, and child care subsidies (Geen, 2003; National Resource Center for Family-Centered Practice and Permanency Planning, 2007). Most kinship caregivers are not licensed providers. Requirements, such as income-level standards, adequate living space for the number of people in the household, U.S. citizenship, among other factors, may disqualify kin providers from receiving financial assistance and resources (Geen, 2003). The most common benefit utilized by kin caregivers is welfare payments. Welfare payments are much smaller than foster care payments and not available to all kinship caregivers. In order to qualify for these benefits, caregivers must meet the poverty guidelines and prove they are related to the child. Kinship caregivers who cannot produce a valid birth certificate to prove their relationship with the child, such as non-related kin (neighbors, family friends, godparents) are not eligible to receive welfare assistance (Geen, 2003). Unlike traditional foster care parents, kinship caregivers may be required to accept placement with little advance notice. Because kinship care providers often accept the child during a period of crisis (Testa, 2001), these caregivers do not have the advantage of extensive preparation time required to include a new child into their family system. With many caregivers having little experience with the bureaucratic system of child welfare, the result is waiting an extended amount of time for services. For kinship caregivers that may qualify as a licensed foster care parent, the process can take up to a year to complete. During this time, these family providers must learn to juggle the plethora of needs required by the child. In addition to maneuvering a highly bureaucratic system, care givers must use creative means to care for the child while they await concrete services. One important resource for kinship caregivers is subsidized guardianship. Subsidized guardianship occurs when a child is permanently placed with a kinship caregiver (American Bar Association, 2008; Bissell and Miller, 2003; Children’s Defense Fund, 2004). This option allows relatives or kin to provide a permanent home for children in situations where adoption may not be appropriate (American Bar Association, 2008; Children’s Defense Fund, 2004). An example of when adoption may not be the best option is when the child is older and does not wish to be adopted, but is unable to return to their biological parents. In these situations, kinship caregivers may provide a permanent home for the child. Subsidized guardianship is also important in ensuring culturally appropriate services to minority children who are overrepresented in the child welfare system (Bissell and Miller, 2003). Subsidized guardianship provides funding for a relative to provide care and vary widely by state; they can be equivalent to federal foster care payments or less than child-only TANF grants (American Bar Association, 2008; Children’s Defense Fund, 2004). Sources of funding for kinship caregivers are also widely varied across the country. Some states fund their programs using federal money, while others utilize limited state and local funds (Bissell and Miller, 2003). Federal funding requires a caregiver to be a United States citizen, which precludes many immigrant family members from becoming caregivers. Currently, 35 states and the District of Columbia offer subsidized guardianship programs (American Bar Association, 2008; Children’s Defense Fund, 2004). The fifteen states that do not offer subsidized guardianship programs include: Alabama, Arkansas, Maine, Michigan,


9

Mississippi, New Hampshire, New York, Ohio, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin (Children’s Defense Fund, 2004).

HISPANIC CHILDREN AND THE CHILD WELFARE SYSTEM Approximately one in five children in the U.S. lives in an immigrant family (Capps, Fix, Ost, Reardon-Anderson, & Passel, 2004). Immigrant families consist of both immigrant and U.S. born second-generation children (those born in the U.S. with at least one parent not born in the U.S). According Beaver and D’Amico (2005), 76% of children in immigrant families are born in the United States and Hispanics account for the largest immigrant group in the United States (Beavers & D'Amico, 2005; Capps et al., 2004). According to the 2000 Census, 52% of children living in immigrant households were from Latin America or had a parent from Latin America; 39% of these households identified Mexico as their country of origin (Beavers & D'Amico, 2005). An additional 9% of Hispanic children were born to two U.S. born parents. Previous research has shown that foreign born and U.S. born children in immigrant families face a number of disadvantages. In 2000, children in immigrant families represented one-fourth of all children in the United States living in poverty (Beavers & D'Amico, 2005). The percentage of foreign-born children living in poverty was much higher (29%) than the poverty rates for second-generation children (20%). Moreover, poverty for children growingup in Mexican-origin families was higher than for other Central and South American countries. With 31% of children migrating from Mexico living in poverty and one out of every three immigrant children originating in Mexico, the rates of poverty and other vulnerabilities of this ethnic subgroup are alarming (Beavers and D’Amico, 2005). In the Hispanic culture there is a strong value placed on extended family relationships and geographic closeness. Familism, a construct commonly used to describe the collective relationship between nuclear and extended family networks (Padilla & Villalobos, 2007), can be viewed as a protective factor for maintaining family cohesion. Family expectations and obligations are shared collectively among its members (Padilla, et al., 2007) and care of children is one example of shared responsibility among family members (Casey Family Programs, 2004). Although the extended family is available when needed, and are often willing to care for the child into adulthood (Casey Family Programs, 2004), Hispanic immigrant children and children of immigrants may underutilize kinship care due to a variety of citizenship barriers. While there are no known national statistics indicating the specific number of immigrant families in child welfare affected by citizenship barriers, Vericker, Kuehn, & Capps (2007) found that first and second generation Hispanic children in Texas were most often placed in residential and congregate care as opposed to kinship care because of these barriers. These findings are particularly concerning due to the growing number of immigrants in the United States.

10


Hispanic Children and Foster Care While the national rates of Hispanic children in foster care is relatively low, these children are concentrated in states with large Hispanic populations. The National Data Analysis System (2005) found that Hispanic children in out-of-home foster care were concentrated primarily in five states: California, Texas, New York, Arizona and Massachusetts (Child Welfare League of America, 2007). In 2006, the Administration for Children and Families estimated that 19% (96,967) of children in foster care nationwide were Hispanic (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children and Youth and Families, & Children's Bureau, 2006). Reports by the Child Welfare League of America (CWLA, 2000) found that the number of Hispanic children in the foster care system doubled from 8% to 15% in 1990-1999. However, between 2000 and 2005, the proportion of Hispanic children entering foster care each year stabilized to 8-10% (Wulczyn, Chen, & Brunner Hislop, 2007). Hispanic children account for approximately 10% of first admissions into foster care, while 48% of first admissions are Caucasian and 36% are African American (Wulczyn, Chen, & Brunner Hislop, 2007). Once in foster care, Hispanic children stay in care for shorter amounts of time than do Caucasian or African American children. Although Hispanic children are less likely than white children to be involved in a child protective services investigation, they are more likely to be placed in foster care once the process has been initiated. Moreover, Hispanic children are less likely to be adopted than white children (Hill, 2007). A child may experience several types of placements once they are removed from the household. Similar to African American and Caucasian children, traditional foster care with non-kin caregivers is the most common type of placement for Hispanic children. Forty-six percent of all Hispanic children are placed in non-kinship foster care settings (Wulczyn et al., 2007). Congregate care (e.g. group homes and other residential settings) is the second most common placement for Hispanic children. Compared to percentages of Caucasian (19%) and African American (20%) children, Hispanic children are the highest proportion in congregate care (28%).

Hispanic Children and Kinship Care In 2005, there were approximately 116,509 children in kinship care in the United States; of these children, approximately 22,231 were Hispanic children (Child Welfare League of America, 2007). During 2000-2005, 24% of Hispanic children were in kinship care compared to 23% of African American children and 19% of Caucasian children (Wulczyn et al., 2007). From a national perspective, Hispanic children were more likely to be in kinship care or spend time in traditional foster care than children from other racial and ethnic backgrounds (Wulczyn et al., 2007). By the end of 2005, approximately 9,858 (69.3%) Hispanic children in kinship care exited foster care (Foster Care Dynamics Report, 2007). Approximately 8.5% of Hispanic children exiting kinship care were reunified with their parents compared to 8.2% of African American children and 6.8% of Caucasian children (Wulczyn et al., 2007). However, across all types of care, Hispanic children were much more likely to run away from placements than


11

African American and Caucasian children (Wulczyn et al., 2007) and remained in foster care rather than be adopted (Bissell and Miller, 2003). Although national and state estimates of the number of Hispanic children in kinship care exist, these figures vary significantly across states. The statistics show that kinship care is highly utilized and successful for Hispanic children. This is due in large part to the family and cultural values of the Hispanic community (Bissell and Miller, 2003). Hispanic families have the highest rate of two-parent families in the United States and extended families are often relied upon for social and financial support (Bissell and Miller, 2003). Despite a community culture and tradition that supports the values of kinship care, recent studies from Texas suggest that systemic factors may hindering kinship care for immigrants and children of immigrants (Vericker, et al., 2007).

Hispanic Families and Barriers to Kinship Care Hispanic immigrant children and children of immigrants encounter a number of barriers to kinship care placement. Many immigrant families leave behind their social and family supports when they migrate to the United States (Salgado de Snyder, 1987; Sluzki, 1979). Thus, children in immigrant families may have fewer kin available to offer support. Mandated background checks are another barrier to kinship care placement for Hispanic children, especially those whose parents have recently immigrated to the U.S. In accordance with section XXII from the Keeping Children and Families Safe Act of 2003 (P.L. 108-36), all prospective foster care parents and other adult relatives and non-relatives living in the household must obtain a background check before a child can be placed in temporary or permanent custody (United States Department of Health and Human Services, 2003). Because background checks require a social security number for the prospective foster parent, many immigrant families cannot complete this requirement. In some cases, caseworkers and family members may identify a placement with relatives living in a foreign country. Although there is no federal legislation concerning placement of child(ren) in kinship care across international lines, child protection agencies have formed Memorandums of Understanding with many of the countries in Latin America. Caseworkers can request a home study in the country where the placement is intended. Despite this policy, current data collection and reporting make it difficult to ascertain how many home studies are requested and conducted in Mexico and Latin America. Several impediments specific to placements in Mexico have been identified. One difficulty is the reluctance of judges to place children outside of the United States. Judges are particularly hesitant to place children who are United States citizens outside of the country regardless of the parents or relatives country of citizenship (Gambrel, 2006). This reluctance is due to difficulties involved with obtaining a home study in a foreign country, the limited capacity to assess the quality of the home study, and the unknown credentials of the home study provider (Gambrel, 2006). Child welfare agencies also considers the medical and therapeutic needs of the child when placing a child outside of the United States (Texas Department of Family and Protective Services, 2008). The medical and psychological treatment environment can be difficult to assess due to different licensing and care standards for providers in countries outside the United States. Moreover, U.S. citizen children are not likely to have access to Medicaid,

12


Social Security, and/or Children’s Health Insurance Program (CHIP), which may limit their access to medical and psychological services. The out-of-pocket costs of these services are more likely to cause financial hardship and may impede the caregiver’s ability to provide for the child(ren). Language barriers and lack of bilingual services create additional barriers for caseworks and family members. Language difficulties may inhibit biological parents from effectively identifying available options for kinship care. Furthermore, young immigrant children may have limited English proficiency. If placed in substitute care settings, these children may not be able to communicate. Differences in food, culture, and language can add unnecessary stress to the child’s experiences, especially if the environment is completely unlike the one from which they were removed.

POLICY RECOMMENDATIONS In general, kinship caregivers have special needs and challenges. They are generally less prepared at the time of placement, face financial hardship, are less educated and less likely to utilize formal support networks and services (Brooks and Barth 1998, Ehrle and Geen 2002, Zimmerman et al. 1998). Current national statistics of Hispanic children in kinship care indicate that this placement option is highly supported by the Hispanic community. Unfortunately, when states with high Hispanic populations are examined more closely, it appears that recent immigrants and their children are at greater disadvantage concerning kinship care placements (Vericker, et al., 2007). There is limited research available to explain this system failure. However, recent research suggests several possible factors limiting the use of kinship care for this group. Certainly problems with communication, as well as the lack of familiarity of the child welfare and court systems, create barriers for immigrant families and caregivers. In addition, policies that prohibit the use of federal funds for non-citizen children and prohibit adoption by non-citizen caregivers hinder kinship placement for this group. Finally, judges and caseworkers lack knowledge and comfort with foreign child welfare agencies and are reluctant to place children with kinship caregivers who are out of the country. To address these barriers to kinship care with Hispanic families, several policy changes are needed to support kinship care among Latino immigrant families. The first recommendation is to increase the number of bilingual caseworkers, which will insure quality and culturally competent services. The ability of service providers to communicate appropriately with immigrant families is essential to identifying all possible kinship placements early in the process. Another essential component to improving kinship care placements with immigrant families is strengthening agency liaisons that are knowledgeable of both the child welfare and immigration systems. Child welfare agencies are in a prime position to facilitate working relationships with the liaisons, judges and attorneys in the United States, Mexico and other Latin American countries. If judges are familiar with child welfare services in these countries, they will be better prepared to access the appropriateness of placement across the border. Thus, improving communication between key players, such as judges, caseworkers, families,


13

and international child welfare organizations may improve and expand placement options for these children. Increased legal representation is another important policy change that would likely improve outcomes for children from immigrant families. Research suggests that parents who are represented by an attorney are more likely to identify and advocate for kinship placements (Pew Commission on Children in Foster Care, 2008). Representation may be especially crucial for immigrants who are concerned about their legal status and are unfamiliar with the United States court system. Current adoption laws that restrict non-U.S. citizens from adopting children are additional impediments to kinship placement for immigrant Hispanic families. These laws prohibit adoption by non-U.S. citizens regardless of the relationship to the child or the length of time the child has been placed with the family. Once possible kinship caregivers are identified, the courts should consider placement with the family regardless of the kinship caregiver’s citizenship status. Barring changes in federal adoption laws, these may be cases where the utilization of subsidized guardianship is appropriate. This would allow permanent placement and funding for kinship caregivers, which is ultimately in the best interest of the child. Finally, because immigrants and children of immigrants are more likely to live in poverty (Capps et al., 2004), access to financial programs is essential. Financial support to non-citizen children and caregivers are particularly limited as they do not qualify for federal funding and must rely on state and local funding. Despite the limited funding available, it is more cost effective for a state to provide subsidized guardianship support to a kinship caregiver than to pay for traditional foster care. Thus, from a financial and humanistic perspective, additional funding for family caregivers is warranted.

EXEMPLAR: KINSHIP CARE IN TEXAS Texas provides a unique opportunity to view kinship care due to its high prevalence of foreign-born residents (United States Census Bureau, 2006). Texas is also geographically important for studying issues related to immigrant families as it borders with Mexico, has a large Mexican immigrant population, and provides foster care services to a wide variety of other minority populations. Moreover, many of the barriers to kinship care, such as language, difficulty maneuvering the child welfare and court systems, citizenship and funding eligibility criteria, and reluctance to place children with kinship caregivers across international borders have been identified as concerns in Texas (Texas Department of Family and Protective Services, 2008; United States Department of Health and Human Services, 2003;Vericker, et al., 2007). According to the U.S. Census, approximately 36% of the population in Texas identify as Hispanic/Latino compared to the national average of 15% (United States Census Bureau, 2006). Texas is ranked seventh in the country for the total number of foreign-born residents (15.9%) and ranked third in the number of residents who speak a language at home other than English (33.8%) (United States Census Bureau, 2006). In 2005, 28,833 children were placed in non-kinship foster care and 6,504 children were placed in kinship care in Texas. Of those children placed in kinship care, 37% were Hispanic (Texas Department of Health and Human

14


Services, 2004). Of that number, male and female children were nearly equally represented. Moreover, children ages one to five were most likely to be placed in kinship care than were children under age one, 6-10 years and 16-18 years of age (Child Welfare League of America). In a study linking Vital Statistics Data and Child Welfare Administrative data from Texas, researchers found that immigrant children and children of immigrants who came from Latin American countries were less likely to be placed in kinship care and more likely to be placed in group home settings than other populations of Hispanic children (Vericker, et al., 2007; Wulczyn et al., 2007). Although limited research is available to determine exactly why kinship care is underutilized with this population in Texas, it is likely that the barriers to placement described above impact the implementation of kinship policies. Like other states with large immigrant populations, Texas has a shortage of bilingual caseworkers. This shortage impedes communication and service provision to immigrant families. In addition, Texas is similar to many other states in that they do not provide legal representation to immigrant families from the beginning of a case. Families are only provided legal representation when their case has been considered and parental rights are at risk of termination (Texas Department of Family and Protective Services, 2007). At the point of termination, the child may have been in state care for twelve months. These impediments make it difficult to identify possible kinship placement early in the case and decrease the likelihood that kinship care placements will be identified. Kinship caregivers in Texas also face financial difficulties similar to those experienced nationally. However, immigrant families may experience even greater financial strain as they are more likely to experience poverty than non-immigrant families. Texas does not have a subsidized guardianship program. Kinship caregivers must rely on relative support programs that vary across regions in the state. These programs offer minimal economic support, and in many areas of the state, there is no financial support offered at all. Kinship caregivers who are struggling with poverty may not have access to any funding to enable them to care for the child. Due to its close proximity with Mexico, Texas has instituted specific policies and procedures to govern placement in a foreign country. The policy on placement in kinship care in a foreign country states that the caseworker should work with their supervisor to request a home study in the country where the placement is intended (Texas Department of Family and Protective Services, 2008). In working with Mexico, the Texas Department of Family and Protective Services must request a home study from Desarrollo Integral de la Familia in Mexico (Texas Department of Family and Protective Services, 2008). Since this process is often complex, the Texas Department of Family and Protective Services has designated three liaisons to assist with locating kinship care placements across the border (Texas Department of Family and Protective Services, 2008). The effective use of these policies depends on the relationship with the foreign government and familiarity and comfort with child welfare agencies in the foreign country. Texas experiences obstacles similar to those discussed nationally in establishing this important relationship. These difficulties decrease the likelihood that judges and child care workers will use international kinship care placements as a viable option. Finally, child welfare workers and judges are concerned with the difficulty associated in monitoring the safety of the child’s placement outside of the United States (Texas Department of Family and Protective Services, 2008). The Texas handbook emphasizes that caseworkers do not have


15

legal authority outside of the United States. Once a child is placed in a foreign country, monitoring the placement and safety of the child is not within the jurisdiction of caseworkers (Texas Department of Family and Protective Services, 2008). In order, for caseworkers to be comfortable with placement they must establish a close working relationship with the child protection agency in Mexico. Despite having some policies and procedures to govern kinship care placements for immigrant children, Texas still has a disproportionately lower number of immigrant children who are placed with kinship caregivers (Vericker et al., 2007). This may be due to having limited resources, insufficient supports, and limited communication with Mexico. It is difficult in these circumstances for caseworkers to have the time and knowledge necessary to address the special needs of immigrant families and children. However, with the national growth of foreign born populations in the United States, more formal ways of addressing these difficulties are needed.

REFERENCES Adoption and Safe Families Act (1997). Beavers, L., & D'Amico, J. (2005). Children in Immigrant Families: U.S. and State-Level Findings from the 2000 Census: Annie E. Casey Foundation Population Reference Bureauo. Berrick, J. D., & Barth, R. P. (1994). Research on kinship foster care: What do we know? Where do we go from here? Children and Youth Services Review, 16(1-2), 1-5. Berrick, J. D., Barth, R. P., & Needell, B. (1994). A Comparison of Kinship Foster Homes and Foster Family Homes: Implications for Kinship Foster Care as Family Preservation. Children & Youth Services Review, 16(1-2), 33-63. Capps, R., Fix, M., Ost, J., Reardon-Anderson, J., & Passel, J. (2004). The Health and WellBeing of Young Children of Immigrants. Washington, D.C.: The Urban Institute. Casey Family Programs. (2004). Commitment to Kin: Elements of a support and service system for kinship care. Washington, DC: Casey Family Programs. Child Welfare League of America (2007). Retrieved 9-18-07, 2007, from http://ndas.cwla.org Child Welfare League of America. (2007). Special Tabulation of the Adoption and Foster Care Analysis Reporting System. Retrieved 9-18-07, 2007 from www.ndas.cwla. org/data_stats Conway, T., & Hutson, R. (2007). Is Kinship Care Good For Kids? Washington, D.C.: Center for Law and Social Policy. Dubowitz, H., Feigelman, S., Harrington, D., Starr, R., Zuravin, S., & Sawyer, R. (1994). Children in kinship care: How do they fare? Children and Youth Services Review, 16(12), 85-106. Fostering Connections to Success and Increasing Adoptions Act (2008). Gambrel, R. (2006). Child Protective Services Supervisor. In. (Ed.) Structure, and staffing of investigative units. San Antonio. Geen, R. (2003). Kinship Care: Making the Most of a Valuable Resource. Washington, D.C.: The Urban Institute.

16


Hegar, R. L. (1993). Assessing attachment, permanence, and kinship in choosing permanent homes. Child Welfare, 72(4), 367-378. Hill, R. (2007). An Analysis of Racial/Ethnic Disproportionality and Disparity at the National, State, and County Levels. Seattle, Washington: Casey Family Programs. Iglehart, A. P. (1994). Kinship foster care: Placement, service, and outcome issues. Children and Youth Services Review, 16(1-2), 107-122. Jones, E. F., & Chipungu, S. (2003). The Kinship Report: Assessing the Needs of Relative Caregivers and the Children in Their Care. Washington, DC: Casey Family Programs. Padilla, Y., & Villalobos, G. (2007). Cultural Responses to Health Among Mexican American Women and their Children. Family and Community Health, 30(1), 24-33. Pew Commission on Children in Foster Care. (2008). Commission Recommendations. Retrieved April 27, 2008, from www.pewfostercare.org Prohn, L. (1994). Relative Foster Parents. Children and Youth Services Review, 16(1-2), 3363. Salgado de Snyder, N. (1987). Factors Associated with Acculturative Stress and Depressive Symptomology among Married Mexican Women. Psychology of Women Quarterly, 11, 475-488. Sluzki, C. M. D. (1979). Migration and Family Conflict. Family Process, 18(4), 379-390. Texas Department of Family and Protective Services. (2008). Child Protective Services Handbook. Texas Department of Health and Human Services. (2004). Department of Family and Protective Services External/Internal Assessment. Retrieved May 5, 2008, from http://www.hhs.state.tx.us/StrategicPlans/HHS05-09/final/pdf/Chapter08.pdf U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children and Youth and Families, & Children's Bureau. (2006). Adoption and Foster Care Analysis and Reporting System (AFCARS). Retrieved May 5, 2008 from www.acf.hhs.gov United States Census Bureau. (2006). American Community Survey. Retrieved April, 26, 2008, from: http://www.census.gov/acs/www/index.html United States Department of Health and Human Services. (2003). The Child Abuse Treatment and Prevention Act, as Amended by The Keeping Children and Safe Families Act of 2003: Including Adoption Opportunities and The Abandoned Infants Assistance Act. Washington D.C.: Administration for Children and Families, United States General Accounting Office. (1999). Foster care: Kinship Care Quality and Permanency Issues. Urban Institute. (2008). Children in Kinship Care. Assessing the New Federalism Retrieved June, 11, 2008, 2008, from www.urban.org/anf Vericker, T., Kuehn, D., & Capps, R. (2007). Latino Children of Immigrants in the Texas Children Welfare System. American Humane, 22(2), 20-40. Wulczyn, F., Chen, L., & Brunner Hislop, K. (2007). Foster Care Dynamics Report, 20002005: A Report from the Multistate Foster Care Data Archive. Chicago: Chapin Hill Center for Children at the University of Chicago.



Chapter 2

CHILDREN OF COLOR IN THE CHILD WELFARE SYSTEM Jillian Jimenez* and Ruth M. Chambers† Department of Social Work, California State University, Long Beach 1250 N. Bellflower Blvd, Long Beach, CA 90840, USA

ABSTRACT The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices. This chapter will also discuss disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It will also highlight the major causes of this problem and provide a critique of relevant policies.

INTRODUCTION The disproportionate levels of ethnic minority children in the child welfare system have been a long standing concern. In recent years, however, due to increasing numbers of children in the foster care system, much more research has been conducted and our understanding of this issue has increased significantly. The current statistics are startling: In the United States, * †

Tel: (562) 985-5237; E-mail: [email protected] Tel: (562) 985-5175; E-mail: [email protected]

18

Jillian Jimenez and Ruth M. Chambers

African American children represent 42% of the foster care system but only make up 15% in the general population. Native American children make up 2% of the foster care population but represent only 1% in the general community. Although Latinos are not overrepresented on a national level, 17 states have disproportionate higher levels of Latino children in foster care. Furthermore, compared to White children, ethnic minorities are more likely to be referred and investigated for child maltreatment, receive inadequate services while in the system, have longer stays in placement and are less likely to be reunified1. Despite national data that demonstrates no ethnic differences between child maltreatment and ethnicity, why do we see such high numbers of ethnic children and families involved in the child welfare system? Causes of this discrepancy include racial bias on the part of child welfare system, especially in professional decision makers, preponderance of community risk factors, including levels of poverty and other economic stressors such as homelessness, and the nature of government policies governing child welfare systems. This chapter will first review the prevalence and primary causes associated with disproportionality in the child welfare system between 2003-2008. Second, African American, Native American and Latino populations will be presented including relevant statistics, causes and if applicable, specific child welfare polices.

ETHNICITY AND CHILD WELFARE According to the National Child Abuse and Neglect Data System (NCANDS), African American, American Indian or Alaskan Native, and Pacific Islander children have higher rates of reported child maltreatment than do other children. In 2005, African American children had a reported maltreatment rate of 19.5 per 1,000 children, Pacific Islander children had a rate of 16.1 per 1,000 children, and American Indian and Alaskan Native children had a reported maltreatment rate of 16.5 per 1,000 children, compared with 10.8 per 1,000 nonHispanic white children, 10.7 per 1,000 Hispanic children, and 2.5 per 1,000 Asian children.2 It is important to note that these statistics are based on cases that are reported to child welfare agencies and found to be not as credible; earlier larger studies known as the National Incidence Studies of Child Abuse and Neglect, undertaken by the federal government in l980, l986 and l993, found no ethnic effect on child maltreatment. However, these large scale federal studies found an economic effect: poorer families were more likely to maltreat their children, regardless of ethnicity.3 The l993 National Incidence Study found that compared to

1

2

3

National Clearinghouse on Child Abuse and Neglect Information, National Adoption Information Clearinghouse. Racial disproportionality in the U.S. child welfare system: What we know. 2003-2005. http://www. hunter.cuny.edu/socwork/nrcfcpp/downloads/bib/Disproportionality_whatweknow.pdf. Retrieved on July 23, 2008. U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm Robert Hill. Synthesis of Research on Disproportionality in the Child Welfare System: An Update. CaseyCSSPAlliance for Racial Equity in the Child Welfare System. October, 2006, http://www. racemattersconsortium.org/docs/BobHillPaper_FINAL.pdf. Retrieved May 11, 2008;

Children of Color in the Child Welfare System

19

children whose families earned $30,000 per year or more, children in families with annual incomes below $15,000 per year were more than 22 times more likely to experience some form of maltreatment. The statistics gathered in these National Incidence Studies are more accurate than the NCANDS reports, which depend solely on cases of child maltreatment that have been reported to Child Protective Service Agencies. The National Incidence Studies draw from a wider range of reporters who may or may not have interacted with the local child protective service agencies. The National Incidence Study design assumes that the maltreated children who are investigated by child protective services (CPS) represent only the “tip of the iceberg,” so while NIS estimates include children investigated at CPS, they also include maltreated children who are identified by a wide range of professionals in representative communities. These professionals, called “sentinels,” are asked to remain on the lookout for children they believe are maltreated during the study period.4 Thus while there are ethnic differences the children who are reported to CPS, there apparently is no ethnic difference established in actual maltreatment, according to these broader studies. Ethnicity has been found to be a strong predictor of investigation in cases of alleged physical abuse and neglect. While whites are more likely to be investigated in cases of sexual abuse, African Americans are twice as likely to be investigated for physical abuse and neglect as whites.5 Are reports of abuse more likely to be substantiated, that is, found to be correct, for African American children? Research suggests that this is indeed the case.6 National data also show that Native American families are more likely to be investigated for child maltreatment compared to White families. Using two national datasets (AFCARS, NCANDS) which included over 800,000 children, Hill found that the Native Americans/Alaska Native child population had twice their representation in the general population at investigation (1% and 2% respectively)7. Once maltreatment is found to be substantiated by the child welfare system, are there ethnic differences in whether children remain in their homes or are placed in foster homes? Are there any differences in length of time in placement and reunification rates for children of color? According to national data, African American children were much more

4

5

6

7

Andrea J. Sedlak & Diane D. Broadhurst, Executive Summary of the Third National Incidence Study of Child Abuse and Neglect. U.S. Department of Health and Human Services. l996. http://www.childwelfare. gov/pubs/statsinfo/nis3.cfm. retrieved May 10, 2008. Department of HHS. Fourth National Incidence Study of Child Abuse and Neglect. https://www.nis4.org/ nishome.asp. retrieved May 10, 2008. John Fluke, Ying-Ying Yuan, John Hedderson & Patrick Curtis. Disproportionate Representation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization. Children and Youth Services Review. 25 Nos 5/6 2003. 359-373; Andrea Sedlack and Dana Schultz. Racial Differences in child Protective Service Investigation of Abused and Neglected Children at Risk of Maltreatment in the General Child Population, in Derezotes et al, 97-119; Brian Gryzlak, Susan Wells,, & Michelle Johnson. The role of race in child protective services screening decisions. In Dennete Derezotes et al. (Eds.) Race matters in child welfare: The overrepresentation of African American children in the system (pp. 63-96). Washington, DC: Child Welfare League of America, 2005. John Fluke, Ying-Ying Yuan, John Hedderson & Patrick Curtis. Disproportionate Representation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization. Children and Youth Services Review. 25 Nos 5/6 2003. 359-373; Hill, 20-21. AFCARS, 2007, Hill, 2007). Robert Hill. Synthesis of Research on Disproportionality in the Child Welfare System: An Update. CaseyCSSPAlliance for Racial Equity in the Child Welfare System. October, 2006. http://www. racemattersconsortium.org/docs/BobHillPaper_FINAL.pdf. retrieved May 11, 2008.

20


likely than white victims of abuse and neglect to be placed in foster care.8 Regional studies have also found that after controlling for gender, age and reason for referral, African American children were slower to exit foster care, and less likely to be reunited with their biological parents than white children.9 Native American children are three times more likely to be placed in foster care10, twice as likely to remain in care for over two years and less likely to be reunified with his/her family.11 Latino children (under the age of 5) are at a greater placement risk;12 enter the foster care system at greater numbers than other children,13 remain in placement rather than return home14 and are less likely to be reunified.15 Finally, children of color receive fewer services than white children while in the child welfare system.16 In a recent mixed method study of forty-eight child welfare State agencies, researchers found that African American families had extreme difficulty in receiving mental health, substance abuse treatment and/or family support services. The inability of the families to get these services resulted in the children being removed from the home, staying longer in care and not being reunified with their biological families.17 For Latino children in care, they were less likely to receive mental health services compared to Caucasian children18 and Native American caregivers were less likely to receive substance abuse and/or mental health treatment.19 8

U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Child Maltreatment 2005 (Washington, DC: US Government Printing Office, 2007). http://www.acf.hhs. gov/programs/cb/pubs/cm05/index.htm; 9 Sheila Ards, Samuel Myers, Allan Malkis. Racial Disproportionality in Reported and Substantiated Child Abuse and Neglect: An Examination of Systematic Bias. Children and Youth Services Review, 25, nos 5/6 2003, 375392.; Yuhwa Lu, John Landsverk, Elissa Ellis-Mcleod, Rae Newton, William Ganger, Ivory Johnson. Race, ethnicity and case outcomes in child protective services. Children and Youth Services Review, 26(5) 2004 447461; Hill, 24. 10 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. The AFCARS Report, Preliminary Estimates for FY 2006 as of January 2008 (14). http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report14.htm. Retrieved on July 20, 2008. 11 Washington State Racial Disproportionality Advisory Committee. Racial disproportionality in Washington State. 2008. http://www1.dshs.wa.gov/pdf/ca/RaceDispro1.pdf. Retrieved on July 19, 2008. 12 Mónica M. Alzate & James A. Rosenthal. Gender and ethnic differences for Hispanic children referred to child protective services. Children and Youth Services Review. In press 2008. 13 Sandra Stukes Chipungu & Tricia B. Bent-Goodley. Meeting the challenges of contemporary foster care. The Future of Children. 14 No. 1 2004. 75-93. http://www.futureofchildren.org/usr_doc/5-stukes.pdf. Retrieved on July 25, 2008 July 29, 2008. 14 Richard Barth. Effects of age and race on the odds of adoption versus remaining in long-term out-of-home care. Child Welfare, 76, 285–309. 1997. 15 Alice M. Hines, Peter Allen Lee, Laurie Drabble, Lonnie R. Snowden, & Kathy Lemon. An evaluation of factors related to the disproportionate representation of children of color in Santa Clara County’s child welfare system: Child family characteristics and pathways through the system, phase 2 final report. 2002. http://www.sjsu.edu/cwrt/Phase2/File1.pdf. Retrieved on July 15, 2008. 16 Hill, 28; Garland, A., Landsverk, J., & Lau, A. (2003). Racial/ethnic disparities in mental health service use among children in foster care. Children and Youth Services Review, 25(5/6): 491-507; Ruth McRoy. The Color of Child Welfare in Eds King Davis& Tricia B. Bent-Goodley. The Color of Social Policy. Alexandria, Va: Council on Social Work Education, 2004 ,36-65. 17 African American Children in Foster Care: Additional HHS Assistance Needed to Help States Reduce the Proportion in Care. GAO, July 2007. http://www.gao.gov/new.items/d07816.pdf. Retrieved July 28, 2008. 18 Elsa A. Ríos & Sandra Duque. Bridging the cultural divide: Building a continuum of support services for Latino families. New York: The Committee for Hispanic Children and Families, Inc. 2007. 19 Anne M. Libby, Heather D. Orton, Richard P. Barth, Mary Bruce Webb, Barbara J. Burns, Patricia Wood, & et al. Alcohol, drub, and mental health specialty treatment services and race/ethnicity: A national study of children and families involved with child welfare. American Journal of Public Health. 96 No. 4 2006. 628631.


21

Many observers note that there is a class and ethnic bias in the reporting and investigation systems found in CPS systems across the country; poorer families, including families from some ethnic groups, are overrepresented, while middle and upper class families are underrepresented. If there is no significant ethnic difference in child maltreatment, as the National Incidence studies have found, then the fact some ethnic groups are overrepresented in the child protective service caseloads is due to systemic problems in child welfare oversight. What factors account for these differences? Some research suggests that differences in reporting exist; poorer communities have more surveillance in terms of who tends to report abuse; these include educational staff, law enforcement and social service personnel.20 Both public and private hospitals have been found to over report abuse among blacks and underreport it among whites. Controlling for actual injury due to abuse, another study found that children of color were more likely to be reported for physical abuse than white children, even when white children were injured by their caretakers. 21 African American women are more likely to be reported for abuse when their newborns test positive for drug use than white women. While some research did not find these ethnic discrepancies, the bulk of the research has found these discrepancies.22 Researchers have established a connection between family poverty and child neglect, with ethnic minority, low-income families more likely to be reported for neglect and the children of these families more likely to be placed in foster care.23 In a recent qualitative study conducted by the U.S. Children’s Bureau, administrators, supervisors and workers at nine child welfare agencies cited poverty as a key reason for the overrepresentation of minority children in the child welfare system.24 In a related study, child welfare officials in thirty-three states contended that poverty was a major factor in foster care placement for African American children.25 In a national conference that addressed the disproportionate numbers of Latino families in the child welfare system, child welfare advocates noted that “caseworkers and mandated reporters are often unable to distinguish between indicators of poverty and indicators of neglect, thus placing low-income Latino families at greater risk for child removal and foster placement”26

20

U.S. Department of Health and Human Services. (2005). Child maltreatment, 2003. Washington, DC: U.S. Government Printing Office. www.acf.hhs.gov/programs/cb/pubs/cm03/index.html. retrieved May 10, 2008. 21 W. Lane, David Rubin & Robert Monteith. Racial Differences in the evaluation of pediatric fractures for physical abuse. Journal of the American Medical Association, 288 (13), 2002, 1603-1609. 22 Hill,17-19; Alice Hines, Kathy Lemon, Paige Wyatt &Joan Merdinger,10-11; Yuhwa Lu, John Landsverk, Elissa Ellis-MacLeod, Rae Newton, William Ganger, & Ivory Johnson. (2004). Race, ethnicity and case outcomes in child protective services. Children and Youth Services Review, 26(5) 2004, 447-461. 23 Nancy A. Rodenborg. Services to African American Children in Poverty: Institutional Discrimination in Child Welfare? Journal of Poverty, 2004, 109-130. 24 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Washington, D.C.: U.S. Government Printing Office. Children of Color in the Child Welfare System: Perspectives from the Child Welfare Community. 2003 25 U.S. Government Accounting Office. African American Children in Foster Care: Additional HHS Assistance needed to help states reduce the proportion in care. 2007. 26 The Committee for Hispanic Children and Families, Inc. Creating a Latino child welfare agenda: A strategic framework for change. New York: Author. 2004, 9.

22


AFRICAN AMERICAN CHILDREN IN THE CHILD WELFARE SYSTEM Although many ethnic disparities in child welfare services exist, the only group over represented in the child welfare system over the past 10 years has been African American children, who are also subjected to poorer treatment within those systems than are other children. African American families are more frequently reported for abuse and neglect of their children, despite the lack of clear evidence that African American children are subject to greater levels of maltreatment, and their children are more frequently removed from their homes. 27 More than one third of children placed outside the home were African Americans in 2006.28 Once in foster care, African American children and youth receive fewer visits from caseworkers and less mental health services than do other children. Studies have found that close to 40% of children in the child welfare system are African American, although they represent only 15% of the child population.29 Causes of this discrepancy which have been the subject of research, include racial bias on the part of child welfare investigators and professional decision makers, preponderance of community risk factors, including levels of poverty, and economic stressors, the nature of policies governing child welfare,30 and racial bias among child welfare workers.31

History of African Americans in the Child Welfare System In the nineteenth and for much of the twentieth century, African American children were raised under an entirely distinct set of circumstances than white children, in families who had a different view of childrearing. These differences were based on both African cultural roots and the oppression African American families endured under slavery and afterward. The social construction of parenting was very different in the African American community than in the white majority community. The unitary view of individual legal responsibility for children that characterized public child welfare law is opposed to the tradition of kin and community responsibility for child rearing in the African American community. Kinship care in these communities was partly a response to discrimination and economic hardship, but it 27

Andrea Sedlak &Dana Schultz. Racial Differences in Child Protective Services Investigation of Abused and Neglected Children. In Denette Derezotes, John Portner & Mark Testa. Race Matters in Child Welfare. New York: Child Welfare League, 2005, 97-110. 28 U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau, Washington, D.C.: U.S. Government Printing Office, 2006; Tanya Coakley. Examining African American fathers’ involvement in permanency planning: An effort to reduce racial disproportionality in the child welfare system. Children and Youth Services Review. 30 (2008), 407-417. 29 Robert Hill. Synthesis of Research on Disproportionality in Child Welfare: An Update. October 2006, CaseyCSSP Alliance for Racial Equity in the Child Welfare System.http://www.aecf.org/media/PublicationFiles/ CW3622.retrieved July 30, 2008. 30 Hill, Synthesis of Research on Disproportionality; Brian Gryzlak, Susan Wells & Michelle Johnson. The Role of Race in Child Protective Services Screening Decisions in Dennete Derezotes, John Poertner & Mark Testa, Eds. Race Matters in Child Welfare. New York; Child Welfare League of America, 2005, 63-97; Nancy Rolock & Mark Testa. Is the Investigation Process Racially Biased? In Derezotes, Poertner & Testa, Eds. Race Matters, 119-131; Robert Goerge & Bong Joo Lee. The Entry of Children from the Welfare System into Foster Care: Differences by Race. in Derezotes, Poertner &Testa. Eds. Race Matters.173-187;Nancy Rodenborg. Services to African American Children in Poverty: Institutional Discrimination in Child Welfare? Journal of Poverty, 8 (3). 2004, 109-115..


23

was also part of the African cultural heritage that continued to inform life in the slave quarters and during the late l9th and 20th century America. West African society featured an intensive kinship network where family relations were widespread and the responsibility for child rearing was collective. In Africa, and later during slavery, extended families shared responsibility for parenting tasks, including community surveillance and discipline, daily care and nurturance of children living with parents, and substitute care for children whose biological parents could not care for them. Substitute care was arranged informally by kinship networks, especially grandmothers. Sometimes, especially in Northern urban areas, fictive kin would assume responsibility for children when families were unable to or had moved away for find work. When parents returned, kin caretakers returned the children to them or joined with them in raising the child. This is one reason why African American families were reluctant to let their children be formally adopted; the idea that parental rights had to be terminated (necessary for legal adoption) was an unwelcome one, since boundaries of responsibility for children were fluid. The white model of closed adoption that dominated in the courts and child welfare system for decades was based on a fiction: adoptive parents acted as if they were the biological parents, even substituting another birth certificate for the original one. This denial of the biological parents’ connection to the child was unheard of in African American families, where the connection between parent and child was not denied, even in cases of informal adoption. Informal adoption of African American children by kin or fictive kin meant that children did not go to orphanages, which did not accept African American children in any case, nor were they adopted under the aegis of the formal legal public system. Because of the practice of informal adoption, few African American children became wards of the state before the l960s. This informal system of child welfare was a necessary substitute for the formal white system of child welfare. It drew on the strengths of communities tested by discrimination and economic deprivation. 32 It was not until the l960s that African American children were welcomed to private orphanages, which then were transformed into residential treatment centers when the federal government began to reimburse states for placement of foster children in these group homes. The overrepresentation of African American children in the child welfare system after l960 parallels their overrepresentation in the juvenile justice system, the subject of concern for over 40 years. 33 As we have seen, there are many decision points in child welfare system, from the first reports to child protective services through the decisions to place children in foster care or reunify them with their biological parents. Many different outcomes are possible for children in the child welfare system, including monitoring in the home, foster care, group homes and adoption. Are African American children overrepresented because child welfare practices at these decisions points are influenced by racism and or discrimination? Or are African American children more likely to be abused and thus more in need of child welfare services? The National Incidence studies discussed earlier seem to 31

32

33

Lawrence Berger, Marla McDaniel &Christina Paxson. Assessing Parenting Behaviors across Racial Groups: Implications for the Child Welfare System. Social Service Review,79, (4), 2005, 653-688. Jillian Jimenez. The history of child protection in the African American community: Implications for current child welfare policies. 28 (2006), 888-905. Dennete Derezotes and John Poetner. Factors contributing to the overrepresentation of African American children in the child welfare system. In Eds. Derezotes ,Poetner & Testa, Eds. Race Matters in Child Welfare, 1-25.

24


indicate that their overrepresentation can be explained by over reporting of child maltreatment in African American families, underreporting of white children, and differences in investigation of cases and in substantiation rates. In fact the National Incidence studies discussed above acknowledged the high risk factors experienced by African American families in terms of low income, single parent status and welfare status, but still found lower incidence of child maltreatment in African American families compared to other groups with these same factors. Perhaps these risk factors are not as salient for African American families. Research suggests that mediating factors which reduce the risk may include the cultural strengths of African American families discussed above. If so, differences in treatment during the child welfare decision making process explain the disproportionality. 34

MULTIETHNIC PLACEMENT ACT In l994 Congress passed the Multiethnic Placement Act prohibiting the use of race, color or national origin to deny or delay children placement in ethnically diverse foster or adoptive homes. Combined with the Adoptions and Safe Families Act of l997 requiring that children who are not reunited with their parents be placed in adoptive homes, these two policies together serve to promote adoptions of ethnic minority children by white families. Critics argue that removing African American children from their families and giving them to white families to adopt is often a mistake because it strips children of their historical and cultural legacies. In 1972, the National Association of Black Social Workers had announced that it was opposed to adoptions that placed black children into white families (known then as transracial adoptions), a stance that had strong repercussions for child welfare policy until the Multi Ethnic Placement Act. The NABSW now focuses its efforts on encouraging adoptions within the African American community. 35 Ironically, most of the children who are considered examples of transracial adoptions over the past ten years are not from the United States, but from outside in the country. Adoption of foreign born children has increased dramatically to over 20,000 a year.36 The concept of transracial adoptions has lost its meaning since MEPA was passed and the need to widen the pool of adoptive applicants, especially for African American children, has emerged as a pressing policy issue.

ADOPTION AND SAFE FAMILIES ACT The Adoption and Safe Families Act, passed into law in l997 introduced several new themes to child welfare practice. This policy represented an l80 degree turn away from family preservation and towards parental termination and adoption. The theory behind the policy was that children should have a limited amount of time in foster care before their permanent futures were decided and those who could not be safely returned should be legally severed from their families and adopted by other families. As a result of this sea change in federal 34

Richard Barth. Child Welfare and Race: Models of Disproportionality. In Derezotes, Poertner & Testa, 25-47. Dorothy Roberts. Shattered Bonds: The Color of Child Welfare. New York: Basic Books, 2002, 246-249. 36 Transracial Adoptions http://racerelations.about.com/od/parentingrace/i/transracialadop_2.htm. Retrieved May 19, 2008 35


25

policy, the weight of the federal government came down fully against biological families, although the Act contained lip service about reasonable efforts to serve families. As opposed to helping families provide adequate care for children, ASFA put child welfare agencies in the position of planning for termination of their parental rights. Many states passed concurrent planning laws, mandating that child protective service workers develop two plans simultaneously when a child was removed: one to reunify children with families, one to terminate parental rights and find permanent adoptive homes. Under ASFA parents were given 12 months, rather than the l8 allowed under the l980 Act, to reunify with their children. ASFA allowed child welfare agencies to deny reunification services to families who committed certain kinds of abuse, including murder or manslaughter of another child, or other aggravated circumstances as determined by the state, including abandonment, torture, chronic abuse and sexual abuse.37 Clearly, ASFA was not targeted toward parents who were at risk for abusing children; there were no extra funds for services for families, instead the funds went to counties as incentives for finding permanent adoptive homes for children in foster care. For many states the federal law gave an excuse to states to deny reasonable efforts to many clients in the child welfare system. California, for example, has added fifteen conditions under which reunification services can be denied.38 ASFA puts the weight of federal law on the side of children’s rights and child safety, and away from efforts to help biological families develop the resources to care for their children adequately. While both goals could conceivably be met in a child welfare policy, to date they have not been. ASFA directly impacts the ability of African Americans families at risk for involvement with the child welfare system to access resources and services that would enable them to meet the needs of their children and therefore remain intact.

Legal Adoption One of the most controversial aspects of ASFA was its intention to promote legal adoption and termination of parental rights for children in the child welfare system. The history of collective informal efforts in African American communities to insure the protection and well-being of their children suggests that the public child welfare system, with its emphasis on unitary, singular responsibility for children was not a good fit with African American families. Contrasting formal, legal adoptions with informal adoption reveals the contractual relationship at the heart of legal adoption, which creates parenthood by law and replaces biological families with legally constructed ones. 39 In African American communities the idea of termination of parental rights and exclusion of biological parents from the child’s life is not culturally congruent, as discussed above. Parties to informal adoptions made room for the return or involvement of the biological parents, no matter how intermittent. Informal adoptions were part of a natural kinship strategy, not a legal contract creating a fictive parent child relationship. This tradition should be incorporated into child 37

Amy D’Andrade & Jill Duerr Berrick. When Policy Meets Practice: The Untested Effects of Permanency Reforms in Child Welfare. Journal of Sociology and Social Welfare, 33, (1), March,2006 31-52. 38 D’Andrade , 37. 39 J. Model. Kinship with strangers: Adoptions and interpretations of kinship in American culture. Berkeley: University of California Press, l994.

26


welfare policy to encourage African American families to adopt children who are kin or non kin. Adoptions from foster care are promoted by the Adoptions and Safe Families Act and have increased since its passage. Adoptions of children with special needs are subsidized by states and the federal government, and adoption tax credits are given by the federal government to all adopting families. These policies have increased the pool of adoptive parents, many of whom were originally foster parents to the adopted child.40 More policies offering permanent adoption subsidies to families who adopt children from foster care would increase the number of adopted children. According to the most recent data available, 114,000 children in the United States foster care system were waiting to be adopted in 2005. During that same year, however, only 51,000 children were actually adopted. Older children and sibling groups are the least likely to be adopted. Children who are adopted are younger by an average of 2 years than those who are not adopted.41 Foster care adoptions increased 78 percent from 1996 to 2000, as a result of ASFA and earlier state initiatives. It is estimated that ASFA requirements and incentives have resulted in an additional 34,000 adoptions from 1998 to 2000 that would not have otherwise occurred. In 2000, the latest year for which national statistical information is available,42% of children adopted out of foster care were African American, 32% were white and l5% were Latino. Children under 6 years of age were more likely to be adopted than older children.42

Kinship Care ASFA encouraged kinship or relative care of children removed from their homes and allowed relatives to be reimbursed in the same way as non relative foster parents providing they received a foster care license from the state. Kinship care may seem like a natural fit for African American children in child welfare system, since it draws on the historical and cultural strengths of African American families. Indeed over the past 20 years more African American children than any other children have been in some form of kinship care. In 2002, of the 2.2 million children in kinship care, 43% were African American. Several types of kinship care exist; the most formal type is kinship foster care, where children are in state custody and then placed with relatives; other types include informal or voluntary kinship care, where families are not supervised by child welfare officials and not compensated at the foster care rate. Instead these families, who are not licensed, receive the lower TANF reimbursement. In 2004 more than half of the approximately 400,000 children in the more formal, supervised, kinship foster care were African American. 43 While kinship care is not a panacea for African American children, it stands on solid historical ground as the natural system that developed in African American communities to insure the welfare of children.

40

Child Welfare Information Gateway. Foster Parent Adoption, 2006. http://www.childwelfare.gov/pubs/f_fospro/ f_fospro.cfm. Retrieved May 24, 2008. Erica Zielewski, Karin Malm, Rob Geen & Steve Christian. Trends in U.S. Foster Care Adoption Legislation. Urban Institute,2006. http://www.urban.org/publications/411380.html.Retrieved Mat 23, 2008. 42 U.S. Department of Health and Human Services' Adoption and Foster Care Analysis and Reporting System (AFCARS), Report 6. 2001, http://www.acf.dhhs.gov/programs/cb/publications/afcars/june2001.htm, Retrieved May 20, 2008. 43 Rob Geen. The evolution of kinship care: Policy and Practice: The Future of Children, vol 14,Washington, D.C.: The Urban Institute, 2004, 115-129. 41


27

Largely because of the lower rate of reimbursement for many kinship care families and the lack of services, children in this form of home care are thought to face more barriers and to fare less well than children in their own homes or in supervised foster placements. The economic deprivation experienced by many kinship families is one important reason for the difficulties faced by children placed there. On the other hand, advantages to kinship care include the family continuity and support it offers and the relative stability it offers children; children in kinship care are less likely to be moved than children in non relative foster care. However, depending on non reimbursed kinship care as a major policy meeting the needs of African American or any children is a flawed strategy, as it compounds the economic disadvantage experienced by minority families. Only when families have the economic and emotional resources to take on what is clearly an extra burden, should kinship placements be made.44 Federal and state funds should be provided for all families who take in children related or non- related, as should child welfare services. Why have kin been utilized as a low cost way to meet the needs of many African American children? Ambivalence over reimbursement of family members for care may be at the heart of the reluctance. However, socially just policies would mandate that both legal guardians and kin caregivers be reimbursed for their efforts to care for children, who would be placed in federally funded, non related foster homes should relatives to refuse to take on this responsibility. Redressing the financial inequities inherent in current kinship care policies is crucial to protecting and promoting the well being of African American children. Reimbursing all kin at the same rate as non-relatives and offering child welfare services to all children in kinship families are crucial first steps in promoting the welfare of African American children in kinship care.

Legal Guardianship As discussed above, African American families may not wish to become involved with permanent adoptions of their family members because of long standing cultural traditions that work against parental termination. Legal guardianship is an arrangement wherein kin or others assume legal custody of children whose birth parents may retain certain rights, such as the right to visitation, the right to consent to adoption and the responsibility for child support, may be more culturally congruent with African American communities. Yet legal guardianship may pose a financial hardship for many families, since in most cases the federal government does not subsidize the care of children in guardianship arrangements. Guardians of children eligible for TANF may receive compensation that is approximately one third to one half of the rate the federal government pays to foster parents, who also care for dependent children. The answer may lie in subsidized guardianship, where guardians (usually kin) are reimbursed at the higher foster care rate. These subsidized guardianships have been approved under a federal waiver in eight states, including Illinois. Research indicates that subsidized guardianships do result in permanency for African American children. In one study in Illinois, relatives in subsidized guardianship arrangements converted their informal arrangements into 44

Julie Miller-Cribbs and Naomi Farber. Kin Networks and Poverty among African Americans: Past and Present. Social Work 53, 1, January, 2008, 43-51; Jimenez,900-902;Carrie Jefferson Smith & Wynetta Devore. African American children in the child welfare and kinship system: from exclusion to over inclusion. Children and Youth Services Review, 26, May 2004, 427-446.

28


formal, open adoptions in greater numbers than in non subsidized guardianships; these adoptions accounted for 58% of all adoptions in the state of Illinois in l999.45 Making subsidized guardianship available in all states would increase the options for permanency with kin for African American children in the child welfare system. According to a report issued by the GAO in 2007, states have expressed a strong desire to be allowed to use federal child welfare funds to provide subsidies to legal guardians.46 This would appear to be the next important federal policy needed to insure that African American children in the child welfare system receive the full measure of social justice they deserve.

INDIAN CHILDREN IN THE CHILD WELFARE SYSTEM Native American families who encounter the child welfare system also experience racial disparities within the child welfare system. Overall, this population comprises 1% of the general child population but constitutes 2% of the foster care population. Research studies have shown that Native American families are more likely to be reported, investigated and as a result have more substantiated reports of child maltreatment than White children. In terms of placement, Native American children are three times more likely to be placed in foster care.47 In looking at state level data, Native American children were 1.73 times more likely to be recommended for out of home placement in Minnesota; in Alaska, 51% of the foster care population consist of American Indian and Alaskan Native children, but only account for 20% in the general child population. Native Indian children who lived in Washington State experienced overrepresentation at all stages in the child welfare system. Compared to Caucasian children, Native Indian children were more likely to be referred to CPS be placed outside the home, experienced longer placement stays (over two years) and were less likely to be reunified with their families.48 In terms of child welfare services, Native Indian caregivers are less likely to receive substance abuse and/or mental health treatment. In a national sample of American Indian caregivers, 22% were identified as having a substance abuse or mental health problem at time of investigation. Only 15% received a formal assessment, approximately 25% were offered services and only 12% actually received the services.49

45

46

47

48

49

Mark Testa. The Changing Significance of Race and Kinship for Achieving Permanence for Foster Children. In Eds. Derezotes ,Poetner & Testa, Eds. Race Matters in Child Welfare,231-241. African American Children in Foster Care: Additional HHS Assistance Needed to Help States Reduce the Proportion in Care. GAO, July 2007. http://www.gao.gov/new.items/d07816.pdf. Retrieved July 28, 2008. Robert B. Hill. Disproportionality of minorities in child welfare: Synthesis of research Findings. http://www.racemattersconsortium.org/docs/whopaper4.pdf. Retrieved on July 25, 2008; United States Census Bureau. 2003. Characteristics of American Indian and Alaska Natives by tribe and language: 2000. Part 1,89. http://www.census. Gove/prod/cen2000phc-5-pt1.pdf. Retrieved May 21, 2008. Erik P Johnson, Sonja Clark, Matthew Donald, Rachel Pedersen, & Catherine Pichotta. Racial disparity in Minnesota’s child protection system. Child Welfare. 86 No. 4 2007. 5-20. Robert B. Hill. An analysis of racial/ethnic disproportionality and disparity at the national, state, and country levels. http:// www.aecf.org/~/media/PublicationFiles/Bob%20Hill%20report%20natl%20state%20racial%20disparity%202 007.pdf. Retrieved on July 25, 2008. National Indian Child Welfare Association. Time for reform: A matter of justice for American Indian and Alaskan Native children. Philadelphia, PA: The Pew Charitable Trusts. 2007. Anne M. Libby, Heather D. Orton, Richard P. Barth, Mary Bruce Webb, Barbara J. Burns, Patricia Wood, & et al. Alcohol, drub, and mental health specialty treatment services and race/ethnicity: A national study of


29

Indian Child Welfare Act In l978 Congress recognized the cultural assault on American Indian identity represented by the large number of placements of American Indian children outside tribal areas with white families. Citing a longstanding government campaign to place these children in white institutions that began in the early 20th century, the Senate held hearings in which witnesses testified that from one quarter to one third of American Indian children had been separated from their families by child protective services. Infants were particularly at risk for adoption by whites. Witnesses blamed culturally biased standards of child rising for the high number of removals, mostly on grounds of neglect or “social deprivation.”50 Congress declared that the continued existence of tribes, along with tribal sovereignty were both threatened by the actions of state child protective service workers. Under the new law child protective service agencies were mandated to make active efforts to guarantee that American Indian children remain with their families and to turn cases of child endangerment over to tribal courts, who would make decisions regarding the welfare of American Indian children. The law applies to foster placements, termination of parental rights, and adoptions. The ICWA defines "Indian child" as a child who is a member of a federally recognized Indian tribe, or is eligible for membership in such a tribe and the biological child of a member. The Multiethnic Placement Act of l994 exempts Indian children from its provisions, in keeping with the goals of the Indian Child Welfare Act. States are allowed to oppose transfer to a tribal court in cases where good cause exists, including the non existence of such a tribal courts. However state agencies must make every effort to locate the tribe to which the child may belong, even if this is not immediately apparent. The Act establishes a minimum federal standard if a state wished to remove American Indian children from their home. It is more difficult for child protective service agencies to place Indian children outside their homes, and these placements are with Indian homes wherever possible. In spite of clearly stated federal intention, lack of state compliance with this Act is a problem; some states decline to enforce it. While some states have passed their own laws to support the federal law, in other States Indian children have been removed from their homes and placed in non-Indian foster or adoptive homes.51 Since the federal government did not allocate funds to tribes to implement ICWA, there is little recourse in cases of state indifference to the Act, and even cooperative state child welfare agencies may find limitations in how tribes can supervise their child welfare responsibilities. The federal government still has not allocated funds for tribal child welfare services.52 As a result of these factors, ICWA has not been not fully implemented. Indian children continue to be at risk for removal on grounds of child neglect, due to the high poverty rates experienced by the American Indian families. In 2000, 22% of American Indian children lived below the poverty level in the United States. Recent policy changes may put these families at greater risk for child removal. Families on economically marginalized

50

51

52

children and families involved with child welfare. American Journal of Public Health. 96 No. 4 2006. 628631. Roberts, 248-250.Madeleine Kurtz. The Purchase of Families into Foster Care: Two Case Studies and the Lessons they Teach. Connecticut Law Review 26 (1994), 1453-1475. Andrea Wilkins. The Indian Child Welfare Act and the States. The National Conference of State Legislatures, 2004. http://www.ncsl.org/programs/stcatetribe/icwa.htm. Retrieved May 21, 2008. Ann MacEachron & Nora Gustavsson. Contemporary Policy challenges for Indian Child Welfare. Journal of Poverty.9 (2) 2005, 43-61.

30


reservations and rural areas have long depended on welfare, since there are few employment opportunities in these areas. Poverty in reservation families may be exacerbated by the 5 year time limit for receiving TANF and pressure for permanency through adoption and parental termination may undermine the goals of the ICWA in families who are not returned to tribal jurisdictions and are subject to the oversight of state child protective service agencies.53

LATINO CHILDREN IN THE CHILD WELFARE SYSTEM Latino families who encounter the child welfare system also experience racial disparities within the child welfare system. Although research studies on this population are severely lacking, current research suggests the Latino children are overrepresented in several states and counties, and at different stages within the child welfare system. Compared to White children, research studies have shown that Latino children (under the age of 5) are at greater placement risk;54 are entering the foster care system at greater numbers than other children, 55 remain in placement rather than return home, and are less likely to be reunified.56 Also, the Adoption and Foster Care Analysis and Reporting System (AFCARS, 2005) provided national trend data (2000-2005) for the Latino population and found that Latino children who entered the foster care increased from 15% in 2000 to 18% in 2005.57 Using the Minority Overrepresentation Index (created by the Office of Juvenile Justice and Delinquency Prevention (OJJDP)) and the U.S. Department of Health and Human Services Child welfare Outcomes Annual report data, Dougherty58 found significant overrepresentation for the Latino population in the foster care system. With the criteria of 1.0 and over considered to be overrepresentation, seventeen states (ranging from 1.0 to 1.9) fell into this category. These numbers are compared to White children who are sufficiently underrepresented in forty-eight states (0.0 to 0.9). In New York City, the number of Latino children in foster care increased 7.4% from 2000 to 2005; however, in 2006, the number increased by 61.4%. In looking more closely at the data, 18 community districts had been identified as “high need” based on the number of children in placement. Nine of the districts had 37% of its children in foster care, “17 of the 18 high need districts were areas where Latinos account for more than half of all residents

53

United States Census Bureau. 2003. Characteristics of American Indian and Alaska Natives by tribe and language: 2000. Part 1,89. http://www.census. Gove/prod/cen2000phc-5-pt1.pdf. Retrieved May 21, 2008. 54 Mónica M. Alzate & James A. Rosenthal. Gender and ethnic differences for Hispanic children referred to child protective services. Children and Youth Services Review. In press 2008. 55 Sandra Stukes Chipungu & Tricia B. Bent-Goodley. Meeting the challenges of contemporary foster care. The Future of Children. 14 No. 1 2004. 75-93. http://www.futureofchildren.org/usr_doc/5-stukes.pdf. Retrieved on July 25, 2008 July 29, 2008. 56 Alice M. Hines, Peter Allen Lee, Laurie Drabble, Lonnie R. Snowden, & Kathy Lemon. An evaluation of factors related to the disproportionate representation of children of color in Santa Clara County’s child welfare system: Child family characteristics and pathways through the system, phase 2 final report. 2002. http://www.sjsu.edu/cwrt/Phase2/File1.pdf. Retrieved on July 15, 2008. 57 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. The AFCARS Report, Preliminary Estimates for FY 2006 as of January 2008 (14). http://www.acf.hhs.gov/programs/cb/stats_research/afcars/tar/report14.htm. Retrieved on July 20, 2008. 58 Susan Dougherty. Practices that mitigate the effects of racial/ethnic disproportionality in the child welfare system. Seattle, WA: Casey Family Programs, 2003.


31

who are not proficient in English.”59 In New Mexico, Latino children consist of 51.8% of the population, but 55.4% are in the foster care system. This can be compared to White children who make up 31.3% of the population but only 29.1% are in the foster care system.60 In California, where more than 13 million Latinos comprise 36% of the state’s population, the number of Latino children in the child welfare system is much higher than in the rest of the nation, although not disproportionate with their numbers in the state population.61 In looking for current national research that addresses the effects of policies, in particular, Adoption and Safe Family Act (ASFA) on the Latino population, is unknown. In a national study that examined how foster care outcomes may have changed since the passage of this legislation, the researchers noted that “changes in foster care outcomes cannot be identified due to the lack of comparable pre and post-ASFA data.”62 The reason for this is because States have only been required to collect demographic data on children in foster care and adoptive families since 1995. Before 1995, States were not mandated to provide this type of information to the federal government. In addition, Wulczyn63 notes that while the data collection process has improved greatly over the years, it takes approximately five to ten years to complete adoptions relative to reunification and exists. In other words, it takes a significant length of time to know how the adoption process is impacted or changed by ASFA. There have been two State studies recently that deserve attention. McWey, Henderson, and Tice examined 168 court cases that resulted in parental right termination. The results indicated that parents were more likely to have their parental rights terminated after ASFA (100%) than before ASFA (79%).64 The second State study compared pre and post ASFA outcomes with a sample of 1, 900 women (71.9% White, 5.2% Black, 2.5% Latino, 5.8% Native American, 0.1% Asian) who were involved in the child welfare system and received substance abuse treatment. The results indicated that post ASFA children were in foster care shorter periods of time (although the average was 421 days), placed in permanent environments quicker and were more likely to achieve adoption.65 However, the primary reason for these outcomes have more to do with how the State prepared for and implemented ASFA than the actual policy effects. For example, a significant amount of coordination between child welfare, substance abuse treatment providers and the courts was completed prior to ASFA, this State also did not institute expedited permanency plans. That is, in the 59

Elsa A. Ríos & Sandra Duque. Bridging the cultural divide: Building a continuum of support services for Latino families. New York: The Committee for Hispanic Children and Families, Inc. 2007. 1. 60 New Mexico Race Matters Coalition. Child welfare in New Mexico. 2007. http://www.nmvoices.org/attachments/ racemattersfactsheets/child_welfare_fact_sheet.pdf. Retrieved on July 25, 2008. 61 Wesley Church, Emma Gross & James Baldwin. Maybe ignorance is not always bliss: The disparate treatment of Hispanics within the Child Welfare System. Children and Youth Services Review. 27, 2005. 1278-1292. 62 U.S. Government Accounting Office. Foster Care: Recent Legislation Helps States Focus on Finding Permanent Homes for Children, but Long-Standing Barriers Remain. 2002. 3. http://www.gao.gov/new.items/d02585.pdf. Retrieved on June, 10, 2008. 63 Fred Wulczyn, Kristen Hislop, Lijun Chen. Adoption Dynamics: An update on the Impact of the Adoption and Safe Families Act. Chicago. Chapin Hall. 2005. http://www.chapinhall.org/article_abstract.aspx?ar= 1384&L2=61&L3=130. Retrieved on July 10, 2008. 64 Lenore M. McWey, Tammy L. Henderson, and Susan N. Tice. Mental Health Issues and the Foster Care System: An Examination of the Impact of the Adoption and Safe Families Act. Journal of Marital and Family Therapy, 195-214, 2006. 65 Anna Rockhill, Beth Green and Carrie Furrer. Is the Adoption and Safe Families Act Influencing Child Welfare Outcomes for Families with Substance Abuse Issues? Child Maltreatment, 2007, 7-19.

32


current legislation, States are given an option to “fast-track” families; meaning that if child welfare workers think that reunification is not viable, then the parents are offered services. The majority of these women did receive substance abuse services. The findings of this study demonstrate that States can enhance services and achieve positive outcomes regardless of federal mandates.

CONCLUSION This chapter discussed disproportionality and disparity for African American, Native American and Latino children in the child welfare system. It also highlighted the major causes of this problem and provided a critique of relevant policies. It is clear from this review that additional research is required in three general areas. The first one is centered on prevalence. While research has indicated how many African American children are reported, investigated, placed in out of home care and either reunified with their families or adopted, the same cannnot be said for Native Americans, Latino and Asian populations. These issues need to examined in future child welfare research. The second line of research should focus on how ASFA has impacted these ethnic minority groups. What are the outcomes of ASFA for families from these ethnic groups? Is this policy producing positive effects for these populations? What effects does ASFA have on their communities? The third area of research should examine how TANF have impacted families who are involved in the child welfare system. Professionals, researchers and scholars predicted that child maltreatment cases would dramatically increase because of welfare reform legislation. However, only a few studies have been conducted with inconclusive results. There must be more research focus on whether or not a family who receives welfare benefits will be more likely to be involved in the child welfare system. Children of color have not been empowered by federal policies over the past two decades. Both TANF and ASFA have taken away rights from economically marginalized children of color; TANF by limiting the federal aid their families can receive and ASFA by putting the weight of the federal government behind termination of parental rights and adoption. Child maltreatment is the result of multiple risk factors, including poverty, substance abuse, domestic violence, social isolation and community factors including high unemployment.66 Many of these problems are experienced disproportionately by African American, Latino and American Indian families. The child welfare system is reinforcing these inequalities by punishing families without adequate services related to the causes of child maltreatment. While protecting children and keeping them safe is necessarily the primary goal of child welfare, the needs of vulnerable children should be meet within their family structure whenever possible. The policies in the United States today render this goal impossible to reach.

66

Ruth McRoy. The Color of Child Welfare, in Eds. King E. Davis and Tricia Bent-Goodley. The Color of Social Policy. Alexandria, VA :Council on Social Work Education. 2004, 37-63.



Chapter 3

ETHICAL ISSUES IN CHILD WELFARE: AN OVERVIEW FOR MENTAL HEALTH PROFESSIONALS Jeffrey H. Sieracki, Jessica A. Snowden, Amy M. Lyons, Scott C. Leon Loyola University, Chicago, IL, USA

ABSTRACT What are the ethical considerations that psychologists, psychiatrists, social workers, and other mental health professionals must take into account when working with the child welfare population? How does a child welfare professional juggle the demands of the child, biological parent(s), foster parent(s), and the courts while remaining responsible to the ethics of his or her profession? This chapter addresses ethical conflicts that might arise when psychologists and other mental health professionals assess, treat, or research children and adolescents in the child welfare system. This chapter reviews the child welfare system and the role of various professionals in child welfare, and a summary is presented of ethical guidelines from the American Psychological Association (APA), the American Psychiatric Association (APA), the National Association of Social Workers (NASW), and other ethics documents from related professions that pertain to this population. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to working with the child welfare population.

Keywords: Child welfare, ethics, substitute care, child custody

34

Jeffrey H. Sieracki, Jessica A. Snowden, Amy M. Lyons et al.

INTRODUCTION Jason is a 10-year-old who lives with foster parents because his biological mother was deemed unfit to parent. His biological mother has had numerous drug related arrests and Jason and his siblings were adjudicated as being neglected. Although her parental rights have not been terminated, the dependency court is moving towards termination of parental rights and his mother has limited visits with Jason. Jason has been having problems at school, and school personnel request that a case study evaluation be conducted. As part of his case study evaluation, Jason is psychologically and cognitively assessed by a psychologist. The Department of Children and Family Services (DCFS), the child protection agency in the state in which Jason resides, provides consent for the case study evaluation; however, upon hearing of the assessment, Jason’s mother argues that she should have been involved in the decision to test and that the assessment should not have been conducted without her knowledge. Furthermore, she wants to block the school from receiving the results from the evaluation, as she is concerned of the stigma that Jason would face if he was labeled or if he is placed in special education. Should the psychologist ethically not have tested Jason until consent was obtained from the biological mother? Now that the tests are complete, should the psychologist release the results to the school, to his foster parents, or to his mother? Maria is a 5-year-old who is currently placed in temporary foster care. Her biological uncle sexually abused Maria over a period of several months, and the courts have not determined whether her mother was aware of the abuse and if it is safe for her to return to her biological family. Therefore, she has been removed from her biological parents, with a longterm goal of family reunification. Maria has been seeing a licensed clinical social worker for several weeks now in order to process her understanding and feelings regarding the abuse. However, Maria’s foster mother is also interested in receiving updates of therapy. The foster mother has functioned as an advocate for Maria and is very concerned about her well-being. From both an ethical and legal perspective should the social worker give updates of therapy to the foster mother despite the fact that she is not her legal caregiver? Jamal is an 11 year old who currently lives in a residential treatment center for boys with behavioral and emotional disorders. He has had numerous arrests for acts ranging from petty theft to assault. His parents are chronic drug abusers and their parental rights have been terminated. The State is now Jamal’s legal guardian. A researcher is studying the relation between antisocial acts and personality in juvenile offenders and wants to include Jamal in his research study. He has obtained informed consent from his university and from the Department of Family and Protective Services, the protection agency in the state in which Jamal resides. Although Jamal is interested in participating in the study, his caseworker does not believe that the study would be good for him psychologically and thinks that he is only interested in participating for the incentive (a $10 giftcard). She believes that it might cause him to become more aggressive and antisocial. Should the researcher include Jamal in his study despite the fact that his caseworker does not believe that the study would be beneficial? The above hypothetical scenarios illustrate the complexities of working with children and adolescents in the child welfare system. Indeed, there are many unique ethical, legal, and clinical issues that arise when working with this population. Jason’s scenario describes a dilemma that a professional might face when conducting an assessment; Maria’s case is related to therapy; and Jamal’s vignette pertains to researching youth in the child welfare

Ethical Issues in Child Welfare

35

system. This chapter will discuss ethical, legal, and clinical issues within these domains, and how ethics and legality overlap in the child welfare sphere. The process of child protective services, removal from the home, and transition to an out of home placement often involves psychologists, psychiatrists, social workers, and other mental health professionals. These individuals may work as part of a treatment team that meets regularly with the child, they may be brought in as consultants, or they may contact the child with the purpose of soliciting research participation (Isaacs-Giraldi, 2002). Regardless of the amount of involvement in the child’s treatment, professionals that work with children and adolescents should be aware of both the state and federal laws and the ethical principles related to the treatment of children in state custody and transitioning into state custody. Training programs offered at job sites and academic institutions often discuss ethical issues; however, these seminars or classes do not always focus on child welfare. Although many clinicians and researchers are certainly well-versed in this topic, ethical considerations in child welfare are an area of such importance that a review is appropriate regardless of level of knowledge. First, this chapter will briefly explore the history of the child welfare system and the role that mental health professionals play within the system. Next, a review of ethics in social services and the ethical guidelines relevant to working with children in the child welfare system will be discussed in terms of the overall ethics code and specific guidelines relevant to child welfare for psychology, psychiatry, social work, professionals serving as researchers, and other related disciplines. This section will also include brief overviews of the role of the various professionals in the child welfare sphere. Finally, ethical issues related to the biological parent and the foster parent will be addressed, and the ethical dilemmas discussed in the opening paragraph will be reexamined. Although ethical codes and guidelines have been published by various organizations, the aim of this chapter is to synthesize this vital information and discuss the implications and controversies related to the child welfare population.

AN OVERVIEW OF CHILD WELFARE Stretching back to the time before independence from England and continuing to present day, communities within the United States placed the responsibility of caring for orphaned, abused, and neglected children on their local or state government (Pecora, Whittaker, Maluccio, 1992). Although the federal government has enacted legislation pertaining to the ways in which the states must operate their child protection services, it remains the responsibility of the state to handle these services. States create their own child welfare laws and enforcement agencies and vary slightly regarding specific child welfare policies and practices. The following paragraphs will present a brief overview of the history of important legislation in child welfare at the state and national level. For these purposes, the state of Illinois and the Illinois Department of Children and Family Services (DCFS) will be discussed in order to provide an example of a state child protection organization. Out of home placements for children and adolescents have existed for several centuries, and the foster care model used in the United States today has existed for several decades (Terpstra & McFadden, 1993). After the publication of The Battered Child Syndrome in 1962

36


(Kempe, Silverman, Steele, Droegemueller, & Silver, 1962), a book which documented the effects of physical abuse on young children and garnered widespread attention in the mainstream media, individual states began to shift the focus of their child service division away from finding placements for orphaned youths to reporting physical abuse. For example, largely due to the influence of the book, The Child Abuse Reporting Act of 1965, which required physicians to report physical abuse, became law in the state of Illinois. By the end of the 1960's, every state had a law on the books regarding reporting child abuse (Pecora et al., 1992). In the state of Illinois, the Child Abuse Reporting Act became the Abused and Neglected Child Reporting Act in 1975, which required physicians practicing within the state to report not only suspected physical abuse, but also suspected neglect (Gittens, 1994). Prior to the 1970s, the federal government did not play a direct role in the child protection realm. However, recognizing the extreme importance in protecting maltreated children and the potential problem with non-uniform laws within the states regarding child abuse reporting, the Child Abuse Prevention and Treatment Act was passed at the national level in 1974 (Public Law 93-247). The act required each state to adopt specific procedures to prevent, identify, and treat victims of child maltreatment and provided federal funding for a range of child services and research. Later, the Adoption Assistance and Child Welfare Act (AACWA) of 1980 (Public Law 96-272) was created in order to promote family reunification as opposed to multiple foster care placements (Downs, McFadden, & Costin, 2000; Gittens, 1994; Pardeck, 2002). This federal act allowed the Illinois DCFS and other state’s child protection services to focus more on permanency planning by providing subsidies for hard to place children. In addition, AACWA required an investigation of all reports of child maltreatment within 24 hours, and focused on placing children in the least restrictive environment. Under AACWA many children in the state of Illinois and other states spent their entire childhood in foster care waiting to be reunited with their family (Gittens, 1994). As a result, in 1997 the federal government passed the Adoption and Safe Family Act (ASFA) (Public Law 105-89). ASFA focused less on family reunification and more on finding a permanent home for children that was in the best interest of the child, regardless of whether that home was a return to the biological parents (Hannett, 2007). Due to the focus on permanency, the adoption of ASFA led to the reduction of children in the child welfare system. Despite the decrease of children in the child welfare system, in 2002, 532,000 children were in the foster care system nationally (Children's Defense Fund, 2005). As a result of these laws, DCFS and similar agencies throughout the United States investigate initial reports of child abuse and/or neglect. After investigating, a report is determined to be substantiated (i.e., there is evidence of abuse and/or neglect) or unsubstantiated (i.e., there is no evidence of abuse and/or neglect). While more than 65% of children who are investigated nationally remain in their homes (Downs et al., 2000), if the findings of the investigation indicate that the child is at risk for immediate harm, the state may decide to take temporary protective custody of the child. In Illinois, in order to ensure that an individual has a right to due process, within two days of removing a child from their parent’s home, a temporary custody hearing takes places to determine if it is in the best interest of the child to remain in DCFS custody. If DCFS retains custody of the child, a case plan is developed to determine what needs to be done before the child returns home (e.g., parenting classes, drug treatment, etc.). After the case plan is developed, an adjudicatory hearing occurs where the court decides whether the


37

parents abused and/or neglected the child in the past. If evidence is present, a dispositional hearing is scheduled. It is there that the court decides if the child should remain in substitute care or if the child should return home. Throughout the child’s time in care, he or she receives a permanency hearing at least every six months where the permanency goals, such as returning home or having parental rights terminated, are discussed. In addition, the parent’s progress towards the case plan is evaluated and what rights the biological parent has towards the child (e.g., visitation) are determined. Through the permanency hearings, if the conditions related to the out of home placement do not improve (as often assessed by parental compliance with rehabilitation programs), the state may move toward termination of parental rights. When parental rights are terminated, the biological parent no longer has the aforementioned rights related to their child. During the course of this process, mental health professionals are frequently asked to make contributions to decisions of child placement. At the beginning of state involvement, they may be asked to perform a court ordered psychological evaluation of the child or the biological parents and testify before the court on the appropriateness of various placement decisions. However, the role of the mental health professional does not end with assessing the appropriateness of placement decisions. Children and adolescents in the child welfare system display an increased rate of emotional and behavioral disturbances, and 40% to 85% of this group are estimated to have an emotional disorder and/or substance use problem (Burns et al., 2004; Garland et al., 2001; Glisson & Green, 2006; Molin & Palmer, 2005; The American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA), 2002a). In recent years, increased attention has been given to assessing whether children in foster care and residential care have their emotional, behavioral, and developmental needs met by the services that they receive. After the publication of an influential report which indicated that nearly two- thirds of children in need of services were either not provided with services or placed in inappropriately restrictive settings (Knitzer, 1982), policymakers have stressed communication between agencies and streamlining delivery of mental health services to children and adolescents. Although new types of interventions and methods of service delivery have been implemented throughout the United States (i.e., the System of Care model of service delivery, the treatment foster care movement, and wraparound community services) (Chamberlain & Smith, 2005; Eber & Nelson, 1997; Stroul & Freidman, 1986), the effectiveness of these models in real world settings relative to “treatment as usual” is often negligible (Bickman, Noser, & Sommerfelt, 1999). Mental health professionals work in the continued attempt to improve service delivery to this population. Improving child welfare services also involves seeking a better understanding of the client base and treatment from a global perspective. Therefore, professionals in the mental health field frequently seek to conduct research on the child welfare population and the interventions that they receive. These researchers may already be working as members of the treatment team or they may not have had any prior contact with their research participants prior to engaging in the research.

38


ETHICS IN SOCIAL SERVICES Ethics is a branch of philosophy dealing with moral problems and judgments (Koocher & Keith-Spiegel, 1998). White (1988) defines ethics as the evaluation of human actions; thus, behavior is evaluated as good or bad, right or wrong, or acceptable or unacceptable according to a moral principle or ethical guideline. Ethical codes date back to about 400 B.C. with the Hippocratic Oath, the first generated code of ethics for professionals (Koocher & KeithSpiegel, 1998). A code of ethics ensures the public that professionals are trustworthy and competent by maintaining a balance between professional privilege with responsibility and a commitment to consumer welfare. Although ethical codes vary by occupation, most ethics codes share several themes: (1) to promote the welfare of consumers served, (2) to maintain competence, (3) to do no harm, (4) to protect confidentiality and privacy, (5) to act responsibly, (6) to avoid exploitation, and (7) to uphold the integrity of the profession through exemplary conduct. General criminal and civil law do not protect consumers from unethical conduct (Koocher & Keith-Spiegel, 1998). Although morals and laws have a similar purpose in outlining rules of conduct in a socially acceptable manner, many issues of morality cannot be sanctioned or enforced by laws. The result, therefore, is that the relationship between ethics and the law is complicated and occasionally incongruent. Sometimes unethical conduct is civilly actionable or criminal. For example, a psychologist convicted of a felony can lose licensure and be expelled from state and national associations. Differences among state legal statutes also cause discrepancies. Having sexual intimacies with a psychotherapy client, for example, is a criminal offense in some states but not in others. In addition, there are many ethical guidelines that are not in violation of any criminal or civil law (e.g., being unfamiliar with the reliability and validity of an assessment technique one is using, participating in the misapplication of research findings, continuing to teach despite a serious emotional condition that compromises professional ability, failing to inform clients that their therapist is an intern). Thus, ethics codes are necessary in order to protect consumers from unethical conduct and ensure the best possible care.

ETHICAL CONDUCT IN CHILD WELFARE: CODES AND GUIDELINES There are ethical codes of conduct specific to all of the major mental health professions in the United States (psychologists, psychiatrists, social workers, etc.). The following section will review these documents, and discuss how these various codes are utilized in the real world. Ethical codes create a uniformed standard of conduct by which professionals must maintain. Failure to meet the standards of the ethical codes could result in disciplinary action including, but not limited to, termination of membership in the professional organization and suspension of licensure (American Psychological Association, 2002). Although many sections of the American Psychological Association (APA) Ethics Code are particularly relevant to working in the child welfare sphere, the majority of the document does not specifically discuss this vulnerable population. In addition, the central ethical documents of other professions, such as psychiatry, and social work, also do not directly discuss child welfare. However, ethics codes are intentionally created to be broad, in order to increase their


39

applicability across the wide spectrum of professional roles that mental health professionals fulfill. In addition, it is noted in the introduction of the APA Ethics Code that the document is not meant to be an exhaustive list of standards. In addition to the Ethics Code, guidelines for performing evaluations in child welfare matters have also been published by the APA (APA, 1999). Unlike the ethical codes, the guidelines are aspirational and not mandatory or relatively exhaustive. The following sections review the APA Ethics Code and guidelines that are particularly relevant in working with this population from the perspective of a psychologist. Following this discussion, the ethics codes of several related disciplines that work with children and adolescents in child welfare will be summarized.

PSYCHOLOGISTS Role of the Psychologist in Child Welfare According to the American Psychological Association (APA), “The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels” (APA, 2008). The primary charge of Clinical Psychology is to use science to establish, disseminate, and apply empirically supported psychological treatments and psychological assessments. In the field of child welfare, clinical psychologists are utilized to perform psychological assessments and to serve as expert witnesses in child protection cases. In addition, they frequently serve as therapists for children and adolescents in the child welfare system.

Ethical Code of Psychologists and Common Ethical Challenges The fundamental document guiding the clinical psychologist’s ethical standards is called the Ethical Principles of Psychologists and Code of Conduct (APA, 2002). This document consists of five general principles and ten sections of ethical standards specific to different domains (i.e., human relations, research, and teaching). Although the Codes of Conduct do not specifically discuss working with children that are in the child welfare system, there are a few general principles and codes that are of particular relevance to working with this population. The general principles of justice and respect for people’s rights and dignity are ideals that psychologists strive for in their conduct. The child’s basic human rights and dignity can be compromised as a result of repeated or inadequate placements. Keeping fairness and justice at the forefront is especially important in the domain of child welfare; children can not advocate for themselves and it is sometimes up to psychologists to ensure that they receive fair and just treatment. Psychologists are expected to protect confidential information that they obtain during their professional relationship with their clients. Confidentiality can often be challenging

40


when the child is in out of home care. The child custody courts could request psychologists to testify, and biological parents without legal custody might demand the information. Before starting the professional activities, psychologists should discuss with the child’s legal guardian the principal of confidentiality and the limits of confidentiality, including the possibility of having records subpoenaed and the psychologist being called in to testify before the courts. To the extent that is developmentally appropriate, the child should also be included in this conversation. In most states, psychologists are required to break confidentiality in certain circumstances; when someone that they are engaged in a professional relationship with is a danger to themselves, a danger to others, or when a child is put in danger. Given the very nature of out of home placement, it is likely that many of the children that the psychologist will work with have been previously put in harms way. However, the duty to break confidentiality and report can become quite complicated for psychologists (Kalichman, 2002). Breaking confidentiality almost always significantly impacts treatment. Kalichman (p. 43) notes that “on the one hand, I feel I must report quickly if a child is in danger. But on the other hand, reporting disrupts treatment, ruins relationships among family members, and the child protection system often acts punitively, even if the family is making therapeutic progress”. Despite these roadblocks to treatment, the protection of the child is most important, and the duty to report helps to protect the child. Psychologists and other professionals must remember this if they are ever conflicted about the duty to report. Regardless of the nature of their involvement in the child welfare domain (i.e., as a researcher, clinician, expert witness in a child protection hearing, etc.), psychologists first and foremost strive to do what is in the best interest of the child (APA, 1999). While they make every effort to keep the child’s best interest in mind, they must continue to follow the ethical codes of conduct of their profession, even in situations in which these two values might conflict (APA, 2002). For example, suppose that a multidisciplinary treatment team believes that it would be in the best interest of a child to sever parental rights and enroll the child in a state-run residential program. A psychologist that conducted an intellectual and psychological assessment on this child might be tempted to draw conclusions that would favor this option. However, if the conclusions were not warranted based on the data obtained in the assessment, this would be a breach of the Ethics Code. In addition to the Ethics Code, which govern the field of psychology in general, the APA Committee on Professional Practice and Standards (COPPS) and the APA Board of Professional Affairs (BPA) have also developed guidelines for psychologists in child protection cases (APA, 1999). As opposed to the Ethics Code, which must be followed at all times and are considered mandatory, the guidelines are meant to be aspirational of desired behavior or conduct. The creators of the guidelines point out that they are intended to raise standards of professional practice and are not always applicable across situations. In addition, they are not to be used as a legal document in legal matters. They primarily refer to situations in which the psychologist is conducting evaluations in child protection matters (as opposed to acting in other roles such as therapist or researcher). Psychologists are often asked to perform assessments or evaluations that influence child welfare decisions; the guidelines were created to aid in this endeavor. The following section will highlight several of the guidelines that are particularly relevant to multidisciplinary professionals that work in child welfare (see Table 1 for a complete list of the guidelines).


41

Table 1. Guidelines for Psychological Evaluations in Child Protection Matters 1. The purpose of the evaluation is to provide relevant, sound results or opinions, in maters where a child’s health or welfare may have been harmed. 2. The child’s interest and well-being are paramount. 3. The evaluation addresses the psychological and developmental needs of the child and/or parent that are relevant to child protection issues. 4. Psychologists conducting evaluations are professional experts who strive to maintain an unbiased, objective stance. 5. The serious consequences of assessment in child protection matters place a heavy burden on psychologists. 6. Psychologists gain special competence. 7. Psychologists are aware of bias and engage in nondiscriminatory practice. 8. Psychologists avoid multiple relationships. 9. The scope of the evaluation is determined by the nature of the referral question. 10. Psychologists must obtain informed consent from all adult participants and, if appropriate, the child participant. 11. Psychologists inform participants about limits of confidentiality. 12. Psychologists use multiple methods of data gathering. 13. Psychologists properly interpret assessment data. 14. Psychologists only provide opinions in child protection matters after conducting an evaluation adequate to support their conclusions. 15. Recommendations are based on whether the child has been or may be harmed, 16. Psychologists clarify financial arrangements. 17. Psychologists maintain appropriate records. American Psychological Association, 1999.

As discussed previously, “the child’s interest and well-being are paramount” (Guideline #2). The state is intervening on the best interest of the child, and psychologists should not lose sight of this fact. Psychologists are often contracted by child welfare agencies to perform assessments. These assessments can have a profound impact on the treatment plan and living situation of the child. When conducting psychological evaluations, the guidelines postulate that the assessments should specifically address the needs of the child that are relevant to the child protection issues (Guideline #3). Therefore, psychologists should tailor their assessments to the individual and to the individual’s prior traumas (i.e., physical, sexual, or emotional abuse, neglect, etc.). Although psychologists may be hired by particular “sides” in the child welfare case, they must remain unbiased and objective (Guideline #4). If the psychologist is unable to remain unbiased, than he or she should consider withdrawing from the case. The psychologist serves as the “expert witness”; although they may be asked to testify by a particular party, they should not be expected to blindly agree with the position of that party. Instead, as discussed previously, they should tailor their treatment recommendations to the best interest of the child. When performing an assessment they should rely on scientific knowledge when making judgments and, during testimony, explain the reasons behind their decisions based on the assessment.

42


Several of the guidelines are also represented in some way or another in the more formal Ethics Code. For example, in conducting child welfare evaluations, the psychologist avoids multiple relationships (Guideline #8). Multiple relationships occur when a psychologist is in more than one professional role with the same person. Although the ethical standard of multiple relationships is discussed in the Code, due to the likelihood of the situation occurring in child protection cases it is also singled out in the guidelines. For example, a psychologist that administers therapy to the child or the family should not also conduct the formal psychological evaluation. Other guidelines that are also extensions of more formal codes of conduct include gaining specialized competence (Guideline #6), refraining from engaging in biased or discriminatory behavior (Guideline #7), obtaining informed consent (Guideline #10), maintaining confidentiality (Guideline #11), properly interpreting test results (Guideline #13), and clarifying financial arrangements (Guideline #16). The guideline of obtaining informed consent deserves special mention. As the first vignette highlights, this can be a thorny issue when the child is in out of home care or transitioning placements. In the opening vignette, the evaluation was performed at the request of the school, however; evaluations are often performed at the request of the courts, the child protection agency, or an attorney. Regardless of the individual or agency that requests the evaluation, the informed consent should clearly articulate the nature of the evaluation and to whom the results will be provided. Depending on the child’s ability level, the psychologist should also explain to the child the reasons why they are being evaluated, and how the results are used. Therapy, like assessment, requires an informed consent to treatment before services can begin. In many cases, regardless of the nature of the services performed, the informed consent does not have to be obtained from the biological parent. The informed consent should be read and completed by the legal guardian. It should also be noted that a referral of evaluation by a caseworker or alternative legal guardian does not represent informed consent. The provider of services does not have a legal obligation to inform the biological parent. A survey of polices of 24 mental health agencies in Massachusetts found that most did not require parents to participate or be informed of assessment or treatment (Molin, 1988). However, although the formal policies did not require parental consent, many agencies in the Massachusetts survey discussed the importance of involving the biological parent when appropriate (i.e., when not detrimental toward the child, when the biological parent is making a concerted effort to regain custody by complying with the courts requests, etc.). Regarding psychological treatment, clinical psychology has been instrumental in bringing new interventions to practicing mental health professionals and advocating that interventions used in the “real world” have demonstrated empirical support (e.g., Chambless & Hollon, 1998). Usually this means that an intervention has been documented to be effective in terms of improved clinical outcomes. Several research methodologies may be employed to accomplish this goal, including the randomized clinical trial (RCT) and the quasi-experiment; the RCT is considered the “gold standard” in terms of research evidence in support of an intervention because it uses a control group and is required before an intervention can be termed “efficacious” (Chambless & Hollon, 1998). While not explicitly stated in the APA ethics code, many psychologists consider it appropriate and ethical to employ only those interventions that have demonstrated empirical support. It is beyond the scope of this chapter to detail the psychological interventions that have accrued appropriate empirical support for child welfare populations, so only a brief description is offered here. Parent training programs (including Parent Child Interaction


43

Therapy, The Incredible Years, and The Triple-P Positive Parenting Program) include curricula elements that provide education, coaching, and training to parents with troubled youth. Since youth in substitute care have often been removed from their homes due to the parental substance abuse and dependence, substance abuse interventions often become a crucial component of many permanency plans. Motivational Interviewing for substance abusing parents focuses on identifying the individual’s current level of motivation to stop using drugs and alcohol, and attempts to engage and overcome barriers to change. Multidimensional Treatment Foster Care is primarily a behavioral intervention program for delinquent youth. MTFC focuses on contingency management, improved communication, and close supervision. Finally, Trauma-focused cognitive behavioral therapy uses relaxation, stimulus control, cognitive restructuring and a variety of other established cognitive behavioral strategies to manage the symptoms of trauma that are so common among maltreated youth in the child welfare system.

PSYCHIATRY Role of the Psychiatrist in Child Welfare In practice, psychiatry is the discipline primarily responsible for conducting and disseminating research on drug therapies, making psychiatric hospital admission decisions, which are often involuntary, in support of the individual’s, or community’s safety, and for managing the individual’s psychotropic treatment regime. In the child welfare system, a psychiatrist would most likely be the individual responsible for prescribing psychotropic medication to the child or adolescent in the system. Many of the ethical dilemmas that psychiatrists face involve these vital professional responsibilities, dilemmas which can become even more heightened among the vulnerable and historically disenfranchised child welfare population.

Ethical Codes of Psychiatrists and Common Ethical Challenges The ethical codes of medical fields, including psychiatry, are listed in a document entitled The Principles of Medical Ethics (American Psychiatric Association, 2006). Many of these basic principles overlap with the American Psychological Association Ethical Code; for example, the basic preamble of the medical code calls for respect of the patient’s rights and maintaining the dignity of the patient. Confidentiality of patient records is also paramount. It is noted that if a psychiatrist is legally deposed, he or she should only discuss the facts that are relevant to the particular situation, and avoid offering speculation as fact. When in doubt, the psychiatrist should error on the side of protecting the confidentiality of the patient. This could be particularly relevant in serving as an expert witness in a child welfare hearing, in which invasive and personal questions may be asked. The amount of psychotropic medications given to youth began to increase in the 1980s and nearly skyrocketed in the 1990s, a situation which remains true today. For example, there was a three fold increase in the use of psychotropic drugs prescribed to youth between 1987

44


and 1996 (Zito et al., 2000). More and more of these medication regimens had limited scientific support, leading the American Academy of Child and Adolescent Psychiatry in 1999 to claim that “…data on safety and efficacy of most psychotropics in children and adolescents remain rather limited and are in sharp contrast with the advances and sophistication of the adult field. In child and adolescent psychiatry, changes in clinical practice have, by far, outpaced the emergence of research data and clinical decisions are frequently not guided by a scientific knowledge base.” (Vitiello, Bhatara, & Jensen, 1999; p. 501). Therefore, an ongoing ethical dilemma for the profession of psychiatry involves balancing the needs of a population of youth and their families who are suffering with mental illness and the ethical responsibility to practice medicine on a large scale that is scientificallybased. This dilemma has been clearly recognized by the child psychiatry profession, as reflected in a 2001 policy statement: “It is important to balance the increasing market pressures for efficiency in psychiatric treatment with the need for sufficient time to thoughtfully, correctly, and adequately, assess the need for, and the response to medication treatment.” (American Academy of Child & Adolescent Psychiatry (AACAP), 2001) Further, the Pediatric Psychopharmacology Initiative calls for all clinical trials to be made public, even when they fail to demonstrate a benefit. For the practicing psychiatrist, it is an ethical imperative to know the scientific literature and the costs and benefits of any regimen. The issue of psychotropic medication overuse receives frequent attention in the popular media, but these reports often fail to acknowledge that the child welfare population is among the most medicated youth populations in the United States today. For example, a recent study of the Texas child welfare system found that almost 35% of the youth in Texas’ foster care system were being treated with psychotropic medications; a full 40% of these youth were treated with regimens consisting of 3 or more psychotropic medicines (AACAP, 2008). In an effort to address this issue, many state child welfare agencies have instituted policies to monitor psychotropic utilization. These include: the development of medication monitoring guidelines and initiatives, the development of policies that make it easier to gain a second opinion, and the development of vetted and trusted “preferred” provider networks. Physicians are one of the few professionals who are publicly entrusted with the right to temporarily take custody of another person; this happens when a patient is “committed” involuntarily as a result of being a threat to themselves or others. As such psychiatrists and other physicians are bound by strict ethical and professional guidelines when making a decision to involuntarily admit a patient. The following four guidelines serve as considerations the physician must assess before involuntarily admitting the youth: (1) The disorder prevents the youth from making treatment decisions, (2) If the youth does not receive treatment, he or she may be at risk of harming him/herself or others (3), The parents give consent to involuntary treatment on the youth’s behalf if they are able to do so. Otherwise, consent may be required in accordance with state laws. In most child welfare cases, the state Legal Guardian gives consent, and (4) The involuntary treatment proposed is in accordance with appropriate state laws


45

SOCIAL WORKERS Role of the Social Worker in Child Welfare Social workers perform many roles within the child welfare system. In general, social workers are responsible for “mediation of the forces driving the tensions between organizational levels” (O’Brien, 2004, p. 107). In the child welfare sphere, these forces may include administration, juvenile court system, prosecuting attorneys, police, agency policies and procedures, the child abuse industry, and education, among others. Social workers in the child welfare system must often cope with conflicting loyalties to those they serve. Thus, ethical dilemmas may occur and ethics must be taken into consideration. When private matters become public issues, such as in child abuse and neglect cases, social workers are expected to intervene. They have a duty to investigate allegations and take appropriate action on behalf of the public, while at the same time helping individuals or families with their private troubles. For example, social workers are expected to protect children, alter family life so that children are safe, and recognize and change social injustices within the child welfare system. Because the child welfare system often involves the court, social workers have a unique role to fulfill in this domain. In addition to acting as an extension of the court, social workers must keep the court process operating (O’Brien, 2004). Responsibilities include investigating abuse and neglect reports, developing case material, writing petitions, preparing and presenting evidence, following through on orders of the court, and providing court services. Although social workers are expected to provide expertise in court proceedings, social worker discretion is controlled through an informal check and balance process.

Ethical Codes of Social Workers and the Common Ethical Challenges According to the National Association of Social Workers (NASW) Code of Ethics (1996), social workers must adhere to broad ethical principles which are based on the core values of service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. The six ethical principle are: (1) social workers’ primary goal is to help people in need and to address social problems, (2) social workers challenge injustice, (3) social workers respect the inherent dignity and worth of the person, (4) social workers recognize the central importance of human relationships, (5) social workers behave in a trustworthy manner, and (6) social workers practice within their areas of competence and develop and enhance their professional expertise. In addition to these principles, it is important for social workers to be aware of culture, values, beliefs, and styles of working with people and how they may influence interactions with children, parents, families, and other professionals (Brittain & Hunt, 2004). In addition to the ethical principles listed above, the NASW Code of Ethics also includes ethical standards for social workers. Some of the standards are enforceable guidelines for professional conduct, whereas others are aspirational. These standards concern: (1) social workers’ ethical responsibilities to clients, (2) social workers’ ethical responsibilities to colleagues, (3) social workers’ ethical responsibilities in practice settings, (4) social workers’

46


ethical responsibilities as professionals, (5) social workers’ ethical responsibilities to the social work profession, and (6) social workers’ ethical responsibilities to the broader society. The ethical principles and standards set by the NASW provide helpful guidelines for social workers to follow while working in the child welfare system. Nonetheless, ethical problems still exist and below represent some of the most problematic. Client selfdetermination, or “the practical recognition of the right and need of clients for freedom in making their own choices and decisions” (Biestek, 1957, p. 103) is the basis of a frequent ethical dilemma. Social workers must respect the client’s right to self-determine his or her present and future; however, this right is often restricted when working in the child welfare system due to obligations to society or other legal situations (O’Brien, 2004). For example, a biological parent may exercise his or her right to decline services (e.g., a parenting course) but the court may limit this right though legal orders (e.g., mandating a parenting course in order to receive custody). Thus, social workers must be respectful of the client’s wishes while abiding by court orders. Social workers may also get caught up in this ethical dilemma by imposing his or her standard of what is right for the client, a concept known as paternalism. Although paternalism may not always be negative (i.e., a child’s right to protection takes precedence over a parent’s right to parent), social workers may be violating client selfdetermination in certain circumstances, including withholding information from the client, deliberately opposing the client’s wishes, and manipulating clients by providing misinformation to them. The ethical dilemma, therefore, is that the client’s right to selfdetermination may be bounded by the social worker’s belief that he or she knows what is best for the client when this may not be the case. A second common ethical situation that social workers face when working in the child welfare system deals with the issue of informed consent. As discussed in previous sections, informed consent is essentially a fundamental attitude of working with clients respectfully (O’Brien, 2004). In helping clients make informed decisions, social workers must discuss options with the client and what the potential outcome may be for each option. In doing so, social workers may believe they can predict the outcome of a particular choice for the client when in actuality there is no way to predict with absolute certainty. One of the most important aspects of informed consent in child welfare is informing clients of their due process rights, with possible outcomes. The right to be informed about one’s due process rights is probably the most basic ethical standards that social workers can follow, and also one that can become problematic. For example, the social worker may be helping the client to oppose recommendations that he or she is making to the court for the parent’s child. Not being fully informed can have deleterious effects on the relationship between the social worker and client. Fiduciary relationships are the legal foundation of the social worker’s relationship with clients and are another common focus for ethical problems (O’Brien, 2004). Because the client is dependent upon the social worker to provide accurate and vital information to the court in addition to well-thought out recommendations, he or she is expected to be trustworthy, clear about boundaries while working with clients, and responsible for maintaining this fiduciary relation. According to the NASW, the exception to this is that the social worker’s fiduciary responsibility to the larger society supersedes loyalty to the client under certain circumstances. When working with a child welfare population, dilemmas regarding this exception often arise. For example, the child welfare system aims to protect children from maltreatment; however the child is dependent upon his or her parents and lives


47

within a family and community. Therefore, the issue of fiduciary relationships may become ethically challenging for social workers. Because social workers in the child welfare system must often face the unique difficulty of representing diverse interests (e.g., child, parent, court, social work agency), ethics is an important issue that must be addressed. The standards and guidelines set by the NASW Code of Ethics represent guiding principles for social workers to adhere by in order to avoid ethical conflicts. It does not, however, force a choice on who the social worker is representing nor do they provide guidance to workers who believe they must decide whose interests they represent (Stein, 1998). Thus, the primary task of social workers is to try and reconcile conflicting views in order to prevent ethical dilemmas from occurring.

RESEARCHERS Role of Researchers in Child Welfare When professionals make claims about outcomes in child welfare, the efficacy of a particular treatment, and other statements, they should have evidence to support their assertions. Scientific, controlled, systematic research helps to provide this evidence. Research in child welfare may be conducted by a multitude of professionals using a multitude of possible methods. Some of the areas that are most frequently researched in child welfare include, outcomes of children in the system, placement decisions in child welfare, levels and types of psychopathology in the population, and cultural and social factors related to child welfare placements. Although the results of specific research is beyond the scope of this chapter, there are several sources that summarize various aspects of child welfare research (Barth, Berrick, & Gilbert, 1994; Maluccio, Ainsworth, & Thoburn, 2000; Pecora et al., 1992)

Ethical Codes of Researchers and the Common Ethical Challenges The ethical issues that arise when working with children in the child welfare system have been given only limited consideration (Molin & Palmer, 2005). Because research may be conducted by several professions, there is not a single ethics document that applies to all researchers in child welfare. However, most of the ethics documents (APA ethics codes; medical ethics, etc.) have sections related to research. Conducting research with children in general can be complicated due to their vulnerability to exploitation and their limited ability to decline participation (Gustavsson & MacEachron, 2007). Children who are wards of the state require even more protection when participating in research and matters may become extremely complex. Researchers must consider the risks and benefits of participation for the child to ensure that the risks do not outweigh the benefits. Informed consent is one ethical issue that is particularly problematic with this population (Bogolub & Thomas, 2005). Because several adults may play a role in the child’s life, it is sometimes uncertain who must give consent for the child to participate in research. There is variation among the legal necessity of birth parent consent for participation, although it is recommended by research texts (e.g., Marshall & Rossman, 1999; Padgett, 1998). The

48


National Association of Social Workers (NASW) Code of Ethics states that if an individual is incapable of providing informed consent an “appropriate proxy” is necessary. For children, therefore, an appropriate proxy may or may not be the birth parent. Overall, the literature suggests that a case can be made for bypassing informed consent from the biological parent in research with children in the child welfare system. In addition, in many states the biological parent cannot legally consent if the child is in out of home care. Although there may be many adults in the child’s life, there may not always be an adult that has the child’s best interest in mind. When conducting research with children, the benefits of participation must outweigh the risks. In order to ensure that children are fully protected, the institutional review board (IRB), a committee at universities and other places in which research is conducted, requires that every child in the child welfare system be appointed an independent advocate (Gustavsson & MacEachron, 2007). The advocate reviews the research procedures, ensures the participants are fully informed, evaluates all possible risks, secures safeguards, and informs participants of their right to withdraw from the research. Although an advocate is required before an IRB will approve the research, compliance with this regulation remains inconsistent. Because the child’s best interest is always paramount, the use of an independent advocate who appreciates the vulnerable position of these children is a necessary component of the research process.

OTHER ETHICS CODES AND GUIDELINES The American Academy of Child and Adolescent Psychiatry (AACAP) and the Child Welfare League of America (CWLA) have published several documents related to the needs of children in out of home care (AACAP & CWLA, 2002a, 2002b). Although these documents do not discuss ethical principles specifically, they offer recommendations for best practice. One policy statement discusses the screening and assessment process of children in out of home placement, while the other addresses more general issues that relate to this population. Similar to the goals of the system of care framework for service delivery (Stroul & Friedman, 1984; Stroul & Friedman, 1994), the AACAP and CWLA advocate for services that are child focused, family centered, and culturally competent. Whenever possible, children and their families should be kept intact. When the child welfare system becomes involved, the policy statement recommends conducting an initial mental health and substance use screening within 24 hours of placement into the child welfare agency, followed by a more comprehensive assessment. The goal of the initial screening is to identify the children in urgent need of mental health services (AACAP & CWLA, 2002b). In addition, interventions for combating the stress of removal from the family should be implemented based on the individual needs of the child. For example, caregivers may need mental health and alcohol or drug services. Repeated individualized reassessment throughout the course of treatment and contact with child welfare is also stressed. In addition to the American Psychological Association and American Psychiatric Association, other professional organizations have their own policies in place regarding out of home care, child welfare, and/or noncustodial parents. However, not all of the professions specifically address the child welfare population. The professional guidelines of The American School Counselors Association (ASCA) primarily address issues related to divorce


49

and separation, as opposed to child welfare (Wilcoxon & Magnuson, 1999). The National Association of Public Child Welfare Administrators guidelines were created for agencies working with children and families experiencing domestic violence (Foley, Berns, Test, Bragg, & Schecter; 2001). The guidelines describe the relationship between domestic violence and child mistreatment, and makes recommendations for child protection agencies. The recommendations are similar to those proposed by the APA, including tailoring the services to the child’s developmental level and maintaining confidentiality.

ETHICAL OBLIGATIONS TO THE BIOLOGICAL PARENTS AND FOSTER PARENTS Permanency is the ultimate goal of the child welfare system. Psychologists and other mental health professionals work with the courts to decide if the working goal for achieving permanency is reunification with the biological parent(s) or moving toward adoption and, therefore, severing parental rights. Due to shared history and established family bonds, reunification is often the preferred option, assuming that the reunification is in the child’s best interest (Sanchirico & Jablonka, 2000). However, professionals working with children in placement must often weigh obligations to the parent with the long-term safety and wellbeing of the child. Because reunification is a desired outcome in many cases, professionals have advocated that unless parental rights have been terminated, the parent should be informed and aware of the progress of his or her child, even if they are not required to be informed (Molin, 1988). Of course, there are situations in which the parent is not allowed to be involved in treatment planning. If the parent is not allowed to participate in the treatment process, he or she should be informed of the reasons why they are excluded, and the steps necessary to increase the likelihood of involvement (Molin & Palmer, 2005). In addition, when a psychological evaluation is ordered, parents should be explained the purpose of the evaluation and how the subsequent treatment will be conducted. They should also be informed when a treatment plan is modified. Again, the involvement of the parent depends on the extent to which he or she is committed to the process. Foster care parents are also an integral part of the treatment team. Mental health providers may be unclear about their relationship and obligations to foster care parents. Depending on the circumstances, if they are interested, foster care parents should be informed of treatment decisions, although they are also not legally required to be informed. The Massachusetts survey of mental health agencies found that, similar to biological parents, most agencies encouraged but did not require foster care parents to be involved in the treatment process (Molin, 1988). The treatment foster care movement has stressed the importance of involvement of the foster caretaker (Chamberlain & Smith, 2005; Reddy & Pfeiffer, 1997). It is primarily a skills-based and behavioral approach to treatment that teaches both parents and youth how to communicate effectively with one another and create consistent expectations for positive reinforcement. In addition to treatment decisions, if the child poses behavioral risks that could spill over into the home environment, than the foster parent should be informed. Similar to biological parents, these rights are not absolute, and in circumstances in which extended involvement of the foster parent is contraindicated, they may not be involved in treatment.

50


Finally, professionals working with both biological and foster parents have an obligation to respect the families' cultural values. Critics of child welfare policies have argued that the "best interest" standard is often based on middle-class values and may be seen as a vehicle for placing children into more educated or affluent families (Westman, 1991). Cultural and class differences regarding parental discipline should also be considered by the professionals working with the families (Freeman, 1997).

ETHICAL DILEMMAS IN PRACTICE: THE OPENING VIGNETTES In the first vignette, a psychologist was assessing a 10 year old that was living in a foster home. Firstly, the psychologist performing Jason’s assessment should always keep his best interests at the forefront of her decision making. If, after reviewing the results of the evaluation and discussing the case with the child’s teacher and foster parents, the psychologist believes that an individualized education plan (IEP) would be in the best interest of the child then she has an ethical duty to recommend this option to the school. Because the state is the legal guardian, Jason’s mother does not have the right to block the school from receiving the evaluation. Depending on the involvement of Jason’s mother and her feelings toward the child welfare system, the decision to not inform her of the evaluation likely made the situation more contentious. However, as long as the State has temporary custody of Jason, his mother cannot intervene in decisions involving his schooling or treatment. In the second vignette, a licensed clinical social worker was treating a 5 year old with a history of sexual abuse. The girl is in foster care and her foster mother is interested in receiving updates on her treatment progress. As discussed previously, from a legal perspective, the foster mother is not required to be informed of treatment progress. However, following the ethical principle of acting in the child’s best interest, it is likely in Maria’s best interest for the foster mother to receive occasional updates, especially if she is acting as an advocate for her foster child. This would also allow the social worker an opportunity to convey any recommendations that he or she might have for parenting and/or the family environment. In the third vignette, a researcher is interested in recruiting a 11 year old with a history of psychopathology for participation in a research study. The parental rights have been terminated and the State is the formal guardian. As discussed previously, when conducting research with children in general, safeguards must be put into place in order to ensure that the risks do not outweigh the benefits. The child welfare population in particular can be a vulnerable subset. In this situation, if the caseworker believes that participating would have negative consequences for Jamal, then ethically the researcher should respect the wishes of the caseworker. The researcher could attempt to meet with the caseworker to discuss the study and any potential benefits and risks; however, ultimately the wishes of the caseworker should be followed. Taking these extra precautions and working with the many adults that are involved in the child’s life is necessary in order to keep his best interests at the forefront.


51

CONCLUSIONS The child welfare system is designed to keep the best interests of the child at the forefront. Psychologists and other professionals that work with children and families that are in the system should be aware of their ethical responsibilities to the child, biological parent, foster parent, and other members of the treatment team. Several codes in the APA Ethical Codes of Conduct are relevant in working with this population, such as informed consent and confidentiality. In addition, APA, the Child Welfare League of America, and several other professional organizations have also published guidelines and policy statements for use in child protection matters. In the scenarios presented at the start of the chapter, and in other child welfare scenarios that are likely to involve multiple stakeholders, an approach to assessment and treatment that keeps the best interest of the child in mind and follows proper ethical conduct is imperative in working with children in child welfare.

REFERENCES American Academy of Child and Adolescent Psychiatry. (2001). Prescribing Psychoactive Medication for Children and Adolescents policy statement. Retrieved July 9, 2008 from http://www.aacap.org/cs/root/policy_statements/prescribing psychoactive_medication_for_children_and_adolescents. American Academy of Child and Adolescent Psychiatry and Child Welfare League of America. (2002a). AACAP/CWLA Foster Care Mental Health Values Subcommittee policy statement. Retrieved May 3, 2007 from http://www.aacap.org/page.ww? section=Policy+Statements&name=AACAP%2F CWLA+Foster+Care+Mental+Health+ Values+Subcommittee American Academy of Child and Adolescent Psychiatry and Child Welfare League of America. (2002b). AACAP/CWLA policy statement on mental health and substance use screening and assessment of children in foster care. Retrieved May 3, 2007 from http://www.cwla.org/programs/bhd/mhaacapcwlapolicy.doc American Psychiatric Association. (2006). The principles of medical ethics with annotations especially applicable to psychiatry. Retrieved December 19, 2007 from http://www. psych.org/psych_pract/ethics/ppaethics.cfm. American Psychological Association. (2008). About Clinical Psychology. Retrieved July 9, 2008 from http://www.apa.org/divisions/div12/aboutcp.html. American Psychological Association. (1999). Guidelines for psychological evaluations in child protection matters, American Psychologist, 54, 586-593. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct, American Psychologist, 57, 1060-1073. Barth, R.P., Berrick, J.D., & Gilbert, N. (1994). Child Welfare Research Review. New York: Columbia University Press. Bickman, L., Noser, K., Summerfelt, W.T. (1999). Long-term effects of a system of care on children and adolescents. Journal of Behavioral Health Services and Research, 26, 185202. Biestek, F.P. (1957). The Casework Relationship. Chicago, IL: Loyola University Press.

52


Bogolub, E.B. & Thomas, N. (2005). Parental consent and the ethics of research with foster children. Qualitative Social Work, 4, 271-292. Burns, B.J., Phillips, S.D., Wagner, H.R., Barth, R.P., Kolko, D.J., Campbell, Y., et al. (2004). Mental health needs and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960-970. Brittain, C. & Hunt, D.E. (2004). Helping in Child Protective Services: A Competency Based Casework Handbook (2nd ed.). New York: Oxford University Press, Inc. Chambless, D.L. & Hollon, S.D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7-18. Children’s Defense Fund (2005). Child Abuse and Neglect Fact Sheet. Retrieved online from http://www.childrensdefense.org/childwelfare/abuse/factsheet2005.pdf. Chamberlain, P. & Smith, D.K. (2005). Multidimensional treatment foster care: A community solution for boys and girls referred from juvenile justice. In Hibbs, E.D. & Jensen, P.S. (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 557-573). Washington, D.C.: American Psychological Association. Downs, S., McFadden, E.J., & Costin, L.B. (2000). Child welfare and family services: Policies and practice. (Sixth edition). Boston, MA: Allyn & Bacon. Eber, L., & Nelson, C.M. (1997). School-based wraparound planning: Integrating services for students with emotional and behavioral needs. American Journal of Orthopsychiatry, 76, 385-395. Foley, R., Berns, D., Test, G., Bragg, H.L., & Schecter, S. (2001). Guidelines for public child welfare agencies service children and families experiencing domestic violence. Washington, D.C.: American Public Health Services Association. Freeman, M. (1997). The Moral status of children: Essays on the rights of the child. The Hague: Netherlands: Kluwer Law International. Garland, A.F., Hough, R.L:., McCabe, K.M., Yeh, M., Wood, P.A., & Aarons, G.A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 409-428. Gittens, J. (1994). Poor relations: The children of the state in Illinois, 1918-1990. Urbana, IL: University of Illinois Press. Glisson, C. & Green, P. (2006). The role of specialty mental health care in predicting child welfare and juvenile justice out-of-home placements. Research on Social Work Practice, 16, 480-490. Gustavsson, N.S. & MacEachron, A.E., (2007). Research on foster children: A role for social work. Commentary for the National Association of Social Workers. Hannett, J.R. (2007). Lessening the string of ASFA: The rehabilitation-relapse dilemma brought about by drug addiction and termination of parental rights. Family Court Review, 45, 524-537. Issacs-Giraldi, G. (2002). The psychologist as consultant in the child welfare system. In Ribner, N.G. (Ed.) The California School of Professional Psychology handbook of juvenile forensic psychology (pp. 579-607). San Francisco, CA: Jossey-Bass. Iwaniec, D. & Hill, M. (2000). Child welfare policy and practice: Issues and lessons emerging from current research. London: Kingsly.


53

Kalichman, S. (2002). Mandated reporting as an ethical dilemma. In: Ethics, Law, & Policy (2nd edition), pp. 43-63. Washington, D.C.; American Psychological Association. Kempe, C.H., Silverman, F.N., Steele, B.F., Droegemueller, W., & Silver, H.K. (1962). The battered-child syndrome. JAMA, 181, 17-24. Knitzer, J. (1982). Unclaimed children: The failure of public responsibility to children and adolescents in need of mental health services. Washington DC: Children's Defense Fund. Koocher, G.P. & Keith-Spiegel, P. (1998). Ethics in Psychology: Professional Standards and Cases (2nd ed.). New York: Oxford University Press. Maluccio, A.N., Ainsworth, F., & Thoburn, J. (Eds.) (2000). Child Welfare Outcome Research in the United States, the United Kingdom, and Australia. Washington D.C.: CWLA Press. Marshall, C. & Rossman, G. (1999). Designing Qualitative Research (3rd ed.). Thousand Oaks, CA: Sage. Molin, R. (1988). Treatment of children in foster care: Issues of collaboration, Child Abuse and Neglect, 12, 241-250. Molin, R. & Palmer, S. (2005). Consent and participation: Ethical issues in the treatment of children in out-of-home care, American Journal of Orthopsychiatry, 75, 152-157. National Association of Social Workers. (1996). Code of Ethics. Retrieved online from http://www.socialworkers.org/pubs/Code/code.asp O’Brien, T.M. (2004). Child Welfare in the Legal Setting: A Critical and Interpretive Perspective. New York: The Haworth Press. Padgett, D. (1998). Qualitative Methods in Social Work Research. Thousand Oaks, CA: Sage. Pardeck, J.T. (2002). Children's rights: Policy and practice. Binghampton, N.Y.: Haworth Press. Pecora, P.J., Whittaker, J.K., Maluccio, A.N. (1992). The Child Welfare Challenge: Policy, Practice, and Research. NY:Aldine de Gruyter. Reddy, L., & Pfeiffer, S. (1997). Effectiveness of treatment foster care with children and adolescents: A review of outcome studies. Journal of the American Academy of Child and Adolescent Psychiatry, 36 ,581-588. Sanchirico, A., & Jablonka, K. (2000). Keeping foster children connected to their biological parents: The impact of foster parent training and support. Child and Adolescent Social Work, 17, 185-203. Stein, T.J. (1998). Child Welfare and the Law (revised edition). Washington, D.C. CWLA Press Stroul, B.A., & Friedman, R.M. (1986). A system of care for children and youth with severe emotional disturbances. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. Stroul, B.A. & Friedman, R.M. (1994). A system of care for children and youth with severe emotional disturbances. (Revised Edition). Washington, D.C.: Georgetown University Child Development Cetner, CASSP Technical Assistance Center. Terpsta, J., & McFadden, E.J. (1993). Looking backward: Looking forward: New directions in foster care. Community Alternatives: International Journal of Family Care, 5, 115133. Vitiello, B., Bhatara, V.S., & Jensen, P.S. (1999). Introduction: Current knowledge and unmet needs in pediatric psychopharmacology. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 501-502.

54


Westman, J.C. (1991). The legal rights of parents and children. In J.C. Westman (Ed.) Who speaks for the children?: The handbook of individual and class advocacy (pp. 45-64). Sarasota, FL: Professional Resource Exchange, Inc. Wilcoxon, S.A., & Magnuson, S. (1999). Considerations for school counselors serving noncustodial parents: Premises and suggestions, Professional School Counseling, 2, 275279. White, T.I. (1988). Right and wrong: A brief guide to understanding ethics. Englewood Cliffs, NJ: Prentice Hall. Zito,J.M., Safer, D.J., DosReis, S., Gardner, J.F., Boles, M., et al. (2000). Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283, 1025-1030.



Chapter 4

THE ROLE OF PARENT-ADOLESCENT CONNECTION IN CHILD WELFARE: A STUDY OF HIGH SCHOOL STUDENTS IN TRANSYLVANIA, ROMANIA Laszlo Brassai and Bettina F. Piko Psychopedagogical Consulting Center, Kovasna County, Romania and University of Szeged, Hungary

ABSTRACT Child welfare is closely related to parent-child connection. Adolescence is particularly a difficult transition period influencing child welfare. Problems between adolescents and their parents may be detected by indicators of child welfare, among others, adolescent substance us. This study presents the results of a research with a sample of Transylvanian youth (in Saint George, Romania). Data collection was going on in a sample of high school students and the study included items measuring frequencies of smoking, alcohol use and illicit drug use as well as aspects of familial influences of youth’s substance use (such as family structure, the quality of the relationship with parents, parental conflicts and the ways of coping with them). Based on a comparison of prevalence rates and frequency distributions, we may conclude that the initiation of substance use may be dated at around 15-16 years of age. Regarding frequencies of smoking and alcohol use, most students have already tried or used them regularly. Gender, family structure, and conflicts with parents proved to be risk factors for all types of substance use. Based on the analysis of parent-child connection, authoritative/supportive parenting style of mother and authoritarian/hard parenting style of father seem to be protective against adolescent substance use. These results may highlight the role of cultural variations in child welfare since parenting efficacy may depend on the special cultural context.

Keywords: child welfare, adolescence, familial influences, parental conflict, substance use

56

Laszlo Brassai and Bettina F. Piko

INTRODUCTION Assuring child welfare should be based on child risk assessment and child protection (Ryan, Wiles, Cash, & Siebert, 2005). The role of family is particularly important in child welfare since familial problems may have an influence on the child health and welfare in many ways (Brannen, Dodd, Oakley, & Storey, 1993). For example, the unemployment and financial strains of family may increase the child abuse risk (Berger, 2004). The poor parentchild connection also may influence children’s health and welfare through a number of processes, such as generating psychosomatic health problems and substance use. This is particularly true during the years of adolescence. Adolescence is a critical period of the lifecycle in terms of child welfare, particularly years of the high school period, when there is a drastic increase in frequencies of substance use (Hawkins, Catalano, & Miller, 1992). Social influences are among the key factors to determining adolescent substance use, most strikingly, the peer group effect has been found to be a dominant risk factor (Gilvarry, 2000; Piko, 2001; Schneider, Levenson, & Schnoll, 2001; Poikolainen, 2002; Bahr, Hoffmann, & Yang, 2005). However, analyzing only the peer group effect without taking the parental effect into account may withdraw us from getting a deeper insight into adolescent substance use and their welfare (Piko, 2000a). Based on all these relationships, we may conclude that the role of social influences is not so simple as it seems. Adolescence is a restructuring period of social network and support system when both striving for autonomy and a need for close relationships are present (Piko, 1998). In modern society, identity formation during socialization is sometimes not easy due to a prolonged period of adolescence (Arnett, 2000). In this period of life, the initiation of successful peer group relations is also necessary to processes of individuation. Normative beliefs concerning close friends and siblings may play an important role in the catalysis and support of intentions to initiate substance use (Scott, Thombs, & Tomasek, 2005). Whereas in early adolescence, a rebellious attitude towards parents is more frequent, in late adolescence, a more balanced attitude tends to appear in which both peers and parents play a different influential role (Piko, 2000a; Piko & Fitzpatrick, 2003). All these processes have an impact on frequencies of substance use or other type of problem behavior, such as depressive symptomatology. A number of studies draw our attention to mutual influences of the role of parents and peers (Wood, Read, Mitchell, & Brand, 2004). Actually, it is not possible to draw a barrier between the roles of parents and peers. As Lau, Quadrel and Hartman (1990) have found, health promoting behaviors are more affected by parents than peers from childhood up to the college years. In relation to this, Bailey and Hubbard (1990) have argued that a good relationship with parents may serve as a protection against early adolescent marihuana use. Similar results were found by Fleming and colleagues (2001) in connection with pre- and early adolescent smoking initiation. The peer group effect seems to become a dominant predictor only in late adolescence. In terms of child welfare, many doubts have been voiced about whether the family would survive as an institution and continue to be an important agent in the socialization of youth. Prior research has shown that the most important factor in fostering resiliency and invulnerability for adolescents is bonding to a caring adult, often found in a parental relationship (Dryfoos, 1998). Family environment is not an unitary dimension. Rather, it is a

The Role of Parent-adolescent Connection in Child Welfare

57

multidimensional construct comprised of heterogeneous psychological and social factors. Parental monitoring, parental style, family connectedness, parent-child communication and family structure have been identified as influences of adolescent health behavior (Vazsonyi, 2003). Adolescents desire parental presence and control in their lives (Ungar, 2004). Parental control is a strong influence among the protective factors against adolescent substance use which is a part of the parental monitoring practice (Li, Stanton, & Feigelman, 2000). In opinion of DiClemente and colleagues, parental monitoring refers to adolescents’ perception of their parents’ knowledge of whom they are with and where they are spending their time when they are not at home or attending school. Certain aspects of parental monitoring and control functions may decrease levels of adolescent substance use. For example, when parents set a curfew or they know where their children are when they are going out with peers are typical aspects of the parental monitoring system (Piko & Fitzpatrick, 2002). This is because these aspects of parental practices help develop a positive attitude towards order and a wellbalanced behavioral control during adolescence (Deković, 1999; Hawkins, Catalano, & Miller, 1992; Piko & Fitzpatrick, 2003). On the other hand, parental monitoring may moderate the effects of peer influences (Beck, Boyle, & Boekeloo, 2004; Coley, Morris, & Hernandez, 2004; Dorius et al., 2004; DeVore & Ginsburg, 2005). Simons-Morton et al. (2001), Wood, Read, Mitchell and Brand (2004), for example, have pointed out that whereas deviant peers elevate the risk of adolescent substance use, the authoritative parental practice (that is, demanding but responsive parenting behavior) may serve as a protection against harmful risk behaviors. Parental involvement has moderated pre-influenced drinking behavior in a sample of late adolescents. Adolescents, whose parents take care of their children’s activities and experiences, tend to avoid from smoking and alcohol use. Adalbjarnardettir and Hafsteinsson (2001), completed views of Gray and Steinberg (1999), argued that it was necessary to overstep focus on single dimension of parent-child relationship in exploring its influence on adolescent substance use. For example, we should recognize the importance of studying various dimensions of parenting style. Based on this opinion, the authors demonstrated that adolescents from autoritative and even authoritarian families tended to report lower levels of legal as well as illicit drug use than adolescents from neglectful and indulgent families. Recent research results (e.g., Castrucci & Gerlach, 2006) also reinforced that authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking. Evidently, besides parental control, the parents’ personal activities and views – such as drug-related attitudes and behavior – may consistently moderate the protective effects of parenting (DiLorio, Dudley, & Soet, 2004, Piko & Fitzpatrick, 2002; Piko, 2001). Parental smoking contributes to the onset of daily smoking in their children even if parents practice a good family management otherwise, for example, hold norms against teen tobacco use, and do not involve their children in their own tobacco use (Bailey, Emmett, & Ringwalt, 1993; Hill et al., 2005; Jackson et al., 1997) and alcohol use (Nash, McQueen, & Bray, 2005). Harakeh and colleagues (2004) demonstrated that quality of the parent-child relationship and parental attitudes affected adolescents’ smoking behavior indirectly, whereas parental smoking behavior had a direct effect. In research reported by Adalbjarnardettir and Hafsteinsson (2001), 14-year-old adolescents were more likely to have experimented with smoking and drinking if their parents smoked (46% versus 17%, OR=3.85) or drinked (63% versus 42%, OR=1.61). Not only parental substance use but a too negative parental attitude

58


may also elevate early risk for substance use as indexed by intentions to use drugs (Myers, Newcomb, Richardson, & Alvy, 1997). These findings are similar to another study (Distefan et al., 1998) which found that parental substance use, from a social learning point of view, was an example of a deviant parent norm. Barnes and colleagues (2000) found in their longitudinal study that adolescents raised in supportive families seemed to be receptive to parental monitoring which was related to a lower likelihood of alcohol misuse. Besides the control function, parent-child connectedness and communications are even more important in relation to substance use (Ackard, NeumarkSztainer, Story, & Perry, 2006). This is particularly true in case of adolescent drug abuse (Bahr, Hoffmann, & Yang, 2005), and smoking (Tilson, McBride, & Lipkus, 2005). Ackard and colleagues (2006), for example, demonstrated a significant relationship between parentchild connectedness and a broad range of serious behavioral and emotional health risk behaviors – substance use, unhealthy weight control, suicide attempts, body dissatisfaction, low self-esteem, and depression – in a diverse sample of boys and girls. As a consequence, connectedness and communication seem to be independent functions of parental practices referring to the quality of the parent-child relations more than the monitoring function. For youth, feeling connected to their families is an important social support resource, and many do turn to parents for information and guidance (Ackard et al., 2006). Another study demonstrated that parental warmth might deter adolescent involvement in problem behavior (Fletcher, Steinberg, & Williams-Wheeler, 2004). As Parker and Benson (2004) have pointed out, adolescents who perceive their parents as supportive are less likely to use drugs and alcohol. Finally, we should also mention that family support may withdraw adolescents from negative peer influences (Buysse, 1997). These findings support the role of the attachment theory in suggesting that supportive relationships provide adolescents with a coherent schema, a map that allows them to interpret the environment in an adequate way. Parental availability and discussions of problems create a trust for adolescent development (Erginoz et al., 2004). Distefan (1998), for example, found that adolescents who communicated with parents about serious problems in their lives were less likely to progress from experimentation to established smoking. Stephenson, Henry and Robinson (1996) demonstrated that teens who experienced the unity of their family in problem solving and stress management, were less likely to use substances as a mode of coping with stress. The security of connectedness seems to act as a base for protection during adolescence, even more than the closeness of relationship (Schneider, Atkinson, & Tardif, 2001). Parental influences, however, are not always protective. A number of studies have found that adolescents living in single-parent families are at a greater risk for substance use than are teens residing in traditional two-parent families (Ellickson, Tucker, Klein, & McGuigan, 2001; Hoffman & Johnson, 1998; Thomas, Farrell, & Barnes, 1996). The nonintact family structure may elevate the risk of adolescent problem behavior, due to the inadequacy of parental control (Demuth & Brown, 2004; Fitzpatrick, 1998). In addition, the intactness of family cannot guarantee the harmonious relations within the family, that is, familial conflicts also may elevate the risk of adolescent problem behavior (Formoso, Gonzales, & Aiken, 2000; Reti et al., 2002). Based on previous research results, the World Health Organization (1999) emphasize the role of familial problems and the nonintact family structure in adolescent problem behavior, among others, substance use. Recent studies also emphasize that not only the nonintact family structure elevates the risk but the reconstructed type as well, sometimes in a greater level (Ackerman et al., 2001; Harland et al., 2002).


59

Being beaten by a parent or child abuse may also contribute to adolescent emotional problems and problem behavior (Piko & Fitzpatrick, 2003). Neglectful family practice may lead to adolescents’ inconsiderate behavioral decisions, for example, regarding substance use, although they are not prepared to make such decisions (Radziszewska et al., 1996). There should be a balance between control and connectedness, namely, besides the unfavorable social climate and nonsupporting/neglectful parental practices, the overprotective parental practices may also help develop bad social skills and substance use among adolescents (Jackson, Henriksen, & Foshee, 1998). We should also mention the role of natural mentors in prevention. Natural mentors are adults – not necessarily a family member – who help neutralize the harmful familial effects. Among others, grandparents or other relatives, teachers, physicians or other acquaintances may act as a natural mentor for adolescents (Zimmerman & Bingenheimer, 2002). This means that support from other adults may have a protective effect on adolescent health behavior. In a word, there should be a balance between risk and protective factors to a healthy development. Among girls, protective factors may be stronger, whereas among boys, there is a higher tendency to turn to substance use when facing risky familial processes such as conflicts or divorce (Formoso, Gonzales, & Aiken, 2000; Hops, Davis, & Lewin, 1999). Based on the literature review, we may conclude that parental influence in adolescent substance use is rather complex. The radical change from socialism to capitalism in east european countries has brought about changes at a variety of levels. At this time, the social change into a consumer culture has become a dominant reality, particulary among youth. Unfortunately, this phenomenon is often combined with a consumerist or hedonist lifestyle which, as a consequence, is often associated with elevated levels of substance use (Piko & Piczil, 2004). Furthermore, the development of a market economy has made people face increasing socioeconomic differences along with a number of social problems. In this psychosocial context, stressful events and the lack of economic and social resources may undermine family management. We know that family management skills can buffer the effects of difficult environments and thus prevent adolescent substance use. Therefore, some aspects of the parent-child relationships may reflect actual cultural influences of primary socialization. All these processes seem to be important factors in relation to adolescent substance use. The main goal of the present study has been two-fold: 1., First, to detect prevalence (frequency levels) and sociodemographic background of substance use in an adolescent population in the Transylvanian region of Romania; and 2., Second, to map certain aspects of parent-child relations (such as the quality of parent-child relation or coping with problems between parents and children) associated with adolescent substance use. We must also note here that in Romania, these problems are relatively underinvestigated except for some previous studies (e.g., Florescu, 2004; Kovács, 2001). However, these papers are not available for an international audience.

60


METHODS Participants and Procedures Data were collected from high school students (grades 9-12) using a randomly selected sample in Saint George, Transylvania, Romania. The total number of students sampled was 292 (every 15th student was invited to participate). Of the questionnaires distributed, 290 were returned and analyzed, the response rate was 99.3 percent. The age range of the respondents was between ages of 14 to 20 years (Mean = 16.0 years, S.D. = 2.2 years) and 57.2 percent of the sample was female and 42.8 percent was male. Data were collected during the fall semester of 2003, using a self-administered questionnaire. Parents were informed of the study with their consent obtained prior to data collection. A standardized procedure of administration was followed. Trained psychologists distributed the questionnaires to students in each class after briefly explaining the study objectives and giving the necessary instructions. Students completed the questionnaires during the class period. The questionnaires were anonymous and voluntary.

Measures The self-administered questionnaires contained items on substance use, some basic sociodemographics as well as parental practices. Three types of substance use were measured: smoking, alcohol and illicit drug use (Kann, 2001). In each case, lifetime and monthly prevalences were measured. Regarding lifetime prevalence of smoking, the following categories were applied: Once or twice (1), 3-5 times (2), 6-9 times (3), 10-19 times (4), 20-39 times (5), more than 40 times (6). Regarding monthly frequencies of smoking, the following categories were applied: less than 1 cigarette per week (1), less than 1 cigarette per day (2), 1-5 cigarettes per day (3), 6-10/day (4), 1120/day (5), more than 20/day (6). Regarding lifetime prevalence and monthly frequencies of alcohol use, the following categories were applied: Once or twice (1), 3-5 times (2), 6-9 times (3), 10-19 times (4), 2039 times (5), more than 40 times (6). Regarding illicit drug use, two categories were applied: ever tried (1) and not tried (2). Among familial measures, the family structure (that is, intactness) was measured (whether intact, nonintact or reconstructed). In addition, two variables were measured (Jackson, Henriksen, & Foshee, 1998). First, the following question was asked. “How would you describe the relationship with your mother/father?” Responses could be ranked on a 6point scale: very good (1) good (2), fair (3), poor (4), very poor (5) and no relationship (6). Regarding familial conflicts, the following three questions were asked: 1. “Do you sometimes get into conflicts with your parents?”; 2. “How do you solve conflicts in your family?”; and 3. “With whom do you talk about your problems in your family?” Response categories regarding the first question were: yes (1) and no (2). In relation with the second question: “We talk about problems and try to find a solution together” (1), “We do not talk about problems” (2), ”Dispute” (3), “Verbal aggression” (4), “Physical aggression” (5), “We talk


61

about problems but avoid from displaying them to other family members” (6). Responses for the third question were: with mother (1): yes/no, with father (2): yes/no. SPSS for MS Windows Release 11.0 program was used in the calculations with a maximum significance level of .05. Besides frequency levels, the analyses consisted of Chisquare tests.

RESULTS Substance Use in the Sample 28.2% of the students did not report, whereas 71.8% of them reported smoking in the past (lifetime prevalence). Most of them had smoked cigarette once or twice (23.4%) and 40 or more times (22.4%). Thirty-three percent of the students also smoked during the past month. There was a relationship between the lifetime and monthly prevalences: 48.6% of those who had ever smoked a cigarette also smoked during the past month. Thus, this was the percentage of actual smokers. Most of them smoked 1-5 pieces per a day (10.3%). Among the students, 83.1% of them had ever drunk alcohol, most frequently once or twice (21.8%). Fifty-four percent of them also drank alcohol during the past month, most often once or twice (34.5%). According to the monthly prevalence of alcohol use, only 1 student (0.4%) reported daily drinking, whereas 8.3% of them reported weekly alcohol use. Most of the actual drinkers (that is, those who reported alcohol use during the past month) are occasional drinkers. Among the respondents, 5.5% of them had ever used an illicit drug, most frequently once or twice (76.7%). The lifetime and monthly prevalence was the highest in terms of marijuana use (lifetime: 2.4%, monthly: 0.3%) which was followed by steroids and amphetamines (12%).

Substance Use according to Age The mean age of trying a substance is between 15-16 years of age which is also the time when students usually start high school studies. Regarding smoking and alcohol use, there is a strong increase in the levels of substance use at the age of 15, whereas regarding illicit drug use, the increase may happen at the age of 16 years (Table 1). There is a statistically significant difference between two age cohorts (15-year-old students and 16-year-old students) in both lifetime and monthly prevalences of smoking. A similar difference can be detected in illicit drug use regarding lifetime prevalence. Regarding alcohol use, however, no statistical difference can be justified between these age-cohorts. Comparing lifetime prevalences, most of them prefer smoking and alcohol use once or twice, or 40 or more times. In relation to monthly prevalences, most of them drink alcohol once or twice and smoke 1-5 cigarettes a day. The regular alcohol use (that is, minimum weekly use) tends to increase by age (Table 1).

62

Laszlo Brassai and Bettina F. Piko Table 1. Lifetime and monthly prevalences and frequencies of smoking, alcohol and drug use according to age

Lifetime and monthly prevalence of smoking Lifetime prevalence (%) Monthly prevalence (%) - Once or twice in the last month (%) - Minimum 40 or more times in the last month (%) - 1-5 cigarettes in the last month (%) Lifetime and monthly prevalence of alcohol use Lifetime prevalence (%) Monthly prevalence (%) - Once or twice in the last month (%) - 3-9 times in the last month (%) - 10-39 times inthe last month (%) Lifetime and monthly prevalence of drug use Lifetime prevalence (%)

Year 14

Year 15

Year 16

Year 17

Year 18

59.9 19.6 27.5 7.8 9.8

55.2 19 25.9 10.3

75.8 35.6 20.7 24.1 8.0

80.4 46.4 21.4 33.9 21.4

83.3 47.2 25 38.9 16.7

75.0 44.0 38.0 4.0 2.0

82.8 48.3 36.2 10.3 1.7

84.1 59.1 35.2 20.4 3.4

89.1 50.0 29.6 18.5 1.9

91.6 66.7 36.1 27.8 2.8

9.2

12.3

41.5

18.5

18.5

Substance Use according to Gender Table 2 shows the levels of substance use according to gender in light of lifetime and monthly prevalences. Among those who had ever smoked there were more boys (76.6%) than girls (65.6%). In contrast with this, among those who smoked during the past 30 days, the proportion of girls (33.1%) was nearly the same as the proportion of boys (33.0%). Regarding lifetime prevalences, boys reported smoking once or twice, or 40 or more times most frequenty, whereas girls reported smoking 10-19 times most frequently. The amount of smoked cigarettes during the past 30 days was 1-5 pieces among boys, and less than 1 piece among girls. All in all, girls showed higher occurrence of being a smoker in their lifetime, whereas boys showed higher occurrence of being a smoker during the past 30 days (Table 3). Table 2. Substance user status in the sample Smoking yes Lifetime prevalence Boys Girls Monthly prevalence Boys Girls

Alcohol use yes no

no

Illicit drug use yes no

95(76.6%) 109(65.6%)

29(23.3%) 57(34.3%)

109(87.9%)* 132(79.5%)

15(12.1%) 34(20.5%)

31(25%) 34(20.5%)

93(75%) 132(79.5%)

41(33%) 55(33.1%)

83(77%) 111(66.9%)

63(50.8%) 90(54.2%)

61(49.2%) 76(45.8%)

2(1.6%) 0(0%)

122(98.4%) 166(100%)

Note: Row percentages, Chi-square test: *p

Child Welfare Issues and Perspectives

Defense, Welfare and Growth: Perspectives and Evidence

Child Welfare: England 1872-1989

Combatting Child Abuse: International Perspectives and Trends (Child Welfare (Oxford Univ Pr))

Child Welfare in Developing Countries

Mortgages: Fundamentals, Issues and Perspectives

Child welfare and child well-being: new perspectives from the national survey of child and adolescent well-being

Gender and Child Welfare in Society

Multicultural Education: Issues and Perspectives

Risk and Citizenship: Key Issues in Welfare

European Welfare States: Comparative Perspectives

European Welfare States: Comparative Perspectives

Human Welfare and Moral Worth: Kantian Perspectives

Welfare State Transformations: Comparative Perspectives

Mental Health and Work Issues and Perspectives

Moving Toward Positive Systems of Child and Family Welfare: Current Issues and Future Directions

Research on Child Health and Pediatric Issues

Child Welfare and Social Action in the Nineteenth and Twentieth Centuries: International Perspectives

Child Development in Context: Voices and Perspectives

The Politics of Child Abuse in America (Child Welfare)

Issues in Economic Thought (Economic Issues, Problems and Perspectives)

Gerontology: Perspectives and Issues, Third Edition

Economic Forecasting (Economic Issues, Problems and Perspectives)

Issues and Perspectives in Landscape Ecology

Environmental Change: Key Issues and Alternative Perspectives

Welfare: The Social Issues In Philosophical Perspective

Disability Classification in Education: Issues and Perspectives

Wetlands: Environmental Issues, Global Perspectives

Child Welfare Issues and Perspectives

Defense, Welfare and Growth: Perspectives and Evidence

Child Welfare: England 1872-1989

Combatting Child Abuse: International Perspectives and Trends (Child Welfare (Oxford Univ Pr))

Child Welfare in Developing Countries

Mortgages: Fundamentals, Issues and Perspectives

Child welfare and child well-being: new perspectives from the national survey of child and adolescent well-being

Gender and Child Welfare in Society

Multicultural Education: Issues and Perspectives

Risk and Citizenship: Key Issues in Welfare

European Welfare States: Comparative Perspectives

European Welfare States: Comparative Perspectives

Human Welfare and Moral Worth: Kantian Perspectives

Welfare State Transformations: Comparative Perspectives

Mental Health and Work Issues and Perspectives

Moving Toward Positive Systems of Child and Family Welfare: Current Issues and Future Directions

Research on Child Health and Pediatric Issues

Child Welfare and Social Action in the Nineteenth and Twentieth Centuries: International Perspectives

Child Development in Context: Voices and Perspectives

The Politics of Child Abuse in America (Child Welfare)

Issues in Economic Thought (Economic Issues, Problems and Perspectives)

Gerontology: Perspectives and Issues, Third Edition

Economic Forecasting (Economic Issues, Problems and Perspectives)

Issues and Perspectives in Landscape Ecology

Environmental Change: Key Issues and Alternative Perspectives

Welfare: The Social Issues In Philosophical Perspective

Disability Classification in Education: Issues and Perspectives

Wetlands: Environmental Issues, Global Perspectives

Recommend Documents